Co‐creating value using customer training and education in a healthcare service design

• DOI: http://doi.org/10.1016/j.jom.2016.10.001
• Author: DeWayne Moore,Cheryl J. Dye,Uzay Damali,Janis L. Miller,Lawrence D. Fredendall
• Published date: 01 November 2016
• Date: 01 November 2016

Co-creating value using customer training and education in a

healthcare service design

Uzay Damali

a

,

*

, Janis L. Miller

b

, Lawrence D. Fredendall

b

, DeWayne Moore

c

,

Cheryl J. Dye

d

a

Peter B.Gustavson School of Business, University of Victoria, Victoria, British Columbia V8W 2Y2, Canada

b

Department of Management, Clemson University, Clemson, SC 29634, United States

c

Department of Psychology, Clemson University, Clemson, SC 29634, United States

d

Department of Public Health Sciences, Clemson University, Clemson, SC 29634, United States

article info

Article history:

Received in revised form

12 September 2016

Accepted 14 September 2016

Available online 30 November 2016

Handling Editor: Mikko Ketokivi

abstract

In services, which require significant customer participation to create value, customers who lack the

knowledge, skills and motivation necessary to participate effectively can negatively impact service

quality and cost outcomes. This paper develops a conceptual model to investigate the effectiveness of

utilizing customer training and education (CTE) to improve customer readiness to provide effective

behaviors in a professional service. The model was tested using survey data from patients diagnosed with

diabetes who received CTE as part of their healthcare service. We found that customers who are taught

why they have to perform the tasks, have higher levels of motivation to perform these tasks effectively.

Further, as proposed by the customer readiness model, when their task performance is higher, they have

improved health and lower healthcare costs.

©2016 Elsevier B.V. All rights reserved.

1. Introduction

Diabetes is a chronic health condition with an annual estimated

cost of $245 billion in the U.S. alone (Centers for Disease Control

and Prevention, 2014), with approximately 9.3 percent of the U.S.

population having diabetes and an additional 27.8 percent having

pre-diabetes, placing them at risk of developing type 2 diabetes

(Centers for Disease Control and Prevention, 2014). Providing

healthcare for patients with diabetes is a professional service which

requires extensive customer inputs to be successful emeal plan-

ning, exercise, and monitoring blood glucose. For this reason, all

hospitals provide customer training and education (CTE) programs

for their patients with diabetes.

This paper expands prior service design models to explicitly

consider how professional services, specifically healthcare,

enhance customer value co-creation through CTE. This is

accomplished through an extensive literature review, and qualita-

tive and quantitative investigations. Specifically, we first reviewed

professional services research (e.g., Harvey, 1990, 2011; Heineke,

1995; Lewis and Brown, 2012), service deign research (e.g.,

Heineke, 1995; Voss et al., 2008; Harvey, 2011); value co-creation

research (e.g., Bowen, 1986; Vargo and Lusch, 2004; Prahalad and

Ramaswamy, 2004; Sampson and Froehle, 2006), and related

literature on customer learning (e.g., Xue and Harker, 2002; Field

et al., 2012; Hibbert et al., 2012; Retana et al., 2016) to create a

conceptual model (presented later as Fig. 2). This model provides a

robust basis for future research. It defines CTE, which is an induced

and deliberate form of customer learning (Field et al., 2012), as

planned service practices that increase a customer's knowledge, ability

and motivation to perform service tasks in order to improve cus-

tomers' performance. Second, we developed a deeper under-

standing of the diabetes education context when creating a

research model as suggested by Ketokivi and Mantere (2010).

Specifically, one researcher attended the entire set of diabetes ed-

ucation classes offered by two different hospitals and attended

several additional three hour education class at four other hospi-

tals. Further interviews with more than twenty patients and

*Corresponding author.

E-mail addresses: udamali@uvic.ca (U. Damali), janism@clemson.edu

(J.L. Miller), flawren@clemson.edu (L.D. Fredendall), moore@clemson.edu

(D. Moore), tcheryl@clemson.edu (C.J. Dye).

Contents lists available at ScienceDirect

Journal of Operations Management

journal homepage: www.elsevier.com/locate/jom

http://dx.doi.org/10.1016/j.jom.2016.10.001

0272-6963/©2016 Elsevier B.V. All rights reserved.

Journal of Operations Management 47-48 (2016) 80e97

educators were conducted. Finally, the research model is tested

using cross-sectional survey data of patient who attended diabetes

education programs and the data is analyzed through three-stage-

least-squares.

