The excellence of patient-centred healthcare: investigating the links between satisfaction, co-creation and empowerment

Andrea Moretta Tartaglione, Ylenia Cavacece, Giuseppe Russo


Purpose. Nowadays, international healthcare agendas are focused on patient centeredness. Each policy is aimed at improving different dimensions, the main ones are patient satisfaction, patient empowerment and value co-creation. The aim of this paper is to investigate the links between these dimensions and analyse their correlation.

Methodology. Through a literature review on patient satisfaction, empowerment and value co-creation, their links are theoretically outlined and it is constructed a questionnaire administered to 246 chronic patients. The results are analysed with the Pearson correlation.

Findings. The results show that the variables investigated positively influence each other. Therefore, in order to increase patient satisfaction, it is necessary to stimulate patient empowerment which in turn has a positive influence on the patient’s ability to contribute to value creation and vice versa.

Practical implications. To practitioners, the study provides suggestions how to achieve a patient-centred healthcare by improving patient satisfaction, knowledge, participation and responsibility in care and his/her involvement in the value creation process.

Originality/value. Over the last decade, healthcare management literature has shifted focus from healthcare organizations to patients. Contributions to patient satisfaction, empowerment, and co-creation exponentially increased, however, these dimensions are often studied separately. This work provides a first useful input to investigate the links between these dimensions and to test them with an empirical analysis.


value co-creation; patient empowerment; patient satisfaction; healthcare quality; empirical analysis

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Aghili R., Khamseh M.E., Malek M., Banikarimi A.S., Baradaran H.R., Ebrahim Valojerdi A. (2013). “Development and validation of diabetes empowerment questionnaire in Iranian people with type 2 diabetes”. Int Nurs Rev., 60(2): 267-73.

Anderson R.M., Funnell M.M. (2010). “Patient empowerment: myths and misconceptions”, Patient Educ Couns., 79(3): 277-82.

Aslani P. (2013). “Patient empowerment and informed decision-making”, Int J Pharm Pract., 21(6): 347-8.

Aujoulat I., D’Hoore W., Deccache A. (2007). “Patient empowerment in theory and practice: polysemy or cacophony?”, Patient Educ Couns., 66(1): 13-20.

Aujoulat I., Deccache A., Marcolongo R., Bonadiman L. (2008). “Reconsidering patient empowerment in chronic illness: A critique of models of self-efficacy and bodily control”, Soc Sci Med., 66(5): 1228-39.

Bann C.M.., Sirois F.M.., Walsh EG. (2010). “Provider support in complementary and alternative medicine: exploring the role of patient empowerment”, J Altern Complement Med., 16(7): 745-52.

Barton P.L. (2003). Understanding the U.S. health services system: Second edition. Washington, D.C.: AUPHA.

Bendapudi N., Leone R.P. (2003). “Psychological Implications of Customer Participation in Co-Production”, Journal of Marketing, 67(1): 14-28.

Boudioni M., McLaren S.M., Lister G. (2012). “Cross-national diagnostic analysis of patient empowerment in England and Greece”, Int J Caring Sci., 5(3): 246-64.

Bulsara C., Styles I., Ward M., Bulsara M. (2006). “The psychometrics of developing the patient empowerment scale”, J Psychosoc Oncol., 24(1): 1-16.

Buranarach M., Thatphithakkul N., Kawtrakul A., Wongrochananan S., Kulnawan N., Jiamjarasrangsi W. (2011). “Development of service systems to support diabetes patient self-management using a personalized service framework”, Proceedings - 2011 Annual SRII Global Conference, SRII 2011: 363-370.

Carrubbo L., Bruni R., Cavacece Y., Moretta Tartaglione A. (2015). “Service System Platforms to Improve Value Co-Creation: insights for Translational Medicine”, in Gummesson, E., Mele, C., Polese, F. (Eds.) (2015), Service Dominant Logic, Network and Systems Theory and Service Science: Integrating three Perspectives for a New Service Agenda.

Chakraborty S., Dobrzykowski D. (2013). “Supply Chain Practices for Complexity in Healthcare: A Service-Dominant Logic View”, The IUP Journal of Supply Chain Management, 10(3): 53-75.

Chakraborty S., Dobrzykowski D. (2014), “Linking service-dominant logic and healthcare supply chain”, in 24th Annual Pom Conference Denver, Colorado, Usa.

Dansky K.H., Miles J. (1997). “Patient satisfaction with ambulatory health care services: waiting time and filling time”, Hosp Health Serv Admin, 42(2): 165 – 77.

Donabedian A. (1988). “The quality of care: How can it be assessed?”, Journal of the American Medical Association, 260: 1743–1748.

Elg M., Engström J., Witell L., Poksinska B. (2012). “Co-creation and learning in health-care service development”, Journal of Service Management, 23(3): 328-343.

Faulkner M. (2001). “A measure of patient empowerment in hospital environments catering for older people”, J Adv Nurs. 34: 676–686.

