Modular care and service packages for independently living elderly

A matching method for elderly care service personnel with multiple types of service expectations

With the rapid growth of the global aging population, the problem of providing for the elderly has become increasingly prominent. As a new model of providing for the elderly in China, home-based care has attracted more and more attention from all walks of life. The research on how to realize reasonable and effective matching between elderly care service personnel and the elderly under the home care model deserves attention and has important practical significance. In this paper, a matching method for elderly care service personnel considering multi-type service expectations is proposed. This approach involves first obtaining the actual values of the expectation indexes for each other, as well as the expectation requirements of the elderly and the service personnel. Next, we compute the satisfaction of the elderly and the service personnel for each other based on the elastic service expectation type, and finally, we make a decision about whom to choose based on the inelastic service expectation indexes. On this basis, the situation is considered that there are sufficient and insufficient elderly care service personnel, the two-sided matching models are constructed, respectively, and the optimal matching results are obtained by solving the models. Finally, an example is given to illustrate the feasibility and effectiveness of the proposed method.

How service modularity can provide the flexibility to support person-centered care and shared decision-making

Background

Today’s healthcare provision is facing several challenges, that cause the level of complexity to increase at a greater rate than the managerial capacity to effectively deal with it. One of these challenges is the demand for person-centered care in an approach that is tuned towards shared decision-making. Flexibility is needed to adequately respond to individual needs.

Methods

We elaborate on the potential of service modularity as a foundation for person-centered care delivered in a shared decision-making context, and examine to what extent this can improve healthcare. We primarily focused on theory building. To support our effort and gain insight into how service modularity is currently discussed and applied in healthcare, we conducted a scoping review.

Results

Descriptions of actual implementations of modularity in healthcare are rare. Nevertheless, applying a modular perspective can be beneficial to healthcare service improvement since those service modularity principles that are still missing can often be fulfilled relatively easily to improve healthcare practice. Service modularity offers a way towards flexible configuration of services, facilitating the composition of tailored service packages. Moreover, it can help to provide insight into the possibilities of care for both healthcare professionals and patients.

Conclusions

We argue that applying a modular frame to healthcare services can contribute to individualized, holistic care provision and can benefit person-centered care. Furthermore, insight into the possibilities of care can help patients express their preferences, increasing their ability to actively participate in a shared decision-making process. Nevertheless, it remains essential that the healthcare professional actively collaborates with the patient in composing the care package, for which we propose a model. Altogether, we posit this can improve healthcare practice, especially for the people receiving care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07267-6.

Value configurations for balancing standardization and customization in chronic care: a qualitative study

BACKGROUND

Demands for both customization and standardization are increasing in healthcare. At the same time, resources are scarce, and healthcare managers are urged to improve efficiency. A framework of three value configurations - shop, chain, and network - has been proposed for how healthcare operations can be designed and organized for efficient value creation. In this paper, use of value configurations for balancing of standardization and customization is explored in the context of care for chronic mental conditions.

METHODS

A typical case is presented to illustrate the manifestations of conflicting demands between customization and standardization, and the potential usefulness of the value configurations framework. Qualitative data were collected from managers and care developers in two focus groups and six semi-structured interviews, completed by a national document describing a care pathway. Data were coded and analysed using an insider-outsider approach.

RESULTS

Operationalization of the balance between standardization and customization were found to be highly delegated and ad hoc. Also, the conflict between the two demands was often seen as aggravated by scarce resources. Value configurations can be fruitful as a means of discussing and redesigning care operations if applied at a suitable level of abstraction. Applied adequately, all three value configurations were recognized in the care operations for the patient group, with shop as the overarching configuration. Some opportunities for improved efficiency were identified, yet all configurations were seen as vital in the chronic care process.

CONCLUSIONS

The study challenges the earlier proposed organizational separation of care corresponding to different value configurations. Instead, as dual demand for customization and standardization permeates healthcare, parallel but explicated value configurations may be a path to improved quality and efficiency. Combined and intermediate configurations should also be further investigated.