Much of the professional services research argues that the value

created within a professional service is due primarily to profes-

sional expertise (e.g., Abbott, 1988; Maister, 1997; von

Nordenflycht, 2010). On the other hand, much of the value co-

creation research argues that effective customer participation im-

proves service performance (e.g., Xue and Harker, 2002; Prahalad

and Ramaswamy, 2004; Vargo and Lusch, 2004; Sampson and

Froehle, 2006; Spohrer and Maglio, 2008). This paper takes the

view that professional services are complex operations and out-

comes depend on the task performance of both the customer and

professional (Harvey, 1992, 2011; Dobrzykowski et al., 2016;

Brandon-Jones et al., 2016), so that variability in customer knowl-

edge, skill and motivation affects both the success of the service and

the reputation of the professional. For example, the treatment of

chronic health conditions, such as diabetes, requires knowledge-

able, skilled professionals to direct patient treatment over long

periods of time, and also requires patients to comply with treat-

ment protocols. These experienced medical professionals may

support providing CTE, if they found increased success when their

customer's knowledge, skill and motivation increased and

customer variability was reduced (Frei, 2006). Fig. 1 demonstrates

that if CTE can reduce variation and transition customers from low

to high performance, service failures can be reduced. In this way

CTE is a unique operations management practice, which focuses on

increasing service productivity and quality.

1.1. Conceptual model of professional services

Prior professional services research recognized that infra-

structural design choices, including CTE, can combine customer

inputs with professional inputs to co-create value(Kellogg and Nie,

1995; Greenwood and Lachman, 1996; Bettencourt et al., 2002;

Harvey, 2011; Lewis and Brown, 2012), but the role of CTE in pre-

paring the customer has not been explicitly studied. As services

become more complex, customers have an increasingly important

role as essential service participants (Harvey, 2011), so service

managers should use formal learning and educational methods to

manage customer inputs (Field et al., 2012).

The conceptual model in Fig. 2 illustrates the design and oper-

ations of professional services. The left rectangle in the model lists

four service design choices: (1) infrastructural design choices

(design of the process and policies, including CTE), (2) structural

choices (tangibles such as facilities and equipment), (3) customer

touch point (the level of intimacy and respect during customer

contact) and (4) integration (information shared internally and

with the external supply chain) (Harvey,1990; Heineke, 1995; Voss

et al., 2008; Harvey, 2011). Fig. 2 shows that the four design choices

lead to “Professional Practice”(see oval),where the inputs provided

by the customer and the professional combine. The professional's

service inputs are typically classified into three distinct stages e

diagnosis, inference/prescription and treatment, which differ based

on the service design. The customer interacts with the professional

by supplying their own appropriate inputs, which corresponds to

the inputs provided by the professional (Harvey, 2011; Lewis and

Brown, 2012). In the first stage, diagnosis, the professional uses

customer inputs such as information and knowledge to understand

the problem (Abbott, 1988; Harvey, 2011).In the second, inference/

prescription, the professional combines his/her expertise with

customer preferences to arrive at one or more possible conclusions

(Abbott, 1988; Harvey, 2011).During the final stage, treatment, the

professional and the customer jointly implement and carry out a

treatment plan (Abbott, 1988; Harvey, 2011). The right part of the

model shows the outcomes of professional practice, frequently

measured in terms of productivity and quality (Harvey, 1990, 2011;

Heineke, 1995). Professional services design, professional practice

and outcomes are all influenced by the environment, consisting of

customer factors (unique problems) and professional identity (be-

liefs, attitudes and ethics which guide professionals) and standards

(enforced by a body external to the firm) (Heineke, 1995; Lewis and

Brown, 2012).

This study explores how the knowledge formally shared

through CTE affects the customer readiness to supply appropriate

service inputs at each stage of the professional service. The study

boundaries are enclosed by dashed lines in Fig. 2. The model views

CTE as an infrastructural design choice that consists of know-what,

know-how and know-why education, which affect the customer's

readiness (role clarity, skill and motivation) to provide their inputs

during each stage of the service process and lead to service

outcomes.

The next section, Section 2, reviews the literature related to

professional services and value co-creation, customer readiness,

and CTE. Section 3then presents the research model and hypoth-

eses, and Section 4describes the methodology used in this study,

followed by a reporting of our results. A discussion of the findings is

in Section 5. Finally the conclusions are given in Section 6.

Throughout the remainder of the paper, when addressing cus-

tomers specifically in the context of healthcare services, we will use

the term patients, which is the most commonly used term in

healthcare services.

Fig. 1. Impact of customer training and education on customer performance.

Fig. 2. Conceptual model of professional services.

U. Damali et al. / Journal of Operations Management 47-48 (2016)80e97 81