CARE OPINION Research chat 6: Perfect ratings with negative comments

Our research chat on 11 May 2021 featured the work of Andrew Gallan, associate professor at Florida Atlantic University in the US. We were delighted to have Andrew join us for this chat.

Research from the US and the UK describes the phenomenon of patients giving healthcare providers perfect ratings (10 out of 10!), yet contradicting this with comments which may include negative experiences and suggestions for improvement.

In this chat we discuss why this happens, what we can learn about the nature of patient feedback, and what implications this might have for policy and practice.

Watch the session

The Impact of Patient Shadowing on Service Design: Insights from a Family Medicine Clinic


A central tenet of patient-centered care is to truly and deeply understand how patients experience health care. One particular qualitative method, patient shadowing, holds the promise of seeing things through the patient’s eyes in real time. The purpose of this research is to utilize patient shadowing to capture the realities of patient experiences in an outpatient family medicine clinic and to report opportunities for improvement to clinic leadership. A total of twenty (20) patients were shadowed at a family medicine outpatient clinic over the course of eight (8) different days, providing a variety of circumstances including staffing levels, shift changes, patient volume, and other factors. Patient shadowing revealed many interesting observations, capturing many best practices in delivering patient experiences as well as a short list of recommendations that could improve patients’ and staff experiences. Areas for improvement include helping patients better understand the entire process, wayfinding from the exam room to check-out, and creating a checklist for patient follow-up items. Patient shadowing presents many benefits to health care organizations and employees, including enhanced communication and teamwork, a greater connection with patient experiences and hardships, and the opportunity to redesign processes to optimize efficiency and service quality.

Healthcare QualityCast Podcast

Just shared my career journey w/ @qualitycoachco – Show Link: #HealthcareQualityCast #HealthcareQualityPeople

Whose experience is it anyway? Toward a constructive engagement of tensions in patient-centered health care

Healthcare delivery faces increasing pressure to move from a provider-centered approach to become more consumer-driven and patient-centered. However, many of the actions taken by clinicians, patients and organizations fail to achieve that aim. This paper aims to take a paradox-based perspective to explore five specific tensions that emerge from this shift and provides implications for patient experience research and practice.

This paper uses a conceptual approach that synthesizes literature in health services and administration, organizational behavior, services marketing and management and service operations to illuminate five patient experience tensions and explore mitigation strategies.

The paper makes three key contributions. First, it identifies five tensions that result from the shift to more patient-centered care: patient focus vs employee focus, provider incentives vs provider motivations, care customization vs standardization, patient workload vs organizational workload and service recovery vs organizational risk. Second, it highlights multiple theories that provide insight into the existence of the tensions and how they may be navigated. Third, specific organizational practices that engage the tensions and associated examples of leading organizations are identified. Relevant measures for research and practice are also suggested.

The authors develop a novel analysis of five persistent tensions facing healthcare organizations as a result of a shift to a more consumer-driven, patient-centered approach to care. The authors detail each tension, discuss an existing theory from organizational behavior or services marketing that helps make sense of the tension, suggest potential solutions for managing or resolving the tension and provide representative case illustrations and useful measures.

Vogus, T.J.Gallan, A.Rathert, C.El-Manstrly, D. and Strong, A. (2020), “Whose experience is it anyway? Toward a constructive engagement of tensions in patient-centered health care”, Journal of Service Management, Vol. ahead-of-print No. ahead-of-print.

Find the article here:

Using Patient Shadowing to Improve and Innovate Customer Service Design

Steve Jobs once said, “Design is not just what it looks and feels like. Design is how it works.”

While organizations do focus on the look and feel, unfortunately, the ‘how it works’ part is ignored. And from the customer’s perspective, this is a pain point that needs to be worked upon.

The concept of customer shadowing can help overcome these pain points and design robust customer service. Customer shadowing is like being the fly on the wall while a customer goes through his/her journey.

To discuss customer shadowing and how to use it to improve and innovate customer service design, I have with me Andrew Gallan, Assistant Professor of Marketing and the Director of The Centre for Services Marketing and Management at FAU School of Business, Florida.

Among other things, Andrew and I discuss:
– What exactly is customer shadowing?
– How is it different from mystery shopping?
– What insights can one expect to derive of a customer shadowing exercise?
– How can customer shadowing impact customer experience?

