A Process Model of Episodic Healthcare Relationship

1. A Process Model of Episodic Healthcare Relationship Anita Virta Doctoral Student University of Oulu, Department of Marketing anita.virta@oulu.fi Finland Supervisor: Jaana Tähtinen, professor, University of Oulu, Department of Marketing, jaana.tahtinen@oulu.fi P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

2. 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?) P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

3. 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 P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

4. Grounded theory as research strategy 1) Research problem out rising from the real life 2) Prior understanding about (care)relationship: beginning, middle and ending of relationship 3) 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) P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

5. Methodology and methods Context= detoxification treatment in Finland Multiple case study approach =Interpretative and longitudinal Cases= 17 young customers undergoing detoxification and 11 members of nursing staff Group interview= with management group of the service provider Ethnographical fieldwork= a) I shared the everyday life of the young customers during weekdays and in the evening as well as on weekends, b) observation, c) participation in the nurses' afternoon reporting (fall 2007, 2008 and 2009) P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

6. The study question of the first essay “How can we describe an episodic healthcare relationship as a process? “ P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

7. Key concepts to understanding a process model Episodic relationship is a relationship that is established for a certain 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 P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

8. Action is the smallest interaction unit in the process 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) P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

9. A process model of episodic healthcare relationship P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

10. 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..”) P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

11. 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. P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

12. The fading state Fading refers here to the state of the relationship in which 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 P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

13. 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 institution • Events: • 1) awareness about continuing the relationship: forexamplecustomer needs to take active role in accepting the help that is offered to manage life in the detoxification treatment P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

14. Factors influencing the customer’s willingness to accept help. P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

15. 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..” 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. P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

16. 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! P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

17. Actions: to give the telephone to the nursing staff for the time of the treatment, changing circadian rhythm, suffering from withdrawal 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 P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

18. The ending state Ending state is as a future-oriented relationship finishing Events: 1)Communication about plans of future Actions: discussing with friends, family, and nursing staff to choose an alternative that would prevent 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. P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

19. 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. P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

20. 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! P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi

21. THANK YOU ! P.O. BOX 4600, 90014 University of Oulu • tel. (08) 553 2905, fax (08) 553 2906 • www.oulubusinessschool.fi