Re-designing the service experience in the value co-creation process: an exploratory study of a healthcare network

2.1 From customer centricity to the service experience

Customer centricity considers customers' needs as the starting point for designing and implementing unique and satisfactory service experiences (Yim et al., 2019). Customers' engagement in service experience co-creation is a critical path to becoming customer-centric; it not only helps companies deliver services that meet customer needs, but also assumes a critical role in supporting innovation processes and co-defining new services that can sustain companies' competitive position (Alam, 2006; Chesbrough, 2017; Yim et al., 2019). The first step in being customer-centric is considering customers' inputs as the starting point for value co-creation along the journey (Lemon and Verhoef, 2016; Rindfleisch and Im, 2019) and improving their experiences to promote differentiation and customer loyalty (Zomerdijk and Voss, 2010). This approach is not a marketing concept, but it implies new business models and new co-creation processes that embrace the complexity of the entire company (Ferraresi and Schmitt, 2006). As such, firms may design situations that better support customers in co-creating their service experiences by assembling single elements (physical artefacts, technology-enabled systems and the actors involved in each activity) to co-create a complex but unitary experience through interactions between customers and providers across different touchpoints (Verma et al., 2012).

A service experience designed in this way should be able to produce positive reactions in terms of cognitive, emotional, behavioural and sensorial feelings during the entire customer journey from booking to the return home. The focus on the customer journey as a starting point to design innovative customer experiences emphasises the importance of creating a holistic experience and lean processes and adopting a cooperative approach in which customers and providers are co-innovators across the entire network (Gummesson, 2008).

Richardson (2010) defined the customer journey as a “diagram that illustrates the steps and touchpoints that customers go through in engaging with companies” from the first interaction with the firm to the period after consumption (Lemon and Verhoef, 2016). Lemon and Verhoef (2016) attempted to map the journey with three main stages as follows: the pre-purchase stage (when need/desire arises and people start to search for and consider alternatives), the purchase stage (when people choose, order and pay) and the post-purchase stage (the moment of truth when people consume and then may express satisfaction or dissatisfaction). For each stage, the authors identified the following four categories of the touchpoints to use: brand-owned touchpoints, which include all the tools used and supplied by the firm (e.g. advertising and websites); partner-owned touchpoints, which are designed and managed by the firm's partners (e.g. mobile applications); customer-based touchpoints, which are tools that firms cannot totally control because they are managed spontaneously by customers (e.g. word of mouth, forums and blogs); and social touchpoints – chiefly, external review platforms (e.g. onlinemedicalcare.org) – that have the power to influence customer decisions at every step.

The customer-centric approach is particularly innovative and interesting to observe in the healthcare context because a majority of the public healthcare systems are more oriented towards customer care than towards the customer experience (Omachonu and Einspruch, 2010; Iyawa et al., 2016). A first attempt to change this approach is being verified with the implementation of new services to help seniors regain their independence by providing new forms of mobility to the people who live in underserved areas and by bridging public health gaps in areas. A great example is Uber Health in the USA, which was created to remove the transportation barriers that cause medical appointment cancellations. It offers transportation, caregivers and staff to manage appointments and home assistance.

In healthcare, innovation has been defined as “the intentional introduction and application within a role, group, or organisation of ideas, processes, products or procedures, new to the relevant unit of adoption, designed to significantly benefit the individual, the group, or wider society” (Länsisalmi et al., 2006). Among the different types of innovations, process innovation best fits with the customer-centric approach because it involves the implementation of a new or significantly improved production or delivery method (Iyawa et al., 2016). This approach includes significant changes in techniques, equipment and/or software. The customer does not usually pay directly for the process, but the process must deliver a product or service and manage the relationships with various stakeholders (Omachonu and Einspruch, 2010).