Fotoukian Z., Shahboulaghi F.M., Khoshknab M.F., Mohammadi E. (2004). “Concept analysis of empowerment in old people with chronic diseases using a hybrid model”, Asian Nurs Res., 8(2): 118-27.

Franke N., Schreier M. (2010). “Why Customers Value Self-Designed Products: The Importance of Process Effort and Enjoyment”, Journal of Product Innovation Management, 27: 1020–1031.

Franke N., Schreier M., Kaiser U. (2010). “The “I Designed It Myself” Effect in Mass Customization”, Management Science, 56(1): 125-140.

Fumagalli L., Radaelli G., Emanuele L., Bertele’ P., Masella C. (2015).“Patient empowerment and its neighbours: clarifying the boundaries and their mutual relationships”, Health Policy, 119(3): 384-94.

Gill L., White L., Cameron I.D. (2011). “Service co‐creation in community‐based aged healthcare”, Managing Service Quality: An International Journal, 21(2): 152-177.

Gkoulalas-Divanis A., Loukides G., Sun J. (20114). "Toward smarter healthcare: Anonymizing medical data to support research studies", IBM Journal of Research and Development, 58(1): 9-11.

Greenfield T.K., Attkisson C.C. (1989). “Steps toward a multifactorial satisfaction scale for primary care and mental health services”, Evaluation and Programme Planning, 12: 271-278.

Gronroos C. (1984). “A service quality model and its marketing implications”, European Journal of Marketing, 18(4): 36-44.

Hair J., Babin B., Money A., Samouel P. (2005). Fundamentos de métodos de pesquisa em administração. Bookman Companhia Ed.

Heitmann M., Lehmann D.R., Herrmann A. (2007). “Choice Goal Attainment and Decision and Consumption Satisfaction”, Journal of Marketing Research, 44 (2): 234-250.

Hibbard J.H., Stockard J., Mahoney E.R., Tusler M. (2004). “Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers”, Health Serv Res,. 39: 1005–1026.

Ishikawa H., Takeuchi T., Yano E. (2008). “Measuring Functional, Communicative, and Critical Health Literacy Among Diabetic Patients”, Diabetes Care, 31(5): 874-879.

Jerofke T.A. (2013). “Concept analysis of empowerment from survivor and nurse perspectives within the context of cancer survivorship”, Res Theory Nurs Pr., 27(3): 157-72.

Keating N.L., Green D.C., Kao A.C., Gazmararian J.A., Wu V.Y, Cleary P.D. (2002). “How are patients’ specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians?”, Journal of General Internal Medicine, 17 (1): 29-39.

Kim S.C., Boren D., Solem S.L. (2001). “The Kim Alliance Scale: development and preliminary testing”. Clin Nurs Res., 10: 314–331.

Larsen D.E., Rootman I. (1976). “Physician role performance and patient satisfaction”, Soc Sci Med (10): 29 – 32.

Loane S.S., Webster C.M. (2014). “Consumer-to-consumer value within social networks”, The Marketing Review, 14(4): 447-462.

Maglio P.P., Spohrer J. (2008), “Fundamentals of service science”, Journal of the Academy of Marketing Science, 36(1): 18-20.

Marshall et al. (1993), The structure of Patient Satisfaction with Outpatient medical care. Psychological assessment, 5(4): 477-483.

McAllister M., Dunn G., Payne K., Davies L., Todd C. (2012). “Patient empowerment: The need to consider it as a measurable patient-reported outcome for chronic conditions”, BMC Health Serv Res. 12: 157.

McColl-Kennedy J.R., Vargo S.L., Dagger T.S., Sweeney J.C, van Kasteren Y. (2012). “Health Care Customer Value Cocreation Practice Styles”, Journal of Service Research, 15(4): 370-389.

McColl-Kennedy J.R., Vargo S.L., Dagger T.S., Sweeney J.C. (2009). “Customers as Resource Integrators: Styles of Customer Co-creation”, in Gummesson, E., Mele, C., Polese, F. (eds), Service Science, S-D logic and network theory, Giannini Editore, Napoli.

McWilliam C.L. (2009). “Patients, persons or partners? Involving those with chronic disease in their care”. Chronic Illn., 5(4): 277-92.

Nordgren L. (2008). “The performativity of the service management discourse: “Value creating customers” in health care”, Journal of Health Organization and Management, 22(5): 510-528.

Nordgren L. (2009). “Value creation in health care services – developing service productivity: Experiences from Sweden”, International Journal of Public Sector Management, 22(2): 114-127.

Oh H.J., Lee B. (2012). “The Effect of computer-mediated social support in online communities on patient empowerment and doctor-patient communication”, Health Commun., 27(1): 30-41.

Oliver R.L. (1981). “Measurement and evaluation of satisfaction process in retail settings”, Journal of Retailing, 75(3): 25 – 48.

