How to Reach the Goal of Quadruple Aim Today in Healthcare Service Ecosystem: Nudges from the A4A Approach

Abstract

The pandemic has uncovered hidden, latent or unknown misalignments in healthcare worldwide. Difficulties, friction, disturbances, misunderstandings, underestimations, carelessness and other issues have ensued quickly, upsetting the ecosystem value creation mechanisms and influencing all actor’s behavior within every country’s Healthcare Service Ecosystems (H-SES). The expected health system impacts are those demarcated by the quadruple aims that include all the actors in the health ecosystem. Such aims address improving patient and caregiver experience; improving the health of populations; reducing per capita cost; and improving the work life of providers. This warranted a search for deeper understanding of the on-going dynamics and relative insights to foster actor engagement, provide a good global service in Healthcare, and fully reach the well-known quadruple aim. By referring to the cyclical model of the actor for actor model (A4A), we consider and review their shared intentionality and finality alignment, to investigate how resource integration work here and what happen in case of contingences (as in the case of a pandemic). It is a theoretical work, but entails many practical issues in Healthcare in terms of patient empowerment, improving population health, lowering cost of care, and maintaining the wellbeing of the care team.

Triggering a patient-driven service innovation to foster the service ecosystem well-being: a case study

“…, 2020). To pursue the purpose of patient engagement (Badr et al. , 2022), it may be useful to embed them in the co-creation of new digital solutions, from use case identification to product design and testing (Stock et al.…”

“…It might be useful to consider a patient-driven service innovation, to adapt innovation to the needs of patients and support them in managing their condition (Aghdam et al, 2020). To pursue the purpose of patient engagement (Badr et al, 2022), it may be useful to embed them in the co-creation of new digital solutions, from use case identification to product design and testing (Stock et al, 2021). Doctors, nurses, patients and citizens have declared fears in terms of results demonstrability; it seems necessary to open the "black box" of AI decision-making systems and pursue aims of reasoned transparency, in order to guarantee greater legitimacy perceived by the public and improve confidence in the tool.…”

How Nudge can support Smart Governance in Smart Cities Ecosystems: An A4A framework

“…In this respect, the actor-for-actor (A4A) (as shown in Figure 1) model can be introduced. This is a structured process of mutually satisfying relationships between actors, paying special attention to the co-creative aspects that occur in 'crowded' contexts, as in the case of smart cities [10,12,35]. In the context of smart cities, the A4A model pays particular attention to the degree of commitment citizens demonstrate in actively participating in the dynamics of the smart city.…”

“…To do this, it is of course necessary that the nudge is tested in an experimental and controlled manner and that there is then empirical evidence that it works. However, it may be fascinating to arrange and interpret it from a more conceptual standpoint by using an established observational lens: the Actor-for-Actor (A4A) approach [10][11][12].…”