2.2 From service innovation to value co-creation: the role of a sharing economy

As argued previously, the service literature focuses on the importance of innovating managerial processes through a customer-centric approach to achieve and maintain a sustainable competitive advantage. This customer-centric approach plays an important role in co-creating a valuable experience (Prebensen and Foss, 2011; Mcmanus, and Ardley and McManus, 2019). According to these authors, when a customer engages in active participation, he/she is co-creating his/her own experience and the company becomes a provider with which the experience is co-created. From the service-dominant logic perspective, there is an interactive nature of value creation; the customer is considered to be a co-creator of value (Vargo and Lusch, 2008). Ranjan and Read (2016) coherently proposed the experience as a value co-creation dimension and argued that active participation (before, during and after consumption) and physical and social interaction produce an experiential value in use. Prebensen et al. (2013) emphasised that experience becomes a co-creating value driver because the customer is personally involved in the presumption (Prebensen and Foss, 2011).

In this sense, a company can interact with its customers and gain value from these customers through continuous interactions during the journey (Barile et al., 2014; Lemon and Verhoef, 2016). The new concept of value is increasingly related to the response generated from inter-organisational relationships, and the prefix “co-” indicates the cooperation among stakeholders and emphasises individual contributions (Troisi et al., 2016). Traditionally, the value for customers has been considered from a utilitarian perspective as the utility derived from a certain product or service (Zeithaml, 1988; Tellis and Gaeth, 1990). By contrast, other authors have represented a more complex model of perceived value that comprises both utilitarian and hedonic dimensions to measure the value construct (Holbrook and Hirschman, 1982). This multidimensional framework shows that value is perceived not only as a trade-off of benefits and sacrifices (rational perspective) but also as a consumption experience that positively or negatively impacts feelings and emotions (experiential perspective).

Consequently, consumer value may not reside in the product/service purchased, in the brand chosen and/or in the object possessed, but in the consumption experience derived therefrom. This approach implies a more personal evaluation of perceived value that might depend on situational and contextual factors (Zeithaml, 1998; Sanchez-Fernandez and Bonillo, 2007). In fact, from an experiential perspective, the concept of perceived value has been broadly used in the service context, in which intangible factors are subjectively perceived. However, when value is co-created along the customer journey, there is a value for customers, for companies and for all stakeholders in the network (Gummesson, 2008).

In recent years, the value creation for consumers, companies and networks has been facilitated by various technologies (e.g. mobile applications, cloud computing, artificial intelligence) (Kannan and Li, 2017; Huang and Rust, 2017; Belk, 2013) that are used together with open business models such as an SE (Frankenberger et al., 2013; Habibi et al., 2017). An SE refers to “a socio-economic system enabling an intermediated set of exchanges of goods and services between individuals and organisations which aim to increase efficiency and optimisation of under-utilised resources in society” (Munoz and Cohen, 2017), generally through ICT. Thus, this open business model could refer to a service experience co-created through the interactions of providers and consumers. Recent scholars investigated the role of value co-creation in an SE, with an examination of consumers' willingness to pay a premium price (Zhang et al., 2018), in contrast with the perception of cheaper provisions of goods or services. However, Dreyer et al. (2017) analysed collaborative consumption business models as examples of an SE, which are particularly important because of their novelty and potential to disrupt established industries and markets. In these directions, this phenomenon has become popular, and many SE-based platforms have been created by following Uber and Airbnb models (Miller et al., 2016).

From a theoretical point of view, technology-based experience providers can be viewed from different perspectives (e.g. transformative service research (TSR) or service-dominant (S-D) logic). TSR analyses how the relationships between the providers and stakeholders of an experiential network (e.g. providers, partners and consumers) influence the outcome value created for both (Anderson et al., 2013). Additionally, according to the S-D logic, value co-creation should impact the stakeholder network system (Vargo and Lusch, 2016; Ramaswamy and Ozcan, 2016; Brodie et al., 2016), and SE platforms could help the exchange of information among different stakeholders (e.g. providers and customers) at different levels within the network.

From a managerial point of view, these service innovations tend to affect not only final consumers but also a range of other stakeholders that appear in various ways along the journey (e.g. technology providers, commercial partners and consumers). To implement a successful experience-based process, an integrated value co-creation approach is required, particularly a process oriented towards the value created at the micro level (e.g. consumer), the meso level (e.g. network) and the macro level (e.g. community).

