Customers as resource
integrators: styles of customer cocreation
Janet McColl-Kennedy
Steve Vargo
Tracey Dagger
Jillian Sweeney
Janet McColl-Kennedy
Professor of Marketing, Research Director
UQ Business School
University of Queensland, Australia
2009 Naples Forum on Service Capri, Italy 16-19 June
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background
• Traditional wisdom says value is created by a
producer and purchased for consumption
• Consumer behaviour literature has focussed on
the consumer’s decision making process rather
than on what they customer does
• More recently, the producer-consumer model has
begun to be replaced by a model of co-creation of
value
• That is, where value is created through joint
activities of providers and customers but also
through the activities of others in the networks of
these parties (McColl-Kennedy et al 2009)
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background
• shift towards a model of co-creation of value has
roots in service –marketing literature (through
production and consumption being inseparable
(ZBP 1983) and B2B where the producerconsumer distinction is inappropriate
• But also Prahalad and Ramaswamy (2000) HBR
• Vargo and Lusch 2004, 2008
– idea of co-creation of value is part of an evolution
toward a general re-orientation of marketing, value
creation and exchange – ie S-D Logic
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research purpose
• To investigate empirically a service
provision process to tease apart multiple
approaches to co-creation and suggest a
schema
• To begin to explore relationships between
co-creation approaches and outcomes
• Healthcare was chosen as the setting as it
provides a full range of co-creation and
co-production activities and styles
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healthcare context
• move from cure to preventative health and
patient self-care which emphasizes the role of
the customer in the medical service delivery
(Roter et al 1988).
• many advantages of inclusion of the customer in
the service process eg.
– reduced cost and increased efficiency of the process
(Jayawardehena and Foley 2000)
– the customer taking some responsibility for the outcome (Auh
et al. 2007; Bitner 1990; Dellande, Gilly and Graham 2004).
– reduce unnecessary health costs
– improve health care outcomes and
– increase trust in and commitment to the doctor (Veranec
1999; McStravic 2000; Michie, Miles and Weinman 2003;
Ouschan, Sweeney and Johnson 2006).
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healthcare literature
• Early literature on participation
showed that participation in an
interchange leads to positive
outcomes (Vroom 1960)
• Compliance – taking medications
• Involvement in decision making
• Coping literature
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overview
• Positioning –
– the research is positioned within S-D
logic in a healthcare context
• Part of 3 year ARC linkage project
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contribution
• 1. using 20 interviews and 4 focus groups
represents the first in-depth empirical
investigation of multiple approaches to cocreation of value
• 2. identify range of activities (behavioural
and cognitive) and six styles
• 3. some styles associated with high quality
of life, others with relatively low quality of
life
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definition of co-creation of
value in our study
• Unavoidable, multi-party nature of value creation
• “joint activities in collaboration with members of
the service delivery network which may include ,
family, friends, other patients, health
professionals and the outside community ”
Community
• Essential features:
– Activities are defined as “performing”
or “doing”
Others
– Doing has 2 components:
• cognitive + behavioural
– Involves some effort on part of
Self
customer
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definition of co-production
• The less compulsory, more effortful
involvement of customers in the
process such as in design, selfservice and other extra-curricula
activities
(ie the activities traditionally
undertaken by the firm)
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conceptual framework
• Customers can no longer be regarded merely as
passive recipients of services
• Customers play an active part of production and
delivery of services (Prahalad and Ramaswamy
2000)
• Yet, little research has addressed the customer’s
role – what the customer actually does
• Payne etal. 2008 provide a useful framework –
emotion (feeling), cognition (thinking) and
behaviour (doing)
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Payne et al., 2008)
• Centrality of the process in value
creation
• Longitudinal nature
• Recognises the customer as ‘feelers’,
‘thinkers’ and ‘doers’
• Recognises that the customer
engages in activities (practices) and
that value (to the customer) is
embedded in these practices
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gap to be addressed
• Yet, little is known about how
customers actually go about doing
the co-creating (Payne et al 2008)
• Little is know about how customers
integrate resources (Vargo and Lusch
2008)
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qualitative stage
Study 1
• Cancer one of seven National Health Priority
Areas
• Increasingly ageing population, higher prevalence
of cancer, increasing reliance on services devoted
to cancer including ambulatory Industry partner –
HOCA (Haemotology and Oncology Clinics of
Australasia)
• Two Cancer day clinics
• 20 in-depth interviews with patients
• Different stages of the patient treatment
