Marketing sciences suggests that, with the maturation of the (digital) service economy, the notion of economic exchange, core to the economy, has shifted from following a goods-dominant logic to now following a servicedominant logic. Key to service dominance is the notion of value in use rather that value in exchange. Value is seen as being created in a process of co creation, involving resource integration. To design, and evaluate, different design options for value co-creation scenarios, a modelling framework is needed to capture such scenarios. The development of this framework is driven by different case studies. This paper is concerned with early results concerning one such case study in value co-creation, in terms of the ParkinsonNet concept for improved healthcare for Parkinson patients (and their family) as pioneered in the Netherlands.
Western countries have seen a transition from a goods-oriented economy to a servicesoriented economy. Most, if not all, services delivered in the service economy are actually digital services in the sense that they are obtained and / or arranged through a digital transaction over information networks [16, 12]. As such, IT is also generally seen as being the key enabler of the (digital) service economy [11].
Marketing sciences [14, 4, 13] suggests that, with the maturation of the (digital) service economy, the notion of economic exchange, core to the economy, has shifted from following a goods-dominant logic to now following a service-dominant logic. Key to service dominance is the notion of value in use rather that value in exchange. Value is seen as being created in a process of co creation, involving resource integration, also further blurring the distinction between consumers and producers.
Combined with the digital transformation, the shift towards service dominance,
results in the creation of what might be called digital service ecosystems [
To ensure that such investments remain controllable, to manage coherence [15], to ascertain if key quality concerns (e.g. sustainability, security, privacy, flexibility) are met, etc., one generally suggests to use an design / architecture oriented approach [6, 9]. Such approaches typically involve modelling frameworks covering different aspects / perspectives of the enterprise / digital service ecosystems, while also maintaining coherence between these aspects / perspectives. Examples include ARIS [10] and ArchiMate [5].
As argued in [8], for value co-creation, it is important to take a holistic perspective of the digital service ecosystems and its context. Concerns, such as sustainability, equity between partners, etc, can only be considered sensibly at the level of the ecosystem as a whole. During last year’s VMBO, we reported on work done, in the context of the ValCoLa project, towards the development of a modelling framework language for value co-creation [8], in particular the strategy we aim to follow in the development of such a framework. One of the key messages was the need to use case studies in the development of such a modelling framework. Contrary to e.g. the development of ArchiMate [5], there is not (yet) a rich experience in the design of value co-creation driven digital service ecosystems.
In line with this, the remainder of this paper is concerned with early results concerning one such case study in value co-creation, in terms of the ParkinsonNet4 concept for improved healthcare for Parkinson patients (and their family) as pioneered in the Netherlands. 2
Background
Parkinson’s disease is a common and disabling neurodegenerative disorder [
The concept of a ParkinsonNetwork has introduced a new way of care, where
“specialised professionals and engaged patients work together to try to achieve optimal
outcomes” [
munity based care, e patients’ homes nts of the ParkinsonNet vidence based recommendations s based statements onnet.nl/parkinson/ tlijnen) linary—for physiotherapy, apy, occupational therapy, d nursing home care linary—includes a consensus el for regional and transmural n of multidisciplinary care and is le in a patient friendly format a restricted number of motivated providers rral d physicians funnel referrals kinsonNet experts to increase ad through use of standardised s with referral criteria ining of participants in treatment 4 days) the job: increase experience by ny patients interaction and information etween participants through ational conference, regional inary meetings (at least twice participation in web based d regional communities ree to work according to uidelines about quality of services and es hed in the Parkinson Atlas (www. tlas.nl) d approach , through use of guidelines , web based communities for rsonal digital community, and a tred questionnaire (PCQ-PD) echnology platform: website (www.ParkinsonNet.nl) search engine (www. orgzoeker.nl) communities for patients and ls (www.MijnParkinsonzorg.nl) ealth record with decision optimal outcomes”, which entails patient participation, empowerment, and self manbmj.com/podcasts agement, combined with the use of information tech!nBoalsotgiayantBolodemrivneanadnMdarskuopvapnodrte,r Vtheget network. Figure 1 depicts the medical disciplines, asdiisdcuesnsttihfiisedanianlys[is1p],aptheraitn aarpeod(cpaosttentially) involved in healthcare for Parkinson’s disease.
