Trajectories of value: an exploration of value co-creation and destruction in cancer services

This is the first study to apply an analytical framework based on service-dominant logic (S-D logic) to a UK specialist health care context. The primary aim is to investigate how value, when framed as value that is perceived and determined on the basis of use (i.e. ‘value-in-use’, Vargo and Lusch 2004a) is conceptualised by service users (patients) and service providers (health care staff) in a specialist cancer service setting. Factors influencing the trajectories of ‘value’ (creation and destruction) in micro-level health service encounters are also analysed. This work is transdisciplinary in nature and combines scholarship from fields including services marketing and public management regarding value, value co-creation and patient and public participation in public services (specifically patient engagement in direct health care). In doing so, this work focuses on the S-D logic framework and the recent application of this approach in public management research (Osborne et al 2013). This study adopts an interpretive approach (using semi-structured interviews and observational data) to the investigation of these focal study phenomena. This study responds to calls for research regarding the empirical application of S-D logic (Ostrom et al 2015). Study findings reveal that ‘value’ is a temporal concept, which varies over time and is experienced ‘in context’. The S-D logic framework usefully focuses attention on the service user and interactions between patients and health care staff during service encounters. S-D logic does not, however, neatly map into a health care context. The findings show that value can be created and destroyed both within single encounters, and across multiple health service encounters. Four main themes are identified which contribute to the creation and destruction of value in the UK specialist cancer care context: access to resources (includes specialist knowledge and skills and physical resources); the quality of interactions; resource use and organisational factors

What matters to me! User conceptions of value in specialist cancer care

This paper is the first to apply the services marketing framework of service-dominant logic (S-D logic) to enhance understanding of patient conceptualizations of value in the context of cancer health services. Using data from a case study, the findings reveal that ‘value’ is a temporal, experiential, and complex concept. Three dominant themes are identified as contributing to value creation; access to resources, quality of interactions, and resource use. Although these findings show a broad degree of support for the S-D logic framework, distinctive variations emerge from this application in a health-care context

Value co-creation through patient engagement in health care: a micro-level approach and research agenda

Patient engagement has gained increasing prominence within academic literatures and policy discourse. With limited developments in practice, most extant academic contributions are conceptual, with initiatives in the National Health Service (NHS) concentrating at macro- rather than at micro-level. This may be one reason why the issue of ‘value co-creation’ has received limited attention within academic discussions of patient engagement or policy pronouncements. Drawing on emerging ideas in the services marketing and public management literatures, this article offers the first elucidation of the importance of studying ‘value co-creation’ as a basis for further empirical analysis of patient engagement in micro-level encounters

Mobile technology supporting trainee doctors' workplace learning and patient care: an evaluation

Background The amount of information needed by doctors has exploded. The nature of knowledge (explicit and tacit) and processes of knowledge acquisition and participation are complex. Aiming to assist workplace learning, Wales Deanery funded “iDoc”, a project offering trainee doctors a Smartphone library of medical textbooks. Methods Data on trainee doctors’ (Foundation Year 2) workplace information seeking practice was collected by questionnaire in 2011 (n = 260). iDoc baseline questionnaires (n = 193) collected data on Smartphone usage alongside other workplace information sources. Case reports (n = 117) detail specific instances of Smartphone use. Results Most frequently (daily) used information sources in the workplace: senior medical staff (80% F2 survey; 79% iDoc baseline); peers (70%; 58%); and other medical/nursing team staff (53% both datasets). Smartphones were used more frequently by males (p < 0.01). Foundation Year 1 (newly qualified) was judged the most useful time to have a Smartphone library because of increased responsibility and lack of knowledge/experience. Preferred information source varied by question type: hard copy texts for information-based questions; varied resources for skills queries; and seniors for more complex problems. Case reports showed mobile technology used for simple (information-based), complex (problem-based) clinical questions and clinical procedures (skills-based scenarios). From thematic analysis, the Smartphone library assisted: teaching and learning from observation; transition from medical student to new doctor; trainee doctors’ discussions with seniors; independent practice; patient care; and this ‘just-in-time’ access to reliable information supported confident and efficient decision-making. Conclusion A variety of information sources are used regularly in the workplace. Colleagues are used daily but seniors are not always available. During transitions, constant access to the electronic library was valued. It helped prepare trainee doctors for discussions with their seniors, assisting the interchange between explicit and tacit knowledge. By supporting accurate prescribing and treatment planning, the electronic library contributed to enhanced patient care. Trainees were more rapidly able to medicate patients to reduce pain and more quickly call for specific assessments. However, clinical decision-making often requires dialogue: what Smartphone technology can do is augment, not replace, discussion with their colleagues in the community of practice

