Value-added strategy models to provide quality services in senior health business

Value-added strategy models to provide quality services in senior health business Abstract Objective The rapid population aging is now a global issue. The increase in the elderly population will impact the health care industry and health enterprises; various senior needs will promote the growth of the senior health industry. Most senior health studies are focused on the demand side and scarcely on supply. Our study selected quality enterprises focused on aging health and analyzed different strategies to provide excellent quality services to senior health enterprises. Design We selected 33 quality senior health enterprises in Taiwan and investigated their excellent quality services strategies by face-to-face semi-structured in-depth interviews with CEO and managers of each enterprise in 2013. Setting A total of 33 senior health enterprises in Taiwan. Participants Overall, 65 CEOs and managers of 33 enterprises were interviewed individually. Intervention(s) None. Main Outcome Measure(s) Core values and vision, organization structure, quality services provided, strategies for quality services. Results This study’s results indicated four type of value-added strategy models adopted by senior enterprises to offer quality services: (i) residential care and co-residence model, (ii) home care and living in place model, (iii) community e-business experience model and (iv) virtual and physical portable device model. The common part in these four strategy models is that the services provided are elderly centered. These models offer virtual and physical integrations, and also offer total solutions for the elderly and their caregivers. Through investigation of successful strategy models for providing quality services to seniors, we identified opportunities to develop innovative service models and successful characteristics, also policy implications were summarized. Conclusions The observations from this study will serve as a primary evidenced base for enterprises developing their senior market and, also for promoting the value co-creation possibility through dialogue between customers and those that deliver service. quality services, value-added strategy model, senior, Taiwan Introduction The rapid population aging has become a global trend. According to a UN report [1], it is estimated that the elderly population will increase to 2 billions by 2050 ad which accounts for 21% of the total population. The increase in the elderly population will bring large-scale qualitative changes to commercial activities and social development. To be well positioned to cope with population aging, countries all over the world have devoted resources in facing challenges regarding aging. The needs of seniors, especially urgent needs in health-related services include health care and medical services. Governments have actively promoted the idea of healthy aging, structured long-term caring service system and other social strategies such as security and financial safety. All these strategies are expected to drive a flourishing growth of industries related to senior services [2]. These interests have certainly not escaped the health service managers’ attention; also, they are interested in how to provide quality services according to seniors’ needs on health-related business. It seems no doubt due to the implicit assumption that improvement in quality and innovation in a service encounter should lead directly to a successful business. However, it is here where the confusion remains. The senior health business focuses on providing the elderly population with services to meet their various demands related to everyday living and health—access to food, clothes, wellbeing, esthetics, medical care and social services [3, 4]. In general, elderly people want to live independently for as long as possible and thus the issues surrounding care provision are extensive to many aspects of life including health, social services, housing, transportation and support services [5, 6]. With this growing industry driven by the increase in daily living demands of the elderly population, there has been an urge to investigate the development of the senior industry [7]. The leaders who refer to research for adopting strategies would hardly find information, if any, that is directly related to providing quality service in senior health firms. We analyzed previous literature regarding aging subjects and found that there had been very few discussions on strategies and quality business models in the senior industry. To date, the study of senior needs, health care provision and medical innovation have dominated the literature [8, 9]. Indeed, there is no research that simultaneously analyzes the relative positioning of the business and senior customers constructs. Enterprises would like to provide quality care [10, 11] and find strategies which maximize the value proposition. This gap in the literature has generated a new call for research. It would be helpful to find out the approach to combine both provider and customer perspectives for adding, co-create value for service encounters and add knowledge for countries experiencing an aging society. Therefore, our study