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Complex services, such as healthcare, struggle to realize the benefits of value co-creation due to the substantial challenges of managing such services over the long-term. Key to overcoming these challenges to value co-creation is a profound understanding of dialogue (i.e., ‘quality of discourse’ facilitating shared meaning) during service interactions. Contributing to an emerging literature, we undertake a longitudinal, ethnographic study to assess dialogue between professionals and patients through the lens of dialogic engagement (i.e., iterative mutual learning processes that bring about action through dialogue). We develop and empirically support six dialogic co-creation and co-destruction mechanisms that impact on the resolution of tensions and integration of knowledge resources between service providers and consumers. We reveal the multidimensional and dynamic nature of value created or destroyed through these mechanisms in dialogue over time. Taking healthcare as an exemplar, we offer a research agenda for developing our understanding of DE in complex services.

Purpose - Research into inter-organisational relationships has been one of the key drivers in the development of services marketing theory. Yet the understanding of the nature of such relationships, and the management of the relationship process, remains limited. Focusing on the development of buyer-seller relationships in an archetypal professional business service, this paper aims to critically examine the nature and format of inter-organisational service relationships.Design methodology approach - Research reported in the paper is based on case study research across multiple dyads (n=7) in the occupational health sector supported by large-scale survey data.Findings - Argues that, rather than adhering to a single format in terms of characteristics or pattern of development, relationships are diverse and complex. A typology of \"ideal type\" relationship formats, ranging from quasi-transactional to internalised, is proposed. Each of these ideal types is characterised by a unique set of causal and resultant conditions.Research limitations implications - The paper is based on data from a single, albeit archetypal, professional business service. Consequently future research should address the replicability of the results across other service sectors.Practical implications - The identification of these discrete relationship formats and their key characteristics along a continuum provides an empirical basis on which service professionals can develop targeted strategies for the management of particular inter-organisational relationships.Originality Value - Building on preceding research, the paper provides empirically based analysis of the nature and format of inter-organisational relationships in professional service markets.

PurposePolicymakers push online health services delivery, relying on consumers to independently engage with online services. Yet, a growing cluster of vulnerable patients do not engage with or disengage from these innovative services. There is a need to understand how to resolve the tension between the push of online health service provision and unengagement by a contingent of health-care consumers. Thus, this study aims to explore the issue of digital unengagement (DU) (i.e. the active or passive choice to engage or disengage) with online health services to better inform service design aligned to actual consumer need.Design/methodology/approachAdopting a survey methodology, a group of 486 health services consumers with a self-declared (acute or chronic) condition were identified. Of this group, 110 consumers were classified as digitally unengaged and invited to write open-ended narratives about their unengagement with online health services. As a robustness check, these drivers were contrasted with the drivers identified by a group of digitally engaged consumers with a self-declared condition (n = 376).FindingsDU is conceptualized, and four levels of DU drivers are identified. These levels represent families of interrelated drivers that in combination shape DU: subjective incompatibility (misalignment of online services with need, lifestyle and alternative services); enactment vulnerability (personal vulnerabilities around control, comprehension and emotional management of online services); sharing essentiality (centrality of face-to-face co-creation opportunities plus conflicting social dependencies); and strategic scepticism (scepticism of the strategic value of online services). Identified challenges at each level are the mechanisms through which drivers impact on DU. These DU drivers are distinct from those of the digitally engaged group.Research limitations/implicationsAdding to a nascent but growing literature on consumer unengagement, and complementing the engagement literature, the authors conceptualize DU, positioning it as distinct from, not simply a lack of, consumer engagement. The authors explore the drivers of DU to provide insight into how DU occurs. Encapsulating the dynamic nature of DU, these drivers map the building blocks that could help to address the issue of aligning the push of online service provision with the pull from consumers.Practical implicationsThis paper offers insights on how to encourage consumers to engage with online health services by uncovering the drivers of DU that, typically, are hidden from service designers and providers impacting provision and uptake.Social implicationsThere is a concern that there will be an unintentional disenfranchisement of vulnerable segments of society with a generic policy emphasis on pushing online services. The paper sheds light on the unforeseen personal and social issues that lead to disenfranchisement by giving voice to digitally unengaged consumers with online health services.Originality/valueOffering a novel view from a hard-to-reach digitally unengaged group, the conceptualization of DU, identified drivers and challenges inform policymakers and practitioners on how to facilitate online health service (re)engagement and prevent marginalization of segments of society.

