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A model for designing healthcare service based on the patient experience

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 International Journal of Healthcare Management

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A model for designing healthcare service based on

the patient experience

DonHee Lee

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patient experience, International Journal of Healthcare Management

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INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT, 2017
https://doi.org/10.1080/20479700.2017.1359956

A model for designing healthcare service based on the patient experience

DonHee Lee
College of Business Administration, Inha University, Incheon, South Korea

ABSTRACT ARTICLE HISTORY

The purpose of this study is to develop a model for designing healthcare service based on the Received 30 January 2017
patient experience. Specifically, this paper views patient’s experiences as an essential element Accepted 21 July 2017
for healthcare value co-creation, and thus proposes a model for designing healthcare service
KEYWORDS
process based on interactions between patients and providers in encounters or touchpoints. Healthcare service design;
This study provides a new design approach to healthcare service that can enhance further patient experiences; care
research on the relationships among care quality, patient satisfaction and experience, and quality; value co-creation
value co-creation. In addition, the developed framework provides how patient’s participation
encourages service interactions for value co-creation. The proposed model for healthcare
service design can help organizations achieve excellent service quality through value co-
creation that encompasses patient experiences in the delivery of quality services. The
application of design thinking in co-creating quality healthcare is the innovative aspect of
this study.

Introduction important aspect of any healthcare service is the pres-

Design thinking is a systematic method of thinking that
aims to implement innovative ideas through an under-
standing of customers’ needs, ultimately in an attempt
to meet such needs while obtaining competitive advan-
tage by introducing new products and services to the
market [1,2]. Such thinking is currently being applied
to service design in the healthcare industry, particularly
in the domains of information technology, digital
assets, medical devices, products/services patient
experiences, and the hospital environment [3–5]. The
healthcare system directly influences the society
through care service delivery and preventing the spread
and impact of diseases in the society [1,6,7]. Of course,
the healthcare system is not obliged to perform disease
prevention and infection management, but still must
determine how to prevent or overcome health pro-
blems that their communities face. To do so, hospitals
should develop a successful network to support com-
munities and rethink how best to engage patients for
value co-creation in the society. However, because
the healthcare industry is highly complex, it is often
exceedingly difficult to properly design effective care
services [5,8].
In the healthcare service design process, consider-
ation of patient’s experience is a priority since the
improvement of care quality can be achieved only
through an understanding of patients’ requirements.
Today, more healthcare providers are searching for
ways to deliver care more effectively, as part of the
overall efforts to manage the ever-increasing pressure
of challenges facing them [1,6,7]. Arguably, the most
ervation of human dignity, and all care activities occur
at service encounters or touchpoints. Across their var-
ious service encounters, each patient has a unique
experience through their interactions with medical
staff. Thus, patients experience represents a rich source
of invaluable information for designing an effective
healthcare services.
Customers play a key role in value co-creation and
collaboration through interactions with service provi-
ders [1,9–11]. These interactions can drive both parties
to discover new customers, evaluate the quality of care
products or services, actually purchase products or ser-
vices, access information, obtain needed support, or
simply part ways. Customer interactions not only pro-
vide insights into the experience of each customer, but
also can help providers improve the overall customer
satisfaction when the positive aspects of these experi-
ences are considered in aggregate [12,13]. However,
Richardson [13] suggested that organizations cannot
control customers’ experiences because each patient
has own perception, emotion, and behavior. Neverthe-
less, patients believe their experiences should be an
essential part of the healthcare service process [14].
A well-designed healthcare service process might
consider both patients’ and providers’ experiences
while still focusing on patient activities because both
types contribute to value co-creation. Therefore, organ-
izations should devise strategies that ensure positive
patient experiences by focusing on their own desire
to create value. Such strategies are likely to involve
manipulating the service design process,

