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論文 / 著書情報 Article / Book Information 論文 / 著書情報 Article / Book Information 題目(和文) Title(English) A Translational Approach to Value Co-creation and Innovation of Healthcare Services 著者(和文) 松下博宣 Author(English) Hironobu Matsushita 出典(和文) 学位:博士（学術）, 学位授与機関:東京工業大学, 報告番号:甲第9911号, 授与年月日:2015年3月26日, 学位の種別:課程博士, 審査員:木嶋 恭一,池上 雅子,後藤 美香,金子 宏直,出口 弘 Citation(English) Degree:, Conferring organization: Tokyo Institute of Technology, Report number:甲第9911号, Conferred date:2015/3/26, Degree Type:Course doctor, Examiner:,,,, 学位種別(和文) 博士論文 Type(English) Doctoral Thesis Powered by T2R2 (Tokyo Institute Research Repository) A Translational Approach to Value Co-creation and Innovation of Health Care Services Ph.D. dissertation February 2015 Hironobu Matsushita A thesis submitted in partial fulfillment of the requirements For the Ph.D. degree in the Department of Value and Decision Science, Graduate School of Decision Science and Technology, Tokyo Institute of Technology THESIS SUMMARY This research sets out to clarify the translational features of value co-creation of health services at a transitional environment by analyzing the processes of human activity systems through which knowledge is generated and transferred. By interacting with various agents and intervening in context with them, an agent attempts to translate such human factor as competencies into value. Once the value is perceived by a customer in a certain context, then it turns into value-in-context regardless a customer encounters services or physical artifact/goods. Context is never static but dynamic elements are innate in it since context is constantly evolving in human activity systems in relations with knowledge. This study, through a mix of quantitative/empirical, qualitative/conceptual, case-based/exploratory, and archival-based/ descriptive methods, showed the followings: (1) the human competencies including interpersonal understanding and relationship building are salient as well as technical expertise particularly in addressing the behavior for value co-creation, where human competencies are relationship-focused while technical expertise are agent-focused. (2) high performers exhibit dynamic actions and contextual transformation such as participation (contextualization), interpretation (re- contextualization), socialization (co-contextualization), objectification (de-contextualization) and translation (trans-contextualization), (3) the policy-centric and product-centric translational cycles characterize the dissemination of service technology of pressure ulcer therapy. This dissertation empirically clarifies the translational features of value co-creation and innovation of healthcare services in light of ba or shared context-in-motion by examining theoretical frameworks and proposing models primarily based on the approaches of service systems sciences. The major contribution to science, if any, could be summarized into three focal points. First, this work empirically models the dynamic interaction between agents’ competencies and dynamic contexts in micro shared context-in-motion typically found in workplace and community of practices. Second, the translational characteristics of innovation processes of healthcare services are identified at macro shared context-in-motion or international industry-hospital-academic-government relations by observing historical diffusions of knowledge and contextualization associated with innovation processes. Third, the general model on translation of knowledge and contextualization is proposed that bridges between micro, mezo and macro phases of shared context-in-motion in addressing value co- creation and innovation of services. Those three points, when used as lenses, shed light on the issues that have not been effectively and efficiently discussed by the conventional approaches usually employed by health services administration or systems approach in healthcare. Greater clarity of translational aspects of value co-creation in health services, discussed herewith in this dissertation, will assist those engaged in service innovation and services systems management in both scientific disciplines and practical fields. - 1 - ACKNOWLEDGEMENTS This dissertation is based on eight years of research devoted in comprehending the dynamics of value co-creation and innovation of services in general and of health services in particular. The significant part of this project was done in collaboration with many researchers and scholars. I would like to express my gratitude to everyone who supported me throughout the course of this project. I am thankful for their insightful guidance, invaluably constructive discussion and friendly advice during the project work. I am sincerely grateful for them for having shared the intuitive and illuminating views on a number of issues related to the project. Among