Purpose -The purpose of this study is to develop and evaluate a model for patient co-creation and learning based on diaries for use in health-care service development. In particular, the study aims to investigate the process of patient co-creation and different mechanisms through which health-care service providers can learn from the patient. Design/methodology/approach -The study is based on an action research approach. First, a development phase for patient co-creation and learning leading to a proposed model was conducted. Second, a test phase of the diary-based method was performed on 53 patients in three cases: orthopaedic care, rehabilitation care and gastroenterology care. Findings -The study suggests a model for co-creation and learning in health-care service development through three learning methods. First, the model may be used as a means for generating and collecting patient ideas; second, a single patient's story can be illustrated and can serve as incentive for health-care service development and creation of patient-centred care; finally, a larger number of diaries can be analysed and combined with patient surveys to provide a deeper understanding of how the patient experiences health care services. Originality/value -This study extends the research on diary-based methods as an operationalisation of co-creation in two ways. First, the study offers new and more diverse ways of using the rich material provided by customer diaries in the development of services. Second, the study suggests a co-creation approach of involving patients in health-care service development through patient diaries.

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Purpose – The purpose of this paper is to explore what motivates patients to participate in service development and how participation may influence their well-being. Health-care providers are increasingly adopting practices of customer participation in such activities to improve their services. Design/methodology/approach – This paper builds on an analysis of data from a service development project in which lung cancer patients contributed by sharing their ideas and experiences through diaries. Out of the 86 lung cancer patients who were invited to participate, 20 agreed to participate and 14 fully completed the task. The study builds on participants’ contributions, in-depth interviews with six participants and the reasons patients gave for not participating. Findings – This paper identifies a number of motives: non-interest in participating, restitution after poor treatment, desire for contact with others, volunteerism, desire to make a contribution and the enjoyment of having a task to complete. A self-determination theory perspective was adopted to show how the need to satisfy basic human needs for autonomy, competence and relatedness determines if and how patients participate. Participation may have important benefits for patients, especially an improved sense of relatedness. Practical implications – Service providers must be prepared to meet different patient needs in service development, ranging from the need to express strong distress to expressing creativity. By understanding the dynamics of motivation and well-being, organizers may achieve better results in terms of improved services and in patient well-being. Originality/value – This study makes a significant contribution to the study of customer participation in service development, especially in relation to health care, by offering a self-determination-based typology for describing different styles of patient participation.

Background -Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction. Methods -This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time. Results -Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary care centres working with Lean healthcare compared to those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time. Conclusions -Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients.

Background Patient empowerment is an important concept and a movement toward person-centered care of patients with chronic conditions. Nevertheless, to date, most research on empowered patients or informal caregivers has been conducted from a narrow clinical perspective. Such research has mainly focused on how health care professionals can empower patients to increase self-care or compliance with treatment. Research on empowered patient and informal caregiver needs and self-empowering activities is scarce. Objective We aimed to explore empowering behaviors from a patient and informal caregiver perspective in the context of self-management and to understand how health care can support such behaviors better. Methods We used an exploratory, qualitative study design. A total of 15 semistructured interviews and 6 focus group interviews were conducted with 48 patients and informal caregivers. We analyzed the interviews using thematic analysis and used a directed content analysis to analyze the focus group interviews. Results A total of 14 patterns of empowering behaviors were identified that were characterized by several exploratory and influencing activities performed by the participants. The participants expressed a desire to be more active in their care than what is expected and supported by health care professionals. The participants also desired better support for activities imposed on them by health care professionals. Conclusions To enable a transformation of the health care system to better support self-empowering behaviors, there is a need to develop self-management approaches from a patient and informal caregiver perspective.