Current developments in delivering customized care: a scoping review

BACKGROUND

In recent years, there has been a growing interest in health care personalization and customization (i.e. personalized medicine and patient-centered care). While some positive impacts of these approaches have been reported, there has been a dearth of research on how these approaches are implemented and combined for health care delivery systems. The present study undertakes a scoping review of articles on customized care to describe which patient characteristics are used for segmenting care, and to identify the challenges face to implement customized intervention in routine care.

METHODS

Article searches were initially conducted in November 2018, and updated in January 2019 and March 2019, according to Prisma guidelines. Two investigators independently searched MEDLINE, PubMed, PsycINFO, Web of Science, Science Direct and JSTOR, The search was focused on articles that included "care customization", "personalized service and health care", individualized care" and "targeting population" in the title or abstract. Inclusion and exclusion criteria were defined. Disagreements on study selection and data extraction were resolved by consensus and discussion between two reviewers.

RESULTS

We identified 70 articles published between 2008 and 2019. Most of the articles (n = 43) were published from 2016 to 2019. Four categories of patient characteristics used for segmentation analysis emerged: clinical, psychosocial, service and costs. We observed these characteristics often coexisted with the most commonly described combinations, namely clinical, psychosocial and service. A small number of articles (n = 18) reported assessments on quality of care, experiences and costs. Finally, few articles (n = 6) formally defined a conceptual basis related to mass customization, whereas only half of articles used existing theories to guide their analysis or interpretation.

CONCLUSIONS

There is no common theory based strategy for providing customized care. In response, we have highlighted three areas for researchers and managers to advance the customization in health care delivery systems: better define the content of the segmentation analysis and the intervention steps, demonstrate its added value, in particular its economic viability, and align the logics of action that underpin current efforts of customization. These steps would allow them to use customization to reduce costs and improve quality of care.

Boundary negotiations: a paradox theoretical approach for efficient and flexible modular systems

Purpose

The purpose of this paper is to explore the interplay between firm boundary decisions and the management of both efficiency and flexibility and the implications this has for modular design in the provision of advanced services.

Design/methodology/approach

A single case study in the defence industry employs semi-structured interviews supplemented by secondary data. Data are analysed using thematic analysis.

Findings

The findings provide a process model of boundary negotiations for the design of efficient and flexible modular systems consisting of three phases; boundary ambiguity, boundary defences and boundary alignment.

Practical implications

The study provides a process framework for boundary negotiations to help organisations navigate the management of both-and efficiency and flexibility in the provision of advanced services.

Originality/value

Drawing upon modularity, paradox and systems theory, this article provides novel theoretical insight into the relationship between firm boundary decisions and the management of both-and efficiency vs. flexibility in the provision of product upgrade services.

Identifying and categorising knowledge reuse activities in electronic repositories

Purpose

Knowledge reuse using electronic repositories, while increasingly important, requires more thorough analysis. Service modularity has been recently applied in services research but has not been integrated into knowledge reuse studies. The purpose of this paper is to draw on both service modularity and knowledge reuse to develop and validate a framework that categorises forms of packaged knowledge in an electronic repository.

Design/methodology/approach

Drawing on knowledge reuse and service modularity research, a model is proposed. The model is empirically tested using a case study research design.

Findings

This research highlighted the value of including both context and process as key dimensions when packaging service knowledge for reuse. This study identifies knowledge types present in modular solutions and how they were configured and reconfigured in the knowledge repository. This research identified five ways modularised services were leveraged. In addition to the traditional scale and stretch approaches, already present, but conflated, in the service literature, three other configurations were identified; shrink, separate and segment.

Research limitations/implications

The findings are based on a single empirical case study which may limit the generalisability of the findings. There is a need for additional research to further validate the model in additional contexts.

Practical implications

This study provides managers with empirical examples of how a modular repository was used in practice and outlines five ways of recombining contextual and processual elements to enable service codification and reuse. It has implications for how knowledge is decomposed and recombined in repositories, suggesting an explicit separation of context and process knowledge while developing modular elements within both.