CONTACT DonHee Lee dhlee04@inha.ac.kr

© 2017 Informa UK Limited, trading as Taylor & Francis Group
2 D. LEE
implementation of designed services, and management
of interactions across all patient and potential customer
activities. The primary purpose of the study is to
develop a model for designing healthcare service
based on the design thinking framework which sup-
ports patients’ participation in care value co-creation.
This paper is structured as follows. The second sec-
tion presents a review of the relevant literature; the
third section proposes a conceptual value co-creation
model; and the fourth section provides the conclusion
and limitation of the study.
Literature review
Healthcare service design for value co-creation
Service design refers to the act of developing new service
processes with the aim of improving the competitive
advantages of an existing system. This can be done
using different approaches and through working with
other organizations to devise new service solutions. Ser-
vice design can be a process of improving customer par-
ticipation in the iterative cycle of design, testing,
measurement, and redesign by considering customer
experiences, and thereby creating better value [4,5,12].
The service design process may involve the evaluation
of how healthcare services are implemented to improve
their utilization and innovate their delivery process.
Service design has the characteristics of interaction
and human-oriented design [4,15]. Miettinen et al.
[4] defined the human-oriented design process as
‘ … involves problem framing, information gathering
and interpretation, and solution ideation, develop-
ment, and evaluation for evaluating an existing service
or in designing a new service solution’ (p. 31). It means
that human-oriented design seeks to include and reflect
on what consumers want by treating customers’
requirements valuable new insights and innovative
suggestions [16]. Traditionally, service design has
focused on the system, resources, and care services to
create value rather than the people, experiences, and
information [17]. However, healthcare services depend
on the participation and experience-including the self-
generated activities-of patients, their family members,
and medical staff [18]. In particular, patients seek to
maximize care quality and satisfaction, which are
indicative of their desire for well-being. Vargo and
Lusch [19] proposed that value is ‘defined by and co-
created with the consumer’ (p. 6). Value can thus be
viewed as the benefits to patients’ quality of life result-
ing from healthcare resources (e.g. medical staff,
advanced technology, information, treatment, etc.).
Given that value is the result as well as the goal of an
interaction, it can be considered as an exchange
among the actors involved in that interaction.
Sangiorgi [20] described service design as part of the
processes of a service interaction platform, and Polaine
[21] reported on the importance of service experiences,
which are the result of human-to-human interactions.
In other words, interactions are an important factor in
the design of care services because they comprise com-
prehensive activities relating to patient experiences.
Furthermore, the activities of service design are effec-
tive tools that utilize patient experiences generated
via communication and interaction to accomplish
value co-creation [6,9]. If a patient has positive
emotions about a physician’s duties and is satisfied
with that physician’s responsibilities, then he or she
would be more cooperative when interacting with
medical staff, and thus the care service is likely to
have a successful outcome. When a patient engages
in an interaction during the care service process, he/
she can exchange information or ideas with medical
staff, providing a new perspective on the situation
and thus generating innovative ways to improve the
quality of care. For instance, in healthcare service
design, such innovation can occur in the care service
delivery process by applying new technologies to suc-
cessfully serve patients and by creating value for better
patient experiences [22]. Therefore, the healthcare ser-
vice design process can help innovate patient-oriented
concepts to create value through patient experiences
and interaction. When a hospital focuses on patient
experiences, it examines service encounters or touch-
points to reflect as by the patient’s experience through
his or her own eyes, in terms of the entire care journey
[6]. Patient journeys include many aspects, which hap-
pen before and after receiving experiences in the care
service process [7].
The healthcare service process design further pro-
vides different perspectives on how care service experi-
ences are formed throughout the patient journey with
different service encounters or touchpoints [6,7]. For
example, when a patient is requested to participate in
care service processes, the patient will do so, and
thereby achieve value, if the hospital is provided with
a new design process, new ideas, or an innovative
way of utilizing technology, or if patients’ needs are
otherwise satisfied. Consequently, healthcare service
design should be offered by care service providers
within the process of value co-creation through
patients’ experience and interactions with providers.
Normann and Ramirez [23] proposed that value co-
creation refers to how customers come together to
co-produce value, while Vargo and Lusch [19] concep-
tualized it as the activities of customer participants in
relational exchanges and coproduction using service-
dominant resources, such as assisting treatment pro-
grams. Vargo et al. [24] noted that value co-creation
relies on the exchange of value through the partici-
pation of certain service systems, including the inte-
gration and application of resources. Randall et al.
[25] later defined the concept of value co-creation as
connection, trust, and commitment, while Grönroos