aimed to categorize successful senior enterprises strategy models and concluded practical approaches for other senior enterprises. We adopted ‘Business Model Generation’ canvas approach proposed by Osterwalder and Pigneur [12] and success patterns categorized by Yang et al. (2016) to investigate the strategy models for senior health business. Materials and Methods This cross-sectional descriptive study design collected data through (i) literature analyses, (ii) Internet data review, (iii) in-depth direct interviews with the enterprise leaders and (iv) direct field observations. A total of 33 quality senior enterprises in Taiwan were selected in 2013. These enterprises were selected by two criteria: (i) targeting on elderly daily health life needs: the services provided by enterprises focus on elderly health life needs, including food, clothing, shelter, communication, recreation, medical care and social services; and (ii) Quality of enterprises are well recognized: enterprises have been awarded by either Taiwan government or well-known NGO’s. A list of semi-structured interviews was generated from prior research on Business Model Canvas [13] and brainstorming based on experiences of research team. We specially focused on the analysis of the enterprises’ key resources, key activities, distribution channels and their customer relationships (Fig. 1). Figure 1 View largeDownload slide Focused elements of Business Model Canvas analyzed in the study. Figure 1 View largeDownload slide Focused elements of Business Model Canvas analyzed in the study. We have conducted 122 h of interviews; each CEO interview took 1–2 h which had been conducted by at least three research team members. An expert panel reviewed the list to assess the appropriateness of its contents. We used content analysis approach for direct interview contents by following ‘ladder of analytical abstraction’ proposed by Carney [14] including steps of transcribing, conceptualizing, propositionalizing, graphing and theorizing. Consensuses on analysis results were reached through research member group discussions. Results The characteristics briefing of 33 selected enterprises includes (i) the mean operation year is 18.2 (SD = 13.4) with maxima 51 years, minion 1 year and 30.3% have operated for <10 years; (ii) the yearly revenue varies from US$30.8 million to US$0.2 million with a mean of US$12.7 million; and (iii) their organization structures are mainly matrix structure, i.e. a hybrid of divisional and functional structure. According to our series studies [4, 7], these enterprises could be classified according to their characteristics in clicks-and-mortar with customers’ residing situation according to CEO’s evaluation into four categories of strategy models as shown in Fig. 2. The characteristics of enterprises have been summarized by the size of bubbles indicating their capital amounts invested and their position in the degree of clicks-and-mortar and elderly residing. X-axis stands home residing for the elderly (higher percentage indicates elderly tends to live home) while Y-axis presents the elderly movement for getting the services (higher percentage indicates elderly tends to move to off-line institutions to receive services). We analyzed and summarized their differences in proposing their value-added strategies based on differentiating these four categories of models: (i) residential care and co-residence model, (ii) Home care and living in place model, (iii) community e-business experience model and (iv) virtual and physical portable device model. Figure 2 View largeDownload slide Four categories of strategy models of senior health enterprises. Figure 2 View largeDownload slide Four categories of strategy models of senior health enterprises. All these four models provide elderly daily health needs in various aspects, including leisure, activities, ongoing learning, support in living, supports in safety, health care, health management, etc. The supply side might cover access to food, clothes, living, transportation, education, entertainment, wellbeing, esthetics, health care, occupation and social services. Residential care and co-residence model Enterprises need to have their key resources such as heavy investment in buildings and hardware to drive their key activities. Along with all health-related services, this model specifically focuses on residence, daily life care provision, medical care treatment and group social services; it focuses on assisting family members in the role of caregivers for the elderlies for a long period of time. The target customers of this model range from healthy elderlies to elderlies with diseases. This model emphasizes on nursing care in reality and adopts the Internet as a virtual assistance platform. By the level of health care required from low to high, health care facilities can be categorized into four types: (i) retirement communities that host elderlies who pay for their own accommodations or those who live alone and require long-term assistance with daily assistance, (ii) residential care centers that accommodate elderlies unable to live independently but do not require specialized nursing care, (iii) long-term care facilities that host elderlies with chronic diseases and those who