Managing engagement behaviors in a network of customers and stakeholders: evidence from the nursing home sector

Firms striving for long-term profitability need to build stronger customer-firm relationships by getting their customers more engaged with the firm. One path to this end is introducing practices to manage different forms of customer engagement behaviors (CEBs). To develop more effective and efficient CEB management practices, this research proposes and empirically tests a theoretical model on managerial and psychological processes to encourage CEBs that are embedded in a broader network of customers and stakeholders. Based on qualitative and quantitative studies in nursing homes, we demonstrate that organizational support and overall service quality toward significant others influence some forms of CEBs—more particularly feedback and positive word of mouth (WOM) behaviors—through customer affect toward the organization. It is interesting to note that customer affect toward the organization encouragesWOMbehaviors, while it discourages feedback behaviors. Conversely, managerial processes that increase customer role readiness—such as organizational socialization and support from other customers—were found to have a positive impact on all forms of CEBs. This research helps managers of nursing homes and other services with a broad network of customers and stakeholders to improve existing CEB management practices and develop new CEB management practices that are beneficial for the firm and its stakeholders

An integrative model of the management of hospital physician relationships

Hospital Physician Relationships (HPRs) are of major importance to the health care sector. Drawing on agency theory and social exchange theory, we argue that both economic and noneconomic integration strategies are important to effective management of HPRs. We developed a model of related antecedents and outcomes and conducted a systematic review to assess the evidence base of both integration strategies and their interplay. We found that more emphasis should be placed on financial risk sharing, trust and physician organizational commitment

In the eye of the beholder: mutual obligations and areas of ambiguity in the hospital-physician relationship

Internationally, many countries are increasing provider accountability for cost and quality of the delivered care. In this challenging environment hospital executives struggle to build effective hospital-physician relations. However, despite the importance of the hospital-physician relationship there has been little research which has examined how physicians and hospital executives describe the terms of their working relationship. This paper seeks to fill this gap by reporting findings of a qualitative study in which we explored the psychological contract between physicians and the hospital they practice at. In-depth interviews with physicians and executives (n=30) of three Belgian hospitals were performed. Our analysis of the transcribed interviews yielded a rich understanding of how physicians and hospital executives interpret and experience mutual obligations and areas of ambiguity within their psychological contract. We found that a distinction should be made between on the one hand administrative obligations (adequate operational support, responsive decision making processes and attractive facilities) and on the other hand professional obligations (clinical excellence and physician autonomous medical decision making). In addition, two areas of ambiguity could be identified reflecting both dimensions of the psychological contract. Firstly, physicians act as independent caregivers generating professional fees. A trade-off exists in their day-to-day interaction with the hospital. Therefore the interpretation about the way the care should be organized differs between executives and physicians. Secondly, hospital prospective financing systems lay the accent on cost-effective care from a societal perspective. In contrast, physicians are remunerated mainly by fee-for-service. The extent to which physicians should take into account the impact that their medical decisions have on the hospital bottom line varies. Our aspiration is that the findings of this study will assist in supporting hospital executives and physicians to build cooperative relationships needed to improve the quality and cost-effectiveness of current health care delivery

Designing the customer journey in a service delivery network: evidence from cancer patient treatments

Customer experiences - not in the least for customers with chronic diseases - depend on a series of exchanges over a considerable amount of time with a variety of service providers and thus a service delivery network (SDN). The impact of SDNs on the customer experience, however, is unclear. This research provides insight into (1) the service delivery system characteristics in SDNs, and (2) their impact on the relationship between customer journey duration and value for time as an important customer experience indicator. The service delivery system characteristics were explored by process travel sheets of patients undergoing cancer treatment in a hospital (n=412). These data were linked to time measurement data (n=262) and survey data (n=312) to explain customer journey duration and value for time, thereby showing the importance of the number of service events and the type of service providers. Theoretical and managerial implications are discussed

Measuring performance in healthcare

Hospitals invest in process management and process optimization from an organizational and patient perspective to increase efficiency and simultaneously the quality of their operations. Consequently, the use of process-oriented performance measurement systems gains importance. This study contributes to the development of a dashboard for the process of hip surgery using a case study design. We integrate strategic goals of hospital management and different stakeholders with the analysis of Business Process Management and Hospital Information Systems’ data. Process-oriented KPIs were integrated into the dashboard using a three-step approach. Dashboards enable healthcare organizations to put process-oriented performance measurement into practice

3D-printing techniques in a medical setting : a systematic literature review

Background: Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Methods: Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. Results: 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. Conclusion: 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D- printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis

Fulfillment of administrative and professional obligations of hospitals and mission motivation of physicians

Background: To be successful, hospitals must increasingly collaborate with their medical staff. One strategic tool that plays an important role is the mission statement of hospitals. The goal of this research was to study the relationship between the fulfillment of administrative and professional obligations of hospitals on physicians' motivation to contribute to the mission of the hospital. Furthermore the mediating role of the physicians' emotional attachment to the hospital and moderation effect of the exchange with the head physicians were considered. Methods: Self-employed physicians of six hospitals participated in a survey. Descriptive analyses and linear regression were used to analyse the data. Results: The results indicate that affective commitment mediated the relationship between psychological contract fulfillment and mission statement motivation. In addition, the quality of exchange with the Chief Medical Officer moderated the relationship between the fulfillment of administrative obligations and affective commitment positively. Conclusion: This study extends our understanding of social exchange processes and mission statement motivation of physicians. We showed that when physicians perceive a high level of fulfillment of their psychological contract they are more committed and more motivated to contribute to the mission statement. A high quality relationship between physician and Chief Medical Officer can enhance this reciprocity dynamic

A policy for the stimulated development of the Transkei

The aim of this study was to investigate the present development of the Transkei and to propose a policy for its future development, bearing in mind the potential of' the country and its people. The Transkei, an independent state, was looked at in relation to the developed areas of Southern Africa, and found to be geographically isolated from such economically developed areas and major communication links. Hence stimulated development is necessary. Physiographically the Transkei can be divided into three regions. Practically speaking two distinct regions can be distinguished, viz. the coastal sub-tropical region and the inland grass regions suitable for mixed farming.The natural resources which have the best development potential are forests, builders' marble, base minerals and water resources in general. Certain areas of the Transkei were found to be ideally suitable for the production of cash crops such as coffee, cotton, sugar, tea and fibre. The rest of the Transkei is suitable for mixed farming. There is thus a possibility of processing various products, i.e. an industrial potential. The problem in the Transkei is defined as basically a social problem; the attitude of the people does not create an environment conducive to economic development. Productivity per morgen and per person is low. With 98% of the population living in the non-urban areas and 85% of the economically active population being engaged in agriculture there is over-crowding on the land and per capita income is low.The standard of education of the people is low and there are virtually no employment opportunities other than in subsistence farming