Sustainable value co-creation in healthcare systems in the context of reduced ease of access

Abstract

Sustainability studies in healthcare systems predominantly have a goods-dominant outlook and focus on the environmental sustainability of hospitals in developed nations. When faced with poor availability and affordability (reduced ease of access), healthcare systems must pay attention to social sustainability. As in the rest of the world, the burden of chronic non-communicable diseases requiring long-term and high patient involvement is increasing in India. ‘Information exchange’ (integrating knowledge) is a crucial co-creation process. Besides ‘information exchange,’ this study considers ‘interaction quality’ (reciprocal understanding) and the customers' ‘knowledge development attitude’ as value-creating processes. The Stimulus-Organism-Response (S-O-R) framework suggests that these cues prompt patients to participate and contribute to healthcare outcomes, resulting in their continued patronage and reduced ease of access weakens this positive influence. Data was collected from General Practitioners (GP) who treat diabetic patients in Jharkhand (with limited healthcare resources and a low-average per-person income). A pilot sample data ensured the reliability of the instrument before the large-scale survey calibrated and independently validated a structural equation model. It was determined that the positive influence of ‘information exchange’ and ‘knowledge development attitude’ (‘interaction quality’) on patients' contribution to healthcare outcomes is (is not) weaker in reduced ease of access. The patients perceive a degree of risk owing to their limited understanding of the healthcare components (e.g., medication). Stated processes reduce this and add to the system's value (knowledge to cure and learn as per service-dominant logic) and improve trust in the service provider. With reduced ease of access, the time spent with the patient has to be effectively used to allay fears and gain trust empathetically. GP clinics with reduced hierarchy and protocols are better suited for required policy changes and service innovations. This is the first study to apply the S-O-R framework interlaced with service-dominant logic in sustainable healthcare.