- Title
- A mixed method study for examining customer participation in value co creation: applying service dominant logic to the provision of living support services to day care oncology patients in Pakistan
- Creator
- Rehman, Muqqadas
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2015
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Quality of life (QOL) is a concern that extends to various specialist areas, such as the provision of oncology and associated ancillary services, and the living support services (LSS) provided to patients. Bringing together healthcare and marketing research, this study develops a new way of thinking about marketing associated with the service-dominant logic (S-D L), or more broadly, service logic (S-L), which generally contends that all value is created by the customer alone, yet this new logic emphasizes the concept of value co-creation. As the oncology healthcare delivery system changes, and new scientific discoveries are integrated into non-clinical oncology care, the role of customer participation in value creation processes involving LSS provision to day-care oncology patients will continue to evolve. It is suggested that patient participation can play a key role in the outcome of the value creation process, effectively contributing to improvements in LSS provision, leading to an improvement or enhancement of the day-care oncology patients’ overall QOL. While co-production and value co-creation imply customer and supplier participation, participation has received relatively little attention in the specialist literature. This research disentangles the notions of the production and co-production of goods and services, from both the creation and co-creation of value propositions, and the assumptions underlying value-in-use. The focus of the analysis is on participation in exchange, and in the value creation process, by customers and suppliers. The project responds to Grönroos and Ravald (2011)’s call for research: Adopting a service logic means that in a value creation context, during the simultaneous consumption and production processes, a supplier makes active use of existing interactions with its customers. These interactions are part of the customers’ practices and consumption processes and hence also part of their value creation. However, understanding the nature of suppliers’ value co-creation opportunities and the customers’ role in this process requires an in-depth understanding of the interaction concept and the role of interactions in value creation (Grönroos & Ravald, 2011, p. 10). Aims of the Study: 1) To study the significance of QOL, in terms of value outcome; and the patient participation in S-L in the context of non-clinical service provision in oncology health care. 2) To explore patient participation determinants in oncology health care. 3) To identify the positive and negative factors, encouraging or discouraging patient participation in LSS provision. 4) To explore the QOL determinants in oncology health care. 5) To identify positive and negative factors, for improving or diminishing QOL of day-care oncology patients. 6) To develop a proposed model of customer participation in service exchange, and to examine its implementation in oncology health care. 7) To explore the relationship between patient participation determinants, patient participation in LSS, and the QOL of day-care oncology patients. Methods and Procedures: A mixed methods approach guided by a pragmatist worldview was adopted in this thesis. Based on the nature of the objectives of the study, the exploratory sequential design, involving an inductive approach (qualitative) leading to a deductive approach (quantitative), was used to explore the perceptions, attitudes and experiences of participants. The participants (both medical experts and patients) for the qualitative and quantitative studies were selected by the researcher’s medico-supervisor, a medical oncologist at SKMCH & RC, using a ‘convenience sampling’ technique. The number of participants for the qualitative study was determined by the rate of new knowledge acquisition, consistent with diminishing returns principles (Lewis, 1994). That is, interviews proceeded until saturation was apparent. The number of participants for the quantitative study was determined in order to achieve sufficient statistical power (McQuitty, 2004). Findings: The findings of this research project suggest that patient participation in LSS provision is a very important element of value co-creation, and is required during all phases of the service exchange production and delivery process. The research findings are meaningful and interesting as this research highlighted many issues related to patient participation in LSS provision and patients’ QOL at SKMCH & RC. More specifically, the qualitative study of the thesis explored seven themes which formed the ‘Patient participation determinants’ in the provision of LSS to day-care oncology patients. These seven themes were: ‘Communication’, ‘Hospital resources’, ‘Doctors and staff’s attitudes’, ‘Relatives’ attitudes’, ‘Religion and culture’, ‘Patients’ attitudes and interest’ and ‘Patient demographics’. In relation to these themes, positive and negative factors were identified, which encouraged or discouraged patient participation in LSS. The qualitative study of the thesis also explored five themes which formed the ‘QOL determinants’ of the day-care oncology patients. These five themes were: ‘Access to appropriate LSS’, ‘Building self-efficacy’, ‘Patients’ education and awareness’, ‘Social engagements’, and ‘Communication’. Similarly, positive and negative factors were identified for improving or diminishing QOL of day-care oncology patients. A proposed model of customer participation in service exchange was developed and its implementation was examined in oncology health care, and finally, the relationship between patient participation determinants, patient participation in LSS, and the QOL of day-care oncology patients was explored through a quantitative study. Contributions: Theoretical Contributions: This project is believed to be the first research which has merged marketing and health theories. It has shown that it is possible to involve cancer patients in the provision of a hospital’s LSS, and based on the S-L philosophy, the project has given importance to the much overlooked concept of value-in-use. Clearly, the thesis discusses customer participation as an aspect unduly overlooked by S-L theory. The main contribution of this research is that it has led to an enhancement of the S-L theory engendered by Grönroos (2009), and has introduced a new ‘Integrated process model for customer participation in service exchange’. It has explained and tested the concept of customer participation in the service exchange, specifically related to the non-clinical day-care oncology health services. Managerial Implications: The ‘Integrated process model for customer participation in service exchange’ provides a useful tool for the managers of SKMCH & RC in order to benefit from patient participation based strategies. Day-care oncology patients can benefit from participating at the different points in time in the LSS provision by the hospital, as indicated in the ‘Integrated process model of customer participation’. Patient participation will allow the patients to inform the hospital about their desired specific needs, and in this way, benefit from customised non-clinical services. One of the advantages of patient participation for the firms is that when patients act as a resource in the process, some responsibility for the outcome will be transferred to them (Chan,Yim & Lam, 2010; Sweeney, 2007). In this manner, there should be fewer complaints received regarding service delivery. The study indicates that, regrettably, there are no clearly defined practical implications of the concept of S-L theory involving co-creation, when applied to the context of the LSS provision to day-care oncology services in a developing nation like Pakistan. However, the implications of the integrated process model of customer participation, when applied to the context of Shaukat Khanum Memorial Cancer Hospital & Research Centre (SKMCH & RC) are meaningful for practitioners.
- Subject
- service-dominant logic; patient participation; value Co-creation
- Identifier
- http://hdl.handle.net/1959.13/1296639
- Identifier
- uon:19286
- Rights
- Copyright 2015 Muqqadas Rehman
- Language
- eng
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