process – 1, 3, 6 and 12months
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method
• Data collection took two years across 2
clinics
• Depth interviews with CEO, oncologists,
Director of Nursing as well as supervisors
of the clinics receptionists
• Participant observation at the two clinics
• 20 depth interviews with patients (either
at the clinic or in their own home)
• Discussions flowed like conversations
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method
• 175 pages of typed transcripts
• 3 researchers plus research officer read
the transcripts
• NVIVO – using one researcher
– Traditional content analysis – two other
researchers acting entirely independently
– Lincoln and Guba’s (1985) constant
comparative method
• Themes were then listed and categorised
using the constant comparative method
(Lincoln and Guba, 1985)
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results - 10 themes
(activities)
• 8 behaviours
– Information use clients accepting, seeking and sharing
of core service information sent one-to-one, one-tomany, many-to-many
– Action relating to core services – client activities that
facilitate core service provision
– Additional health activities –
– Participation in non-essential (supplementary) eg diet,
exercise, alternative therapies
– Distracting with activities – distracting from realities
eg overseas holiday, hobbies
– Organising/managing practicalities of life
– Managing the practicalities of life in the circumstances
(eg keeping a diary, setting goals, time activities)
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10 themes (activities)
• 8 behaviours (cont)
– Managing physical identity – managing
physical appearance to maintain sense of self
(eg wig, make up)
– Relationships – client putting effort into
relationships with stakeholders (eg friends,
family, broader community)
– Regulating emotions – form of behavioural
management of emotions for sake of
interpersonal relationships (eg
protecting/supporting family, avoiding negative
situations)
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10 themes (activities)
• 2 thinking activities
– Positive thinking –choosing positive
emotions and applying them (eg self talk)
– Being philosophical – assessing the situation
in terms of a critical and generally systematic
approach which relies on reasoned argument
(eg accepting, dealing with it and moving on)
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co-creation styles
• 6 profiles
– Team manager
– Passive compliant
– Isolate controller
– Partner
– Spiritualist
– Adaptive realist
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team manager
• typified by Linda and Barry who manage their ‘team’ which
includes staff, friends and family.
•
– Linda believes in a team approach which she coordinates. She
says “you do it”, you don’t leave it up to fate, God or the
doctors. Rather, she with her team will make it happen.
– She has a circle of support people and is very open in her
communication with her team. For example:
“You do it on your own and there is no other way for it to be and
you have to do it on your own, I think you have to. It is not just
about inner strength …, I have still showered myself…I think that
it is very important just to have a sense that you are doing
something for yourself. But I have a support team…my husband
and my sister are really the center of my support then it goes out
in concentric circles, the there is my children, …then the Bahai
community and of course my parents… I discuss everything with
everyone.” (Linda, 52 years)
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passive compliant
• The “Passive Compliant” first and foremost follows orders.
They are accepting of what the doctors tell them. They do
not tend to question the doctors.
• They tend not to take initiatives, such as searching the
Internet for more information, going to a gym, changing
their diet. The “Passive Compliant” often will stay close to
home as they feel safe there. They see little if any choices.
• Mary is an example of this profile. She is accepting of what
the doctors say.
• “I am fairly accepting …there are not many choices, no no,
the only real choice was do you want your chemo this week
or would you want to put it off a week…but otherwise no,
this is what we want to do and I am reasonably compliant
so I just said (to the doctor) you know best….I prefer to be
at home… …I potter in my garden. You have to be pleasant
and accepting of what they have got to do and you have to
get yourself there on time even though you might have to
wait. So just being compliant.” (Mary, 60 years)
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passive compliant
•
“My role is to front up every two weeks, and just probably proceed
to treatment” (Neil, 65 years)
•
“ you don’t feel in control…the doctor teed up the other two
specialists for me and I felt good about the amount they (doctors)
knew and shared….Whenever I did see him (family doctor) he
knew what was going on…It is such standard treatment in so
many ways…its what every woman after breast cancer gets…I see
him (the oncologist) each time or a say someone else…I didn’t
have any questions or whatever…you can’t control, well I chose
not to control what treatment I underwent …that was passive
…you have so many tests…you are not in control.” (Tina, female,
45 years)
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isolate controller
• keeps themselves away from close family members and
chose to work with only certain medical staff.
• like to be alone and not to share their feelings and
problems with others.
