Value co-creation in social marketing wellness services

Customer perceived value is concerned with the experiences of consumers when using a service and is often referred to in the context of service provision or on the basis of service quality (Auh, et al., 2007; Chang, 2008; Jackson, 2007; Laukkanen, 2007; Padgett & Mulvey, 2007; Shamdasani, Mukherjee & Malhotra, 2008). Understanding customer perceived value has benefits for social marketing and allows scholars and practitioners alike to identify why consumers engage in positive social behaviours through the use of services. Understanding consumers’ use of wellness services in particular is important, because the use of wellness services demonstrates the fulfilment of social marketing aims; performing pro-active, positive social behaviours that are of benefit to the individual and to society (Andreasen, 1994). As consumers typically act out of self-interest (Rothschild, 1999), this research posits that a value proposition must be made to consumers in order to encourage behavioural change. Thus, this research seeks to identify how value is created for consumers of wellness services in social marketing. This results in the overall research question of this research: How is value created in social marketing wellness services? A traditional method towards understanding value has been the adoption of an economic approach, which considers the utility gained and where value is a direct outcome of a cost-benefit analysis (Payne & Holt, 1999). However, there has since been a shift towards the adoption of an experiential approach in understanding value. This experiential approach considers the consumption experience of the consumer which extends beyond the service exchange and includes pre- and post-consumption stages (Russell-Bennett, Previte & Zainuddin, 2009). As such, this research uses an experiential approach to identify the value that exists in social marketing wellness services. Four dimensions of value have been commonly conceptualised and identified in the commercial marketing literature; functional, emotional, social, and altruistic value (Holbrook, 1994; Sheth, Newman & Gross, 1991; Sweeney & Soutar, 2001). It is not known if these value dimensions also exist in social marketing. In addition, sources of value said to influence value dimensions have been conceptualised in the literature. Sources of value such as information, interaction, environment, service, customer co-creation, and social mandate have been conceptually identified both in the commercial and social marketing literature (Russell-Bennet, Previte & Zainuddin, 2009; Smith & Colgate, 2007). However, it is not clear which sources of value contribute to the creation of value for users of wellness services. Thus, this research seeks to explore these relationships. This research was conducted using a wellness service context, specifically breast cancer screening services. The primary target consumer of these services is women aged 50 to 69 years old (inclusive) who have never been diagnosed with breast cancer. It is recommended that women in this target group have a breast screen every 2 years in order to achieve the most effective medical outcomes from screening. A two-study mixed method approach was utilised. Study 1 was a qualitative exploratory study that analysed individual-depth interviews with 25 information-rich respondents. The interviews were transcribed verbatim and analysed using NVivo 8 software. The qualitative results provided evidence of the existence of the four value dimensions in social marketing. The results also allowed for the development of a typology of experiential value by synthesising current understanding of the value dimensions, with the activity aspects of experiential value identified by Holbrook (1994) and Mathwick, Malhotra and Rigdon (2001). The qualitative results also provided evidence for the existence of sources of value in social marketing, namely information, interaction, environment and consumer participation. In particular, a categorisation of sources of value was developed as a result of the findings from Study 1, which identify organisational, consumer, and third party sources of value. A proposed model of value co-creation and a set of hypotheses were developed based on the results of Study 1 for further testing in Study 2. Study 2 was a large-scale quantitative confirmatory study that sought to test the proposed model of value co-creation and the hypotheses developed. An online-survey was administered Australia-wide to women in the target audience. A response rate of 20.1% was achieved, resulting in a final sample of 797 useable responses after removing ineligible respondents. Reliability and validity analyses were conducted on the data, followed by Exploratory Factor Analysis (EFA) in PASW18, followed by Confirmatory Factor Analysis (CFA) in AMOS18. Following the preliminary analyses, the data was subject to Structural Equation Modelling (SEM) in AMOS18 to test the path relationships hypothesised in the proposed model of value creation. The SEM output revealed that all hypotheses were supported, with the exception of one relationship which was non-significant. In addition, post hoc tests revealed seven further significant non-hypothesised relationships in the model. The quantitative results show that organisational sources of value as well as consumer participation sources of value influence both functional and emotional dimensions of value. The experience of both functional and emotional value in wellness services leads to satisfaction with the experience, followed by behavioural intentions to perform the behaviour and use the service again. One of the significant non-hypothesised relationships revealed that emotional value leads to functional value in wellness services, providing further empirical evidence that emotional value features more prominently than functional value for users of wellness services. This research offers several contributions to theory and practice. Theoretically, this research addresses a gap in the literature by using social marketing theory to provide an alternative method of understanding individual behaviour in a domain that has been predominantly investigated in public health. This research also clarifies the concept of value and offers empirical evidence to show that value is a multi-dimensional construct with separate and distinct dimensions. Empirical evidence for a typology of experiential value, as well as a categorisation of sources of value is also provided. In its practical contributions, this research identifies a framework that is the value creation process and offers health services organisations a diagnostic tool to identify aspects of the service process that facilitate the value creation process.

