A Process Model of Episodic Healthcare Relationship

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A Process Model of Episodic Healthcare Relationship

Anita Virta

Doctoral Student

University of Oulu, Department of Marketing

[email protected]

Finland

Supervisor: Jaana Tähtinen, professor, University of Oulu, Department of Marketing, [email protected]


Background information of the current paper

My doctoral thesis being made consists of four essays as follows:

1) States of an episodic drug treatment relationship (it is presented at the 28th IMP “Industrial Marketing and Purchasing Group “ Conference, September 13 – 15, 2012, Rome, Italy)

2) Individual and social factors that influence the states of episodic healthcare relationship (will be presented 2013 some where?)


3) Empirical-based six-matrix model to successful episodic drug treatment relationship (will be presented 2013 some where?)

4) The role of social identity in the successful episodic healthcare relationship ( was presented IMP2011

conference, 30.8.-3.9.2011, Glasgow, England)

Research project financed by the Academy of Finland “An Emotional View to Challenging Buyer-Seller Relationships” EmoCha 1.9.2011-31.8.2015

Grounded theory as research strategy


1) Research problem out rising from the real life2) Prior understanding about (care)relationship: beginning, middle and ending of relationship3) Field-entering without theoretical framework in autumn 2007 (non-medicated treatment), 2008 (combining non-medicated to medicated treatment) and 2009 (medicated treatment)4) Emergent theory: prior literature is as additional data (Glaser 1978; 1998)

Methodology and methods


Context= detoxification treatment in FinlandMultiple case study approach =Interpretative and longitudinalCases= 17 young customers undergoing detoxification and 11 members of nursing staffGroup interview= with management group of the service providerEthnographical fieldwork= a) I shared the everyday life ofthe young customers during weekdays and in the evening aswell as on weekends, b) observation, c) participation in the nurses' afternoon reporting (fall 2007, 2008 and 2009)

The study question of the first essay


“How can we describe an episodic healthcare relationship as a process? “


Key concepts to understanding a process model

Episodic relationship is a relationship that is established for acertain purpose and/or time period and thus end when it researches its purpose and/or time period(Duck, 1981,14;Halinen and Tähtinen,2002, 168)

State define here as a change in the relationship, actors move from one state to another in random (Batonda and Perry 2003) Event is a change-driver that reflects a change in the state


Standard time is as a routine process time, several identical repetitions by nursing staff (Lillrank, Groop, and Venesmaa; 2011)Elapsed time is as a customer’s process progressing time. The customer who has several treatments will always make a matter during a new period of treatment otherwise, in other words is not a

systematic repetition ( emergence from empirical data 2007-2009)

Action is the smallest interaction unit in the process


A process model of episodic healthcare relationship

The initiation state


Challenging and unpredictability state of the process as customer’s mental state. With some customers it can last two years or only two weeks Events: 1) becoming aware of the importance of the relationship to both actors (“ I realized that I had no money, and I was about to lose my mind if I continued like this for long..”

2) deciding to begin the relationship; decision to take action (“ All my friends are users, so it is not easy to decide to end using..”)


Actions: information- seeking of the detoxification treatment,a telephone the detoxification treatment, arrival of the customer in detoxification treatment.

After these actions relationship may lead to a development state or to a fading state.

The fading state


Fading refers here to the state of the relationship inwhich its strength is weakening. May lead to the end of the relationship slowly or suddenly (Åkerlund, 2005; Tähtinen, 2001)before or after or during development state.

Events: positive (getting a job) and negative (breaking rules)

Actions: customers leaves the detoxification treatment as “the doors banging” but want to come back, spontaneously act by strong feelings

The development state


Can be kept, the biggest of the process stages at least in contents and thus challenging to customer as well as a staff. Customer is a physical in detoxification institutionEvents:1) awareness about continuing the relationship: for example customer needs to take active role in accepting the help that is offered to manage life in the detoxification treatment


Factors influencing the customer’s willingness to accept help.


3) Conflicts arise from disagreement in interpersonal (care)relationships and involve strong emotional element. I claim that the treatment culture in the detoxification treatment is as conflict-prone. A mix of several diverse types of customers, and the person of the nursing staff each has their own personalities.

2) emotional engagement as the customer’s ability to go through the emotions stirred during the treatment period as well as the ability of the nursing staff to meet customer’s needs/emotions (a)...the nurses should ask how is it going with you; instead some of them ask ‘ What on earth are

you doing here.?”.(b)some of the nurses see us as second-rate citizens, thus it would be so easy to let words hurt us when one is also in a weak state..”


4) Resolving conflicts is quite difficult to manage especially in the specific context as detoxification treatment is. In everyday life people encounter situations that they may be willing to negotiate or not(Miles, 2010) as following:“..they indeed work like a bouncer- the first one takes you into treatment and next one throws out immediately if you break the rules..” Interesting metaphorical concept the Bouncer!


Actions:to give the telephone to the nursing staff for the time of the treatment, changing circadian rhythm, suffering fromwithdrawal symptoms, doing of the treatment agreement,

arrival interview, giving of blood samples, inspection of the body, checking of the customer's things, checking of rooms, following of rules, outdoor recreation only with the supervisor. In other words the customer loses all privacy and the life forms the schedules following

The ending state


Ending state is as a future-oriented relationship finishingEvents: 1)Communication about plans of future Actions: discussing with friends, family, andnursing staff to choose an alternative that wouldprevent the relapses after detoxification treatment period.

2) Becoming aware of the customer’s social identity change (Virta and Tähtinen, 2011). If customers are able to change a identity of drug addict as a group of people to which they do not belong after detoxification treatment the ending is a like “ beautiful exit” (Alajoutsajärvi et al. 2000) thus the episodic healthcare relationship is succeed.


Actions (in future): replacing telephone numbers and deleting unhelpful numbers, such as their drug dealer’s from the telephone’s memory, change a town, so far it possibly, get new hobbies with new friend, to avoid the “wrong” street corners of the city and to find something instead of the use of drugs something sensible doing.


A little discussion

Initiation state mostly takes place in the mind of customer and majority of the contacts for the treatment take place customer is under the influence of intoxicants. Thus in this state nursing staff plays a significant role, especially in how they answer the first call of customer: can they really understand the situation of the customer as well as encourage them enough to enter substance abuse treatment. Also, those who answer the telephone have to show empathy and respect in their tone. Nursing staff can do harm (not consciously ) to healthcare relationship during its initiation state as well as good.

So, would it be necessary to take the empathy of the voice into consideration in the recruiting of the future from the applicant with the voice sample? All the voices have not been created as radio voices either!


THANK YOU !

A Process Model of Episodic Healthcare Relationship

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