Enhancing public service innovation through value co-creation: capacity building and the 'innovative imagination’

This article considers how a perspective on value co-creation, known as ‘service-dominant logic’ (S-D logic), contributes to theoretical and empirical understandings of the processes underlying social innovation and co-creation in public services. Specifically, this explores how adopting a service ecosystems perspective to interpret empirical data regarding participation experiences in a UK public service innovation programme, enhances understanding of learning and knowledge exchange processes, experimentation and value co-creation in public service innovation projects

How a mobile app supports the learning and practice of newly qualified doctors in the UK: an intervention study

Background The transition from medical school to the workplace can be demanding, with high expectations placed on newly qualified doctors. The provision of up-to-date and accurate information is essential to support doctors at a time when they are managing increased responsibility for patient care. In August 2012, the Wales Deanery issued the Dr.Companion© software with five key medical textbooks (the iDoc app) to newly qualified doctors (the intervention). The aim of the study was to examine how a smartphone app with key medical texts was used in clinical workplace settings by newly qualified doctors in relation to other information sources and to report changes over time. Methods Participants (newly qualified - Foundation Year 1 - doctors) completed a baseline questionnaire before downloading the iDoc app to their own personal smartphone device. At the end of Foundation Year 1 participants (n = 125) completed exit questionnaires one year later. We used Wilcoxon Signed Rank test to analyse matched quantitative data. Results We report significant changes in our participants’ use of workplace information resources over the year. Respondents reduced their use of hard-copy and electronic versions of texts on PCs but made more use of senior medical staff. There was no significant difference in the use of peers and other staff as information sources. We found a significant difference in how doctors felt about using a mobile device containing textbooks in front of patients and senior medical staff in the workplace. Conclusions Our study indicates that a mobile app enabling timely, internet-free access to key textbooks supports the learning and practice of newly qualified doctors. Although participants changed their use of other resources in the workplace, they continued to consult with seniors. Rather than over-reliance on technology, these findings suggest that the app was used strategically to complement, not replace discussion with members of the medical team. Participants’ uncertainty about using a mobile device with textbook app in front of others eased over time

Transitions in medicine:Trainee doctor stress and support mechanisms

Purpose - This paper describes experiences of transition from medical school to new doctor in the UK and examines the development and evaluation of initiatives designed to lessen anxiety and assist transition. Design/methodology/approach - The evaluations of two recent interventions for new doctors are reported, one at organisational and one at the individual level: (i) a longer induction programme; and (ii) provision of a library of medical textbooks on smartphones (the "iDoc" project). The paper also reports on mindfulness training designed to help trainees’ well-being. Findings - These initiatives address different aspects of transition challenges (related to roles and responsibilities, cognitive and environmental factors). Benefit can be gained from multiple approaches to supporting this time of uncertainty. Research limitations/implications - The development, piloting, evaluation and implementation of these initiatives is not currently part of a collaborative programme to support transition. Further work is needed to research the impact of a multi-pronged support strategy. Practical implications - Given the link between transition, doctor stress and patient safety, there is a need to review existing strategies to ameliorate the stress associated with transition and seek novel ways to support new doctors. We argue that diverse approaches, targeted at both the organisational and individual level, can support new trainees both practically and emotionally. Originality/value - The paper reports initiatives that support transition, of value to medical schools, deaneries, researchers and trainees themselves