Olsson E.M. (2016). “Interpersonal complaints regarding cancer care through a gender lens”, International Journal of Health Care Quality Assurance, 29(6): 687-702.

Ouschan R., Sweeney J.C., Johnson L.W. (2000). “Dimensions of patient empowerment: implications for professional services marketing”, Heal Mark Q., 18(1-2): 99-114.

Parasuraman A., Zeithaml V.A., Berry L.L. (1988). “SERVQUAL: A multi-item scale for measuring consumer perceptions of service quality”, Journal of Retailing, 64: 21-40.

Pascoe G.C. (1983). “Patient satisfaction in primary health care, a literature review and analysis”, Evaluation and program planning. 6(3/4): 185 – 97.

Polese F., Moretta Tartaglione A., Cavacece Y. (2016). “Patient empowerment for healthcare service quality improvements: a value co-creation view”, in proceedings 19th Toulon-Verona International Conference Excellence in Services, University of Huelva (Spain), 5-6 September.

Prakash B. (2010). “Patient Satisfaction”, Journal of Cutaneous and Aesthetic Surgery, 3(3): 151-155.

Quinn G.P., Jacobsen P.B., Albrecht T.L., Ellison B.A., Newman N.W., Bell M., Ruckdeschel, J.C. (2004). “Real-time patient satisfaction survey and improvement process”, Hospital Topics. 82(3): 26-32.

Rantala K., Karjaluoto H. (2016). “Co-creation in health care: Insights into the transformation from value creation to value co-creation through digitization”, Proceedings of the 20th International Academic Mindtrek Conference, pp. 34-41

Reichheld, F.F. (2003). “The one number you need to grow”, Harvard Business Review, 81(12): 46-54.

Rodwell CM. (1996). “An analysis of the concept of empowerment”, J Adv Nurs., 23(2): 305-13.

Salmon P., Hall G.M. (2004). “Patient empowerment or the emperor’s new clothes”. J R Med., 97(2): 53-6.

Shearer N., Cisar N., Greenberg EA. (2007). “A telephone-delivered empowerment intervention with patients diagnosed with heart failure”, Hearung, 36(3): 159-69.

Small N., Bower P., Chew-Graham C., Whalley D., Protheroe J. (2013). “Patient empowerment in long-term conditions: development and preliminary testing of a new measure”, BMC Heal Serv Res.; 13:263.

Stavins, C.L. (2006). Developing employee participation in the patient satisfaction process. ACHE: Fellowship Case Reports.

Stelfox H.T., Gandhi T.K., Orav E.J., Gustafson M.L. (2005). “The relation of patient satisfaction with complaints against physicians and malpractice lawsuits”, Am J Med., 118(10): 1126-1133.

Ünver Ö., Atzori, W. (2013). Document D3.2 – Questionnaire for Patient Empowerment Measurement Version 1.0. ICT PSP – Empowering patients.

Van Oerle S., Mahr D., Lievens A. (2016). “Coordinating online health communities for cognitive and affective value creation”, Journal of Service Management, 27(4): 481-506.

Vargo S.L., Lusch R.F. (2004). “Evolving to a new dominant logic for marketing”, Journal of marketing, 68(1): 1-17.

Vargo S.L., Maglio P.P., Akaka M.A. (2008). "On value and value co-creation: A service systems and service logic perspective", European Management Journal, 26(1): 145-52.

Vargo S.L., Lusch R.F. (2006). “Service dominant logic: what it is, what it is not, and what it might be”, in Lusch, R.F. and Vargo, S.L. (eds), The Service-Dominant Logic of Marketing: Dialog, Debate and Directions, Armonk: M. E. Sharpe, pp. 43-56.

Ware J.E., Snyder M.K., Wright W.R. (1984). “Defining and measuring patient satisfaction with medi-cal care”, Eval Program Plan, 6: 247–263.

Ware J.E. (1987). “Measuring the quality of care: The patient satisfaction component”, National Conference on Quality Assurance in Ambulatory Health Care, Chicago.

Weisman E., Koch J. (1989). “Progress notes: Special patient satisfaction issue”, Quality Review Bulletin, 15: 166–167.

Wentzer H.S., Bygholm A. (2013). “Narratives of empowerment and compliance: studies of communication in online patient support groups”, Int J Med Inform., 82(12): 386-94.

World Health Organization. Regional Office for Europe. Health 2020 policy framework and strategy document [Internet]. Geneva: WHO; 2012.

Yi Y., Gong T. (2013). “Customer value co-creation behavior: scale development and validation”, Journal of Business Research, 66(9): 1279-1284.

Zainuddin N. , Russell-Bennett R., Previte J. (2013). “The value of health and wellbeing: an empirical model of value creation in social marketing”, European Journal of Marketing, 47(9): 1504-1524.

Zanetti C.A., Taylor N. (2016)., “Value co-creation in healthcare through positive deviance”, Healthcare, 4(4): 277-281.


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