Originality/value

To the best of the author’s knowledge, this is the first study that explicitly uses context and process as dimensions and draws on service modularity to understand types of knowledge reuse in electronic repositories. In doing so, it adds value by developing and validating a model that identifies five types of reuse.

Elaborating on modular interfaces in multi-provider contexts

Purpose

This study examines how modular interfaces manifest in multi-provider contexts and how they can improve coordination and customization of services. The aim of the study is to describe interfaces in multi-provider contexts and elaborate on how they support the delivery of integrated patient care.

Design/methodology/approach

A qualitative, multiple case study was conducted in two multi-provider contexts in healthcare services: one representing paediatric Down syndrome care in the Netherlands and one representing home care for the elderly in Finland. Data collection involved semi-structured interviews in both contexts.

Findings

This study provides insight into several types of interfaces and their role in multi-provider contexts. Several inter- and intra-organizational situations were identified in which the delivery of integrated patient care was jeopardized. This study describes how interfaces can help to alleviate these situations.

Originality/value

This study deepens the understanding of interfaces in service modularity by describing interfaces in multi-provider contexts. The multi-provider contexts studied inspired to incorporate the inter-organizational aspect into the literature on interfaces in service modularity. This study further develops the typology for interfaces in modular services by adding a third dimension to the typology, that is, the orientation of interfaces.

Revisiting the unholy alliance of health-care operations: payor–provider integration of occupational health services

Purpose

To investigate the effects of payor–provider integration on the operational performance of health service provision. The research explores whether integration governs agency problems and tilts the incentives of diverse actors toward more systematic outcomes.

Design/methodology/approach

A two stage multimethod case study of occupational health services. A qualitative stage aimed to understand the reasons, mechanisms, and outcomes of payor–provider integration. A quantitative stage evaluated the performance of the integrated hospital against fee-for-service partner hospitals with a sample of 2,726 patients.

Findings

Payor–provider integration mitigates agency problems on multiple levels of the service system by complementing formal governance mechanisms with informal mechanisms. Compared to partner hospitals, the integrated hospital yielded 9% lower the total costs of occupational injuries achieved primarily by emphasizing conservative care and faster recovery.

Research limitations/implications

Focuses on occupational health services in Finland. Provides initial evidence of the effects of payor–provider integration on the operational performance.

Practical implications

Vertical integration may provide systematic outcomes but requires mindful implementation of multiple mechanisms. Rigorous change management initiative is advised.

Social implications

For patients, the research shows payor–provider integration of health services can be implemented in a manner that it reduces care costs while not compromising care quality and customer satisfaction.

Originality/value

This study provides a rare longitudinal analysis of payor–provider integration in health-care operations management. The study adds to the knowledge of operational performance improvement of health services.

Purchase and use of home healthcare devices for the elderly: a pilot study in Shanghai, China

BACKGROUND

In China, home-based healthcare/rehabilitation has always been advocated by the government and is the most prevalent healthcare pattern. However, there is currently no data on how many each product has been purchased, and it is not clear what factors are associated with their use. The research aims to clarify the current practices and attitudes of the elderly on such matters, and further analyze their influence factors.

METHODS

This pilot study consisted of two-round regional survey, conducted from July 25 to August 3, 2015 and July 20 to August 10, 2018 respectively. Both surveys released on-site paper questionnaires and collected after filling out in different communities.

RESULTS

Two hundred forty-four valid questionnaires from 52 communities were collected. Compared with 2015 (30.8%), the number of people who did not purchase home healthcare devices in the same area decreased in 2018 (28.2%). Hemopiezometer (44.3%), glucometer (18.4%), massager (21.3%) and walking devices (19.3%) are the four main types of products that urbanites are most willing to buy. In addition, users' age group, education level, and income level were significantly correlated with the purchase of certain products.

CONCLUSIONS

The types of home healthcare devices purchased by respondents are consistent with the distribution of chronic diseases of urban residents in China. The analysis of product brands also revealed the existing problems and huge growth space of the industry market, which also requires the government to introduce relevant policies and measures to regulate the market and accelerate the development of the industry.