[26] reported it to be ‘joint collaborative activities by
parties involved in direct interactions, aiming to con-
tribute to the value that emerges for one or both par-
ties’ (p. 6). This latter definition refers to how value
is not always co-created [27] and that it can be co-cre-
ated through direct interactions [28,29]. McColl-Ken-
nedy et al. [9] defined value co-creation as the
realization of benefits through the integration of
resources and the interaction of the customer and pro-
vider in an existing system. These numerous defi-
nitions suggest that it is exceedingly difficult to
understand precisely what researchers and prac-
titioners mean by ‘value co-creation’. To avoid con-
fusion, we conceptualize value co-creation in this
study as the experiences generated during patients’
interaction with medical staff that help maximize
their own care quality.
McColl-Kennedy et al. [9] suggested a framework
for the process of value co-creation that was character-
ized by how the effort involved in a given activity deter-
mined its impact on co-creation-namely, ‘low-level
activities’ had little impact, whereas ‘high-level activi-
ties’ had much greater impact. The study also defined
two types of activities as follows (p. 9): low-level activi-
ties refer to ‘range from simple activities, such as com-
pliance with service providers’, and high-level activities
refer to ‘sorting and assorting information to complex
activities, such as co-learning, actively seeking and
sharing information, providing feedback, and changing
ways of doing things’.
Within the service encounter, interactions between
the service provider and customer help illuminate the
engagement of each individual with others in the ser-
vice process [6,9]. In relation to healthcare, interactions
between patients and medical staff are driven by the
unique perceptions of both parties and their various
activities, and motivated by the value proposition of
better healthcare treatment. Given their complex
Table 1. Expectations on value co-creation.
Expectation and participation Service encounter
Co-produce value together Interaction
between patients and
medical staff
The activities in relational exchanges
and coproduction
Exchange of value
Connection, trust, and commitment
Collaborative activities in interactions
The integration of resources in an
existing system
Using technology system: e.g. Existed system:
electronic health record,
picture archiving and
communication systems,
reservation system,
use of mobile health devices, etc.
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 3
interface, healthcare services are also associated with
interactions between patients and medical staff. These
characteristics make the design of healthcare services
necessarily iterative [9].
As discussed above, co-creation is generated by cus-
tomer participation in the service delivery process to
create a better care service, which in turn can enhance
the perceived value for patients [27,30]. Thus, patients
can undertake a range of value creation activities to
enhance their healthcare and quality of life, given
that the value may be maximized by the co-creation
activities of patients and providers [6,9].
In summary, this research focuses on value co-cre-
ation through the patient’s experiences in the care ser-
vice process. This study modifies expectations of value
co-creation suggested by McColl-Kennedy et al. [9].
Table 1 summarizes possible value co-creation activi-
ties based on patient’s expectations and participation.
These activities can be obtained by both patients (e.g.
relationships with medical staff) and providers (e.g.
interactions with patients).
Patient experiences
Patients, just like any individual customer, are unique
because of their differing diseases and treatments.
When patients are delighted by their experience with
a healthcare service and their expectations are
exceeded, they tend to have great satisfaction with
the care service. Creating an experience that is memor-
able and satisfactory for the patient will in turn lead to
better competitive advantage of the provider. In par-
ticular, the patient’s experiences are associated with
ease of acquisition, loyalty, and intention to revisit.
It is important to note that the individuality of patients
in general is a key reason that patient’s experience can-
not be controlled; in other words, each patient offers a
Expectations on value co-creation
Participate in the care service process;
actively sharing disease status;
decision making
Communicate to support his/her own health problems and share personal medical
treatment history;
seeking information for better treatment
Patients provide health conditions and then medical staff suggest diagnosis and
treatment ways/ potential values;
interaction with others with illness
Interaction and exchange of information between patients and providers;
managing to participate suggested recommendations
Work together between patients and medical staff for seeking and sharing information,
providing feedback, and interacting with products/services
Processes of proving, collecting and analyzing patients’ feedback will be integrated;
collected data about diagnosis and treatment entered into a database in a hospital;
Faster, accurate and efficient response;
enables contact with medical staff or patient family member;
care servicing, monitoring and communicating;
reminder messages for appointments;
protection of personal medical treatment history
4 D. LEE
unique experience in terms of their emotion, personal-
ity, context, and diversity [31].
Both García-Haro et al. [32] and Shaw et al. [33]
