The Service Profit Chain Customer Value Equation – an application to Health Care

The assessment of value in health care is most often considered from a population perspective, using techniques such as burden of illness and economic evaluation. While necessary, such techniques are not sufficient to maximise health benefits from the perspective of the individual. The Service Profit Chain is a model by which better outcomes for both service providers and customers can be achieved. A core component, the Customer Value Equation, describes the perceived value of a service to an individual as: outcomes plus perceptions of the quality of service delivery (process quality) / monetary fees plus access costs (such as time). Based on a series of studies using real-world data, this thesis discusses applicability of these ideas to the health care environment, focusing on process quality and the relationship between clinicians and their consulting patients. Patients must be equal partners in the decision-making process; where this occurred, outcomes were generally better. Engagement, empathy and good communication between clinician and patient were shown to be necessary factors to maximise outcomes. Disconnects between clinical and patient regarding disease severity, recognition of symptoms and side-effects, and perceived lack of communication were all associated with worse quality of life, lower satisfaction and lower adherence to treatment plans. Policy implications arising from the research findings are discussed, including equipping clinicians to better understand the objectives and needs of their patients, improving clinical-patient communication, more widespread use of models of care such as Shared Decision Making, and developing tools to measure satisfaction with the care process. This thesis demonstrates the advantages of real-world data regarding the measurement of process activity and outcomes, highlighting the value of any data source able to capture both clinician and patient perspectives of the same health care encounter. This allows assessment of