A central theme underpinning the reform of healthcare systems in western economies since the 1980s has been the emphasis on reorienting service provision around the patient. Healthcare organizations have been forced to re-appraise the design of the service delivery process, specifically the service encounter, to take account of these changing patient expectations. This reorientation of healthcare services around the patient has fundamental implications for healthcare professionals, specifically challenging the dominance of service professionals in the design and delivery of health services. Utilizing a qualitative methodological framework, this paper explores the responses of healthcare professionals to service redesign initiatives implemented in acute NHS hospitals in Scotland and considers the implications of such professional responses for the development of patient-focused service delivery. Within this, it specifically examines evolving professional perspectives on the place of a service user focus in a publicly funded healthcare system, professional attitudes towards private sector managerial practices, and the dynamics of changing professional behaviour.

Purpose The purpose of this paper is to focus on the changing nature of healthcare service encounters by studying the phenomenon of triadic engagement incorporating interactions between patients, local and virtual networks and healthcare professionals. Design/methodology/approach An 18-month longitudinal ethnographic study documents interactions in naturally occurring healthcare consultations. Professionals (n=13) and patients (n=24) within primary and secondary care units were recruited. Analysis of observations, field notes and interviews provides an integrated picture of triadic engagement. Findings Triadic engagement is conceptualised against a two-level framework. First, the structure of triadic consultations is identified in terms of the human voice, virtual voice and networked voice. These are related to: companions’ contributions to discussions and the virtual network impact. Second, evolving roles are mapped to three phases of transformation: enhancement; empowerment; emancipation. Triadic engagement varied across conditions. Research limitations/implications These changing roles and structures evidence an increasing emphasis on the responsible consumer and patients/companions to utilise information/support in making health-related decisions. The nature and role of third voices requires clear delineation. Practical implications Structures of consultations should be rethought around the diversity of patient/companion behaviours and expectations as patients undertake self-service activities. Implications for policy and practice are: the parallel set of local/virtual informational and service activities; a network orientation to healthcare; tailoring of support resources/guides for professionals and third parties to inform support practices. Originality/value Contributions are made to understanding triadic engagement and forwarding the agenda on patient-centred care. Longitudinal illumination of consultations is offered through an exceptional level of access to observe consultations.