Demand for hospital emergency departments : a conceptual understanding

BACKGROUND: Emergency departments (EDs) are critical to the management of acute illness and injury, and the provision of health system access. However, EDs have become increasingly congested due to increased demand, increased complexity of care and blocked access to ongoing care (access block). Congestion has clinical and organisational implications. This paper aims to describe the factors that appear to infl uence demand for ED services, and their interrelationships as the basis for further research into the role of private hospital EDs. DATA SOURCES: Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) and relevant journals were searched using terms related to EDs and emergency health needs. Literature pertaining to emergency department utilisation worldwide was identified, and articles selected for further examination on the basis of their relevance and significance to ED demand. RESULTS: Factors influencing ED demand can be categorized into those describing the health needs of the patients, those predisposing a patient to seeking help, and those relating to policy factors such as provision of services and insurance status. This paper describes the factors influencing ED presentations, and proposes a novel conceptual map of their interrelationship. CONCLUSION: This review has explored the factors contributing to the growing demand for ED care, the influence these factors have on ED demand, and their interrelationships depicted in the conceptual model.

Measuring National Accessibility to Cardiac Services using Geographic Information Systems

The Cardiac Access-Remoteness Index of Australia (Cardiac ARIA) used geographic information systems (GIS) to model population level, road network accessibility to cardiac services before and after a cardiac event for all (20,387) population localities in Australia., The index ranged from 1A (access to all cardiac services within 1 h driving time) to 8E (limited or no access). The methodology derived an objective geographic measure of accessibility to required cardiac services across Australia. Approximately 71% of the 2006 Australian population had very good access to acute hospital services and services after hospital discharge. This GIS model could be applied to other regions or health conditions where spatially enabled data were available.

Can the Cardiac ARIA Index Improve Cardiac Care for Australia's Indigenous Population?

Background: Timely access to appropriate cardiac care is critical for optimising outcomes. Our aim was to derive an objective, comparable, geographic measure reflecting access to cardiac services for Australia's 20,387 population locations. Methods: An expert panel defined a single patient care pathway. Using geographic information systems (GIS) the numeric/alpha index was modelled in two phases. The acute phase index (numeric) ranged from 1 (access to tertiary centre with PCI ≤1 h) to 8 (no ambulance service, >3 h to medical facility, air transport required). The aftercare index was modelled into 5 alphabetic categories; A (Access to general practitioner, pharmacy, cardiac rehabilitation, pathology ≤1 h) to E (no services available within 1 h). Results: Approximately 70% or 13.9 million people lived within a CardiacARIAindex category 1A location. Disparity continues in access to category 1A cardiac services for 5.8 million (30%) of all Australians, 60% of Aboriginal and Torres Strait Islander people and 32% of people over 65 years of age. In a cardiac emergency only 40% of the Indigenous population reside within one hour of category 1 hospital. Approximately 30% (81,491 Indigenous persons) are more than one to three hours from basic cardiac services. Conclusion: Geographically, the majority of Australian's have timely access for survival of a cardiac event. The CardiacARIAindex objectively demonstrates that the healthcare system may not be providing for the needs of 60% of Indigenous people residing outside the 1A geographic radius. Innovative clinical practice maybe required to address these disparities.