those people, special thanks go to my committee chair professor Jim Kijima. Without his insightful guidance this dissertation would not have been realized. Also my gratitude goes to Hiroshi Deguchi, Hironao Kaneko, Mika Goto, Masako Ikegami who cordially shared opportunities to discuss the implications of major findings of my research. Through joining International Symposium on Service Systems Science for these three years at Tokyo Institute of Technology, I fortunately have had precious opportunities in sharing ideas with such outstanding individuals as David Ing (Aalto University), Gary Metcalf (Sullivan University), Jim Spohrer (IBM Almaden Research Center), Marja Toivonen (VTT Technical Research Centre of Finland), Mary Edson (Equipoise Enterprises, Inc.), Paul Maglio (University of California at Merced), Paul Lillrank (Alto University, Finland) and Steve Vargo (University of Hawaii). I owed quite a lot to the insightful discussions with those people on diverse issues related with service science in particular. I owed the research outcomes to the friends representing their hospitals; Masako Kurose, vice president and nursing director of Kurashiki Hospital and Noriko Tabuchi vice president of Ehime University Hospital. I really enjoyed value co-creation and action learning opportunities in the projects with those outstanding health services and research institutions. In the course of completing chapter four, where Asia-African transnational and translational community of practice were discussed, I enjoyed the discussion with ex-professor Toshihiko Hasegawa at Nippon Medical School who also gave me the precious opportunities to carry out the engagements at Sri Lanka, Peoples Republic of the Congo and Japan on 5S-Kaizen-TQM. I am thankful to Noriaki Ikeda, a physician at National Center of Global Health and Medicine for his invaluable inputs about quality and safety issues of health services. We worked together in Colombo and Kinshasa for localizing 5S- Kaizen-TQM into the health services systems in those countries. Also Yujiro Handa, professor at Health Sciences University of Hokkaido provided insightful discussion opportunities with me on quality improvement both in industry and health services. - 2 - Katsumi Fujitani, professor at Bunkyo Gakuin University was helpful in approaching health services issues from the perspective of communication and consensus building. Shinji Ono, associate professor, an ophthalmologist shared lots of occasion with seminars and panel discussions on safety, quality improvement and coaching at Japanese Association of Health Management. In the field of pressure ulcer treatment and the risk assessment for pressure ulcer no one had made more contribution to my thesis than Hiromi Sanada, professor at Tokyo University and Takehiko Ohura, professor emeritus of Hokkaido University for our co-work on cost effectiveness research of modern dressing care of pressure ulcer. This study formed a base of technology transfer and diffusion of risk assessment tools which was incorporated in the Chapter 7. The discussion with Kayoko Kano, professor of nursing at Kanagawa University of Human Services gave me keen awareness about the importance of soft competencies in human service settings. The author has been on the board of International Center for Social entrepreneurs. The activities with Takashi Watanabe and Kazuo Inoue continue to broaden my perspective on social innovation and social corporate responsibility. On oral care and team approach for improving quality of health services Syuichiro Nagaosa, a dentist, has been terrific in sharing novel ideas with me. In the course of carrying out this project, I have had numerous opportunities in chatting on the issues about social innovation, entrepreneurship, technology management and health services with many friends including Kamijo Yukiko, Jerome Gulbran, Noriyuki Ueda, Tomomi Takagi, Phillipe Valdois, Katsuhide Takashima, Inoue Hideaki, Nagisa Takahashi, Masayoshi Nakamura, Mayako Tsuyuki, Shin Yamamoto, Osamu Kumasaka, Etsuo Kanuka, Tomomi Yoshida, Naoki Aikawa, Shinichi Hitsumoto and Shizuo Asogawa. Finally thanks to Kengo and Shogo, my two precious sons, for all the love and strength they give to me. And thanks to Kiyomi who shares my life and always has been my best supporter. When I completed my masters at Cornell in 1988 we were lovers, whereas twenty seven years later when I complete this dissertation, we are the parents of the two kids who are attending colleges. Without my family I would not have had energy to execute this project. - 3 - TABLE OF CONTENTS THESIS SUMMARY ........................................................................................................1 ACKNOWLEDGEMENTS ..............................................................................................2
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