Customers as resource integrators: styles of customer co-creation

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Customers as resource integrators styles of
customer co-creation

• Janet McColl-Kennedy
• Steve Vargo
• Tracey Dagger
• Jillian Sweeney
• Janet McColl-Kennedy
• Professor of Marketing, Research Director
• UQ Business School
• University of Queensland, Australia
• 2009 Naples Forum on Service Capri, Italy 16-19
  June

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background

• Traditional wisdom says value is created by a
  producer and purchased for consumption
• Consumer behaviour literature has focussed on the
  consumers decision making process rather than on
  what they customer does
• More recently, the producer-consumer model has
  begun to be replaced by a model of co-creation of
  value
• That is, where value is created through joint
  activities of providers and customers but also
  through the activities of others in the networks
  of these parties (McColl-Kennedy et al 2009)

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background

• shift towards a model of co-creation of value has
  roots in service marketing literature (through
  production and consumption being inseparable (ZBP
  1983) and B2B where the producer-consumer
  distinction is inappropriate
• But also Prahalad and Ramaswamy (2000) HBR
• Vargo and Lusch 2004, 2008
• idea of co-creation of value is part of an
  evolution toward a general re-orientation of
  marketing, value creation and exchange ie S-D
  Logic

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research purpose

• To investigate empirically a service provision
  process to tease apart multiple approaches to
  co-creation and suggest a schema
• To begin to explore relationships between
  co-creation approaches and outcomes
• Healthcare was chosen as the setting as it
  provides a full range of co-creation and
  co-production activities and styles

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healthcare context

• move from cure to preventative health and patient
  self-care which emphasizes the role of the
  customer in the medical service delivery (Roter
  et al 1988).
• many advantages of inclusion of the customer in
  the service process eg.
• reduced cost and increased efficiency of the
  process (Jayawardehena and Foley 2000)
• the customer taking some responsibility for the
  outcome (Auh et al. 2007 Bitner 1990 Dellande,
  Gilly and Graham 2004).
• reduce unnecessary health costs
• improve health care outcomes and
• increase trust in and commitment to the doctor
  (Veranec 1999 McStravic 2000 Michie, Miles and
  Weinman 2003 Ouschan, Sweeney and Johnson 2006).

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healthcare literature

• Early literature on participation showed that
  participation in an interchange leads to positive
  outcomes (Vroom 1960)
• Compliance taking medications
• Involvement in decision making
• Coping literature

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overview

• Positioning
• the research is positioned within S-D logic in a
  healthcare context
• Part of 3 year ARC linkage project

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contribution

• 1. using 20 interviews and 4 focus groups
  represents the first in-depth empirical
  investigation of multiple approaches to
  co-creation of value
• 2. identify range of activities (behavioural and
  cognitive) and six styles
• 3. some styles associated with high quality of
  life, others with relatively low quality of life

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definition of co-creation of value in our study

• Unavoidable, multi-party nature of value creation
• joint activities in collaboration with members
  of the service delivery network which may include
  , family, friends, other patients, health
  professionals and the outside community
• Essential features
• Activities are defined as performing or
  doing
• Doing has 2 components
• cognitive behavioural
• Involves some effort on part of
• customer

Community
Others
Self
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definition of co-production

• The less compulsory, more effortful involvement
  of customers in the process such as in design,
  self-service and other extra-curricula activities
  
• (ie the activities traditionally undertaken by
  the firm)

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conceptual framework

• Customers can no longer be regarded merely as
  passive recipients of services
• Customers play an active part of production and
  delivery of services (Prahalad and Ramaswamy
  2000)
• Yet, little research has addressed the customers
  role what the customer actually does
• Payne etal. 2008 provide a useful framework
  emotion (feeling), cognition (thinking) and
  behaviour (doing)

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Payne et al., 2008)

• Centrality of the process in value creation
• Longitudinal nature
• Recognises the customer as feelers, thinkers
  and doers
• Recognises that the customer engages in
  activities (practices) and that value (to the
  customer) is embedded in these practices

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gap to be addressed

• Yet, little is known about how customers actually
  go about doing the co-creating (Payne et al 2008)
• Little is know about how customers integrate
  resources (Vargo and Lusch 2008)

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qualitative stage

• Study 1
• Cancer one of seven National Health Priority
  Areas
• Increasingly ageing population, higher prevalence
  of cancer, increasing reliance on services
  devoted to cancer including ambulatory Industry
  partner HOCA (Haemotology and Oncology Clinics
  of Australasia)
• Two Cancer day clinics
• 20 in-depth interviews with patients
• Different stages of the patient treatment
  process 1, 3, 6 and 12months