require long-term medical services and (iv) nursing homes that look after elderlies with chronic diseases and need long-term nursing care or those who require nursing after hospitalization. There are facilities that provide continuous care covering all levels described above and also include care for the demented people, accompanying elderlies in their last few years of life. Home care and living in place model Most senior citizens belonging to the Chinese culture prefer to stay at home instead of living in co-residence facilities. However, they need assistance with mobility to live in their own communities. Target customers in this model consist of elderlies who live at home and require support in living and health care services. This model in particular offers short-term assistance for family members who take care of the elderlies. Along with all health and daily care services, this model specifically focuses on diet serving, daily life assistance, medication consultants, medical visits companion and social interaction services, such as preparing healthy meals, washing clothes, cleaning environments, buying daily merchandises, assuring safety in movements, especially assisting the journey of hospital outpatient visits. Community e-business experience model This model provides the elderlies with health supplements, portable devices, prosthetic aids, learning skills, physical rehabilitation facilities and medical examination services driven by their key resources, the e-commerce, and form the web community. The target customers of this model—the elderlies and/or their children who are able to visit the physical stores that provide products or services—would search for products on websites, on online platforms, or consult with online customer services before visiting the physical shops for trying out and purchasing the products or services. This model provides even more by integrating enterprises’ key partners with capabilities and technologies. Enterprises that adopt this model often have a website and chain services for their physical stores to overcome issues regarding traveling distance. Some enterprises in this model with decent revenues might start to enter the bigger market for being an international e-business. Virtual and physical portable device model As for the distribution channels and customer relationships, this model emphasizes the development and the application of Internet platforms in assisting customers with the use of portable and mobile devices to enhance the physical and mental wellbeing of the elderlies. Along with other applications of online technologies, this model focuses on education and entertainment. The target customers of this model range from elderlies with high mobility to those with low mobility, with a special focus on elderlies with physical disabilities. This model may assist family members in the transportation of the elderlies, or even remove the need for transportation. For example, the development of portable devices, applications (APPs), or aids may assist the elderlies with barrier-free travels, or build consultation platforms for experiencing education-related products and services. In this, the elderlies become from being taken care of to being proactively participating as discussed in past research. They can also empower and encourage their peers to participate in and promote interactions between the supply and demand sides, and achieve value co-creation through their own contributions in a way that meets their own demands. Discussion The rapid population aging is an urgent global issue. The increase in elderly population will impact health care industry and health enterprises; various senior needs will promote growth of the senior health industry. Most senior health studies focused on the demand side and scarcely in the supply side. Our study selected quality enterprises to focus on aging health and analyzed their strategies. The study has identified categories of strategies for providing quality senior health business by interviewing CEO’s and reviewing data of 33 selected quality senior health enterprises. The results indicated strategy models for senior enterprises that meet the elderly and the caregivers’ needs with a total solution and one-stop shopping services. ‘We believe that providing quality services is essential to our business. We keep discussing on how to add more value with customers by interviewing them, listening to them carefully. We believe one day we can co-create value with our senior customers, and create more room for market and revenue.’ Our results indicate that there are different strategy models for providing quality services and well using key resources of enterprises. Our results add further evidence that key resources and key activities are important decision-making criteria for business to provide quality senior health services [15]. We observed that elderly oriented paradigm shift from the interview with CEOs. The ‘paradigm shift’ identifies that the mind-sets of enterprises are a shift from mainly focusing on professional-driven quality to focus much more on voices of elderly and their caregivers [16]. Most CEOs recognized the importance of providing quality services and especially attempted to maximize the value of services. One described that: In reflecting the principle of elderly centered services, most senior enterprises tend to adopt combinations of the four models, but with different proportions and significance of each model depending on their core business structures and key resources. Many of the success senior enterprises interviewed choose to develop businesses in home-care and in place systems. This may be influenced by Chinese culture that most elderlies want to age in a familiar environment, such as their homes. However, nowadays more and more elderlies accept residential care and co-residence services [17]. From the community e-business experience model and the virtual and physical portable device model, we found that the elderlies or their caregivers’ proactive seeking of products or services would drive the application of technologies in the senior industry to create innovative services, which in return attracts the customers to shopping. Our findings support the thoughts of Chesbrough [18]. The elderlies can also empower and encourage their peers to participate in and promote interactions between the supply and demand sides, and achieve value co-creation through their own contributions in a way that meets their own demands, which echoes a recent study [19]. The application of Internet platforms in assisting customers with the use of portable and mobile devices can enhance the physical and mental wellbeing of the elderlies. Enterprises that adopt this model often have a website and chain services for their physical stores to overcome issues regarding traveling distance, which is the main concern for elderly [20–22]. Due to different lifestyles among different cities, there is a need to consider such issues in future studies to understand elderly needs and the necessarily extended service models [23]. As metropolitan and rural lifestyles may require different industry types, the needs of the elderly rural society and the relatively young urban society also vary, and may even develop into different adaptive product and service models. Therefore, the innovative service model may also be concealed with a localized operational testing model, hoping to gain relevant operational experience to serve as the basis for replication and expansion, and seeking international development opportunities to serve the middle- to older-aged adult groups [24, 25]. These value‐added strategies were accomplished through analyzing key resources, integrating with key partners and figure approaches out to empower consumers. These results exemplify how the degree of clicks-and-mortar and elderly residing, particularly the emergence of key partner cooperatives, can be employed as strategic factors in developing a competitive approach in a newly developing industry such as senior health business. Different models have been concluded from our study. Besides single business models, we suggest that researchers can explore the possibilities to generate multiple hybrid models. Limitations Qualitative methodology was selected in this study because our purpose was to investigate CEO’s perspectives about their quality senior health services and summarized it into strategy models. Qualitative methodology is appropriate for these aims because it allows for the open-ended generation of ideas and yields conceptual frameworks. The qualitative investigation is also time-consuming and resource intensive. As is the case with any research project, this study has limitations that should be considered. First, while the qualitative methodology can provide useful insights, it has limitations on generalizability and inter-subjectivity. The participants we interviewed are from quality enterprises and not representing the industry. More investigation in both quantitative and qualitative approaches is needed to infer empirical operations of senior health business. In addition, a follow-up study on long-term outcomes of enterprises adopted each model for adopting value-added strategies is suggested. Conclusions Population sharply rising in the elderly sector as affected by the era of baby boomers has generated a unique sector with massive consuming capabilities and huge health needs. Our objective for this study was to analyze different strategies to provide excellent quality services in senior health enterprises. Our study interviewed CEOs of 33 selected quality senior health enterprises in Taiwan in 2013. We classified these enterprises by degree of clicks-and-mortar of services and residing situation and summarized four categories of strategy models for senior enterprises that there were meeting diversified lifestyles and substitutive needs for the elderly and their caregivers. It is expected that future research will further explore the opportunities for the senior industry and innovative service models, and investigate on the various designs for products/services and the capabilities of product design and service export. Future research can also further the study on and promote the value co-creation between the supply and demand sides, so as to help increase the quality of life of the elderlies, to discover new business opportunities for the industry, to overcome the health care barriers, and lastly, to achieve satisfaction and happiness for the elderlies. Funding This research was financially supported by a grant from the Golden Dream Project (grant number 105-6100-001-400) launched by TaiShang Resource International Group. Our interpretation and conclusions contained herein do not represent those of the funding body. References 1 World Population Ageing 2013. United Nations, 2013 December. http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf (13 July 2015, date last accessed). 