Effect of waiting time on health outcomes and service utilization : A prospective randomized study on patients admitted to hospital for hip or knee replacement

Although the principle of equal access to medically justified treatment has been promoted by official health policies in many Western health care systems, practices do not completely meet policy targets. Waiting times for elective surgery vary between patient groups and regions, and growing problems in the availability of services threaten equal access to treatment. Waiting times have come to the attention of decision-makers, and several policy initiatives have been introduced to ensure the availability of care within a reasonable time. In Finland, for example, the treatment guarantee came into force in 2005. However, no consensus exists on optimal waiting time for different patient groups. The purpose of this multi-centre randomized controlled trial was to analyse health-related quality of life, pain and physical function in total hip or knee replacement patients during the waiting time and to evaluate whether the waiting time is associated with patients health outcomes at admission. This study also assessed whether the length of waiting time is associated with social and health services utilization in patients awaiting total hip or knee replacement. In addition, patients health-related quality of life was compared with that of the general population. Consecutive patients with a need for a primary total hip or knee replacement due to osteoarthritis were placed on the waiting list between August 2002 and November 2003. Patients were randomly assigned to a short waiting time (maximum 3 months) or a non-fixed waiting time (waiting time not fixed in advance, instead the patient followed the hospitals routine practice). Patients health-related quality of life was measured upon being placed on the waiting list and again at hospital admission using the generic 15D instrument. Pain and physical function were evaluated using the self-report Harris Hip Score for hip patients and a scale modified from the Knee Society Clinical Rating System for knee patients. Utilization measures were the use of home health care, rehabilitation and social services, physician visits and inpatient care. Health and social services use was low in both waiting time groups. The most common services used while waiting were rehabilitation services and informal care, including unpaid care provided by relatives, neighbours and volunteers. Although patients suffered from clear restrictions in usual activities and physical functioning, they seemed primarily to lean on informal care and personal networks instead of professional care. While longer waiting time did not result in poorer health-related quality of life at admission and use of services during the waiting time was similar to that at the time of placement on the list, there is likely to be higher costs of waiting by people who wait longer simply because they are using services for a longer period. In economic terms, this would represent a negative impact of waiting. Only a few reports have been published of the health-related quality of life of patients awaiting total hip or knee replacement. These findings demonstrate that, in addition to physical dimensions of health, patients suffered from restrictions in psychological well-being such as depression, distress and reduced vitality. This raises the question of how to support patients who suffer from psychological distress during the waiting time and how to develop strategies to improve patients initiatives to reduce symptoms and the burden of waiting. Key words: waiting time, total hip replacement, total knee replacement, health-related quality of life, randomized controlled trial, outcome assessment, social service, utilization of health services

Service firms´ action upon negative incidents in high touch services: A narrative study

The study concerns service management, and specifically the action service firms take with regard to customer dissatisfaction, customer complaints and complaining customers in high touch services. Customer dissatisfaction, customer complaints and complaining customers are called negative incidents in the study. The study fills a research gap in service management studies by investigating negative incidents as a part of an open service system. In contrast to main stream service management studies defining service quality as how the customer as a consumer defines it, in the present study, the concept of interactive service quality is adopted. The customer is considered as a co-producer of service who thus has a role to play in service quality and productivity. Additionally, the study juxtaposes the often opposed perspectives of the manager and the customer as well as the often forgotten silent voices of service employees and supervisors. The study proposes that the service firm as an entity does not act but it is the actors at the different hierarchical layers who act. Additionally, it is acknowledged in the study that the different actors at the different hierarchical layers have different knowledge of the service system and different objectives for service encounters. Therefore, they interpret the negative incidents from different perspectives and their actions upon negative incidents are subsequently guided by their interpretations. The research question is: how do service firms act upon negative incidents in high touch services? In order to answer to the research question a narrative research approach was chosen. The actors at the different hierarchical layers acted as informants of the study and provided stories about customer dissatisfaction, customer complaining and complaint handling in high touch services. Through storytelling, access to the socially constructed reality of service firms’ action was achieved. Stemming from the literature review, analysis of empirical data and my theoretical thinking, a theory about service firms’ action upon negative incidents in high touch services was developed and the research question was answered. The study contributes to service recovery and complaint management studies as well as to studies on customer orientation and its implementation in service firms. Additionally, the study has a methodological contribution to service management studies since it reflects service firms’ action with narratives from multiple perspectives. The study is positioned in the tradition of the Nordic School of Marketing Thought and presents service firms’ action upon negative incidents in high touch services as a complex human-centered phenomenon in which the actors at the different hierarchical layers have crucial roles to play. Ritva Höykinpuro is associated with CERS, the Centre for Relationship Marketing and Service Management at Hanken School of Economics.