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method

• Data collection took two years across 2 clinics
• Depth interviews with CEO, oncologists, Director
  of Nursing as well as supervisors of the clinics
  receptionists
• Participant observation at the two clinics
• 20 depth interviews with patients (either at the
  clinic or in their own home)
• Discussions flowed like conversations

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method

• 175 pages of typed transcripts
• 3 researchers plus research officer read the
  transcripts
• NVIVO using one researcher
• Traditional content analysis two other
  researchers acting entirely independently
• Lincoln and Gubas (1985) constant comparative
  method
• Themes were then listed and categorised using the
  constant comparative method (Lincoln and Guba,
  1985)

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results - 10 themes (activities)

• 8 behaviours
• Information use clients accepting, seeking and
  sharing of core service information sent
  one-to-one, one-to-many, many-to-many
• Action relating to core services client
  activities that facilitate core service provision
  
• Additional health activities
• Participation in non-essential (supplementary) eg
  diet, exercise, alternative therapies
• Distracting with activities distracting from
  realities eg overseas holiday, hobbies
• Organising/managing practicalities of life
• Managing the practicalities of life in the
  circumstances (eg keeping a diary, setting goals,
  time activities)

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10 themes (activities)

• 8 behaviours (cont)
• Managing physical identity managing physical
  appearance to maintain sense of self (eg wig,
  make up)
• Relationships client putting effort into
  relationships with stakeholders (eg friends,
  family, broader community)
• Regulating emotions form of behavioural
  management of emotions for sake of interpersonal
  relationships (eg protecting/supporting family,
  avoiding negative situations)

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10 themes (activities)

• 2 thinking activities
• Positive thinking choosing positive emotions and
  applying them (eg self talk)
• Being philosophical assessing the situation in
  terms of a critical and generally systematic
  approach which relies on reasoned argument (eg
  accepting, dealing with it and moving on)

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co-creation styles

• 6 profiles
• Team manager
• Passive compliant
• Isolate controller
• Partner
• Spiritualist
• Adaptive realist

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team manager

• typified by Linda and Barry who manage their
  team which includes staff, friends and family.
• Linda believes in a team approach which she
  coordinates. She says you do it, you dont
  leave it up to fate, God or the doctors. Rather,
  she with her team will make it happen.
• She has a circle of support people and is very
  open in her communication with her team. For
  example
• You do it on your own and there is no other way
  for it to be and you have to do it on your own, I
  think you have to. It is not just about inner
  strength , I have still showered myselfI think
  that it is very important just to have a sense
  that you are doing something for yourself. But I
  have a support teammy husband and my sister are
  really the center of my support then it goes out
  in concentric circles, the there is my children,
  then the Bahai community and of course my
  parents I discuss everything with everyone.
  (Linda, 52 years)

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passive compliant

• The Passive Compliant first and foremost
  follows orders. They are accepting of what the
  doctors tell them. They do not tend to question
  the doctors.
• They tend not to take initiatives, such as
  searching the Internet for more information,
  going to a gym, changing their diet. The Passive
  Compliant often will stay close to home as they
  feel safe there. They see little if any choices.
• Mary is an example of this profile. She is
  accepting of what the doctors say.
• I am fairly accepting there are not many
  choices, no no, the only real choice was do you
  want your chemo this week or would you want to
  put it off a weekbut otherwise no, this is what
  we want to do and I am reasonably compliant so I
  just said (to the doctor) you know best.I prefer
  to be at home I potter in my garden. You have
  to be pleasant and accepting of what they have
  got to do and you have to get yourself there on
  time even though you might have to wait. So just
  being compliant. (Mary, 60 years)

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passive compliant

• My role is to front up every two weeks, and just
  probably proceed to treatment (Neil, 65 years)
• you dont feel in controlthe doctor teed up
  the other two specialists for me and I felt good
  about the amount they (doctors) knew and
  shared.Whenever I did see him (family doctor) he
  knew what was going onIt is such standard
  treatment in so many waysits what every woman
  after breast cancer getsI see him (the
  oncologist) each time or a say someone elseI
  didnt have any questions or whateveryou cant
  control, well I chose not to control what
  treatment I underwent that was passive you have
  so many testsyou are not in control. (Tina,
  female, 45 years)

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isolate controller

• keeps themselves away from close family members
  and chose to work with only certain medical
  staff.
• like to be alone and not to share their feelings
  and problems with others.
• restrict the amount of details they tell others
  about the illness, symptoms and problems they are
  experiencing.
• They would rather do things themselves, such as
  taking vitamins, doing exercise, diet, being
  generally healthy.
• I make their job easier to make sure that I am as
  healthy as can be apart from what we have to deal
  with as far as cancer goesI ate well, I slept
  well Regarding her mother, Christine said, I had
  to be very careful what I said to her because it
  would get broadcast that night, email right
  around, right around, and then I would get emails
  the next day, and I would just have to answer
  emailsso I have sort of kept them at a
  distance. (Christine, Spring Hill, 49 years).

