Toward Equity and Value Co-creation in Healthcare

Licentiate thesis, 2014

The prevailing inequities within the Swedish healthcare system constitute a major challenge, not the least in cancer care. An international comparison shows that outcomes for Swedish cancer care score highly. Even so, the process of how care is delivered to its customers has been questioned, with particular emphasis on disregarded groups of the population. Using the notion of value co-creation, the process of service delivery is highlighted. Moreover, the collaborative and relational elements are considered crucial in service interactions, giving the customer an active role in engaging in various activities to co-create value with service providers and others. However, value co-creation has not been thoroughly investigated in a healthcare context. This thesis addresses the current situation for segments of healthcare customers and explicitly aims to increase equity in healthcare. To achieve this goal, barriers that groups of healthcare customers face during the service delivery process are illuminated, as are the various activities in which they engage to co-create value. The thesis also explores the kinship among various domains; particularly the theories of quality management, value co-creation, and social construction, as well as the methodology of action research. The empirical material draws from two studies that took place in the Western Region of Sweden. The first study explored how a participatory action research approach may contribute to raising awareness about preventive health services, thus increasing the number of participants in a cervical cancer screening program among foreign-born women. The second study investigated complaints of cancer patients and their relatives by focusing on the interpersonal aspects of service delivery and by applying a gender lens. The results underline the importance of how healthcare services are provided, particularly the collaborative, interactional, and relational aspects that enable customers’ value co-creation processes. Incorporating social construction theory into value co-creation offers a collective dimension; the unique knowledge and skills of customer segments should be used more productively, thus enabling healthcare providers to offer more tailored value propositions that better meet the needs and expectations of particular groups. In line with value co-creation ideas, policy makers and practitioners must realize that a need exists to move beyond the two-party sphere of provider–patient by including other actors from the customer’s network, such as family members and civil society. By adopting an action research approach and tools from quality management, disparities may be revealed and quality may be improved to contribute to increased equity in healthcare.