Value configurations for balancing standardization and customization in chronic care: a qualitative study

BMC Health Services Research

Andreas Hellström¹  Ida Gremyr¹  Christian Colldén² 

[1] Department of Technology Management and Economics, Division of Service Management and Logistics, Chalmers University of Technology, Gothenburg, Sweden;Department of Technology Management and Economics, Division of Service Management and Logistics, Chalmers University of Technology, Gothenburg, Sweden;Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden;

关键词: Healthcare management;    Standardization;    Customization;    Individualization;    Personalization;    Value configurations;    Value in healthcare;    Organizational architecture;    Mental healthcare;    Quality in healthcare;   

DOI  :  10.1186/s12913-021-06844-z

来源: Springer

【 摘 要 】

BackgroundDemands for both customization and standardization are increasing in healthcare. At the same time, resources are scarce, and healthcare managers are urged to improve efficiency. A framework of three value configurations – shop, chain, and network – has been proposed for how healthcare operations can be designed and organized for efficient value creation. In this paper, use of value configurations for balancing of standardization and customization is explored in the context of care for chronic mental conditions.MethodsA typical case is presented to illustrate the manifestations of conflicting demands between customization and standardization, and the potential usefulness of the value configurations framework. Qualitative data were collected from managers and care developers in two focus groups and six semi-structured interviews, completed by a national document describing a care pathway. Data were coded and analysed using an insider-outsider approach.ResultsOperationalization of the balance between standardization and customization were found to be highly delegated and ad hoc. Also, the conflict between the two demands was often seen as aggravated by scarce resources. Value configurations can be fruitful as a means of discussing and redesigning care operations if applied at a suitable level of abstraction. Applied adequately, all three value configurations were recognized in the care operations for the patient group, with shop as the overarching configuration. Some opportunities for improved efficiency were identified, yet all configurations were seen as vital in the chronic care process.ConclusionsThe study challenges the earlier proposed organizational separation of care corresponding to different value configurations. Instead, as dual demand for customization and standardization permeates healthcare, parallel but explicated value configurations may be a path to improved quality and efficiency. Combined and intermediate configurations should also be further investigated.

【 授权许可】

CC BY