=Paper=
{{Paper
|id=Vol-2383/paper11
|storemode=property
|title=Value Co-creation in Parkinson Networks
|pdfUrl=https://ceur-ws.org/Vol-2383/paper11.pdf
|volume=Vol-2383
|authors=Henderik A. Proper,Michael P. T. Alkema,Pierre-Jean Barlatier
|dblpUrl=https://dblp.org/rec/conf/vmbo/ProperAB19
}}
==Value Co-creation in Parkinson Networks==
https://ceur-ws.org/Vol-2383/paper11.pdf
Value Co-creation in Parkinson Networks ∗
Henderik A. Proper1,2 , Michael P. T. Alkema3 , and Pierre-Jean Barlatier1
1 Luxembourg Institute of Science and Technology (LIST), Belval, Luxembourg
2 University of Luxembourg, Luxembourg
3 Radboud University Nijmegen, Nijmegen, the Netherlands
E.Proper@acm.org, M.Alkema@student.ru.nl,
Pierre-Jean.Barlatier@list.lu
Abstract. Marketing sciences suggests that, with the maturation of the (digi-
tal) 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 ex-
change. Value is seen as being created in a process of co creation, involving re-
source 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.
Keywords: Value co-creation, Service Economy, ParkinsonNet
1 Introduction
Western countries have seen a transition from a goods-oriented economy to a services-
oriented economy. Most, if not all, services delivered in the service economy are ac-
tually 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, re-
sults in the creation of what might be called digital service ecosystems [3]. In the (joint)
∗ This work has been partially sponsored by the Fonds National de la Recherche Luxembourg
(www.fnr.lu), via the ValCoLa project.
development / growth of such digital service ecosystems, infrastructural investments
(in people, infrastructures, processes, etc) need to be made by the participants in order
to prepare themselves for the actual co-creation of value. Such infrastructural invest-
ments could e.g. include cultural / knowledge assets, as well as “institutions” in terms
of rules, norms, meanings, symbols, practices, and similar aides to collaboration [13],
social / contractual assets in terms of defined institutional arrangements [13], contracts
with partners in the value web, etc, as well as technological assets such as shared tech-
nology platforms, etc.
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 co-
herence between these aspects / perspectives. Examples include ARIS [10] and Archi-
Mate [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 concern-
ing one such case study in value co-creation, in terms of the ParkinsonNet 4 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 [1]. To im-
prove the quality of care, while at the same time reduced costs, for healthcare for
patients (and their families) suffering with Parkinsons disease, Dutch researchers in
the Parkinson’s domain have pioneered the concept of Parkinson networks. The Dutch
ParkinsonNet has indeed been able to achieve these goals [1], triggering other countries
to try and copy the same model, such as Luxembourg.5
The concept of a ParkinsonNetwork has introduced a new way of care, where “spe-
cialised professionals and engaged patients work together to try to achieve optimal
outcomes” [1]. Key in this is that it introduces a “new “collaborative culture of care”
where specialised professionals and engaged patients work together to try to achieve
4 https://www.parkinsonnet.nl
5 https://www.parkinsonnet.lu
ANALYSIS
optimal outcomes”, which entails patient participation, empowerment, and self man-
bmj.com/podcasts
Net has succeeded in agement, combined with the use of information technology
! Bastiaanto driveand
Bloemn and support,
Marko the
van der Vegt
re away from institutions network. Figure 1 depicts the medical disciplines, asdiscuss this analysis
identified paper
in [1], thatin are
a podcast
(poten-
mmunity based care, tially) involved in healthcare for Parkinson’s disease.
he patients’ homes
ents of the ParkinsonNet Neurosurgeon Speech language
Psychiatrist therapist
Geriatrician
evidence based recommendations
Physiotherapists
us based statements
General practitioner
sonnet.nl/parkinson/ Pharmacist Occupational
htlijnen) therapist
plinary—for physiotherapy, Patient
and family
rapy, occupational therapy,
nd nursing home care
Neurologist and Parkinson Nursing home specialist
plinary—includes a consensus nurse specialist Rehabilitation specialist
del for regional and transmural Sex
on of multidisciplinary care and is Social worker therapist
ble in a patient friendly format
Expert centre Dietician
f a restricted number of motivated Patient foundation
Home care (Neuro-)
providers psychologist
erral
nd physicians funnel referrals Fig 1Fig.