Comparing modular and personal service delivery in specialised outpatient care: A survey of haematology and oncology patient preferences

Background

Oncology and haematology are shifting from inpatient to outpatient care, requiring new care delivery models. This study compares preferences of oncology patients treated by named nurses in a traditional specialty-focused day hospital and haematology patients treated without named nurses in a modularised day hospital.

Methods

Questionnaires to explore patient preferences on number of treating nurses and named nurses, and satisfaction in day hospital care were distributed to 300 haematology and 410 oncology patients. Binomial logistic regressions were performed to study how background variables influenced preferences for having (i) a named nurse or (ii) maximum three treating nurses in the day hospital.

Results

In 2016, 156 (52%) haematology and 289 (70%) oncology surveys were completed and returned. Both groups were satisfied with day hospital care. Haematology patients preferred named nurses less often than oncology patients (odds ratio (OR) = 0.09, p < 0.0005). Haematology patients were less likely to prefer a maximum of three treating nurses (OR = 0.12, p < 0.0005).

Conclusion

This study suggests that patients can be satisfied with outpatient care with or without named nurses. However, as several factors affect patient satisfaction and experience, more in-depth research is needed to understand how modularisation and patient preferences may be linked.

Unleashing hidden potential: customer engagement in modular service innovation

Purpose

This paper aims to explore the role of customer engagement during the production of services in a modular innovation. Modularity can be used to explain the structure and relationship in services innovation.

Design/methodology/approach

The authors explore the theory of modularity focussing on the context of consumer engagements. They adopted ideas from product modularity and approach services using modular principle.

Findings

Contrary to the extant literature, the authors are content that the transactions between the participants were mainly conducted at thick crossing points. By focusing on thin crossing point, the service provider will achieve better overall service structure.

Research limitations/implications

There is a need to focus on specifying interface to define how service modules and service providers interact with the customer within the service.

Practical implications

By engaging customer, modular principle can help firms achieve cost efficiency, higher product and process variety, as well as better response to individual customer needs.

Originality/value

This paper scrutinises the engagement of customer and conceptualises the role of customer in modular innovations that have been previously neglected.

Modularising outpatient care delivery: A mixed methods case study at a Finnish University Hospital

BACKGROUND

Modularisation is a potential means to develop health care delivery by combining standardisation and customisation. However, little is known about the effects of modularisation on hospital care. The objective was to analyse how modularisation may change and support health care delivery in specialised hospital care.

METHODS

A mixed methods case study methodology was applied using both qualitative and quantitative data, including interviews, field notes, documents, service usage data, bed count and personnel resource data. Data from a reference hospital's unit were used to understand the context and development of care delivery in general.

RESULTS

The following outcome themes were identified from the interviews: balance between demand and supply; support in shift from inpatient to outpatient care; shorter treatment times and improved management of service production. Modularisation supported the shift from inpatient towards outpatient care. Changes in resource efficiency measures were both positive and negative; the number of patients per personnel decreased, while the number of visits per personnel and the bed utilisation rate increased.

CONCLUSIONS

Modularisation may support health care providers in classifying patients and delivering services according to patients' needs. However, as the findings are based on a single university hospital case study, more research is needed.

Evolution of modularity literature: a 25-year bibliometric analysis

Purpose

The purpose of this paper is to review and analyze the modularity literature to identify the established and emerging perspectives.

Design/methodology/approach

A systematic literature search and review was conducted through the use of bibliometrics and network analysis. The analysis identified structure within the literature, which revealed how the research area evolved between 1990 and 2015. Based on this search, the paper establishes the basis for analyzing the structure of modularity literature.

Findings

Factors were identified within the literature, demonstrating how it has evolved from a primary focus on the modularity of products to a broader view of the applicability of modularity. Within the last decade, numerous research areas have emerged within the broader area of modularity. Through core-periphery analysis, eight emerging sub-research areas are identified, of which one is the study of modularity in the context of services.

