Creating advantages through franchising in healthcare: a qualitative, multiple embedded case study on the role of the business format

BMC Health Services Research

Isabelle N Fabbricotti¹  Robbert Huijsman¹  Karlijn J Nijmeijer² 

[1]Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, 3000 DR, The Netherlands

[2]The Rotterdam Eye Hospital, Rotterdam, 3000 LM, The Netherlands

关键词: Cooperation;    Organization;    Performance;    Professionals;    Business format;    Franchise;   

Others  :  1092408
DOI  :  10.1186/s12913-014-0485-5

 received in 2013-09-17, accepted in 2014-10-03,  发布年份 2014

【 摘 要 】

Background

Business format franchising is an organizational form that originates from the business sector. It is increasingly used in healthcare, being a promising organizational form for improving the competitiveness and efficiency of organizations, the quality of care, and the professional work environment. However, evidence is lacking concerning how these healthcare franchises should be designed to actually deliver the promised benefits. This study explores how the design of the central element in franchising, the business format (i.e., brand name, support systems, specification of the products and services), helps or hinders the achievement of positive results.

Methods

A qualitative comparative embedded case study was conducted. The cases focused on three Dutch healthcare franchises providing mental healthcare, hospital care and care for the intellectually disabled. The data were collected through document analyses, observations, and 96 in-depth, semi-structured interviews with franchisors and unit actors (franchisees, unit managers, professionals). The interviews were recorded and transcribed verbatim. A conceptual model based on a systematic review of studies in other industries was used as an initial method for coding the data. New inductive codes were used to enrich and extend the analysis. The data were subjected to within-case and cross-case comparative thematic analyses.

Results

Different business format designs have different effects on results, as perceived by franchisors and unit actors. The analysis revealed how this variation in perceived effects can be explained by different dynamics with regard to system-wide adaptation, local adaptation, professionals’ resistance to change, ease of knowledge sharing, bureaucracy, overhead, uniform brand presentation, accelerating effects and reliable performance levels. The analysis resulted in a new typology of four types of business formats, showing how combinations of business format elements facilitate or hinder the achievement of different types of results.

Conclusions

Practitioners using healthcare franchising as a model to improve client-related, strategic, organizational and professional results should carefully consider how to design their business format in order to facilitate the achievement of desired results. The developed typology can be used as a starting point for these practitioners and as a basis for future scholarly research. Further quantitative research is recommended to confirm the results.

