Relationship between patient value co-creation behaviour and quality of medical care: a cross-sectional survey

Abstract

BackgroundPatients' support and cooperation are necessary during treatment. The effectiveness of treatment and the quality of medical care can be improved though joint efforts by doctors and patients. Therefore, it is of great importance to introduce value co-creation theory to the medical field. Value creation is closely related to participants' behaviour. The DART (dialogue, access, risk assessment, transparency) model is widely used in commercial field research because it defines and classifies value co-creation behaviour clearly and systematically, whereas there is little research using the DART model in the field of health care. This study established a research model of patient value co-creation behaviour and quality of medical care based on the DART model, to explore the relationship between them. MethodsA cross-sectional survey was conducted with patients (inpatients and outpatients, n=483) of a tertiary-level hospital in Guangzhou, Guangdong, China. The participants were asked to complete an anonymous questionnaire. The survey response rate was 94·4% (456 of 483). Questionnaires with missing data or those in which participants had chosen more than one answer (only one response was allowed per question) were considered invalid and were excluded, leaving 442 valid questionnaires. All items in the questionnaire were evaluated with a five-point Likert scale (1, strongly disagree; 5, strongly agree) according to the patients' perception. The quality of medical care was divided into technical (disease treatment quality) and non-technical (patient satisfaction and loyalty) quality. Patient value co-creation behavior was evaluated with the DART dimensions. Analysis with the structural equation model (SEM) was performed using AMOS 21.0 software to examine the relationship between patient value co-creation behavior and medical care quality. FindingsSEM analysis showed that patient value co-creation behaviour had a significant positive effect on patients' perception of medical care quality (standardised total effect 0·657, p=0·003), with a greater effect on patients' satisfaction (non-technical) than perceived disease treatment (technical) quality (standardised indirect effect 0·616, p<0·003). InterpretationThe results show that value co-creation is relevant to the medical field. Patients who more actively engaged in value co-creation behavior, such as active communication with doctors and truthful responses to doctors' questions, had a better impression of the medical service. However, with improvement in living standards and health awareness, patients are also paying increasing attention to non-technical qualities of medical care, such as service attitude and behaviour of medical staff, and not just to disease treatment and the latest medical technology. Therefore, the cooperation and active participation of patients are needed, and instead of investing large quantities of resources in medical technology, hospitals should pay more attention to non-technical medical services, encourage patients to participate during treatment, and return to the essence of health care; humanistic, patient-centered medical care. FundingThis study was supported by the Key Laboratory of Public Health Policy Research and Evaluation (2015WSY0010) and the Guangzhou Public Health Services System Construction Research Base (2018–2020). The funders did not participate in study design, data collection, or analysis.