2.3 Theoretical speculation

This study attempts to extend the service management literature by conducting a service innovation study that considers the use of an SE-based platform as an enabler of value co-creation at different levels (micro, meso and macro). As affirmed by Gummesson and Mele (2010), interaction and co-creation in networks strive to improve service systems through a better matching among resources, processes and outcomes. Thus, the exchange of value among providers and customers would be helpful for the best application of new technologies and should be welcomed and encouraged (Payne et al., 2008; Vargo et al., 2008; Ramaswamy and Ozcan, 2018). Digital technologies offer different benefits to all players in terms of the speed and security of information (Hashem et al., 2016; Lenka et al., 2017). Moreover, information derived from an SE-based platform helps actors to develop more suitable business approaches and analyse industry competitive trends, opportunities and threats. For instance, the exchange of value has become essential in the development process in the healthcare industry; indeed, the use of ICT solutions guarantees the fluidity of communication that involves public and private actors (e.g. customers, physicians and policy makers). The World Health Organisation (WHO) contends that to promote and guarantee greater health and well-being in a sustainable way, the public health approach must involve working with other sectors to strengthen and integrate public health services and reduce inequalities. Thus, SE-based platforms represent a great example of how a virtuous network of private and public players may overcome the service gap derived from a public healthcare management system. In Italy, for example, where healthcare is entirely public and its management is decentralised to the single regions, private organisations using SE-based platforms may help regional systems in reaching all citizens.

In addition, digital health is changing the concept of well-being in daily life (Zainuddin et al., 2013). Currently, the health research and innovation in the field of new technologies is very broad and leads to the creation of new global markets. For these reasons, the health business model will be tailored to become more customer oriented (Robbins et al., 2013).

By drawing on the three different purchase stages (pre-purchase, purchase and post-purchase) of the customer experience conceptualised by Lemon and Verhoef (2016), we can develop some theoretical speculation about how SE-based platforms can support the innovation of the service experience and co-create value. We adopted Lemon and Verhoef's (2016) study because it is one of the most informative conceptual frameworks in the service management research regarding the different steps of the customer journey.

For these reasons, the support of SE-based platforms for value co-creation in service management can be resumed in two directions. First, it can improve customer satisfaction (micro level) by helping to make several benefits (e.g. reliable services) and outcomes (e.g. traceability of the system) available during their pre-purchase stage of the service experience. The digitalisation of information is increasingly improving data collection and making it more difficult to manage and understand as a whole. Firms can more proactively design innovative solutions (e.g. innovative touchpoints) to increase process quality and to meet customer needs during the purchase stage.

Second, each actor involved in the network (meso level) must adapt his/her tactics and business processes and even redefine his/her services to quickly seize new opportunities for managing the value and sustainability of digitalisation. Thus, business process redesign also depends on the use of ICT-based solutions (especially data interchange) to create business relationships. Organisations increasingly rely on developing digitalisation capabilities to find new forms of interaction and co-create value with their customers during the purchase and post-purchase stages. This final step is fundamental to redesigning the service experience from a value co-creation perspective to create a collaboration system between organisations and people within the community (macro level).

3.1 The case of Saluber: background and setting

This research explores the healthcare network managed by Saluber, a company that specialises in health logistics services, via a digital platform based on SE principles. As described on the platform's official webpage, “Saluber is a digital platform that wants to help your business improve the way you manage your client's rides” https://www.saluber.me/en/home. This digital app was developed by the new-co Bourelly 4.0 SRL, which is devoted to presenting innovative projects and was awarded the SMAU 2018 innovation prize. Although this SE platform has not yet been put on the free market because it is currently being tested in the Campania region (south of Italy), the Saluber app has been approved by Bourelly Health Services (the app's first logistic partner). The app allows users to book, geo-localise and follow the entire customer journey and the service performed through a tablet or a mobile phone. It provides three types of services, namely, medical transport, disabled transport and home assistance.