Research limitations/implications

Although bibliographic methods are limited as they are based on common citations within the field, they enable systematic analysis and the identification of structure within an emergent field of research. Such analysis has implications by for a growing and inter-disciplinary field like modularity by providing overview and suggesting future directions.

Originality/value

This paper contributes by conducting a systematic review based on the citation structure within modularity and identifies the established and emerging areas of research on modularity.

Modularizing specialized hospital services

Purpose

Modularity promises to relieve problems of complexity in service systems. However, limited evidence exists of its application in specialized hospital services. The purpose of this paper is to identify enablers, constraints, and outcomes of modularization in specialized hospital services.

Design/methodology/approach

A qualitative comparative study of a hematology unit with modular service architecture and an oncology unit with integral service architecture in a university hospital is performed to analyze the service architectures, enablers and constraints of modularization, and outcomes.

Findings

A framework and five propositions combining the characteristics of specialized hospital services, enabling activities, and outcomes of modularization were developed. Modular service architecture was developed through limiting the number of treatment components, reorganizing production of standardized components into a separate service unit, and standardizing communication and scheduling in interfaces. Modularization increased service efficiency but diluted ownership of services, decreased customization, and diminished informal communication. This is explained by the specific characteristics of the services: fragmented service delivery, professional autonomy, hierarchy, information asymmetry, and requirement to treat all.

Research limitations/implications

Modularization can increase efficiency in specialized hospital services. However, specific characteristics of specialized care may challenge its application and limit its outcomes.

Practical implications

The study identifies enabling activities and constraints that hospital managers should take into account when developing modular service systems.

Originality/value

This is the first empirical study exploring the enablers, constraints, and outcomes of modularization in specialized hospital services. The study complements literature on service modularity with reference to specialized hospital services.

Service modularity and architecture – an overview and research agenda

Purpose

Services are highly important in a world economy which has increasingly become service driven. There is a growing need to better understand the possibilities for, and requirements of, designing modular service architectures. The purpose of this paper is to elaborate on the roots of the emerging research stream on service modularity, provide a concise overview of existing work on the subject, and outline an agenda for future research on service modularity and architecture. The articles in the special issue offer four diverse sets of research on service modularity and architecture.

Design/methodology/approach

The paper is built on a literature review mapping the current body of literature on the topic and developing future research directions in service modularity and architecture.

Findings

The growing focus on services has triggered needs to investigate the suitability and implementation of physical-product-focused modularity principles and theories in service contexts, and to search for principles/theories that enhance services. The expanding research stream has explored various aspects of service modularity in empirical contexts. Future research should focus on service-specific modularity theories and principles, platform-based and mass-customized service business models, comparative research designs, customer perspectives and service experience, performance in context of modular services, empirical evidence of benefits and challenges, architectural innovation in services, modularization in multi-provider contexts, and modularity in hybrid offerings combining service and tangible product modules.

Originality/value

Nine areas are recommended for further research on service modularity and architecture. The introductory piece also discusses the roots of service modularity and provides an overview of current contributions.

What professionals consider when designing a modular service architecture?

Purpose

The purpose of this paper is to explore how functional and appropriateness arguments influence the adoption of modularity principles during the design of a professional service architecture.

Design/methodology/approach

Action design research was conducted to examine the design process of a modular service architecture for specialised elderly care by a multi-professional group. Data collection methods included, partly participatory, observations of the interactions between professionals during the design process, interviews and document analysis. Data analysis focussed on the emerging design choices and the arguments underlying them.

Findings

A wide range of both functional and appropriateness considerations were enlisted during the design process. The three core modularity principles were adapted to varying degrees. In terms of the design outcome, the interdependencies between the modularity principles necessitated two trade-offs in the modular design. A third trade-off occurred between modularity and the need for professional inference where services were characterised by uncertainty. Appropriateness was achieved through the professionals reframing and translating the abstract modularity concept to reconcile the concept’s functionality with their professional norms, values and established practices.