• restrict the amount of details they tell others about the
illness, symptoms and problems they are experiencing.
• They would rather do things themselves, such as taking
vitamins, doing exercise, diet, being generally healthy.
• I make their job easier to make sure that I am as healthy
as can be apart from what we have to deal with as far as
cancer goes…I ate well, I slept well” Regarding her
mother, Christine said, I had to be very careful what I said
to her because it would get broadcast that night, email
right around, right around, and then I would get emails the
next day, and I would just have to answer emails…so I
have sort of kept them at a distance.” (Christine, Spring
Hill, 49 years).
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isolate controller
• Deluce has her own recovery program with a
team of people that she has selected including an
oncologist, surgeon, dietician, psychologist,
personal trainer and gym instructor.
• She believes that the power is with her and that
it is up to her to get her team together.
•
“You’ve got to start your own health program and your
own exercise program so I’ve now got on board my own
team which include obviously my GP, my oncologist from
HoCa, my surgeon who did the work, and my dietician and
my psychologist, my gym and in the next few weeks
hopefully a personal trainer might get on board. … but all
that’s come from me … I feel as though that’s my own kind
of recovery program that I’ve put in place.” (Deluce, 46
years)
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partner
• partners primarily work with the doctors and other service
providers
• “working with” her doctor, being engaged in the process, “because
it’s a partnership”, “I’m working with her (doctor)” and “pulling my
share of the weight”.
• “I’m learning and I'm getting a lot stronger… I can now
think, I can get the doctor's report, radiology report, get on
the Web and I can look up stuff, …if I don't like something
I ask, I went into day with my pen and paper to take no, I
said to my doctor I want you to listen …I went in there,
and so is the first time I really feel in control, …being in
control, yes it is, to be engaged, because it's a partnership,
because I now feel I am of more benefit to her as the
patient as well, the relationship to me is more equal, in
that, I am not a victim. I have never been a victim with a
disease,… I am capable of working with her and pulling my
share of the weight” (Christine, New Farm, 56 years)
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partner
•
“I can do it with him (the doctor)…I share everything with Dr
Paul…I do my part, I try to drink, make sure I am hydrated
because I think it helps your veins and things …I do things that I
can do “I can do everything in my world…with all the support
things and all the psychological support, then the other part can
be dealt with by the doctors.” (Pamela, 59 years)
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spiritualist
• “I’m a woman of prayer, a woman who believes in
God … you know that I believe in, faith and the spirit
… I think I’d prayed every scripture in the bible
[chuckles] and that’s the end of that. God knows
best, he does know best … I had accepted it.
(Yvonne, 49 years)
• Barbara believes in her faith in God and that this is
her main source of peace. She speaks about taking
each day at a time “being carried along on prayer”.
“I am coping today and that’s all I have got to worry
about”. She trusts implicitly in her doctors “I just
trusted the doctors…They checked were you happy
with your surgeon, were you happy with your
oncologist and I said I was always happy.
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adaptive realist
• Life goes on but differently
• “Right now, and when I was diagnosed with cancer I was a single
•
•
mum. …it was only 48 hours from when I was diagnosed to when I
had surgery….the motivation to keep on going was my ten year
old. I had to do all of these things so that I could be around, to see
him grow up.” (Sherryl, 52 years)
Robert - goes to the toilet 21 times in an evening, considers wearing long
pants instead of shorts as he has no bladder control but not once does he
consider giving up his tennis or his golf.
“…so now I can do a lot of things that I did, I can play tennis, … I
remember going to a friend's place one night, the worst thing you
know was white wine, so that, “ I'll just have one glass” oh all
right one glass and that was it…But I have to go to the toilet 21
times some evenings. …so it had its moments. I could still play
golf because there were plenty of trees, but never on a mixed day,
never played mixed golf again. You have to adapt don't you?.”
(Robert, 70 years)
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Relationship to quality of life
• Highest
– Adaptive realist
– Spiritualist
• Relatively high
– Partner
– Team manager
• Relatively low
– Passive compliant
– Isolate controller
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conclusions
• Co-creation extends previous
conceptualisations of both participation and
coping
– Participation traditionally focused on compliance and
decision making
– Coping concerns managing and aiming toward the status
quo
• Co-creation includes:
– Thinking and doing
– Multi-party - involves various other people or groups
– Multiple facets
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moving forward…next steps
• scale development
• application to other health areas eg
heart disease, diabetes
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