Thus, through this sharing of means, this innovative solution places onto the same network different organisations that on their own, could have difficulty managing the customer journey and that do not provide the same services. Specifically, the network created by this sharing economy platform comprises (1) “intermediary centres” that include different types of healthcare organisations, such as private clinics or pharmacies; (2) “carriers” that are intended as companies with a vehicle fleet for non-emergency medical transport or disabled transport; and (3) “healthcare professionals” such as doctors, physiotherapists or nurses. To manage the customers' requests, the adopted criterion is related to the vehicle/healthcare professional closest to the request. Because of a technology based on geo-referencing, users, whether consumers or businesses, can conveniently book the interventions that they need at their preferred intermediary centres and receive the chosen service directly at home.

3.2 Research structure

Through a qualitative research approach based on primary and secondary data, we used multiple sources of evidence for the triangulation of data (Yin, 2017), and we organised the case study analysis into four phases. We collected information from (1) archival records and physical artefacts (e.g. digital platform characteristics) provided by the official website at https://www.saluber.me/, (2) personal interviews, (3) participant observations and (4) online documentation such as reports, statistical data and specialised press articles (Table 1).

As a primary source of data, we conducted 15 interviews with the various actors involved in the network. Through a semi-structured questionnaire, we requested information on the three main Saluber actors (the founder, the platform developer and the key account manager), three intermediary centres, three carriers, two doctors, one physiotherapist and three customers who used the healthcare services (Table 2). The personal interviews comprised open-ended questions to collect the perceptions about the usage and benefits of an SE-based platform in the healthcare network. Each conversation typically took 60 min. All interviews were audio-recorded, transcribed verbatim to facilitate the analysis and anonymised.

Afterwards, one of the authors spent a period of one month (July 2019) in the field to participate in Saluber activities and to record observations and data. The aim was to understand the service design and how this process could contribute to the co-creation of value at different levels (micro, meso and macro). As secondary sources, several media publications and official reports from January 2019 to September 2019 were also analysed to understand the impact of Saluber solutions and their influence in co-creating value in the healthcare system.

The analysis practised an iterative and inductive approach. The inductive theory based on qualitative data is considered to be appropriate in an understudied empirical environment in which there is relatively little prior work (Bansal et al., 2018). The multiple data elements furnish a stronger demonstration and consistency of the key objectives of the case study. Although multiple sources of evidence (e.g. personal interviews and online documentation) are different and independent, their combination can be fundamental to scholars as complementary perspectives of the phenomenon may be produced. Therefore, personal interviews, archival records, media publications and other evidence were triangulated and analysed through a thematic analysis (Braun and Clarke, 2006). We considered the research question to code, and we associated the emerging themes based on the space within each source of evidence (e.g. personal interview). The software NVivo 8 was implemented to identify the emerging themes through a word frequency analysis. However, argument modelling that uses thematic analysis might result in some words being associated with more than one emerging themes; thus, we screened the emerging elements and synthesised the findings into the following three main points of view: (1) the customer experience at the micro level, (2) the business processes for the network of healthcare organisations (HOs) at the meso level and (3) the social service experience within the community at the macro level.

Finally, the evidence is classified according to the specific steps of the value co-creation processes to which they refer. To clarify the research context and the main services provided by the SE-based platform, the proposed research method also explains and strengthens the key information of the selected case study in the next section.

4.1 Effects of co-creation through a sharing economy at a micro level: the customer experience

The attention to customers' experience during their entire journey is increasingly important in a network created by a digital platform based on the principles of SE. These types of platforms provide several benefits across the full spectrum of care. By focusing on the healthcare network, we identified three stages of the customer experience. First, the SE acts at the pre-purchase stage with the customer request, which may refer to a search for the nearest available vehicle for an immediate intervention or to book a vehicle for a specific future date and time. The first relevance of value co-creation is demonstrated by the SE-based platform that can provide three main services, specifically, (1) non-emergency medical transport (in case of resignation, hospitalisation and transfers), (2) disabled transport (to request a vehicle approved for people with disabilities) or (3) a home-care service (to book an intervention at home by a health specialist). Usually, a platform-owned touchpoint (e.g. tablets and touchscreen devices) is provided in the intermediary centre structure. Once the customer chooses the desired service, we identified the reliable services to extract useful data for the intervention as follows: personal information; the customer's telephone number, to which the SE platform sends a text message with information to track the carrier's GPS position in real time; a service evaluation questionnaire; and the customer's email address so that he/she can receive a summary of the reservation and the final invoice. As affirmed by Saluber's founder, “Our mission is inspired performance across broad indicators of quality, safety and customer experience during his journey”.