Originality/value

The study adds to service modularity theory by formulating three trade-offs that are required in translating the core modularity principles into a functional set of design choices for a multi-professional service environment. Moreover, the inherent intertwinedness of the core modularity principles in professional services requires an iterative design process. Finally, the authors saw that the ambiguity present in the service modularity concept can be used to develop a design that is deemed appropriate by professionals.

The development of outbound logistics services in the automotive industry

Purpose

The automotive industry has been studied extensively, but few studies focus on outbound logistics in automotive supply chains, or on the logistics service provider’s (LSP’s) point of view. Furthermore, there is hardly any research on service model innovation in LSPs. The purpose of this paper is to narrow these research gaps.

Design/methodology/approach

The analysis is based on a single-case study – an LSP that specializes in services for the automotive industry. The paper examines the company’s service models and their development over time.

Findings

The findings show how the case company has moved towards multifaceted service models through a number of radical and incremental innovations. Moreover, it has used the same methods in developing all its new service models, and has applied modularity principles in service innovation to achieve better process efficiency and service effectiveness.

Research limitations/implications

The rather narrow focus of this study – automotive logistics in a specific area – decreases the generalizability of the findings beyond this context. However, the single-case approach offers in-depth insights, and the analytical frameworks developed herein for service models is applicable in other contexts.

Practical implications

The analysis may help LSPs and service companies in their service design and development. The use of modularity principles makes it easier to offer mass-customized services and to develop efficient processes.

Originality/value

This study narrows a research gap in examining outbound logistics services in the automotive supply chain and focussing on the LSP’s perspective.

Modularity matters: a critical review and synthesis of service modularity

Purpose

– The literature on modularity is extensive, but most research has been concerned with the manufacturing sector and much less with the service sector. The purpose of this paper is to investigate the existing research, to provide a critique of the empirical literature on service modularity and to discuss future research opportunities.

Design/methodology/approach

– To perform this analysis of service modularity, a list of top-tier journals in the field of business management and organisation was compiled. From there, each and every article was identified, examined, coded and classified into high-level themes. These were then reviewed, analysed and interpreted.

Findings

– This paper argues that the application of modularity in services will likely be influenced by certain characteristics that distinguish services from products. Second, modularity, from the service perspective, has been closely connected to productisation of services, and the discussion of modularity related to services has been greatly influenced by the earlier discussion on product modularity. This paper concludes that modularity in the service development context is still seeking its theoretical “identity” and requires further theoretical and empirical work on service design modularity conceptualisation, methods and measures.

Originality/value

– This paper has reviewed several significant fields with which research on service modularity has been concerned. It captures and presents the core notion of service modularity in a critical way that might spur further research in the field.

Service decomposition: a conceptual analysis of modularizing services

Purpose

– Applying “modularity” principles in services is gaining in popularity. The purpose of this paper is to enrich existing service modularity theory and practice by exploring how services are being decomposed and how the modularization aim and the routineness of the service(s) involved may link to different decomposition logics. The authors argue that these are fundamental questions that have barely been addressed.

Design/methodology/approach

– The authors first built a theoretical framework of decomposition steps and the design choices involved that distinguished six decomposition logics. The authors conducted a systematic literature search that generated 18 empirical articles describing 16 service modularity cases. The authors analysed these cases in terms of decomposition logic and two main contingencies: modularization aim and service routineness.

Findings

– Only three of the 18 articles explicitly addressed the service decomposition by reflecting on the underlying design choices. By unravelling the decomposition in each case, the authors were able to identify the decomposition logic and found four of the six theoretically derived logics: single-level process oriented; single-level outcome oriented; multilevel outcome oriented; and multilevel combined orientation. Although the authors did not find a direct relationship between the modularization aim and the decomposition logic, the authors did find that single-level decomposition logics seem to be mainly applied in non-routine service offerings whereas the multilevel ones are mainly applied in routine service offerings.