suggested that participating in value co-creation activi-
ties can influence customer satisfaction. Additionally,
service organizations have begun to recognize that cus-
tomers can create value when they interact with differ-
ent aspects of the organization across multiple
touchpoints. Specifically, hospitals understand that
patients engage with different staff when they require
particular types of care, services, and support. Thus,
patients’ experience of a healthcare service is crucial
to healthcare service design because of its effect on
care quality and patient satisfaction through value co-
creation. In designing value propositions of each care
process, it is necessary to consider patients’ experience
with the utilized service as a whole. Hospitals also try to
use healthcare technologies to enhance patient’s
experiences [22]. Thus, when designing the healthcare
service process, the development effort should consider
the entire process with consideration of all possible
care activities and contact points.
As a patient’s experience can only be fully under-
stood by each patient with a set of unique feelings, hos-
pitals must engage and interact with patients in order
to improve care quality. Patient experiences can be cap-
tured via integration of the provider’s interactions with
patients with certain care service, facilities, equipment,
and technology [3,5,22]. For example, patient journey
mapping is a method of discovering various patient-
oriented processes and planning with a focus on
patient activities at different stage of care service deliv-
ery [6]. A patient journey map enables a more precise
view of the patient activity cycle, including touchpoints
of care service delivery.
In today’s digital era, the crucial determinants of
patient experiences are no longer merely face-to-face
interactions with staff, but rather include interactions
across various channels, customer service, and the pro-
ducts/services themselves [5]. Patients utilizing care
services should have the opportunity to leverage their
personal care preferences, previous care experiences
(whether positive or negative), desired interactions,
and preferred means of interaction. Based on these
patient resources, a care provider can better under-
stand the following: how to listen to patients’ voice,
how to encourage patients’ participation in treatment,
and how to create interactions for value co-creation.
These potential solutions can help create better care
services and customize value through addressing
patient experiences [34]. Consequently, patient experi-
ence is exceedingly important for value co-creation in
the process of designing healthcare services, and any
model of healthcare service design involving value
co-creation must be based on patient experiences.
Since patient experience refers to the outcomes of
interaction between a provider/a hospital and a patient
over the duration of their relationship [6,7], a good
patient experience means that the individual’s percep-
tion during all points of contact meets the individual’s
expectations. In this study, patient experience refers to
what patient has experiences in a hospital. This study
therefore intends to design a model that ensures that
these experiences are consistent across all components
of healthcare service delivery, including healthcare
technology.
Conceptualizing value co-creation
A model of designing healthcare services for
value co-creation using patient experiences
The healthcare service design process considers a num-
ber of specific types of resources, such as the patient,
provider, medical technology, and social media [35].
A healthcare service encounter can be divided into
three main processes: preprocessing, the responding
process, and the resulting process [35]. Healthcare
institutions have direct and indirect two-way relation-
ships with medical and administrative staff, who in
turn have a direct two-way relationship with the
patient. The patient has a one-way relationship with
the care service outcomes that are determined by the
patient after the care service has been provided [35].
Cha et al. [36] examined the components of a service
encounter in relation to the whole care process for
patients. These two studies, Lee [35] and Cha et al.
[36], illustrate the importance of care service design
for improving patient satisfaction.
As discussed above, encounters between patients
and the provider staff are critical components of
patient experiences. Encounters within healthcare ser-
vices in particular are characterized by a high degree
of person-to-person interactions and the absence of
an exchange of tangible goods. Healthcare-technol-
ogy-facilitated service encounters are also employed
nowadays to facilitate face-to-face communication
between patients and staff. However, such encounters
are generally only possible if the service representative
and patient have access to the same technology. For
example, when a patient visits a physician office and
requires a medical device for treatment, the patient
might suggest unique ways of accessing the medical
device on their own without requiring specific experi-
ential knowledge. Shah and Robinson [37] mentioned
the roles that patients can play in leading to new pro-
duct ideas, reduced development costs, access to user
perspective and faster innovation diffusion. As another
example that is of design thinking without sophisti-
cated technology, when a physician examines a sick
child for diagnosis, the doctor may use a tongue
depressor with an image of a kitty to intrigue the
child and lessen the fear. These examples demonstrate
that patients can initiate designing healthcare services

