Oliver Brant J, Batalden Paul B, DiMilia Peter Rocco, Forcino Rachel C, Foster Tina C, Nelson Eugene C, Garre Boel Anderson
Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
BMJ Open. 2020 Oct 5;10(10):e037578. doi: 10.1136/bmjopen-2020-037578.
Coproduction introduces a fundamental shift in how healthcare service is conceptualised. The mechanistic idea of healthcare being a 'product' generated by the healthcare system and delivered to patients is replaced by that of a service co-created by the healthcare system and the users of healthcare services. Fjeldstad offer an approach for conceptualising value creation in complex service contexts that we believe is applicable to coproduction of healthcare service. We have adapted Fjeldstad's value creation model based on a detailed case study of a renal haemodialysis service in Jonkoping, Sweden, which demonstrates coproduction characteristics and key elements of Fjeldstad's model.
We propose a five-part coproduction value creation model for healthcare service: (1) v, characterised by a standardised set of processes that serve a commonly occurring need; (2) v, which offers a customised response for unique cases; (3) a , which involves groups of individuals struggling with similar challenges; (4) between shop, chain and network elements and (5) . We will seek to articulate and assess the value creation model through the work of a community of practice comprised of a diverse international workgroup with representation from executive, financial and clinical leaders as well as other key stakeholders from multiple health systems. We then will conduct pilot studies of a qualitative self-assessment process in participating health systems, and ultimately develop and test quantitative measures for assessing coproduction value creation.
This study has been approved by the Dartmouth-Hitchcock Health Institutional Review Board (D-HH IRB) as a minimal risk research study. Findings and scholarship will be disseminated broadly through continuous engagement with health system stakeholders, national and international academic presentations and publications and an internet-based electronic platform for publicly accessible study information.
共同生产带来了医疗服务概念化方式的根本性转变。医疗服务是由医疗系统“生产”并提供给患者的一种“产品”这一机械观念，已被医疗系统与医疗服务使用者共同创造服务的观念所取代。菲耶尔斯塔德提出了一种在复杂服务环境中概念化价值创造的方法，我们认为该方法适用于医疗服务的共同生产。我们基于对瑞典延雪平一项肾透析服务的详细案例研究，对菲耶尔斯塔德的价值创造模型进行了调整，该案例展示了共同生产的特征以及菲耶尔斯塔德模型的关键要素。
我们提出了一个医疗服务共同生产价值创造的五部分模型：（1）v，其特点是有一套标准化流程，满足常见需求；（2）v，针对独特案例提供定制化响应；（3）a，涉及面临类似挑战的个体群体；（4）商店、连锁和网络元素之间的（此处原文不完整）以及（5）（此处原文不完整）。我们将通过一个实践社区的工作来阐述和评估该价值创造模型，该实践社区由一个多元化的国际工作组组成，成员包括行政、财务和临床领导以及来自多个卫生系统的其他关键利益相关者。然后，我们将在参与的卫生系统中进行定性自我评估过程的试点研究，并最终开发和测试用于评估共同生产价值创造的定量指标。
本研究已获得达特茅斯 - 希区柯克医疗机构审查委员会（D - HH IRB）批准，属于低风险研究。研究结果和学术成果将通过与卫生系统利益相关者持续互动、在国内和国际学术会议上发表演讲和文章，以及通过一个基于互联网的电子平台广泛传播，该平台提供可公开获取的研究信息。