Purpose Policymakers push online health services delivery, relying on consumers to independently engage with online services. Yet, a growing cluster of vulnerable patients do not engage with or disengage from these innovative services. There is a need to understand how to resolve the tension between the push of online health service provision and unengagement by a contingent of health-care consumers. Thus, this study aims to explore the issue of digital unengagement (DU) (i.e. the active or passive choice to engage or disengage) with online health services to better inform service design aligned to actual consumer need. Design/methodology/approach Adopting a survey methodology, a group of 486 health services consumers with a self-declared (acute or chronic) condition were identified. Of this group, 110 consumers were classified as digitally unengaged and invited to write open-ended narratives about their unengagement with online health services. As a robustness check, these drivers were contrasted with the drivers identified by a group of digitally engaged consumers with a self-declared condition (n = 376). Findings DU is conceptualized, and four levels of DU drivers are identified. These levels represent families of interrelated drivers that in combination shape DU: subjective incompatibility (misalignment of online services with need, lifestyle and alternative services); enactment vulnerability (personal vulnerabilities around control, comprehension and emotional management of online services); sharing essentiality (centrality of face-to-face co-creation opportunities plus conflicting social dependencies); and strategic scepticism (scepticism of the strategic value of online services). Identified challenges at each level are the mechanisms through which drivers impact on DU. These DU drivers are distinct from those of the digitally engaged group. Research limitations/implications Adding to a nascent but growing literature on consumer unengagement, and complementing the engagement literature, the authors conceptualize DU, positioning it as distinct from, not simply a lack of, consumer engagement. The authors explore the drivers of DU to provide insight into how DU occurs. Encapsulating the dynamic nature of DU, these drivers map the building blocks that could help to address the issue of aligning the push of online service provision with the pull from consumers. Practical implications This paper offers insights on how to encourage consumers to engage with online health services by uncovering the drivers of DU that, typically, are hidden from service designers and providers impacting provision and uptake. Social implications There is a concern that there will be an unintentional disenfranchisement of vulnerable segments of society with a generic policy emphasis on pushing online services. The paper sheds light on the unforeseen personal and social issues that lead to disenfranchisement by giving voice to digitally unengaged consumers with online health services. Originality/value Offering a novel view from a hard-to-reach digitally unengaged group, the conceptualization of DU, identified drivers and challenges inform policymakers and practitioners on how to facilitate online health service (re)engagement and prevent marginalization of segments of society.

Purpose - The complexity of customer relationships has been recognized in the relationship marketing literature. Yet, the understanding of how this complexity impacts on the formation and development of different relationship forms is limited. Focusing on the development of customer-service provider relationships in a financial services context, this paper aims to critically examine the nature and formation of business-to-consumer service relationships.Design methodology approach - Qualitative methods were employed, with in-depth interviews undertaken with a sample of UK bank customers.Findings - The complexity of customer relationships was documented by approaching relationships as multidimensional, dynamic and contextual. A relationship typology based on four key relationship components (trust, commitment, buyer-seller bonds, and relationship benefits) is proposed. This typology suggests that for a relationship to exist it does not necessarily have to encompass an emotional dimension. Moreover, the paper demonstrates the importance of the fit between customers' relational expectations and their experiences with service providers in developing long-term committed relationships.Research limitations implications - The study was limited to the UK context. The extension of this study to other sectors or financial institutions operating in different regulatory and technological environments needs to be tested.Practical implications - It is crucial that relationships are viewed as multidimensional, taking into account various relationship components. Since different relationship components influence relationships differently, organisations need to develop different relationship marketing strategies for each consumer segment according to consumers' relational expectations.Originality value - Building on preceding research, this paper broadens understanding of the complexity of customer-firm relationships by presenting insight into the affective element of relationships and highlighting the role of the fit between customers' relational expectations and their experiences in relationship development.

The organization of the corporate marketing function has attracted increasing attention from marketers in the 1990s. This reflects both the significant conceptual developments in marketing theory and a questioning of the role of the centralized marketing department to organizations operating in post-industrial service economies. Drawing on data from a broader research project into marketing activity in the acute health care sector in the UK, a paper examines the organizational solutions adopted by self-governing hospitals in managing the marketing function. The core theme to emerge from the research is the imperative for such professional service organizations to facilitate the development of flexible, project focused marketing teams, effectively mirroring the notion of the buying center, capable of integrating core technical professionals directly into the marketing process. Coupled to this is the notion of marketing professionals having to abdicate ownership, and even dominance, of the corporate marketing process.

Driven by technological developments, deregulation, and globalisation the service sector in post-industrial economies is facing unprecedented change. Utilising a scenario planning framework, the paper examines the impact of such changes on a cross-section of service categories. Acknowledging that the derivation of generic sector wide trends from the analysis of discrete service categories runs the risk of over simplification, three core trends were identified: the increasing importance of technological mediation; changing consumer and professional roles; and decreasing importance of relational factors in consumer decision making. These trends pose fundamental challenges to service providers and offer researchers a rich context in which to advance marketing theory.