【 授权许可】

   
2014 Nijmeijer et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Cutler DM: Equality, efficiency, and market fundamentals: the dynamics of international medical-care reform. J Econ Literature 2002, 60:881-906.
• [2]Berwick DM, Hackbarth AD: Eliminating waste in US health care. JAMA 2012, 307:1513-1516.
• [3]A new Health System for the 21st Century. National Academy Press, Washington, D.C.; 2001.
• [4]Nembhard IM, Alexander JA, Hoff TJ, Ramanujam R: Why does the quality of health care continue to lag? Insights from management research. Acad Manage Perspect 2009, 23:24-42.
• [5]Gigantesco A, Picardi A, Chiaia E, Balbi A, Morosini P: Job satisfaction among mental health professionals in Rome, Italy. Community Ment Hlt J 2003, 39:349-355.
• [6]Blair RD, Lafontaine F: The Economics of Franchising. Cambridge University Press, Cambridge and New York; 2005.
• [7]Falbe CM, Welsh DHB: NAFTA and franchising: a comparison of franchisor perceptions of characteristics associated with franchisee success and failure in Canada, Mexico, and the United States. J Bus Venturing 1998, 13:151-171.
• [8]Komoto K: Innovation in franchise organizations. Jpn Econ 2005, 33:119-135.
• [9]Christensen DB, Curtiss FB: A survey of pharmacy franchising in the upper Midwest. J Am Pharm Assoc 1977, 1:696-699.
• [10]Hogan P, Purcey T, Hager A: A closer look at franchised home care. Home Health Care Manag Pract 2006, 18:138-143.
• [11]Montagu D: Franchising of health services in low-income countries. Health Policy Plan 2002, 17:121-130.
• [12]Schlein K, Montagu D: Clinical Social Franchising Compendium: An Annual Survey of Programs. The Global Health Group, Global Health Sciences, University of California, San Francisco, San Francisco; 2012.
• [13]Stephenson R, Tsui AO, Sulzbach S, Bardsley P, Bekele G, Giday T, Ahmed R, Gopalkrishnan G, Feyesitan B: Franchising reproductive health services. Health Serv Res 2004, 39:2053-2080.
• [14]Knott AM, Corredoira R, Kimberly J: Improving consistency and quality of service delivery: implications for the addiction treatment field. J Subst Abuse Treat 2008, 35:99-108.
• [15]Agha S, Karim AM, Balal A, Sosler S: The impact of a reproductive health franchise on client satisfaction in rural Nepal. Health Policy Plan 2007, 22:320-328.
• [16]Agha S, Gage A, Balal A: Changes in perceptions of quality of, and access to, services among clients of a fractional franchise network in Nepal. J Bios Sci 2007, 39:341-354.
• [17]Evans CD, Eurich DT, Lamb DA, Taylor JG, Jorgenson DJ, Semchuk WM, Mansell KD, Blackburn DF: Retrospective observational assessment of statin adherence among subjects patronizing different types of community pharmacies in Canada. J Manag Care Pharm 2009, 15:476-484.
• [18]Ngo AD, Alden DL, Hang N, Dinh N: Developing and launching the government social franchise model of reproductive health care service delivery in Vietnam. Soc Mar Q 2009, 15:71-89.
• [19]Ngo AD, Alden DL, Pham V, Phan H: The impact of social franchising on the use of reproductive health and family planning services at public commune health stations in Vietnam. BMC Health Serv Res 2010, 10:54. BioMed Central Full Text
• [20]Shah NM, Wang W, Bishai DM: Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost? Health Policy Plan 2011, 26:i63-i71.
• [21]Nijmeijer KJ, Fabbricotti IN, Huijsman R: Is franchising in healthcare valuable? A systematic review. Health Policy Plan 2014, 29:164-176.
• [22]Tuunanen M, Hyrsky K: Entrepreneurial paradoxes in business format franchising: an empirical survey of Finnish franchisees. Int Small Bus J 2001, 19:47-62.
• [23]Grünhagen M, Dipietro RB, Stassen RE, Frazer L: The effective delivery of franchisor services: a comparison of US and German support practices for franchisees. J Market Channel 2008, 15:315-335.
• [24]Knott AM: The organizational routines factor market paradox. Strateg Manage J 2003, 24:929-943.
• [25]Gillis WE, Combs J: Franchisor strategy and firm performance: making the most of strategic resource investments. Business Horizons 2009, 52:553-561.
• [26]Nijmeijer KJ, Fabbricotti IN, Huijsman R: Making franchising work: a framework based on a system review. Int J Manag Rev 2014, 16:62-83.
• [27]Kaufmann PJ, Eroglu S: Standardization and adaptation in business format franchising. J Bus Venturing 1998, 14:69-85.
• [28]Michael SC, Combs JG: Entrepreneurial failure: the case of franchisees. J Small Bus Manage 2008, 46:73-90.
• [29]Hing N: An empirical analysis of the benefits and limitations for restaurant franchisees. Int J Hospit Manag 1996, 15:177-187.
• [30]Lewis MC, Lambert DM: A model of channel member performance, dependence, and satisfaction. J Retailing 1991, 67:205-225.
• [31]Shane S, Shankar V, Aravindakshan A: The effects of new franchisor partnering strategies on franchise system size. Manage Sci 2006, 52:773-787.
• [32]Merrilees B, Frazer L: Entrepreneurial franchisees have hidden superior marketing systems. Qual Market Res Int J 2006, 9:73-85.
• [33]Minguela-Rata B, López-Sánchez JI, Rodríguez-Benavides MC: The effect of knowledge complexity on the performance of franchise systems in the service industries: an empirical study. Serv Bus 2009, 3:101-115.
• [34]Shane SA: Research notes and communications: making new franchise systems work. Strateg Manage J 1998, 19:697-707.
• [35]Tuunanen M: An ounce of prevention is worth a pound of cure: findings from national franchisee (dis-)satisfaction study. J Market Channel 2002, 10:57-89.
• [36]Morrison A, Lashley C: A franchise: a resource-rich small firm? Surv Ind J 2003, 23:135-149.
• [37]Clarkin JE, Rosa PJ: Entrepreneurial teams within franchise firms. Int Small Bus J 2005, 23:303-334.
• [38]Kidwell RE, Nygaard A, Silkoset R: Antecedents and effects of free riding in the franchisor-franchisee relationship. J Bus Venturing 2007, 22:522-544.
• [39]Shane S: Organizational incentives and organizational mortality. Organ Sci 2001, 12:136-160.
• [40]Baucus DA, Baucus MS, Human SE: Consensus in franchise organizations: a cooperative arrangement among entrepreneur. J Bus Venturing 1996, 11:359-378.
• [41]Yin RK: Case Study Research. Design and Methods. Sage Publications, Thousand Oaks, California; 2003.
• [42]Elango B, Fried VH: Franchising research: a literature review and synthesis. J Small Bus Manage 1997, 35:68-81.
• [43]Eisenhardt K: Building theories from case study research. Acad Manage Rev 1989, 14:532-550.
• [44]Halinen A, Törnroos JA: Using case methods in the study of contemporary business networks. J Bus Res 2005, 58:1285-1297.
• [45]Patton MQ: Qualitative Evaluation and Research Methods. Sage, Newbury Park, CA; 1990.
• [46]Eisenhardt KM, Graebner ME: Theory building from cases: opportunities and challenges. Acad Manage J 2007, 50:25-32.
• [47]Miles MB, Huberman M: Qualitative Data Analysis: An Expanded Sourcebook. Sage, Thousand Oaks, CA; 1994.