University of Liverpool Management School, Chatham Street, Liverpool, L69 7ZH, UK.
Soc Sci Med. 2021 May;277:113912. doi: 10.1016/j.socscimed.2021.113912. Epub 2021 Apr 9.
A paradigm shift toward healthcare inter-professional collaboration is leading to searches for ways to better facilitate integration. However, policy rhetoric often fails to acknowledge the complexity of healthcare service systems, and the difficulties involved in achieving successful collaborations. Consequently, more research is called for. We utilize the concept of a service ecosystem, a perspective currently prominent in service science, which is transforming the ways service systems are studied. This research aims to examine palliative care provision through a service ecosystem lens in order to uncover previously unidentified insights and opportunities for improvement. The palliative care ecosystem under study encompasses a defined geographical area of the UK. Data comprises pathographies (i.e., narratives of illness) with patients and their families (n = 31) and in-depth interviews with a variety of palliative care providers (n = 21), collected between 2017 and 2018. Capability issues comprising collaboration, coordination, and resource integration, together with communicating value all emerged as common themes impacting palliative care services. Taking a service ecosystem perspective, we also found shared intentionality for better integration and collaboration, with a desire among palliative care providers for the ecosystem's hospice organization to take the role of leader and facilitator. Acting on these findings, we demonstrate the ways new institutional arrangements provide a foundation for value cocreation. We make a contribution to the burgeoning service ecosystem literature which currently lacks empirical insights, particularly in health. We argue that in complex service systems such as healthcare, the focus must be on service design rather than organizational design, approached from the perspective of aggregation of service providers. We demonstrate empirically how reconfiguring resources and developing new institutional arrangements at the meso level can change micro-macro level interaction, enabling the emergence of new and enhanced value cocreation in palliative care.
向医疗保健跨专业合作的范式转变正在促使人们寻找更好的整合方法。然而，政策言辞往往未能认识到医疗保健服务系统的复杂性，以及实现成功合作所涉及的困难。因此，需要进行更多的研究。我们利用服务生态系统的概念，这是服务科学中当前突出的观点，它正在改变服务系统的研究方式。本研究旨在通过服务生态系统的视角来考察姑息治疗服务的提供，以揭示以前未被发现的见解和改进机会。研究中的姑息治疗生态系统涵盖了英国的一个特定地理区域。数据包括患者及其家属的病史（即疾病叙述）（n=31）和对各种姑息治疗提供者的深入访谈（n=21），这些数据是在 2017 年至 2018 年间收集的。能力问题包括合作、协调和资源整合，以及沟通价值，这些问题共同成为影响姑息治疗服务的共同主题。从服务生态系统的角度来看，我们还发现了更好的整合和合作的共同意图，姑息治疗提供者希望生态系统中的临终关怀组织承担领导和促进者的角色。根据这些发现，我们展示了新的制度安排为价值共创提供基础的方式。我们为正在兴起的服务生态系统文献做出了贡献，该文献目前缺乏健康领域的经验见解。我们认为，在医疗等复杂的服务系统中，重点必须放在服务设计上，而不是组织设计上，要从服务提供者聚合的角度来考虑。我们从经验上展示了如何在中观层面重新配置资源和发展新的制度安排，从而改变微观-宏观层面的互动，使姑息治疗中出现新的和增强的价值共创。