for value co-creation during their service encounters,
and that both the patient and the physician are design
thinkers who participating in value co-creation. Conse-
quently, designing healthcare services with consider-
ation of value co-creation must consider both
patient and provider experiences at touchpoints or
encounters.
As mentioned above, service encounters or touch-
points play an important role in interactions. For
example, education and training can promote patient
satisfaction by redefining the importance of key
encounter roles to patient experiences or value co-cre-
ation [39]. In particular, encounters between patients
and medical staff are a critical factor for improving
care quality and patient satisfaction. This is especially
evident when patients must frequently engage in inter-
actions with staff, which can be a gratifying experience
or a painful one. Since patients might have multitouch-
points and multichannels (e.g. new channels, devices,
applications, and face-to-face exchange with other
patients, etc.) in their journey [38], hospitals need to
provide consistent care service. Thus, leaders or man-
agers should examine how staff can interact with
patients at various encounters, and how the organiz-
ation can provide needed facilities or information to
create effective touchpoints, such as medical facilities,
websites, devices, applications, and information centers
that support patients in their journey [6,7].
In this study, the healthcare service design process
for value co-creation based on patient experiences
Figure 1. Proposed model of the healthcare service process design for value co-creation.
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 5
refers to the integration of a wide range of different
forms of co-design involving patients, medical staff,
and others as co-workers. The proposed model of
healthcare service design for value co-creation is illus-
trated in Figure 1. More specifically, a, reading Figure 1
from right to left illustrates how care service outcomes
are a function of patient-experienced value generated
through patient interactions with medical staff and
others.
Point ① refers to how patients seek out the best-fit
hospital using various touchpoints, such as infor-
mation technology, websites, word -of -mouth, and
hospital information centers. Each touchpoint affords
a unique experience for patients. It implies that the
patient can create value indirectly using facilities in
the phase of selecting a hospital or a physician. For
example, Korean healthcare institutions are classified
according to a number of beds, such as 1st (clinic),
2nd (general hospital), and 3rd (tertiary hospital),
thus a patient can select a healthcare institution or a
physician. In the US, patients can select a physician
who chooses the hospital for the patient. We assumed
that, at this stage, information technology can help
provide better and more accurate information on the
preferred hospital choice. In addition, with the aging
population in our society and increasing usage of
smart devices (e.g. smartphones) and communication
systems, senior citizens will require a well-built system
that is easy to access and use [7]. For example, the
‘smartphone is a challenging tool’ for improving the
6 D. LEE
healthcare quality and well-being of elderly people [7].
If a hospital provides applications and implications of
smartphone based on requirements of elderly people,
their positive experiences will intense the intentions
to use it again. There are some applications and impli-
cations for seniors to contact hospitals through smart
devices as follows: to contact with medical staff and
or family members; to link their health status; to
check their daily activities; to receive on automatic
message for appointment; to see guidelines for preven-
tion of diseases; and to make treatment appointments
[7]. This stage, importantly, can lead to patients’
desired experiences [1,40]. Therefore, Point ① can be
considered an antecedent of an experience encouraging
patient participation in various healthcare services to
obtain needed care.
Points ②, ③, and ④ reflect patient interactions with
medical staff and relevant others, which can improve
their satisfaction with their care experiences. Since pro-
viders and customers are co-creators of value [19],
patients and medical staff/others can co-create value
at various internal and external touchpoints of care ser-
vices in point ②. Sweeney et al. [6] proposed that
patient’s activities on value co-creation effect on satis-
faction and intention by improving care quality.