2 Green G. Age-friendly cities of Europe. J Urban Health  2013; 90 Suppl 1: 116– 28. doi:10.1007/s11524-012-9765-8. Google Scholar CrossRef Search ADS PubMed  3 Roberts K. Across the health-social care divide: elderly people as active users of health care and social care. Health Soc Care Community  2001; 9: 100– 7. Google Scholar CrossRef Search ADS PubMed  4 Yang YT, Hsu YE, Chen YM et al.  . Observations on quality senior health business: success patterns and policy implications. Int J Qual Health Care  2016; 28: 209– 13. Google Scholar CrossRef Search ADS PubMed  5 Zhavoronkov A, Cantor CR. Methods for structuring scientific knowledge from many areas related to aging research. PLoS One  2011; 6:e22597. https://doi.org/10.1371/journal.pone.0022597. 6 Stock RD, Reece D, Cesario L. Developing a comprehensive interdisciplinary senior healthcare practice. J Am Geriatrics Soc  2004; 52: 2129– 33. Google Scholar CrossRef Search ADS   7 Yang YT, Iqbal U, Chen YM et al.  . Co-creating value through demand and supply integration in senior industry—observations on 33 senior enterprises in Taiwan. Int J Qual Health Care  2016; 28: 497– 501. Google Scholar CrossRef Search ADS PubMed  8 Bravo G, Dubois MF, Demers L et al.  . Does regulating private long-term care facilities lead to better care? A study from Quebec, Canada. Int Qual Health Care  2014; 26: 330– 6. Google Scholar CrossRef Search ADS   9 Ellis JM, Howe A. The role of sanctions in Australia’s residential aged care quality assurance system. Int Qual Health Care  2010; 22: 452– 60. Google Scholar CrossRef Search ADS   10 Stock RD, Reece D, Cesario L. Developing a comprehensive interdisciplinary senior healthcare practice. J Am Geriatr Soc  2004; 52: 2129– 33. Google Scholar CrossRef Search ADS   11 Wu WN, Bliss G, Bliss EB et al.  . A direct primary care medical home: the Qliance experience. Health Aff  2010; 29: 959– 62. Google Scholar CrossRef Search ADS   12 Osterwalder A, Pigneur Y. An ontology for e-business models. Val Creat E-Bus Model  2004; 4: 65– 97. 13 Simpson M, Cheney G. Marketization, participation, and communication within New Zealand retirement villages: a critical-rhetorical and discursive analysis. Discourse Commun  2007; 1: 191– 222. Google Scholar CrossRef Search ADS   14 Carney TF. Collaborative Inquiry Methodology . Windsor, Ontario, Canada: University of Windsor, Division for Instructional Development, 1990. 15 Epstein MJ, Roy MJ. Sustainability in action: identifying and measuring the key performance drivers. Long Range Plann  2001; 34: 585– 604. Google Scholar CrossRef Search ADS   16 Ritala P, Golnam A, Wegmann A. Coopetition-based business models: the case of Amazon.com. Ind Mark Manage  2014; 43: 236– 49. Google Scholar CrossRef Search ADS   17 Peng R, Wu B. Changes of health status and institutionalization among older adults in China. J Aging Health  2015; 27: 1223– 46. Google Scholar CrossRef Search ADS PubMed  18 Chesbrough HW. Open Innovation: The New Imperative for Creating and Profiting From Technology . Boston, MA: Harvard Business School Press, 2006. 19 Hill R, Betts LR, Gardner SE. Older adults’ experiences and perceptions of digital technology: (Dis) empowerment, wellbeing, and inclusion. Comput Human Behav  2015; 48: 415– 23. Google Scholar CrossRef Search ADS   20 Etchemendy E, Banos RM, Botella C et al.  . An e-health platform for the elderly population: the butler system. Comput Educ  2011; 56: 275– 9. Google Scholar CrossRef Search ADS   21 Gokalp H, Clarke M. Monitoring activities of daily living of the elderly and the potential for its use in telecare and telehealth: a review. Telemed Health  2013; 19: 910– 23. Google Scholar CrossRef Search ADS   22 Bujnowska-Fedak MM, Pirogowicz I. Support for e-health services among elderly primary care patients. Telemed Health  2014; 20: 696– 704. Google Scholar CrossRef Search ADS   23 Kylen M, Ekstrom H, Haak M et al.  . Home and health in the third age—methodological background and descriptive findings. Int J Environ Res Public Health  2014; 11: 7060– 80. Google Scholar CrossRef Search ADS PubMed  24 Kelly AJ, Fausset CB, Rogers W et al.  . Responding to home maintenance challenge scenarios: the role of selection, optimization, and compensation in aging-in-place. J Appl Gerontol  2014; 33: 1018– 42. Google Scholar CrossRef Search ADS PubMed  25 Benefield LE, Holtzclaw BJ. Aging in place merging desire with reality. Nurs Clin North Am  2014; 49: 123. Google Scholar CrossRef Search ADS PubMed  © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal for Quality in Health Care Oxford University Press

Value-added strategy models to provide quality services in senior health business

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Abstract

