Given rising global health care expenditures and growing demand, it is unsurprising that increasing emphasis is placed upon attaining ‘value’ in health care systems (Joiner and Lusch 2016). Despite some attention having been paid to producers’ conceptions of value, service users’ perceptions of value remain under-researched. This paper combines scholarship from the services marketing and public management literatures to present the first application of the Services-Dominant (S-D) logic framework to consider conceptualisations of value in a UK specialist health care context (Ostrom et al 2015; Osborne et al 2013; Osborne et al 2016).
In applying the S-D logic framework, this study investigated how value, when framed as value that is perceived and determined on the basis of use (‘value-in-use’, Vargo and Lusch 2004; Grönroos 2011) is conceptualised by service users and service providers in a specialist cancer service setting. To answer the two questions “What does ‘value’ mean in a specialist cancer service settings?” and “to what extent can S-D logic enhance understandings of ‘value’ in this health care context?” this study adopted an interpretive approach, using semi-structured interviews (57 patient/patient and family member interviews; 24 staff interviews) and observational data, to the investigation of these focal study phenomena. Conceptualisations of ‘value’ are interpreted through synthesis of the range of data sources.
This study offers both conceptual and empirical contributions to scholarship in the fields of public management and services marketing. First, the findings from this study reveal that ‘value’ in cancer services is a temporal concept, which varies over time and is experienced ‘in-context’. Second, this study provides insight into factors facilitating or restricting value formation and the processes underlying value co-creation (service exchange and resource integration). Four main themes are identified which contribute to the creation 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. The capacity to engage in service exchange, and to use and integrate the resources offered, is shaped by both: (a) patients’ perceptions of their capacity to undertake and engage in resource exchange and integration, and (b) the nature of the resources offered. In some instances, co-learning is required to enable patients to optimise and benefit from the resources offered.
Reflecting critically on our application of the S-D logic framework with a cancer services context, it seems that whilst it usefully focuses attention on the service user and interactions between patients and health care staff during service encounters, it does not neatly map into a health care context.
Value co-creation, co-design and co-production in public services