These effects contribute to the co-creation of value at the micro level. Furthermore, the sharing economy allows the actors to make the data of the intervention available (Figure 1) and furnishes the customer with information on the most appropriate vehicle for his/her intervention. By using SE-based platforms, customers can benefit from the traceability of the system through a geo-localisation-based system because they can input not only the starting address and destination address but also the preferred “stops” for the vehicle (with Saluber, there is a minimum threshold of 1 h to fulfil all customer activities).

Regarding the price element, the SE offers the most advantageous option for the requested transport, as detailed by the Saluber platform developer: “Saluber always guarantees the lowest price to its customers with attention to their needs. We allow intermediary centres to accept payment in three different ways: (1) credit card, for payments managed through the POS device provided on loan; 2) cash, with reference to payments taken over manually by the operator who takes care of the booking; and 3) debit, for payments for which the intermediary centre is responsible, indeed, in this case, the payment is managed with separate invoicing”.

At the purchase stage, when the payment is made, the SE-based platform can provide a countdown timer that indicates the time available for the carrier to accept or reject the customer's request. If the time available expires, the request is automatically rejected, and the system searches for another vehicle that can carry out the intervention. Thus, the customer experience in the SE-based network can improve in terms of the availability of information and the speed of services. Referring to the intervention process in the healthcare network, Saluber's key account manager said, “Saluber allows you to quickly identify the status of each intervention by using specific colours on the screen: blue for on-going interventions; orange for when the customer is arriving or leaving the intermediary centre; light blue for interventions that are scheduled for the day but that have not yet started; green for when the interventions are finished and therefore the customer has arrived at his destination; and grey if the intervention has been cancelled”. Once the intervention starts, the carrier can communicate on the screen when the customer has reached the destination for which the service was requested.

Finally, the relevance of the SE is seen in the post-purchase stage when the customer decides whether he/she wants to be dropped off at his/her house or monitored, with 24-h assistance. Through this redesigned healthcare service, customers can benefit from the use of technological tools and can book an on-demand ride or schedule one based on their needs. As affirmed by a customer during his journey, “I'm able to monitor the status of each ride, from pick-up to drop-off, with the carrier's information in real time thanks to the traceability of the system”.

4.2 Effects of co-creation through a sharing economy at the meso level: the business processes for the network of healthcare organisations

The recent pandemic explosion of COVID-19 is calling entire governments to redefine their approach to healthcare (http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic). Furthermore, the current healthcare landscape is generating complicated data to manage; HOs use innovative solutions (e.g. a digital platform) to manage the vast array of data to extract the important pieces of information that can change their healthcare services and decision-making on their business processes. The portfolio of services offered by the SE platform positively impacts and transforms critical points in healthcare by using a unique network to create value for all the different stakeholders involved. As described on the official platform webpage (the brand-owned touchpoint), “Saluber helps to increase the volume of your business by becoming part of a network in continuous growth” https://www.saluber.me/en/home.

By using the principles of an SE, the effect of co-creation is evident when the platform places into the network different structures (e.g. clinics and pharmacies) that do not provide the same services but may need to use mobility services and establish long-term business relationships. For instance, one of the key benefits is the possibility of offering blood transport, which is a frequently discussed topic among analysis laboratories in the Campania region, where there are central laboratories to which collection laboratories (small laboratories) need to transport test tubes. For this reason, the blood transport service is optimal and shows that transport is beneficial not only for customers but also for HOs. As affirmed by the director of a private clinic, “There is the possibility to increase your business by expanding the range of your services. There is also the possibility of networking with people who do not belong to the same group but [are] of different groups with whom there are collaborative relationships and activities. The benefits refer to the geo-localization of the service and the possibility to expand our business processes within a shared network”.