Geriatrician
Patient and family
Fig 1FDiigs.c1ip.lDiniessciinpvlionlveesdi ninvothlveecdarienotfhpeactiaernetsowfiptahtPieanrktsinwsoitnh’sPdairskeiansseo.nTshodsiseeiansteh,etaceknetnraflrtormian[g1l]e are involved consistently; other disciplines can be engaged as needed ef ectiveness and complications for the various positive, showing an increase in Parkinson spetreatment options in advanced ParkinsPoanr’ksidnisso-n network puts the patient (and their family)
As Figure 1 also illustrates, a cifi c knowledge among participating therapists, ecaesne,traalllo,wwihniglethdeimffteorepnatrtriceilpeavtaenitnhmeaakltihngdaisnciplines, administrative actors, etc, contribute a better adherence to the treatment guidelines, intofortmheedndeeecdiseidonh. eInalatdhdictaiorne.paHtieeanlttsharceagriveenprofaenssdioanmalosreatrheanthseenveenxfopledcitnedcreoansetihneacnrnousasl tsheecotpiotinonbeotfwheaveinngthceoinrsduilstactiipolninseinatnhdeiProarwkninsopnadtiiesnetasveo.lume for ParkinsonNet therapists homeTshtherocuogmhbsiencautrieodnvoidfeoa lninektsw. ork, the focuscoomnpathreedcwoi-thcrceoanttiroonl tohfer(ahpeisatlsthbe)twvaeleune2b00e-3 tween patients, family, and health professionaalnsd,a2n0d06th.1e8 ProalrekionfsoinnfNoertmcoavteiorangteewchansoglroadguyDtoevbelroinpgmethnetapnadrtimiepsletomgeentthaetri,onmoafkes the creaatilolynexotfenPdaerdk,inacshoinevninegtwnaotrikosnwaindeincotevreersatgienign gcuaisdeelfionersthe ValCoLa project. 2010. There are now 66 regional networks with TreatTmheentingiutidaetolirnsesofotrhpehDysuiotcthePraapriksitnsswoenrNeet 2a9lr7e0a dtryaihnaed pthroefeidsseiaontoalsgfernoemraalwisiedethreancgoeno-f dceevpetl.oBpeodthbyinatnearmtiosnoafl prea-naeplpolfypihnygstiohtehmeroa-del diniscoitphleinrecsofuonrtarrioeusn,dbu5t0a0l0so0 tpoatgieenntesr(afilgisuerei)t. piinstosaandgenneeuraolohgeisatlstwhcitahrexcpoenrtciseepitntthraeattcinoguld Tbheebleanrgeefisctiaglrotuoppsaitniecnlutsdewpithhysoitohtehrerfaoprmistss Poafrkcihnrsoonnipcadtiiesnetass,ea,nsduscuhppaosrAtedlzbhyetihmeeDr’ust.ch (n=1022), occupational therapists (n=392), Parkinson Patient Foundation and the Royal speech-language therapists (n=379), dietitians Dutch Society of Physiotherapy. The guidelines (n=156), nursing home physicians (n=129), a3re baAsepdponrsocaiecnhtifi ac nevdidiennciet,iasulprpelesmuelnttsed and specialised Parkinson nurses (n=76). The with practice based evidence generated by con- only professionals not yet part of ParkinsonsIennsduesvmeleoeptiinnggstahmeoPnagrkeixnpseornts.n1e7tOwthoerrkg(su)idcea-se sNtuedtayrweneeaulrsoosuorbgseeornvsea(dn)dtgheerinaetreidciafonrs;vtahleusee lcinoe-scrweearteiotnhebnedtwraewenn uthpebyressiemairlcahrncaotmionmaul nitideissciinpvlionlevseadr.eWschheerdeutlehde tVoableCtorLaianepdrolajetecrt. enxepeedrtepdaancealss(easgtauindys,utphpeoPrtaerdkibnystohneNpeattwieonrtks hGaevneeraalnpereadcttitoiobneetrtsearruenndoetrpsltaannndedthteo be part workfionugnsdoatfiosnucahndnreetlwevoarnktsp,raosfewsseilolnaasl omrgaakneistah-eir odfePvaerlkoipnmsoennNt esttrbaetceaguisees tmheoyrehaevxeplliitctliet.dTirhecet tions) for speech therapists and occupational involvement in Parkinson specifi c management therapists and to define best care in nursing decisions and therefore do not need to receive homes and by nurse specialists (box). specialised training. Nevertheless, they have an important generic role in overseeing comorbidity and polypharmacy, and in referring patients to specialised members of the network. We therefore ensure that GPs know about the existence of ParkinsonNet and the healthcare fi nder, to structure the referral process.