Abstract Objective The rapid population aging is now a global issue. The increase in the elderly population will impact the health care industry and health enterprises; various senior needs will promote the growth of the senior health industry. Most senior health studies are focused on the demand side and scarcely on supply. Our study selected quality enterprises focused on aging health and analyzed different strategies to provide excellent quality services to senior health enterprises. Design We selected 33 quality senior health enterprises in Taiwan and investigated their excellent quality services strategies by face-to-face semi-structured in-depth interviews with CEO and managers of each enterprise in 2013. Setting A total of 33 senior health enterprises in Taiwan. Participants Overall, 65 CEOs and managers of 33 enterprises were interviewed individually. Intervention(s) None. Main Outcome Measure(s) Core values and vision, organization structure, quality services provided, strategies for quality services. Results This study’s results indicated four type of value-added strategy models adopted by senior enterprises to offer quality services: (i) residential care and co-residence model, (ii) home care and living in place model, (iii) community e-business experience model and (iv) virtual and physical portable device model. The common part in these four strategy models is that the services provided are elderly centered. These models offer virtual and physical integrations, and also offer total solutions for the elderly and their caregivers. Through investigation of successful strategy models for providing quality services to seniors, we identified opportunities to develop innovative service models and successful characteristics, also policy implications were summarized. Conclusions The observations from this study will serve as a primary evidenced base for enterprises developing their senior market and, also for promoting the value co-creation possibility through dialogue between customers and those that deliver service. quality services, value-added strategy model, senior, Taiwan Introduction The rapid population aging has become a global trend. According to a UN report [1], it is estimated that the elderly population will increase to 2 billions by 2050 ad which accounts for 21% of the total population. The increase in the elderly population will bring large-scale qualitative changes to commercial activities and social development. To be well positioned to cope with population aging, countries all over the world have devoted resources in facing challenges regarding aging. The needs of seniors, especially urgent needs in health-related services include health care and medical services. Governments have actively promoted the idea of healthy aging, structured long-term caring service system and other social strategies such as security and financial safety. All these strategies are expected to drive a flourishing growth of industries related to senior services [2]. These interests have certainly not escaped the health service managers’ attention; also, they are interested in how to provide quality services according to seniors’ needs on health-related business. It seems no doubt due to the implicit assumption that improvement in quality and innovation in a service encounter should lead directly to a successful business. However, it is here where the confusion remains. The senior health business focuses on providing the elderly population with services to meet their various demands related to everyday living and health—access to food, clothes, wellbeing, esthetics, medical care and social services [3, 4]. In general, elderly people want to live independently for as long as possible and thus the issues surrounding care provision are extensive to many aspects of life including health, social services, housing, transportation and support services [5, 6]. With this growing industry driven by the increase in daily living demands of the elderly population, there has been an urge to investigate the development of the senior industry [7]. The leaders who refer to research for adopting strategies would hardly find information, if any, that is directly related to providing quality service in senior health firms. We analyzed previous literature regarding aging subjects and found that there had been very few discussions on strategies and quality business models in the senior industry. To date, the study of senior needs, health care provision and medical innovation have dominated the literature [8, 9]. Indeed, there is no research that simultaneously analyzes the relative positioning of the business and senior customers constructs. Enterprises would like to provide quality care [10, 11] and find strategies which maximize the value proposition. This gap in the literature has generated a new call for research. It would be helpful to find out the approach to combine both provider and customer perspectives for adding, co-create value for service encounters and add knowledge for countries experiencing an aging society. Therefore, our study aimed to categorize successful senior enterprises strategy models and concluded practical approaches for other senior enterprises. We adopted ‘Business Model Generation’ canvas approach proposed by Osterwalder