Honestly, I didn’t know much about Customer Shadowing before this podcast. Thanks to Andrew, I learnt a great deal and I can assure you that you would learn something really interesting in this podcast.

Connect with Andrew Gallan on:

The podcast can we found here:

Patient Ecosystem Management w/ FAU’s Andrew Gallan, Ph.D.

FREE podcast on connecting patient experiences to community well-being.

Engaging a wider range of resources to connect patients with organizations within their community can help transform healthcare and improve overall well-being, according to new research published in the Journal of Business Research by faculty at Florida Atlantic University’s College of Business. The article, “Transforming Community Well-being Through Patients’ Lived Experiences,” introduces the concept of “patient ecosystem management” (PEM), which the authors describe as an organizational process that focuses on treating patients differently in terms of assessing, managing and expanding resources to achieve patient health and well-being goals.

Andrew Gallan, Ph.D. – lead author of the article, assistant professor in FAU’s marketing department, and director of the FAU Center for Services Marketing and Management – joined Jim Hellegaard, Media Relations Director at FAU Business, to discuss the research.

Handling Difficult Patients

I thought I’d share this with you – to demonstrate how passionate the PX community is, and how they desire to support one another and to put patients first.

12 replies, 137 retweets, and 802 likes.

This is not about the impact one tweet had. It is about the reaction that the Twitterverse had to transforming the view of a “difficult patient” into the view of a patient in a difficult situation. What should/can you do differently when you transform your perspective?

Transforming Community Well-Being through Patients’ Lived Experiences

Journal of Business Research

The purpose of this article is to (1) explicate micro-to-meso linkages of well-being, (2) provide a theoretical framework to guide research on connecting patient experiences to community well-being, and (3) offer guidelines to policymakers. We develop a conceptual framework establishing connections between micro and meso levels through the expansion of patients’ lived ecosystems. We introduce the concept of patient ecosystem management (PEM), an organizational process that focuses on treating patients differently in terms of assessing, managing, and expanding resources to achieve patient health and well-being goals. This process establishes a foundational perspective that is necessary to connect patients’ ecosystems and to facilitate community well-being. Theoretically, this research creates ties between micro-level interactions and a collective measure (community well-being). Policymakers and healthcare professionals should take a PEM perspective, which will require new roles and behaviors, and leverage technology to expand and overlap patients’ individual service ecosystems (intra-alignment), thus enlarging community well-being (inter-alignment).


Patient experienceCommunity well-beingValue cocreationPatient ecosystem managementTransformative service researchWell-beingService Ecosystem

Customer Experience Challenges: Bringing Together Digital, Physical and Social Realms

The purpose of this paper is to explore innovations in customer experience at the intersection of the digital, physical and social realms. It explicitly considers experiences involving new technology-enabled services, such as digital twins and automated social presence (i.e. virtual assistants and service robots).

Future customer experiences are conceptualized within a three-dimensional space – low to high digital density, low to high physical complexity and low to high social presence – yielding eight octants.

The conceptual framework identifies eight “dualities,” or specific challenges connected with integrating digital, physical and social realms that challenge organizations to create superior customer experiences in both business-to-business and business-to-consumer markets. The eight dualities are opposing strategic options that organizations must reconcile when co-creating customer experiences under different conditions.

A review of theory demonstrates that little research has been conducted at the intersection of the digital, physical and social realms. Most studies focus on one realm, with occasional reference to another. This paper suggests an agenda for future research and gives examples of fruitful ways to study connections among the three realms rather than in a single realm.

This paper provides guidance for managers in designing and managing customer experiences that the authors believe will need to be addressed by the year 2050.

This paper discusses important societal issues, such as individual and societal needs for privacy, security and transparency. It sets out potential avenues for service innovation in these areas.

The conceptual framework integrates knowledge about customer experiences in digital, physical and social realms in a new way, with insights for future service research, managers and public policy makers.

Citation: Ruth N. BoltonJanet R. McColl-KennedyLilliemay CheungAndrew GallanChiara OrsingherLars WitellMohamed Zaki, (2018) “Customer experience challenges: bringing together digital, physical and social realms”, Journal of Service Management,

Words Matter: What Is a Consumer?