Disciplines involvedinvolved
1. Disciplines in the care
inofthe
patients
care ofwith Parkinson’s
patients disease. Those
with Parkinsons in thetaken
disease, central triangle
from [1]
rkinsonNet experts to increase are involved consistently; other disciplines can be engaged as needed
oad through use of standardised
ms with referral criteria effectiveness and complications for the various positive, showing an increase in Parkinson spe-
As Figure
treatment options1 in
also illustrates,
advanced a Parkinson
Parkinson’s dis- network puts the
cific knowledge patient
among (and theirtherapists,
participating family)
central, while different relevant health disciplines, administrative actors, etc,
ease, allowing them to participate in making an a better adherence to the treatment guidelines, contribute
aining of participants in treatment to the needed
(4 days) informed decision.health care.patients
In addition Healtharecare
givenprofessionals
and a moreare thanthen expected
sevenfold on the
increase cross
in annual
section between their discipline and Parkinson disease.
the option of having consultations in their own patient volume for ParkinsonNet therapists
n the job: increase experience by
any patients homes through
The secured video
combination of a links.
network, the focuscompared with control therapists
on the co-creation of (health)between
value2003
be-
18 role of information technology
s interaction and information
tween patients, family, and health professionals, andand2006.
the ParkinsonNet coverage was gradu-
between participants through Development
to bring the and implementation
parties of
together, makes ally extended,
the creation achieving
of Parkinson nationwide
networks coverage in
an interesting
national conference, regional guidelines
case for the ValCoLa project. 2010. There are now 66 regional networks with
linary meetings (at least twice Treatment guidelinesoffor
The initiators thephysiotherapists were 2970
Dutch ParkinsonNet alreadytrained
had professionals from a widethe
the idea to generalise range
con-of
d participation in web based developed
cept. Bothbyinaterms
nationalof panel of physiothera-
re-applying the model disciplines for around
in other countries, 50also
but 000 patients (figure).
to generalise it
nd regional communities pists
into and neurologists
a general with expertise
healthcare conceptinthat
treating
could The largest groups
be beneficial includewith
to patients physiotherapists
other forms
t Parkinson
of chronic patients,
disease,and supported
such by the Dutch (n=1022), occupational therapists (n=392),
as Alzheimer’s.
gree to work according to Parkinson Patient Foundation and the Royal speech-language therapists (n=379), dietitians
guidelines Dutch Society of Physiotherapy. The guidelines (n=156), nursing home physicians (n=129),
y about quality of services and are
3 based on scientific
Approach evidence,
and initialsupplemented
results and specialised Parkinson nurses (n=76). The
mes with practice based evidence generated by con- only professionals not yet part of Parkinson-
17
shed in the Parkinson Atlas (www. sensus meetingsthe
In developing among experts.network(s)
Parkinson Other guide- Net are
case study neurosurgeons
we also observe(d)andthe
geriatricians; these
need for value
Atlas.nl) lines were then drawn up by similar national disciplines are scheduled
co-creation between the research communities involved. Where the ValCoLa project to be trained later.
expert panels (again supported by the patient General practitioners are not planned to be part
ed approach needed a case study, the ParkinsonNetworks have a need to better understand the work-
foundation and relevant professional organisa- of ParkinsonNet because they have little direct
e, through use of guidelines ings of such networks, as well as make their development strategies more explicit. The
tions) for speech therapists and occupational involvement in Parkinson specific management
s, web based communities for
ersonal digital community, and a
therapists and to define best care in nursing decisions and therefore do not need to receive
ntred questionnaire (PCQ-PD) homes and by nurse specialists (box). specialised training. Nevertheless, they have an
important generic role in overseeing comorbidity
technology platform:
Implementation of regional networks and polypharmacy, and in referring patients to
e website (www.ParkinsonNet.nl)
The first regional network was established specialised members of the network. We there-
search engine (www.