Thus, interaction is an important means of improving
care quality in each particular setting at this stage. At
points ③ and ④, either patients or medical staff
indirectly generate their own ideas for care service
improvements or requirements. For example, a patient
can discuss his/her own health condition with a family
member, who can in turn transfer the patient’s require-
ments or current health problem to medical staff. Thus,
the patient can create and have experience value inde-
pendently in point ④.
Point ⑤ involves assessment of patients’ conditions
following their treatment; this stage involves measuring
the overall gap between patients’ expectations and
actual experiences. It also can help determine patients’
intention to revisit or not based on their overall experi-
ence of the received care services at the hospital [8,35].
The outcome of a treatment can influence patient sat-
isfaction, including those not directly involved in the
treatment through word-of-mouth recommendations
to other patients.
Traditionally, interactions occurred only at touch-
points [41], but in the current digital era, such inter-
actions can even occur in virtual spaces rather than
physical ones via information and communication
technology (ICT) [42,43]. ICT allows for interpersonal
communications and resource exchanges [42,44], and
provides a new set of opportunities and challenges
for value co-creation [11,45]. Therefore, at points ①
to ⑤ in Figure 1, advanced medical technology can be
used to enable patients’ indirect engagement in inter-
actions with medical staff or administrators (e.g. a tech-
nology-assisted service encounter). This can enhance
the convenience of the service process, which in turn
can help patients obtain better care.
Patients may be able to better participate in the care
design process by providing valuable insight to medical
staff. To participate in the care service process, patient
experiences are a valuable resource for the hospital in
designing care services in a way that enhances value
co-creation. Although patients do not always interact
with the same staff and may not build a positive
relationship with the staff, they might nevertheless
develop certain expectations about care services based
on previous interactions with the service provider.
Additionally, patients might not be able to directly
interact with medical staff depending on their physical
condition, or can find it inconvenient or annoying to
interact. In sum, interactions should be considered a
powerful and important resource of value co-creation.
Taken as a whole, the proposed model of the health-
care service design process through patient experiences
emphasizes patients’ participation in value co-creation
at encounters and various internal and external touch-
points [1,9]. This model considers the continuous
improvement of care quality as a journey, and helps
deliver an excellent care service experience and value.
Consequently, a well-developed model of the health-
care service design process will ensure that patient
needs and wants are effectively integrated with provi-
der-based experiences at encounters or touchpoints.
As patient experiences are quite diverse, organizations
need to prioritized patient experiences and require-
ments and using the information to search for ways
to improve quality of care [13]. Furthermore, patients
can be involved in this design process to maximize
their value, such as obtaining high quality care, having
their needs meet, and suggesting service improvements.
To successfully promote the proposed model of
healthcare service design process for value co-creation,
hospitals need to develop new opportunities for patient
value enhancement. Additionally, medical information
technologies/systems that connect the various data in
the healthcare system can help improve care quality,
increase flexibility, and facilitate positive interactions
with patients or their family members. Finally, hospi-
tals should provide a safe environment (e.g. personal
information protection, accuracy, convenience, ease,
kindness, simplicity) to support patients’ participation
in the healthcare services delivery process to ensure
value co-creation through their experiences.
Conclusions
Service design is part of a much wider concept that
addresses overall patient experiences and the care ser-
vice delivery process. There has been a considerable
amount of evidence showing the benefits of an effective
service design approach. In the past, care quality
improvement was sought by rallying all employees’