Colours as Non-Verbal Signs on Packages

Colour is an essential aspect of our daily life, and still, it is a neglected issue within marketing research. The main reason for studying colours is to understand the impact of colours on consumer behaviour, and thus, colours should be studied when it comes to branding, advertising, packages, interiors, and the clothes of the employees, for example. This was an exploratory study about the impact of colours on packages. The focus was on low-involvement purchasing, where the consumer puts limited effort into the decision-making. The basis was a scenario in which the consumer faces an unpredictable problem needing immediate action. The consumer may be in hurry, which indicate time pressure. The consumer may lack brand preferences, or the preferred brand may be out of stock. The issue is that the choice is to be made at the point of purchase. Further, the purchasing involves product classes where the core products behind the brands are indistinguishable from each other. Three research questions were posed. Two questions were answered by conjoint analysis, i.e. if colours have an impact on decision-making and if a possible impact is related to the product class. 16 hypothetical packages were designed in two product classes within the healthcare, i.e. painkillers and medicine against sore throats. The last research question aimed at detecting how an analysis could be carried out in order to understand the impact of colours. This question was answered by conducting interviews that were analysed by applying laddering method and a semiotics approach. The study found that colours do indeed have an impact on consumer behaviour, this being related to the context, such as product class. The role of colours on packages was found to be threefold: attention, aesthetics, and communication. The study focused on colours as a means of communication, and it proposes that colours convey product, brand, and product class meanings, these meanings having an impact on consumers’ decision-making at the point of purchase. In addition, the study demonstrates how design elements such as colours can be understood by regarding them as non-verbal signs. The study also presents an empirical design, involving quantitative and qualitative techniques that can be used to gain in depth understanding of the impact of design elements on consumer behaviour. Hannele Kauppinen is associated with CERS, the Centre for Relationship Marketing and Service Management of the Swedish School of Economics and Business Administration

Use of Customer Information: An Ethnography in Service Development

Service researchers have repeatedly claimed that firms should acquire customer information in order to develop services that fit customer needs. Despite this, studies that would concentrate on the actual use of customer information in service development are lacking. The present study fulfils this research gap by investigating information use during a service development process. It demonstrates that use is not a straightforward task that automatically follows the acquisition of customer information. In fact, out of the six identified types of use, four represent non usage of customer information. Hence, the study demonstrates that the acquisition of customer information does not guarantee that the information will actually be used in development. The current study used an ethnographic approach. Consequently, the study was conducted in the field in real time over an extensive period of 13 months. Participant observation allowed direct access to the investigated phenomenon, i.e. the different types of use by the observed development project members were captured while they emerged. In addition, interviews, informal discussions and internal documents were used to gather data. A development process of a bank’s website constituted the empirical context of the investigation. This ethnography brings novel insights to both academia and practice. It critically questions the traditional focus on the firm’s acquisition of customer information and suggests that this focus ought to be expanded to the actual use of customer information. What is the point in acquiring costly customer information if it is not used in the development? Based on the findings of this study, a holistic view on customer information, “information in use” is generated. This view extends the traditional view of customer information in three ways: the source, timing and form of data collection. First, the study showed that the customer information can come explicitly from the customer, from speculation among the developers or it can already exist implicitly. Prior research has mainly focused on the customer as the information provider and the explicit source to turn to for information. Second, the study identified that the used and non-used customer information was acquired both previously, and currently within the time frame of the focal development process, as well as potentially in the future. Prior research has primarily focused on the currently acquired customer information, i.e. within the timeframe of the development process. Third, the used and non-used customer information was both formally and informally acquired. In prior research a large number of sophisticated formal methods have been suggested for the acquisition of customer information to be used in development. By focusing on “information in use”, new knowledge on types of customer information that are actually used was generated. For example, the findings show that the formal customer information acquired during the development process is used less than customer information already existent within the firm. With this knowledge at hand, better methods to capture this more usable customer information can be developed. Moreover, the thesis suggests that by focusing stronger on use of customer information, service development processes can be restructured in order to facilitate the information that is actually used.