Originality/value

– By contributing to a common understanding of modular service decomposition and proposing a framework that explicates the design choices involved, the authors enable an enhanced application of the modularity concept in services.

Access to long-term care: perceptions and experiences of older Dutch people

Purpose

– Despite the current focus on demand-based care, little is known about what clients consider important when they have a request for formal long-term care services. The paper aims to discuss this issue.

Design/methodology/approach

– Questions about the access process to care services were added to the “Senior Barometer”, a Dutch web-based questionnaire that assesses the opinion of older people about different aspects in life. The questionnaire surveyed both people who already requested care services (“users”), and people that did not (“future clients”).

Findings

– The results show a significant difference in what people expect to be the first step from what users actually did, when requesting formal care services. In addition, there was a significant difference on how “users” and “future clients” rated several access service aspects.

Research limitations/implications

– The results give valuable information on how both “users” and “future clients” value the access process. The findings also provide valuable input for organizations providing long-term care for older clients about the important issues that have to be considered when organizing the access process.

Originality/value

– This study shows what older people in the Netherlands find important during the access process to care and this has not been explored before. The difference between what “users” and “future clients” find of importance in the care access process suggests that it is difficult for people to foresee what will be important once the need for care arrives, or where they will turn to with a request for care services.

Organising health services through modularity

Purpose

– The purpose of this paper is to analyse the way in which the factors influencing a transformation towards or away from modularity, according to general modular systems theory, appear in the context of health services, and the extent to which the special characteristics of health services might support or prevent its application.

Design/methodology/approach

– The arguments constructed in the study are based on the theme of modularity, reflected against the special characteristics of health services identified in the context of health economics.

Findings

– The results include 11 proposition pairs that direct health services both towards and away from modularity.

Research limitations/implications

– Health services are highly heterogeneous in nature and the authors illustrate this with a wide range of examples from elderly care as the authors discuss the application of modularity in this context. Nevertheless, the authors recognise that modularity might suit some health services better than others. The findings provide potentially important information to health service managers and providers, enabling them to understand how modularity would benefit health service provision and where contradictions are to be expected.

Originality/value

– This study contributes to the discourse on service modularity in general, and complements the literature on modularity with reference to both public and private health services.

Collaborative purchasing of complex technologies in healthcare

Purpose

– The purpose of this paper is to investigate how buyers and the vendors pursue alignment in collaborative purchasing (CP) of complex medical technologies.

Design/methodology/approach

– Through a literature review in CP, the paper identify factors for shareholder alignment (i.e. aligning the needs of the buyers within the purchasing group) and customer alignment (i.e. aligning buyers’ needs with the vendors offering strategies) and investigate how they manifest in the case of CP of complex technology in the Danish National Healthcare System.

Findings

– Shareholder alignment requires appropriate management of the relationships, expertise and guidance in simplifying procedures and effective management of the purchasing group. Customer alignment is facilitated by buyers’ understating of the vendor’s design options, which are moderated by the vendor’s design strategies.

Research limitations/implications

– The findings and generalizations from a single case study are limited to the complexity of the purchased technology and the specific cultural context. However the paper represents the first explorative study that poses the attention on the relevance of shareholder and customer alignment in CP.

Practical implications

– The study can offer hospitals, vendors, governmental and regional institutions a better understanding about the alignment mechanisms for successful implementation of CP and how to avoid pitfalls.

Originality/value

– Literature on CP is scarce as there are virtually no contributions that debate the key elements and tradeoffs that need to be considered for strategic alignment. The study addresses this gap.

Refining case management for dementia using insights from operations management

Purpose

– Providers of healthcare services face increasing performance demands in terms of cost-efficiency as well as client centeredness. Dementia care is an illustrative example in this respect. Due to the aging society, the number of dementia clients is expected to grow significantly, which implies increasing costs. At the same time, demands in terms of coherent and high-quality care for dementia clients are increasing, putting a stronger emphasis on demand driven, responsive care and service processes. Literature shows that case management in dementia care is beneficial for persons with dementia and caregivers, but costly. Using insights from operations management (OM), the purpose of this paper is to develop a new model for case management in dementia care.

