Reducing referral leakage: an analysis of health-care referrals in a service ecosystem

Abstract

Purpose The purpose of this paper is to address a critical problem for health-care organizations: patient referral leakage. This paper explores the nature of patient referrals by examining how health-care providers’ breadth and depth of connectivity within a hospital network and identification with each other influence the likelihood of future patient referrals. Design/methodology/approach The data was collected by using a multi-sourced data set from the health-care industry. The proposed model was tested by using logistic regression to determine the likelihood of a primary care physician’s (PCP) referral to a specialist within a hospital network. Findings A model linking provider connectivity to examine co-creation practices in the form of patient referrals is tested. Results indicate that patient referrals are multidimensional. A PCP’s likelihood to refer to a specialist within the hospital network is influenced by the breadth and depth of connectivity of each provider. Research limitations/implications This investigation extends service ecosystems to patients, health-care providers and hospital organizations, making it the first to explore how different degrees of connectivity (breadth of referral partners and depth of exchange) between and among health-care providers influence the likelihood of future patient referrals. Findings complement extant literature on service ecosystems by empirically showing that provider relationships are interdependent and rely on the mutual coordination of benefits within the entire health-care organization and network. Practical implications Managers and health-care professionals can use the framework to build and strengthen relational ties/alliances within a service organization. An ecosystems perspective reduces patient referral leakage through enhanced organizational performance, competitive advantage and continuity of care. Originality/value The authors offer a novel view of referral relationships using hard-to-access proprietary data. Moreover, this study responds to the need for transformative service research by offering service researchers and policymakers a means to enhance consumer well-being. The main contribution of this study is a framework to gain a better understanding of patient referral relationships between employees (i.e., health-care providers) in an organization, thereby affording an opportunity to bolster operational efficiencies, improve clinical outcomes and strengthen referral pathways. By viewing health-care networks through a service ecosystems perspective, contextual boundaries and the relative power of relationships are also identified. The novel use of rarely available hospital data in this setting helps explain how patient leakage compromises the health of the ecosystem and its members.

A transformative and social marketing ecosystem investigation into drug use among young adults

“…Reliance on the microsystem level is noted as a common issue in understanding transformative and social marketing services more broadly (French et al, 2017). While it is useful to understand motivators from the individual level (microsystem level), TSR and social marketing research suggests that a more comprehensive approach into the complete ecosystem is required (O'Connor and Cook, 2020). While this current research is the first to investigate the ecosystem in young adult drug consumption, it also exposes the need for further primary research into the broader ecosystem especially given the The findings from the current study extend the service and illicit drug literature by applying and extending the motivational model of alcohol use (Cooper et al, 1995) to a different social behavior.…”

“…TSR and social marketing research suggests that a more comprehensive approach should be employed where the entire ecosystem is considered (Anderson et al, 2013;O'Connor & Cook, 2020) rather than individual motivators. A comprehensive approach that considers the entire ecosystem allows for transformative and social marketing services to be developed that take into consideration a wide range of factors that influence one's behavior.…”

Dyadic, network and ecosystem alliances: systematic literature review and research agenda

“…, 2014) which require increasing degrees of collaboration and closeness for knowledge transfer with increasing levels of knowledge embeddedness and complexity; multi-sided platforms (MSPs) (Santoso and Wahyuni, 2018), where the alliances between MSPs are used for increasing their collective user base; services (Pathak et al. , 2020) that use ecosystems for value co-creation amongst actors with leader's active participation and guidance; healthcare (O'Connor and Cook, 2020) where patient referrals depend on the connectedness of staff networks within the healthcare system; or small local firms (Oyedele and Firat, 2020) who use the networks for their survival in complex markets in Nigeria.…”

“…, 2017; Magas and Kiritsis, 2022). Actors who are better connected within a network are able to improve their own and network effectiveness, specially for actors close to customers (O'Connor and Cook, 2020). Firms within a network simultaneously compete and cooperate.…”

“…While there are obvious strategic advantages for firms in high tech industries to form alliance networks and ecosystems, other industries can also benefit from unified value proposition development and execution as an ecosystem. These examples include retailing platforms (Yan et al, 2019) which need to build pricing policies as a governance and control mechanism to equitably share the gains from ecosystem along with ecosystem partners; technical services (Rusanen et al, 2014) which require increasing degrees of collaboration and closeness for knowledge transfer with increasing levels of knowledge embeddedness and complexity; multi-sided platforms (MSPs) (Santoso and Wahyuni, 2018), where the alliances between MSPs are used for increasing their collective user base; services (Pathak et al, 2020) that use ecosystems for value co-creation amongst actors with leader's active participation and guidance; healthcare (O'Connor and Cook, 2020) where patient referrals depend on the connectedness of staff networks within the healthcare system; or small local firms (Oyedele and Firat, 2020) who use the networks for their survival in complex markets in Nigeria.…”