Rebuilding housing after a disaster : factors for failure

Disasters, particularly those triggered by nature are often followed by a swift humanitarian relief response to address the resultant emergencies. These efforts are then transitioned through the medium recovery stage, eventually aimed at providing a long term post-disaster reconstruction solution. Emergency humanitarian relief focuses on responding to the immediate need for restoration of basic services, medical treatment and medical supplies, food and temporary shelter, and is a short term strenuous effort. Reconstruction of permanent houses, on the other hand, is a continuous process that often requires decades of effort to return a community to normality. Whilst emergency relief is generally perceived to be very effective, post-disaster housing reconstruction projects often fail to meet their set objectives. This paper outlines and discusses factors that contribute to the failure of post-disaster housing reconstruction projects and the subsequent immediate and long term negative impacts of failure on project outcomes.

The GST Compliance Costs Of Nonprofit Organisations

On 2 December 1998, the Federal Government tabled their policy paper entitled Regulation Impact Statement for the Introduction of a Goods and Services Tax (RIS) in the House of Representatives. The Federal Government predicted that total gross GST compliance costs to Australian businesses in the first year of implementation would be approximately $1,912 million (or $1,195 per firm). Furthermore, it is estimated that the recurrent net compliance costs will be much lower at $131 per firm. Whilst the government made brief references to charitable organisations in their analysis, it stated that the compliance costs faced by nonprofits would, in substance, be no different to the compliance costs faced by businesses or government departments. This paper examines the RIS process in relation to nonprofit organisations in the context of recent taxation legislation affecting nonprofit organisations. It argues that the assumption that nonprofit compliance costs are similar to government and business costs is flawed and makes a case for the RIS process to be reformed to include more appropriate assessments of the impact of legislation on nonprofit enterprises.

The impact of the GST on the community services sector in Queensland

The impact of the GST has on nonprofit organisations has been largely ignored in the compliance cost literature. Most studies to date, both in Australia and overseas, have focused exclusively on measuring the nature and extent of GST compliance costs of businesses in the for-profit sector (particularly the impact on small businesses). This paper examines the impact of The New Tax System, and in particular, the GST on Queensland community sector organisations. The results are extracted from a QCOSS report entitled “Taxing Goodwill: The Impact of GST on Community Services” released in October 2001.

Health status and use of health services among recently arrived men with refugee backgrounds: A comparative analysis of urban and regional settlement in South-east Queensland

Approximately one-third of refugee and humanitarian entrants to Australia are adult men. Many of these men and their families settle in regional areas. Little is known about the health status of refugee men and the use of health services, and whether or not there are differences between those living in urban and regional areas. This paper reports on the cross-sectional differences in health status and use of health services among a group of 233 recently arrived refugee men living in urban and regional areas of South-east Queensland. Overall, participants reported good levels of subjective health status, moderate to good levels of well-being, and low prevalence of mental illness. Men living in urban areas were more likely to have a longstanding illness and report poorer health status than those settled in regional areas. In contrast, men living in regional areas reported poorer levels of well-being in the environment domain and were more likely to visit hospital emergency departments. Targeted health promotion programs will ensure that refugee men remain healthy and develop their full potential as members of the Australian community. Programs that facilitate refugees’ access to primary health care in regional areas may promote more appropriate use of hospital emergency departments by these communities.

Is language a barrier for quality care in hospitals? A case series from an Emergency Department of a teaching hospital in Brisbane

Aim: The aim of this pilot study is to describe the use of an Emergency Department (ED) at a large metropolitan teaching hospital by patients who speak English or other languages at home. Methods: All data were retrieved from the Emergency Department Information System (EDIS) of this tertiary teaching hospital in Brisbane. Patients were divided into two groups based on the language spoken at home: patients who speak English only at home (SEO) and patients who do not speak English only or speak other language at home (NSEO). Modes of arrival, length of ED stay and the proportion of hospital admission were compared among the two groups of patients by using SPSS V18 software. Results: A total of 69,494 patients visited this hospital ED in 2009 with 67,727 (97.5%) being in the SEO group and 1,281 (1.80%) in the NSEO group. The proportion of ambulance utilisation in arrival mode was significantly higher among SEO 23,172 (34.2%) than NSEO 397 (31.0%), p <0.05. The NSEO patients had longer length of stay in the ED (M = 337.21, SD = 285.9) compared to SEO patients (M= 290.9, SD = 266.8), with 46.3 minutes (95%CI 62.1, 30.5, p <0.001) difference. The admission to the hospital among NSEO was 402 (31.9%) higher than SEO 17,652 (26.6%), p <0.001. Conclusion: The lower utilisation rates of ambulance services, longer length of ED stay and higher hospital admission rates in NSEO patients compared to SEO patients are consistent with other international studies and may be due to the language barriers.