and Pigneur [12] and success patterns categorized by Yang et al. (2016) to investigate the strategy models for senior health business. Materials and Methods This cross-sectional descriptive study design collected data through (i) literature analyses, (ii) Internet data review, (iii) in-depth direct interviews with the enterprise leaders and (iv) direct field observations. A total of 33 quality senior enterprises in Taiwan were selected in 2013. These enterprises were selected by two criteria: (i) targeting on elderly daily health life needs: the services provided by enterprises focus on elderly health life needs, including food, clothing, shelter, communication, recreation, medical care and social services; and (ii) Quality of enterprises are well recognized: enterprises have been awarded by either Taiwan government or well-known NGO’s. A list of semi-structured interviews was generated from prior research on Business Model Canvas [13] and brainstorming based on experiences of research team. We specially focused on the analysis of the enterprises’ key resources, key activities, distribution channels and their customer relationships (Fig. 1). Figure 1 View largeDownload slide Focused elements of Business Model Canvas analyzed in the study. Figure 1 View largeDownload slide Focused elements of Business Model Canvas analyzed in the study. We have conducted 122 h of interviews; each CEO interview took 1–2 h which had been conducted by at least three research team members. An expert panel reviewed the list to assess the appropriateness of its contents. We used content analysis approach for direct interview contents by following ‘ladder of analytical abstraction’ proposed by Carney [14] including steps of transcribing, conceptualizing, propositionalizing, graphing and theorizing. Consensuses on analysis results were reached through research member group discussions. Results The characteristics briefing of 33 selected enterprises includes (i) the mean operation year is 18.2 (SD = 13.4) with maxima 51 years, minion 1 year and 30.3% have operated for <10 years; (ii) the yearly revenue varies from US$30.8 million to US$0.2 million with a mean of US$12.7 million; and (iii) their organization structures are mainly matrix structure, i.e. a hybrid of divisional and functional structure. According to our series studies [4, 7], these enterprises could be classified according to their characteristics in clicks-and-mortar with customers’ residing situation according to CEO’s evaluation into four categories of strategy models as shown in Fig. 2. The characteristics of enterprises have been summarized by the size of bubbles indicating their capital amounts invested and their position in the degree of clicks-and-mortar and elderly residing. X-axis stands home residing for the elderly (higher percentage indicates elderly tends to live home) while Y-axis presents the elderly movement for getting the services (higher percentage indicates elderly tends to move to off-line institutions to receive services). We analyzed and summarized their differences in proposing their value-added strategies based on differentiating these four categories of models: (i) residential care and co-residence model, (ii) Home care and living in place model, (iii) community e-business experience model and (iv) virtual and physical portable device model. Figure 2 View largeDownload slide Four categories of strategy models of senior health enterprises. Figure 2 View largeDownload slide Four categories of strategy models of senior health enterprises. All these four models provide elderly daily health needs in various aspects, including leisure, activities, ongoing learning, support in living, supports in safety, health care, health management, etc. The supply side might cover access to food, clothes, living, transportation, education, entertainment, wellbeing, esthetics, health care, occupation and social services. Residential care and co-residence model Enterprises need to have their key resources such as heavy investment in buildings and hardware to drive their key activities. Along with all health-related services, this model specifically focuses on residence, daily life care provision, medical care treatment and group social services; it focuses on assisting family members in the role of caregivers for the elderlies for a long period of time. The target customers of this model range from healthy elderlies to elderlies with diseases. This model emphasizes on nursing care in reality and adopts the Internet as a virtual assistance platform. By the level of health care required from low to high, health care facilities can be categorized into four types: (i) retirement communities that host elderlies who pay for their own accommodations or those who live alone and require long-term assistance with daily assistance, (ii) residential care centers that accommodate elderlies unable to live independently but do not require specialized nursing care, (iii) long-term care facilities that host elderlies with chronic diseases and those who require long-term medical services and (iv) nursing homes that look after elderlies with chronic diseases and need long-term nursing care or those who require nursing after hospitalization. There are