Implementation of regional networks The first regional network was established in 2004 in the catchment area of the cities of Nijmegen and Arnhem, and initially included 19 physiotherapists, nine occupational therapists, and nine speech-language therapists (selected on the basis of personal motivation,
Making the most of information technology N c e D p P s s ide rse v f o e r R P e r a C s r e f e R s r e f e R s i s o n g a i D n e m t a e tr l a iit n I h c r a e s e R t ceh isp e ra p e S th th lsa l a n he iso d s ie fe lA rp o t n e m t a e r T g n i n i a r T s e d i v o r P l a n t io is t p a a p r u e cc th O t s i g o l o r u e N ilna se icp lin e is d td iu i l g u M y p a r e th s l en a li n e y rap se the li n e io d ysh iug
P P c s e c o r p h lt a e H n tn ito e u it i b a tr P n o c a
P initiators of ParkonsonNetworks have a need to use such insights and / or capitalise on their own experiences.
Condering the broadness of the stakeholders involved in the “running” and
“growing”, of a ParkinsonNet, it is key to take a value co-creation perspective, thus ensuring
that the goals of all relevant stakeholders are met sustainably. This resulted in the
strategy to:
1. At a generic level identify:
– generic stakeholder types for ParkinsonNetworks,
– generic potential value flows between the stakeholders,
– any generic “rules of the game”.
2. At the more specific level (of a specific network) identify / specialise:
– specific stakeholder types for ParkinsonNetworks,
– specific potential value flows between the stakeholders,
– specific “rules of the game”?
3. Articulate growth strategies:
– How to grow a sustainable ParkinsonNetwork?
– Are there different stages?
– Different roles of stakeholders during different stages?
– Is it possible to make changes to the rules of the game?
An example, of a “rule of the game”, and how this may differ between countries, is the
fact that in the Netherlands, health insurance companies provide a better coverage of
the costs, when patients use a health professional from the ParkinsonsNetwork. Based
on experiences within the network, there is evidence that the overall costs of
Parkinson disease related health care is lower when patients receive care via the network [
From the perspective of the ValCoLa research project, answering the above questions also provide(s/d) insights into the modelling concepts needed in a modelling framework for value co-creation.
For the identification of stakeholders, Figure 1, as provided in [
In identifying the typical stakeholders and their goals, we soon realised that there where goals (and even stakeholders) that pertain to the running activities of the network (e.g. patients needing care, health care professionals looking job satisfaction by being more effective in providing healthcare, etc) and those that pertain to growing the network (e.g. insurance companies, governments, health care organisations, etc).
The overview of the relevant stakeholders, at a generic level, is shown in Figure 3. For each of the arrows shown in Figure 3, a further analysis was made (at the generic
Parkinson network level) regarding the potential value flows between the involved actors. An overview of this analysis is provided in Figure 4.
The inclusion of re-usable, value co-creation driven, strategies to grow
ParkinsonNetworks results in a need to have a framework to “codify” such strategies. To this
end, we will use the underlying structures as used in the ISPL (Information Services
Procurement Library) [
Conclusion and next steps In this paper, we discussed the early results of an ongoing value co-creation case study,vin terms of the ParkinsonNet concept for improved healthcare for Parkinson patients (and their family) as pioneered in the Netherlands.
We are now in the process of (1) better documenting the potential stakeholders
and their potential value exchanges (based on a literature study on papers dealing with
the development of Parkinson networks), (2) more broadly validating these with the
domain experts, (3) making the “reasoning structure” used in ISPL [
Job satisfaction PD Patients Expertise Cooperation Health Professionals Career advancement possibilities
Money
Costs Transparency Community Travel time Intimacy
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