What health problems overcrowd hospital emergency departments in Queensland and has this changed over time? A case study of two hospitals in Queensland 2001 - 2009

Aim: to describe what health problems patients attending emergency department with and whether this changed over time. Methods: Electronic data was retrieved from EDIS (Emergency Department Information System) and HBCIS (Hospital Based Clinical Information System) in two hospitals in Queensland in the period 2001-2009. The ICD-10 code of patient's diagnosis was then extrapolated and then group into ICD-10 chapters, such that the health problem can be presented. Results: Among the specific health problems, Chapter XIX 'Injury and poisoning' ranked number one consistently (ranging from 22.1% to 31.2% of the total presentations) in both the urban and remote hospitals in Queensland. The top ten specific presenting health problems in both the urban and remote hospital include Chapter XI 'Digestive system', Chapter XIV 'Genitourinary system', Chapter IX 'Circulatory system', and Chapter XIII 'Musculoskeletal system and connective tissue'. Chapter X 'Respiratory system' made the top ten presenting Chapters in both hospitals, but ranked much higher (number four consistently for the eight years, ranging from 6.8% to 8.3%) in the remote hospital. Chapter XV 'Pregnancy childbirth and puerperium' made to the top ten in the urban hospital only while Chapter XII 'Skin and subcutaneous tissue', Chapter I 'Infectious and parasitic diseases' made the top ten in the remote hospital only. Conclusion: The number one health problem presenting to both the urban and remote hospitals in Queensland is Chapter XIX 'Injury and poisoning', and it did not change in the period 211 - 2009.

A randomised controlled trial to prevent hospital readmissions and loss of functional ability in high risk older adults: a study protocol

Background Older people have higher rates of hospital admission than the general population and higher rates of readmission due to complications and falls. During hospitalisation, older people experience significant functional decline which impairs their future independence and quality of life. Acute hospital services comprise the largest section of health expenditure in Australia and prevention or delay of disease is known to produce more effective use of services. Current models of discharge planning and follow-up care, however, do not address the need to prevent deconditioning or functional decline. This paper describes the protocol of a randomised controlled trial which aims to evaluate innovative transitional care strategies to reduce unplanned readmissions and improve functional status, independence, and psycho-social well-being of community-based older people at risk of readmission. Methods/Design The study is a randomised controlled trial. Within 72 hours of hospital admission, a sample of older adults fitting the inclusion/exclusion criteria (aged 65 years and over, admitted with a medical diagnosis, able to walk independently for 3 meters, and at least one risk factor for readmission) are randomised into one of four groups: 1) the usual care control group, 2) the exercise and in-home/telephone follow-up intervention group, 3) the exercise only intervention group, or 4) the in-home/telephone follow-up only intervention group. The usual care control group receive usual discharge planning provided by the health service. In addition to usual care, the exercise and in-home/telephone follow-up intervention group receive an intervention consisting of a tailored exercise program, in-home visit and 24 week telephone follow-up by a gerontic nurse. The exercise only and in-home/telephone follow-up only intervention groups, in addition to usual care receive only the exercise or gerontic nurse components of the intervention respectively. Data collection is undertaken at baseline within 72 hours of hospital admission, 4 weeks following hospital discharge, 12 weeks following hospital discharge, and 24 weeks following hospital discharge. Outcome assessors are blinded to group allocation. Primary outcomes are emergency hospital readmissions and health service use, functional status, psychosocial well-being and cost effectiveness. Discussion The acute hospital sector comprises the largest component of health care system expenditure in developed countries, and older adults are the most frequent consumers. There are few trials to demonstrate effective models of transitional care to prevent emergency readmissions, loss of functional ability and independence in this population following an acute hospital admission. This study aims to address that gap and provide information for future health service planning which meets client needs and lowers the use of acute care services.

