CHAPTER 4 – RESEARCH METHODOLOGY
4.5 F RAMEWORK A PPLICATION
deliver value to external service quality? What’s the influence relationship between stakeholders in e-Health? In this section, we will show a summary of the questionnaire analyses and the result of the case interpretations based on research framework we proposed on Table 4-6.
Table 4-6 Summary of Analysis Results
Components Post-discharge
Patients’ Value Low-medium Medium-high Medium High
Tangibles Low High Medium Medium
Reliability High Low Medium High
Responsiveness Low High Medium Medium
Assurance Medium High Low High
Empathy Low Medium Medium High
Sacrifice* Low High Low Medium
Rate of Case Growth 77% 117% 212% 300%
Note1: Scoring features: 1: Strongly disagree, 2: Disagree, 3: No opinion, 4: Agree, 5: Strongly agree Note2: * reverse component
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Business Value of Hospital
Some of physicians in the case took a stance on program implementation; from their responses, the results suggest that financial, customer, internal business, and learning and growth are all of equal importance. In addition, their responses reflect that hospice care service has the highest business value within the hospital, in comparison to post-discharge care and chronic disease care. We considered that hospice patients paid charges on a daily basis, which would directly affect quality of performance.
E-Health care service would also be the most helpful for patients in hospice care, especially if they had required home care; additionally, it would raise the reputation of hospital and improve internal operations.
Physicians’ Value
Referring to Table 4-5, the questionnaire results displayed that ―belongingness‖ is the highest perceived value by physicians and ―security‖ is the lowest. It could be explained that e-Health care led to a closer relationship between the physician and patient, but it consequently brought physicians more responsibility and risks. On the other hand, hospice care physicians also felt the highest value in comparison to post-discharge care and chronic disease care. This might mean that physicians in hospice care felt that their patients could be well taken care of using e-Health care services, which would’ve indirectly helped their jobs and increased confidence.
Case Managers’ Value
After analyzing the questionnaire, we found that case managers tended to believe that
―basic needs‖ had the lowest value out of choices: basic needs, security, belongingness, esteem and self-actualization. This result could be explained by the fact that case managers commonly aren’t satisfied with their wages. On the other hand, after comparing the three services, including post-discharge care, chronic disease care, and hospice care, we found that case managers’ value of hospice care service was the lowest between the three sectors. This situation will be discussed in the next chapter.
Patients’ Value (for original Chinese content of interviews, see Appendix E)
Tangibles. In the case, the accessible tangibles that the patients came in contact with were: the hospital indoor environment, medical devices, and case managers/nurses.
Among them, medical devices affect patients’ value the most. According to case managers, e-Health care service is an innovative services for patients so that they worried whether the device is easy to operate. Out of the three different e-Health service categories that had similar conditions and the same number of service providers, only cardiovascular disease care services supplied devices had different
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functions and interfaces; cardiovascular care facilities require highly complex medical devices for data measurements, such as blood pressure, blood sugar, weight, body temperature, peak flow reading, electrocardiogram readings, and oxyhemoglobin saturation. Chronic disease care service and hospice care service offered only the basic equipment (see Table 4-1). Additionally, post-discharge care service did not provide any equipment and encouraged patients to provide these measuring devices themselves. Hence, the degree of patient perceptive value degrees can be easily differentiated by analyzing the function complexity of medical devices. Accordingly, services offering more complex devices such as cardiovascular disease care resulted in a ―high‖ value of tangibles, whereas services that offered minimally complex devices such as chronic disease care and hospice care had ―medium‖ and ―low‖
ratings, respectively, Post-discharge care service had the lowest ratings for tangibles.
Reliability. Each of the four types of disease conditions needed tele-monitoring services to make optimize patient health care planning; these monitoring systems played an important role in delivering e-health service. As the case managers mentioned, ―when measuring devices were inaccurate or monitoring system was unstable, patients worried greatly and called the e-Health service care center to confirm whether the information had been correctly delivered.‖ Using this case, we made an estimation of ―reliability‖ based on patient anxiety in response to device dependency. Comparing these four service categories, post-discharge care, cardiovascular disease care, and hospice care had higher device dependency than chronic disease care service. Cardiovascular disease care service, in particular, had many equipment failures and out of order issues that made patients feel anxious. As a result post-discharge care and hospice care had ―high‖ values of reliability, chronic disease care had ―medium‖ values, and cardiovascular disease care had ―low‖ values.
Responsiveness. Tele-consultation service in this study offered a channel for patients or their family to call for help; in this situation, case managers would try their best to answer the patient’s and/or their family’s question. One case manager has commented that ―patients feel satisfied about this service, because they can call-in for help besides regular office hours.‖ Although these four service categories all had tele-consultation service, they were not all in real time. Therefore, we could easily make an estimate regarding the ―responsiveness‖ value by analyzing whether the patients received prompt responses from the e-Health care service center. Service time for post-discharge care service was only available from about 8 a.m. to 12 p.m. (refer to Table 4-1). In contrast, the other three service categories had 24 hours service, with the chronic disease care service and hospice care service only providing basic consultations during daytime working hours due to their night shift on call policy. We
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found that ―responsiveness‖ remained ―high‖ with cardiovascular disease care,
―medium‖ with chronic disease care and hospice care, and ―low‖ with post-discharge care service.
Assurance. Different diseases require different expertise, but some diseases are so common in the nation that many people have some knowledge about how to control it.
However, if patients or their families do not know how the disease develops and how to control it; they would lose confidence and trust. For instance, a case manger in hospice care said ―patients' families were anxious about follow-up caring after discharge, but they became more relieved while they joined in e-Health service.‖
Therefore, we could measure ―assurance‖ through extent of knowledge provided by case managers or physicians. Cardiovascular disease and hospice care tend to be difficult to diagnose and unstable and tend to present a knowledge barrier for most people. Chronic diseases need long-term control and are easier to obtain related care information compared to other diseases. For these reasons, the ―responsiveness‖ value is ―high‖ for cardiovascular disease care, ―medium‖ for chronic disease care and hospice care, and ―low‖ for post-discharge care service.
Empathy. Active caring through phone calls is a direct expression of empathy to patients in e-Health cases. One case manager commented that the call-out services are especially beneficial to elderly patients who live alone; they feel cared for when they receive phone calls from the center.‖ Caring service is often carried out in different frequencies in each service category (see Table 4-1), so we’ve use caring frequency as a symbol of ―empathy‖ degree. Hospice care service had the most frequent caring;
cardiovascular disease care and chronic disease care service had similar frequencies, which were both higher than that exhibited by post-discharge care service. Thus, the result of ―empathy‖ value was ―high‖ with hospice care, ―medium‖ with cardiovascular disease care and chronic disease care, and ―low‖ with post-discharge care service.
Sacrifice. One physician has commented about the service fee. He believed that a large portion of patients might not afford the service and would be very possible to discontinue the service after free-trial. Although we could easily sort degree of
―sacrifice‖ by service charge (see Table 4-1), patients also needed to prepare the device by themselves in some cases, as with post-discharge service. Hence, we included both service price and patient acquisition costs as adequate measures of patient ―sacrifice‖. The result of ―sacrifice‖ value was ―high‖ with cardiovascular disease care, ―medium‖ with hospice care, and ―low‖ with post-discharge care and chronic disease care service.
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