Words matter. They convey our thoughts, they illuminate our understandings, and they can comfort or not. Many people use the word “consumer” in the context of health care without thinking about its meaning. I urge you to think more deeply and clearly about its meaning before you use it again.

According to Miriam-Webster, a consumer is “one that (sic) consumes, such as: one that (sic) utilizes economic goods. E.g., Many consumers make purchases on the Internet” ( To consume is “(a) to do away with completely; (b) to spend wastefully; (c) to eat or drink especially in great quantity; (d) to waste or burn away” ( A consumer, then, has a pejorative meaning, one who is artificially separated from production or productive activities. Is that what you want to say when you use the term “health care consumer”?

The concepts of consumption and production, as separate and distinct activities, were developed long ago by economists, who attempted to quantify economic activities (Vargo and Lusch 2004). This perspective is no longer useful in explaining the cocreation of value, because it holds the potential to create an antagonistic relationship between providers and patients. Why? Because when one produces something of value, and another “consumes” it, value is defined exclusively by the producer. “We do all this great stuff here at XYZ Hospital, and often the patient just comes in and spoils it.” This is fundamentally wrong, and you instinctively know it.

So what is the proper term? More importantly, what is the proper perspective that can guide you into thinking about this issue in a more appropriate manner? I argue that experiences are coproduced by patients, providers, families, caregivers, and potentially many others. Value is always cocreated between at least two parties, most often among multiple parties (Black and Gallan 2015). Health care organizations cannot create value without patients. At most, they create value propositions that invite patients to engage with their services. Only when patients do so, and only when interactions go well, can value (as health and well-being), be cocreated. That is, patients experience health care in such a way that creates a better state for them (progression toward a goal, improved well-being, improved health, etc.).

Likewise, when a health care interaction goes well, a health care organization can capture value in various forms as well. For instance, it can capture financial value (money), it can capture value as employee fulfillment and satisfaction, and it can capture positive feelings and attributions toward its brand and organization (positive word-of-mouth and loyalty behaviors). All of these are desirable outcomes for health care organizations.

So when is a person a patient? A customer? Something else? My position is that people assume multiple roles in different situations, and thus must be treated accordingly. One health care clinician, who I fail to recall, put it thusly: “When a person is horizontal, they are a patient. When a person is vertical, they are a customer.” This is a bit simplistic, but, like all pithy sayings, has an element that rings true. I am not trying to tell clinicians that my perspective usurps their clinical domain; rather, I am rendering unto them what is theirs. When a person is being evaluated clinically, they are a patient, with all the rights and responsibilities that conveys. However, if clinicians, clinics, organizations want positive evaluations, reduced readmissions, bills paid on time, reduced no-show appointments, etc., they should understand that people have choices, degrees of freedom, and a voice. At that time, it is appropriate to consider a person as a customer. Increasingly, people are exercising these rights through technology. This does not make one a “consumer.” It only shows that a person is a complex individual, who acts in different and interesting ways.

When we are allowed to be labelled as a “consumer,” we are permitting ourselves to be pigeon-holed as one who can only offer economic benefit to an organization. We are more than that. Indeed, we are the very people who the health care system is designed to serve (evaluate the meaning of “service” too). Don’t allow yourself to be defined by this term: likewise, don’t define your patients as such. They are whole people, who act in a variety of roles throughout their health care experiences and their lives.


P.S. I also have an issue with the term “THE patient experience.” The term “the” creates an understanding that there is a singular experience that is perfect. Or that patient experience is an object that is separated from the person who is experiencing it. It objectifies the experience, and artificially separates a patient from the timeline of her life. Instead, I urge you to use the term “patients’ experiences,” because it inserts humanity into the term. It automatically urges us to think about patients as people, and experiences as their own. Think of it this way: “Improving THE patient experience” is much different in meaning from “Improving patients’ experiences.”


Black, Hulda G. and Andrew S. Gallan (2015), “Transformative Service Networks: Cocreated Value as Well-Being,” The Service Industries Journal, 35 (15-16), 826-45.

Vargo, Stephen L. and Robert F. Lusch (2004), “Evolving to a New Dominant Logic for Marketing,” Journal of Marketing, 68 (1), 1-17.