A randomised, feasibility trial of a tele-health intervention for Acute Coronary Syndrome patients with depression ('MoodCare')

Background Coronary heart disease (CHD) and depression are leading causes of disease burden globally and the two often co-exist. Depression is common after Myocardial Infarction (MI) and it has been estimated that 15-35% of patients experience depressive symptoms. Co-morbid depression can impair health related quality of life (HRQOL), decrease medication adherence and appropriate utilisation of health services, lead to increased morbidity and suicide risk, and is associated with poorer CHD risk factor profiles and reduced survival. We aim to determine the feasibility of conducting a randomised, multi-centre trial designed to compare a tele-health program (MoodCare) for depression and CHD secondary prevention, with Usual Care (UC). Methods Over 1600 patients admitted after index admission for Acute Coronary Syndrome (ACS) are being screened for depression at six metropolitan hospitals in the Australian states of Victoria and Queensland. Consenting participants are then contacted at two weeks post-discharge for baseline assessment. One hundred eligible participants are to be randomised to an intervention or a usual medical care control group (50 per group). The intervention consists of up to 10 × 30-40 minute structured telephone sessions, delivered by registered psychologists, commencing within two weeks of baseline screening. The intervention focuses on depression management, lifestyle factors (physical activity, healthy eating, smoking cessation, alcohol intake), medication adherence and managing co-morbidities. Data collection occurs at baseline (Time 1), 6 months (post-intervention) (Time 2), 12 months (Time 3) and 24 months follow-up for longer term effects (Time 4). We are comparing depression (Cardiac Depression Scale [CDS]) and HRQOL (Short Form-12 [SF-12]) scores between treatment and UC groups, assessing the feasibility of the program through patient acceptability and exploring long term maintenance effects. A cost-effectiveness analysis of the costs and outcomes for patients in the intervention and control groups is being conducted from the perspective of health care costs to the government. Discussion This manuscript presents the protocol for a randomised, multi-centre trial to evaluate the feasibility of a tele-based depression management and CHD secondary prevention program for ACS patients. The results of this trial will provide valuable new information about potential psychological and wellbeing benefits, cost-effectiveness and acceptability of an innovative tele-based depression management and secondary prevention program for CHD patients experiencing depression.

Impact of opening a new emergency department on healthcare service and patient outcomes : analyses based on linking ambulance, emergency and hospital databases

Background Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload. Aim To investigate the impact of opening a new ED on patient and healthcare service outcomes. Methods A 24-month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia. Results Total volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre-existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10 min, POST: 10 min, P < 0.001; Hospital B PRE: 10 min, POST: 15 min, P < 0.001); ED length of stay: (Hospital A PRE: 242 min, POST: 246 min, P < 0.001; Hospital B PRE: 182 min, POST: 210 min, P < 0.001); and access block: (Hospital A PRE: 41%, POST: 46%, P < 0.001; Hospital B PRE: 23%, POST: 40%, P < 0.001). Time series modelling indicated that the effect was worst at the hospital furthest away from the new ED. Conclusions An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre-existing ED. There is an inherent need to take a ‘whole of health service area’ approach to solve crowding issues.

Queensland Emergency Medicine Research Foundation: Special report

The development of any new profession is dependent on the development of a special body of knowledge which is the domain of the profession and key to this is the conduct of research. In 2007, as part of the settlement of an Enterprise Bargaining Agreement and following sustained lobbying by Emergency Physicians, the Queensland Government agreed to establish an Emergency Medicine Research Fund to foster the development of research activities in Emergency Medicine in Queensland. That fund is now managed by the Queensland Emergency Medicine Research Foundation. The aims of this article are to describe the strategic approaches taken by the Foundation and its first three years of experience, to describe the application of research funds and to foreshadow an evaluative framework for determining the strategic value of this community investment. The Foundation has developed a range of personnel and project support funding programs and competition for funding has increased. Ongoing evaluation will seek to determine the effectiveness of this funding strategy on improving the effectiveness of research performance and the clinical and organisational outcomes that may derive from that initiative.