The use of the SE in healthcare services was met with great enthusiasm by all the actors involved in the network. In Italy, the national health service is regionally based, with local authorities that offer the possibility to book the use of non-emergency medical transport some days before the established date through the intermediary centre. The weakness is that family doctors can make the prescription for only a single non-emergency medical transport, not for repetitive medical transports in “cycles”. Thus, SE-based platforms could be a solution to the co-creation effects derived from the platform-owned touchpoints (e.g. a tablet used to book the service is on loan for free for one year). Intermediary centres make them available to customers to book and design their transport services. In this case, value creation occurs for the network, including intermediary centres, customers and SE companies. For these reasons, HOs’ business processes can be redefined because the SE also offers the possibility of having mobility services available that can meet the needs of disabled customers or the elderly or infirm who do not have friends or relatives to accompany them.

Thus, participation in this network allows a diagnostic centre to redesign its business processes to increase process quality. Diagnostic centres usually do not offer transport services because they are concerned with performing laboratory tests (e.g. food allergy tests or breath tests) or diagnostic radiology (e.g. ultrasounds). HOs that participate in the SE-based network promote on their websites in the pre-purchase stage the option to transport customers. As affirmed by the administrative manager of an intermediary centre, “We have the possibility to offer a transport service for our customers. From the tablet, the request is routed to the smartphone of the carrier closest to the pick-up location. The service can be booked either live (directly, so ‘I need an ambulance now') or scheduled on a date to be allocated for the scheduled intervention”. The customer can use the legal and traceable transport service for several intermediary centres. Thus, a private clinic or a pharmacy offers this additional service, which provides them an advantage over other organisations.

4.3 Effects of co-creation through a sharing economy at the macro level: the social service experience within the community

An SE-based platform in a healthcare network can act as a social service organisation to support the customer in the post-purchase stage within the health community. Through back-end solutions that use vast amounts of data, SE-based platforms allow for action from a social services perspective. In fact, a first co-creation effect comes from the established network that can closely follow the citizens who belong to vulnerable groups to, thus, avoid unnecessary hospitalisations, which provides obvious economic savings and an improvement in the quality of life for the people in these categories. Once a customer returns home, Saluber identifies the availability of 24-h services for specific cases. A detailed analysis by Saluber's founder is given as follows: “Saluber fits into the community with a great social role. With the increasing average age of the population, we have many elderly people who often have access to health services, who have disabilities, or who do not drive a car, or who have difficulties because their families cannot accompany them. Saluber puts the citizen/customer in the condition, through the intermediary centre where he must go for health services, to have easy access to a form of transport. The social role is very important, and traceability makes this service very secure and accessible”.

The SE-based network provides healthcare professionals with a limited number of cars that can be used for home assistance. For instance, if a physiotherapist does not have a private car, the SE platform offers the practitioner a newly registered vehicle. “Saluber is also a wonderful social service experience. I used a Volkswagen Up for my first home assistance in the heart of Naples. It was an electric car with low environmental impact”, said an interviewed nurse. Thus, the message launched by this renovated and innovative scenario is the following: “I will protect your health and the health of the planet”. Other related evidence emerged from the key account manager: “We offer daily pampering that others do not offer, and that is why our customers are loyal. I will never see a person as a number, we see people as individual entities. We collect data. If you use the service a second time, I know who you are, what your name is, what pathology you have and what treatment plan you follow, who is the person who accompanies you, etc. If I collect data, I know the person very well and I can personalize the service based on the individual customer”.

Another key relevant factor that testifies to the social role in the post-purchase stage within the community is the installation of specific measures to monitor each customer or offering psychological assistance to improve the customer's social life. An SE-based platform can link clients to community services to offer a support program and social care in the cases in which the disease can affect the emotional aspect of the customer. Value co-creation derives from monitoring the real-time data of customers' clinical and social practices with two primary benefits: first, clinics can suggest an ad hoc advice to customers, and second, they can still creatively think of organising future social needs in an effective way. The aim is to expand the journey beyond the intermediary centres' walls (e.g. clinics, pharmacies or points of interest) and following customers with social care 24 h or helping them to enter into social service organisations.

Among other factors, we identified that this form of interaction includes increased investment in the field and an effective co-modality in the creation of innovation networks that promote the well-being of all actors within the community (Figure 1).