in 2004 in the catchment area of the cities of fore ensure that GPs know about the existence
Zorgzoeker.nl)
Nijmegen and Arnhem, and initially included of ParkinsonNet and the healthcare finder, to
communities for patients and
19 physiotherapists, nine occupational thera- structure the referral process.
als (www.MijnParkinsonzorg.nl)
pists, and nine speech-language therapists
health record with decision
(selected on the basis of personal motivation, Making the most of information technology
Online Community
Patient
community Stakeholder Virtual public Community
Virtual public
Document
Process
Professional
community
Provides Supports
Patient
General practitioner Patient Family Maintains
Providers National coordination Creates
centre
Enables
Provides PD Nurse Checks
Care Physical Receives
specialist therapist
Refers
Refers Refers
Initial treatmen Diagnosis
Allied health Speech
Treatment therapist Research
professionals
Provides Training
Occupational
Neurologist
therapist
1 day 3 hour Newspaper 3 day
Treatment clinic visit seminar basic course Guidelines
Physiotherapy Language therapy Occupational therapy Multidisciplinary
guidelines guidelines guidelines guidelines
Patient Professional
Health proces
contribution contribution
Fig. 2. Landscape of ParkinsonNet
Self-care Create diagnosis Royal Dutch Society Dutch Parkinson
of Physiotherapy patient foundation
Providing personal Create medical
information terminology
Suggestions Create prescripton
treatment
Contributing
ideas service
Patient- Doctor discourse
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 “grow-
ing”, 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 strat-
egy 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 Parkin-
son disease related health care is lower when patients receive care via the network [1].
This enables to insurance companies to let patients essential “share” in these financial
benefits, making it more attractive for patients to seek health care from the network. In
Luxembourg, however, such differentiation of refund of medical costs is not allowed
due to the “free choice” principle, which allows patients to freely choose which (rele-
vant) health care professional should treat them.
From the perspective of the ValCoLa research project, answering the above ques-
tions 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 [1], served as one
of the inputs. However, additional stakeholders are involved as well, for example, in-
surance companies, government agencies, funding agencies, etc. Figure 2 provides an
overview of the resulting landscape of potential stakeholders. The role (or even pres-
ence) of these stakeholders may differ from country to country.
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 net-
work (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
Fig. 3. Main stakeholders involved in a 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 Parkinson-
Networks 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) [2, 7] as a starting point. In particular, in terms of its situational
analysis, risk analysis (in terms of the latter), and heuristics to select / define risk miti-
gation strategies and project delivery strategies.
4 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 [2, 7] suitable to
capture different growth strategies for ParkinsonNetworks, in particular by adding the
role of value co-creation between stakeholders, and (4) capturing (and comparing) suc-
cessful / failed strategies in growing ParkinsonNetworks explicit in terms of the former
“reasoning structure”
Value flows Stakeholders PNet
1 ParkinsonNet --> Health Providers 4 Health Insurance --> Health Providers
Job satisfaction + Sponsoring +
PD Patients +
Expertise + <--
Cooperation (Unnecessary) service utilisation in
+ -
Health Professionals healthcare
Career advancement
+ + Efficiency healthcare
possibilities
Money + + Aid in patients
<--
+ Money
+ Work efficiency
2 ParkinsonNet --> Patient and Family 5 Patient and Family --> Health Insurance
Costs - Insurance claims -
Transparency + Money -
Community +
Travel time + <--
Intimacy + - Money
<--
+ Community participation
+ Feedback
3 ParkinsonNet --> Health Insurance 6 Health Providers --> Patient and Family
Costs - Quality of care +
Reimbursement
- Self- management +
negotiations
Efficiency (less waste) + Referrals +
Promotion +
<--
<-- + Self- management
+ Money - Money (when not insured)
+ Patients
Fig. 4. Potential flow of value between the main stakeholders involved in a Parkinson network
References
1. B. R. Bloem and M. Munneke. Revolutionising management of chronic disease: the parkin-
sonnet approach. BMJ, 348, 2014.
2. M. Franckson and T. F. Verhoef, editors. Managing Risks and Planning Deliveries. In-
formation Services Procurement Library. Ten Hagen & Stam, Den Haag, the Netherlands,
1999.