Design/methodology/approach

– To address both cost containment and customer orientation, insights from OM, in particular front/back office (FO/BO) configuration and modularity theory, are used to develop an innovative conceptual model for case management in dementia care.

Findings

– This framework offers a new way of conceptualizing care provision throughout the different phases of a chronic disease process. Linking FO/BO configurations and modular organizing with case management makes it possible to create a cost-effective and client-centered system of healthcare management.

Originality/value

– A new model is developed to address both cost containment and customer orientation based on insights from OM, in particular FO/BO configuration and modularity theory.

A person-centred segmentation study in elderly care: towards efficient demand-driven care

Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care. This paper describes a person-centred segmentation study of elderly, a large and increasing target group confronted with heterogeneous and often interrelated difficulties in their functioning. In twenty-five diverse healthcare and welfare organizations as well as elderly associations in the Netherlands, data were collected on the difficulties in biopsychosocial functioning experienced by 2019 older adults. Data were collected between March 2010 and January 2011 and sampling took place based on their (temporarily) living conditions. Factor Mixture Model was conducted to categorize the respondents into segments with relatively similar experienced difficulties concerning their functioning. First, the analyses show that older adults can be empirically categorized into five meaningful segments: feeling vital; difficulties with psychosocial coping; physical and mobility complaints; difficulties experienced in multiple domains; and feeling extremely frail. The categorization seems robust as it was replicated in two population-based samples in the Netherlands. The segmentation's usefulness is discussed and illustrated through an evaluation of the alignment between a segment's unfulfilled biopsychosocial needs and current healthcare utilization. The set of person-centred segmentation variables provides healthcare providers the option to perform a more comprehensive first triage step than only a disease-based one. The outcomes of this first step could guide a focused and, therefore, more efficient second triage step. On a local or regional level, this person-centred segmentation provides input information to policymakers and care providers for the demand-driven allocation of resources.

Modular health services: a single case study approach to the applicability of modularity to residential mental healthcare

BACKGROUND

The Dutch mental healthcare sector has to decrease costs by reducing intramural capacity with one third by 2020 and treating more patients in outpatient care. This transition necessitates enabling patients to become as self-supporting as possible, by customising the residential care they receive to their needs for self-development. Theoretically, modularity might help mental healthcare institutions with this. Modularity entails the decomposition of a healthcare service in parts that can be mixed-and-matched in a variety of ways, and combined form a functional whole. It brings about easier and better configuration, increased transparency and more variety without increasing costs.

AIM

this study aims to explore the applicability of the modularity concept to the residential care provided in Assisted Living Facilities (ALFs) of Dutch mental healthcare institutions.

METHODS

A single case study is carried out at the centre for psychosis in Etten-Leur, part of the GGz Breburg IMPACT care group. The design enables in-depth analysis of a case in a specific context. This is considered appropriate since theory concerning healthcare modularity is in an early stage of development. The present study can be considered a pilot case. Data were gathered by means of interviews, observations and documentary analysis.

RESULTS

At the centre for psychosis, the majority of the residential care can be decomposed in modules, which can be grouped in service bundles and sub-bundles; the service customisation process is sufficiently fit to apply modular thinking; and interfaces for most of the categories are present. Hence, the prerequisites for modular residential care offerings are already largely fulfilled. For not yet fulfilled aspects of these prerequisites, remedies are available.

CONCLUSION

The modularity concept seems applicable to the residential care offered by the ALF of the mental healthcare institution under study. For a successful implementation of modularity however, some steps should be taken by the ALF, such as developing a catalogue of modules and a method for the personnel to work with this catalogue in application of the modules. Whether implementation of modular residential care might facilitate the transition from intramural residential care to outpatient care should be the subject of future research.

Improving long-term care provision: towards demand-based care by means of modularity

BACKGROUND

As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes.

METHODS

Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software.

RESULTS

Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services.

CONCLUSION

The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further enable demand-based provision of long-term care by means of modularity.