Abstract
Patients are not considered passive recipients of the healthcare offer anymore. They can play an active role in the process of health service provision. This chapter has the scope to address the possible facets of such contribution, identifying the main areas of activity. The chapter starts with background information about service co-creation, a social and scientific paradigm born within service industry and marketing theory, recently adapted to the healthcare sector. Then the analysis continues with the description of two key spheres of patients' activities and contributions to healthcare delivery: education and research and development. It ends with conclusions and future research directions.
TopBackground
In the last years, advancements in service industry and in marketing theory have led to the affirmation of the value co-creation paradigm (Grönroos, 2008; Prahalad & Ramaswamy, 2000, 2004; Vargo & Lusch, 2004, 2012). The concept of value co-creation is based on the assumption that value is created by a joint effort of user/consumer and producer of a certain product or service. Such vision inverts the traditional one, based on the predominance of suppliers as value creators (Makadok & Coff, 2002; Priem, 2007). Co-creation is not limited to consumers’ consultation, but it postulates the pervasive integration of customers into processes of products and services’ innovation (Galvagno & Dalli, 2014). In general terms, value co-creation requires a multi-stakeholder and participatory process of resource integration (Aquilani et al., 2016). Yi and Gong (2013, as cited by Russo et al., 2019) identify two possible co-creative behaviors: participation behaviors (search for information, information-exchange); and citizenship behaviors (provision of feedback, service promotion to other people).
A similar perspective has been recently assumed regarding the healthcare sector, aimed at overcoming the passive role of patients toward their involvement in co-creative healthcare processes (Carrubbo et al., 2015). The concept of patient participation in health is not new in literature, health practice and policy making. The 1978 Alma Ata declaration of World Health Organization (WHO, 1978) stated that people’s participation in the planning and implementation of their own healthcare is at the same time a right and a duty. By then, the Eighties’ neoliberal policies and the democratic deficit observed in the 1990s, triggered all over the world a social demand for greater public accountability and the inclusion of citizens in decision-making processes (Fung & Wright, 2003, as reported by De Freitas, 2017, p. 31).
The value co-creation offers a broad paradigm in which to comprehend the key relationships between the most relevant actors of the healthcare system (e.g. doctors, nurses, patients, caregivers, administrators). On the one hand, it is well known that stakeholders within healthcare have often conflicting goals, e.g. access to services, profitability, high quality, cost containment (Porter, 2010). However, achieving high value for patients should be the overarching goal of healthcare delivery (Porter & Teisberg, 2006). Patients (like customers) can participate in the creation of health value by sharing their information, competencies and resources between each other and with health professionals (McColl-Kennedy et al., 2012).
Thus, patient becomes the most important actor in the network of value co-creation and his participation in the form of health literacy, shared decision-making, treatment control and communication with the health professionals may have several positive effects on the healthcare quality improvement (Polese et al., 2016). Despite the recognition of the importance of patients in healthcare services’ co-creation, people’s perception to be effectively involved is often scarce (Coulter & Jenkinson, 2005). If the program Health 2020 of the World Health Organization’s (WHO, 2012) includes patient-centeredness and patients’ empowerment within the priority areas for policy action, the effective adoption of co-creation in healthcare has been slow (Makhni, 2017)
Key Terms in this Chapter
European Medicines Agency (EMA): Decentralized agency of the European Union responsible for the scientific evaluation, supervision and safety monitoring of medicines in the EU. It is a networking organization whose activities (carried out by the scientific committees) involve thousands of experts across Europe.
Research Synopsis: The plan of a certain research protocol, providing the rationale, the main objectives, and the methods for data collection. Standard synopses are usually organized in the following headings: title (to be short, clear and self-explanatory), that can be enriched by a more descriptive sub-title; abstract, which is a brief summary (150-200 words) of the stated problem, research goals, theories and methods; introduction (providing background information about the addressed problem); detailed literature review about the research problem; objectives of the study (in turn based on the literature review); hypotheses (prediction of the outcomes of the study in terms of relations between variables); limitations, i.e. specific aspect of the problem not addressed by the study; methodology and methods suitable to achieve the objectives of the study, where the researchers choose a comprehensive methodology (experiments, surveys, models, case studies) within which it is possible to use different methods (qualitative and quantitative) for data collection and analysis; results (analyses of data, organized in tables and graphs); discussion (connection of the results to the objectives); conclusion (about research contribution and recommendations for future studies); literature references.
Research Design: A detailed methodological plan guiding the entire research. It is a framework of methods and techniques chosen by the researchers to address the research questions. Thus, the focus is on how the research is going to be conducted and contains explanations about data collection methods, measurement and analysis. The design has to be neutral (not biased), reliable (if research is repeated, similar results are expected); valid (the measuring tools chosen for the research have to lead to relevant results for the specific ongoing research); and generalizable (the research results should be extended from the sample to a wider population). The research design can be quantitative or qualitative, depending on whether statistical conclusions are required for the study. It can also be descriptive (only describing the issue under research); experimental (aiming to state causal relationships between independent and dependent variables); correlational (to establish if there exists a relation between two variables, with no statement of what causes what else); diagnostic (deep analysis of the causal tissue of a certain topic); explanatory (where the researcher provides personal ideas and thoughts about a certain theme).
Value Co-Creation: Paradigm based on the assumption that value is created by a joint effort of user/consumer and producer of a certain product or service. Such vision inverts the traditional one, based on the predominance of suppliers as value creators, and postulates a multi-stakeholder participatory process of resource integration. Value co-creation can also be applied to the healthcare sector, to switch the patient from a mere recipient of professionals’ directives toward a more active and creative role.