Lars Nordgren

Value creation in health care services - developing service productivity: Experiences from Sweden

Purpose – The “old” concept of productivity seems to be misleading in health care, because it does not involve the contribution of the patient in value creation. The purpose of this paper will therefore be to explore possibilities for developing service productivity in theory and practice.Design/methodology/approach – The analysis is based on a discursive reading of authoritative texts, an understanding of how health care work is organised and of several examples illustrating value creation. A proposed theoretical frame draws on “value creation”, “match matching” and “agency”. Empirical material is used, as are an analysis of a service meeting in health care, official texts in a Swedish context and narratives written by “users” and professionals.Findings – The concept of service productivity in the context of health care encompasses values such as experienced health, quality of life, accessibility, trust, communication, avoidable suffering and avoidable deaths, and not only reduced costs, activities and o...

The Performativity of the Service Management Discourse - “Value Creating Customers” in Health Care

PURPOSE The formation and spreading of market-, management- and individual-rights discourses into society, as well as the movement of consumerism, have paved the way for a transformation of the linguistic usage. The transformation suggests that the view of the care seeker has shifted from a waiting patient, via a consumer to a customer creating value. Another example of the process is that the former medical meeting between patient/doctor now is described as a service meeting. With this background, the purpose of this paper is to explore the transformation of linguistic usage and to analyse the performativity of the service management discourse in health care. DESIGN/METHODOLOGY/APPROACH The concept of performativity (Butler) supported with discursive formation and subjectivization (Foucualt) is used as theoretical framework. The performativity of the discourse is understood as a vehicle within the discourse, which influences people on an ontological level that names and makes them active subjects in line with what the discourse is saying. FINDINGS When the service management discourse travels into the world of health care, discursive tensions between medical-, care- and management discourses follow. These become apparent in the distinction between the different discursive constructions of patient--related to passivity, and customer--related to the performative image of active participation in value creating health. Even if the customer in service management discourse is imagined as an agent for himself with power and individual responsibility it is doubtful if people view themselves as customers. The dialectics between the use of the customer concept in commercial service meetings and the patient--doctor meeting, which is illustrated, point to unexpressed and implicit presumptions of an ontological kind in the ways service management researchers describe service meetings. Recent health care research can be interpreted as if a majority of patients have a desire to be part of their value creating processes. Since the responsibilities and tasks of the professions in health care however are regulated by law and institutionalised, the process of delegating tasks to patients seems not to be a matter of course. PRACTICAL IMPLICATIONS It seems to be problematic to replace the patient concept with the customer concept in general. This concept gives hardly much room for the vulnerability that characterises a sick person. A reasonable approach would of course be to use the customer concept in a nuanced way. ORIGINALITY/VALUE The paper demonstrates that the performativity of service management theories, through the use of discursive analysis, is valuable in order to understand shifts in linguistic usage.

Indoleamines in blood plasma of schizophrenics a critical study with sensitive and selective methods

Abstract Plasma samples from 9 schizophrenics, selected according to diagnostic criteria which are discussed, were analysed for the presence of indoleamines. Care was taken to exclude an underlying organic, manic-depressive, or cycloid psychosis. Control samples were taken from 4 non-psychotics under treatment on the same ward. Several different methods of extraction, chromatography, and detection were used, and the detection limit for different amines was determined. No indoleamine, except 5-hydroxytryptamine, could be detected in any of the plasma samples, despite good recoveries of added standard substances. This is at variance with the findings of other authors, who have used whole blood samples. The conclusion is that the indoleamines supposed to be present in the blood of normals and psychotics are presumably confined to the blood cells.

Effect of haloperidol on monoamines in brain and heart

Summary Rats receiving haloperidol for three days showed a dose dependent decrease of brain catecholamines. The hypothermic effect of the drug did not cause this. Haloperidol counter-acts the monoamine depletion of reserpine in both the brain and the heart provided it is given shortly before reserpine.

Healthcare matching - Conditions for developing a New Service System in Healthcare’

Purpose – The purpose of this paper is to outline the conditions for a new service system in healthcare, which will be able to match the available capacity in and between healthcare units, in order to match the need of care for the patients.Design/methodology/approach – By drawing on statements from patients, experiences from similar services (a literature review), empirical research into the effects of the reforms on free choice and the care guarantee and a theoretically informed discussion drawing on value‐creation and service productivity, it is claimed that a matching system is needed to be developed.Findings – As healthcare lacks incentives and structures of matching capacity between various care providers, and for coordinating episodes of care for the patient, the result is management of capacity that is difficult and uncertain for patients. Continuity and coordination during all the healthcare process are seen as important values by patients. It is valuable for patients to be matched in the coordin...

Guaranteeing Healthcare: What Does the Care Guarantee Do?

According to the Swedish Health and Medical Services Act, healthcare is to be provided to the population according to need and on equal terms. It must also be accessible – a part of healthcare that has been criticized. In an effort to improve accessibility, the Swedish Association of Local Authorities and Regions and the government have both agreed to introduce a national care guarantee with effect from 01‐11‐2005. On 01‐07‐2010, the guarantee was incorporated into the Health and Medical Services Act. This paper considers, using the ideas of Foucault (discursive formation), Butler and Callon (performativity), how the idea of a care guarantee came to be influential during the formulation of Swedens healthcare policies and on the management of services in hospitals. The concept of performativity is used to illustrate how the care guarantee becomes binding on the county council, as a promise to the patient.

From one-sized to over-individualized? Service logic’s value creation

Purpose There is a current trend in healthcare management away from produced and standardized one-size-fits-all processes toward co-created and individualized services. The purpose of this paper is to increase understanding of the value concept in healthcare organization and management by recognizing different levels of value (private, group and public) and the interconnectedness among these levels. Design/methodology/approach The paper uses social constructionism as a lens to problematize the individualization of service logics value concept. Theories from consumer culture theory/transformative service research and public management add group and public levels of value to the private level. Findings An intersubjective (rather than subjective) approach to value creation entails the construction and sharing of value perceptions among groups of people. Such an approach also implies that group members may face similar barriers in their value creation efforts. Practical implications Healthcare management should be aware of the inherent individualism of service logic and, consequently, the need to balance private value with group and public levels of value. Social implications Identifying and addressing disadvantaged groups and the reasons for their disadvantaged positions is important in order to enhance the individuals value creation prerequisites as well as to address public and societal values, such as equal/equitable health(care). Originality/value It is important to complement service logics value creation with group and public levels in order to understand the complexity and interconnectedness of value and the creation thereof.