participation in quality improvement activities as a
form of quality control.
This study reviewed the relevant literature to pro-
pose a model for healthcare service design based on
patient experiences for value co-creation. A well-
designed healthcare service process can influence care
quality improvement through the experiences of
patients and providers, and value co-creation can
occur through interactions between these two parties
at various touchpoints or encounters [1]. In other
words, interactions between the patient and the provi-
der affect patient activities in a way that creates value in
healthcare services. Thus, patient experiences for value
co-creation can be maximized through a well-designed
healthcare service delivery process.
The service design process is human-oriented [5],
which means that the features of the provider’s services
cannot be uniform or standardized. Nevertheless, it
points to how the healthcare service design process
can support hospitals by improving patient experiences
through value co-creation. While Grönroos and Voima
[29] presented value co-creation as the direct inter-
action between customers and providers, the healthcare
system differs from other service industries. For
example, medical errors may occur during interactions
characterized by poor communication between patients
and medical staff [46]. The range in prevalence of such
errors caused by medical staff is from 30 to 80% [47].
These poor interactions generally involve patients
accepting the treatment that medical staff suggests with-
out offering their opinions. Thus, to improve communi-
cation and thereby reduce medical errors, which, in
turn, will positively influence patient experiences, hos-
pitals must provide and support educational programs
targeting effective communication and interactions.
When patients interact with healthcare providers,
the co-creation of value in service processes relies on
both parties with high ethical standards. Good ethical
behavior is a necessary element of interactions because
the participants-both patients and providers-are work-
ing toward a shared goal and thus require trust. For
example, if a physician is engaged in malpractice by
turning over responsibility of the patient to another
healthcare provider without justification, the patient
might switch physicians because of their unethical or
dishonest behavior. Therefore, the ethical behavior of
both parties is an important factor of interaction in ser-
vice design because such interactions emphasize the
quality of information exchange and humanity [48].
This study has several implications for research.
First, patient experiences for value co-creation are an
important area for hospitals that are looking beyond
the service design process. Patient experiences can be
accumulated by interactions with medical staff and
administrators, and thereafter can be used to generate
innovative ideas for improvement in care treatment.
Indeed, patients might want to engage with providers
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 7
to create value in order to achieve the best method of
treatment based on their experiences. Service providers
must ensure value co-creation in the context of care
treatment for patients. Second, value co-creation can
occur through collaboration of patients and providers.
Consequently, managers must provide the necessary
organizational support for their co-activities with
staff, particularly by ensuring that staff have the needed
facilities and information in co-working areas to create
encounters and investigating ways of improving the
system at its various touchpoints. Third, organizations
should develop strategic ways of encouraging patients’
active participation in value co-creation. If patients can
learn to engage in the healthcare service delivery pro-
cess, their experiences will contribute to the value co-
creation process and thus will obtain greater benefits.
Fourth, organizations must ensure a continuous design
process that can quickly reflect patient needs and
respond to fact changing circumstances. Finally, with
the continual development of advanced ICT, the
healthcare service design process should actively
adapt such technologies for value co-creation.
The proposed model of the healthcare service design
process is, at present, at the conceptual stage. It would
be necessary to conduct an empirical study to confirm
the causal relationships among the various components
of quality healthcare delivery. There is also a need to
further study healthcare service systems that include
medical-technology-based service platforms and
where value co-creation actually occurs during the
care delivery process.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes on contributor
DonHee Lee is an Assistant Professor of Service Operations
Management at Inha University. Her research interests
include service and production operations management,
CSR, service innovation and quality, and supply chain man-
agement. She has published research in refereed journals
such as International Journal of Operations & Production
Management, International journal of Production Econ-
omics, The Service Industries Journal, Total Quality Man-
agement & Business Excellence, Service Business, and
Technological Forecasting & Social Change, etc., primarily
on the topic of operations management, healthcare manage-
ment, and SCM.
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