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isolate controller

• Deluce has her own recovery program with a team
  of people that she has selected including an
  oncologist, surgeon, dietician, psychologist,
  personal trainer and gym instructor.
• She believes that the power is with her and that
  it is up to her to get her team together.
• Youve got to start your own health program and
  your own exercise program so Ive now got on
  board my own team which include obviously my GP,
  my oncologist from HoCa, my surgeon who did the
  work, and my dietician and my psychologist, my
  gym and in the next few weeks hopefully a
  personal trainer might get on board. but all
  thats come from me I feel as though thats my
  own kind of recovery program that Ive put in
  place. (Deluce, 46 years)

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partner

• partners primarily work with the doctors and
  other service providers
• working with her doctor, being engaged in the
  process, because its a partnership, Im
  working with her (doctor) and pulling my share
  of the weight.
• Im learning and I'm getting a lot stronger I
  can now think, I can get the doctor's report,
  radiology report, get on the Web and I can look
  up stuff, if I don't like something I ask, I
  went into day with my pen and paper to take no, I
  said to my doctor I want you to listen I went
  in there, and so is the first time I really feel
  in control, being in control, yes it is, to be
  engaged, because it's a partnership, because I
  now feel I am of more benefit to her as the
  patient as well, the relationship to me is more
  equal, in that, I am not a victim. I have never
  been a victim with a disease, I am capable of
  working with her and pulling my share of the
  weight (Christine, New Farm, 56 years)

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partner

• I can do it with him (the doctor)I share
  everything with Dr PaulI do my part, I try to
  drink, make sure I am hydrated because I think it
  helps your veins and things I do things that I
  can do I can do everything in my worldwith all
  the support things and all the psychological
  support, then the other part can be dealt with by
  the doctors. (Pamela, 59 years)

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spiritualist

• Im a woman of prayer, a woman who believes in
  God you know that I believe in, faith and the
  spirit I think Id prayed every scripture in
  the bible chuckles and thats the end of that.
  God knows best, he does know best I had
  accepted it. (Yvonne, 49 years)
• Barbara believes in her faith in God and that
  this is her main source of peace. She speaks
  about taking each day at a time being carried
  along on prayer. I am coping today and thats
  all I have got to worry about. She trusts
  implicitly in her doctors I just trusted the
  doctorsThey checked were you happy with your
  surgeon, were you happy with your oncologist and
  I said I was always happy.

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adaptive realist

• Life goes on but differently
• Right now, and when I was diagnosed with cancer
  I was a single mum. it was only 48 hours from
  when I was diagnosed to when I had surgery.the
  motivation to keep on going was my ten year old.
  I had to do all of these things so that I could
  be around, to see him grow up. (Sherryl, 52
  years)
• Robert - goes to the toilet 21 times in an
  evening, considers wearing long pants instead of
  shorts as he has no bladder control but not once
  does he consider giving up his tennis or his
  golf.
• so now I can do a lot of things that I did, I
  can play tennis, I remember going to a friend's
  place one night, the worst thing you know was
  white wine, so that, I'll just have one glass
  oh all right one glass and that was itBut I have
  to go to the toilet 21 times some evenings. so
  it had its moments. I could still play golf
  because there were plenty of trees, but never on
  a mixed day, never played mixed golf again. You
  have to adapt don't you?. (Robert, 70 years)

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Relationship to quality of life

• Highest
• Adaptive realist
• Spiritualist
• Relatively high
• Partner
• Team manager
• Relatively low
• Passive compliant
• Isolate controller

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conclusions

• Co-creation extends previous conceptualisations
  of both participation and coping
• Participation traditionally focused on compliance
  and decision making
• Coping concerns managing and aiming toward the
  status quo
• Co-creation includes
• Thinking and doing
• Multi-party - involves various other people or
  groups
• Multiple facets

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moving forwardnext steps

• scale development
• application to other health areas eg heart
  disease, diabetes