3. B. van Gils and H. A. Proper. Enterprise modelling in the age of digital transformation.
In R. A. Buchmann, D. Karagiannis, and M. Kirikova, editors, The Practice of Enterprise
Modeling - 11th IFIP WG 8.1. Working Conference, PoEM 2018, Vienna, Austria, Octo-
ber 31 - November 2, 2018, Proceedings, volume 335 of LNBIP, pages 257–273. Springer,
Heidelberg, Germany, 2018.
4. C. Grönroos and A. Ravald. Service as Business Logic: Implications for Value Creation and
Marketing. Journal of Service Management, 22(1):5–22, 2011.
5. M. M. Lankhorst, S. J. B. A. Hoppenbrouwers, H. Jonkers, H. A. Proper, L. van der Torre,
F. Arbab, F. S. de Boer, M. M. Bonsangue, M.-.E. Iacob, A. W. Stam, L. Groenewegen,
R. van Buuren, R. J. Slagter, J. Campschroer, M. W. A. Steen, S. F. Bekius, H. Bosma, M. J.
Cuvelier, H. W. L. ter Doest, P. A. T. van Eck, P. Fennema, J. Jacob, W. P. M. Janssen,
Jonkers, H., D. Krukkert, D. van Leeuwen, P. G. M. Penders, G.E. Veldhuijzen van Zan-
ten, and R. J. Wieringa. Enterprise Architecture at Work - Modelling, Communication and
Analysis. Springer, Heidelberg, Germany, 2005.
6. M. Op ’t Land, H. A. Proper, M. Waage, J. Cloo, and C. Steghuis. Enterprise Architecture
- Creating Value by Informed Governance. The Enterprise Engineering Series. Springer,
Heidelberg, Germany, 2008.
7. H. A. Proper. ISP for Large–scale Migrations. Information Services Procurement Library.
Ten Hagen & Stam, Den Haag, the Netherlands, 2001.
8. H. A. Proper, M Bjeković, C. Feltus, and I. S. Razo-Zapata. On the development of a mod-
elling framework for value co-creation. In J. Gordijn and H. A. Proper, editors, Proceedings
of the 12th International Workshop on Value Modeling and Business Ontologies, VMBO
2018, Amsterdam, The Netherlands, February 26th - 27th, 2018, volume 2239 of CEUR
Workshop Proceedings, pages 122–132. CEUR-WS.org, 2018.
9. H. A. Proper, R. Winter, S. Aier, and S. de Kinderen, editors. Architectural Coordination of
Enterprise Transformation. The Enterprise Engineering Series. Springer, Heidelberg, Ger-
many, 2018.
10. A.-W. Scheer. ARIS – Business Process Modeling. Springer, Heidelberg, Germany, 2000.
11. J. Spohrer, P. P. Maglio, J. Bailey, and D. Gruhl. Steps Toward a Science of Service Systems.
IEEE Computer, 40(1):71–77, January 2007.
12. M. W. A. Steen, M. E. Iacob, M.M Lankhorst, H. Jonkers, M. Zoet, W. Engelsman,
J. Versendaal, H. A. Proper, L. Debije, and K. Gaaloul. Service Modelling. In M. M.
Lankhorst, editor, Agile Service Development: Combining Adaptive Methods and Flexible
Solutions, The Enterprise Engineering Series, chapter 3, pages 59–94. Springer, Heidelberg,
Germany, 2012.
13. S. L. Vargo and R. F. Lusch. Institutions and axioms: an extension and update of service-
dominant logic. Journal of the Academy of Marketing Science, 44(1), January 2016.
14. S. L. Vargo, P. P. Maglio, and M. A. Akaka. On value and value co-creation: A service sys-
tems and service logic perspective. European Management Journal, 26(3):145–152, 2008.
15. R. Wagter, H. A. Proper, and D. Witte. A Theory for Enterprise Coherence Governance. In
P. Saha, editor, A Systematic Perspective to Managing Complexity with EA. IGI Publishing,
Hershey, Pennsylvania, 2013.
16. K. Williams, S. Chatterjee, and M. Rossi. Design of emerging digital services: A taxonomy.
European Journal of Information Systems, 17(10), 2008.