facilities that provide continuous care covering all levels described above and also include care for the demented people, accompanying elderlies in their last few years of life. Home care and living in place model Most senior citizens belonging to the Chinese culture prefer to stay at home instead of living in co-residence facilities. However, they need assistance with mobility to live in their own communities. Target customers in this model consist of elderlies who live at home and require support in living and health care services. This model in particular offers short-term assistance for family members who take care of the elderlies. Along with all health and daily care services, this model specifically focuses on diet serving, daily life assistance, medication consultants, medical visits companion and social interaction services, such as preparing healthy meals, washing clothes, cleaning environments, buying daily merchandises, assuring safety in movements, especially assisting the journey of hospital outpatient visits. Community e-business experience model This model provides the elderlies with health supplements, portable devices, prosthetic aids, learning skills, physical rehabilitation facilities and medical examination services driven by their key resources, the e-commerce, and form the web community. The target customers of this model—the elderlies and/or their children who are able to visit the physical stores that provide products or services—would search for products on websites, on online platforms, or consult with online customer services before visiting the physical shops for trying out and purchasing the products or services. This model provides even more by integrating enterprises’ key partners with capabilities and technologies. Enterprises that adopt this model often have a website and chain services for their physical stores to overcome issues regarding traveling distance. Some enterprises in this model with decent revenues might start to enter the bigger market for being an international e-business. Virtual and physical portable device model As for the distribution channels and customer relationships, this model emphasizes the development and the application of Internet platforms in assisting customers with the use of portable and mobile devices to enhance the physical and mental wellbeing of the elderlies. Along with other applications of online technologies, this model focuses on education and entertainment. The target customers of this model range from elderlies with high mobility to those with low mobility, with a special focus on elderlies with physical disabilities. This model may assist family members in the transportation of the elderlies, or even remove the need for transportation. For example, the development of portable devices, applications (APPs), or aids may assist the elderlies with barrier-free travels, or build consultation platforms for experiencing education-related products and services. In this, the elderlies become from being taken care of to being proactively participating as discussed in past research. They can also empower and encourage their peers to participate in and promote interactions between the supply and demand sides, and achieve value co-creation through their own contributions in a way that meets their own demands. Discussion The rapid population aging is an urgent global issue. The increase in elderly population will impact health care industry and health enterprises; various senior needs will promote growth of the senior health industry. Most senior health studies focused on the demand side and scarcely in the supply side. Our study selected quality enterprises to focus on aging health and analyzed their strategies. The study has identified categories of strategies for providing quality senior health business by interviewing CEO’s and reviewing data of 33 selected quality senior health enterprises. The results indicated strategy models for senior enterprises that meet the elderly and the caregivers’ needs with a total solution and one-stop shopping services. ‘We believe that providing quality services is essential to our business. We keep discussing on how to add more value with customers by interviewing them, listening to them carefully. We believe one day we can co-create value with our senior customers, and create more room for market and revenue.’ Our results indicate that there are different strategy models for providing quality services and well using key resources of enterprises. Our results add further evidence that key resources and key activities are important decision-making criteria for business to provide quality senior health services [15]. We observed that elderly oriented paradigm shift from the interview with CEOs. The ‘paradigm shift’ identifies that the mind-sets of enterprises are a shift from mainly focusing on professional-driven quality to focus much more on voices of elderly and their caregivers [16]. Most CEOs recognized the importance of providing quality services and especially attempted to maximize the value of services. One described that: In reflecting the principle of elderly centered services, most senior enterprises tend to adopt combinations of the four models, but with different proportions and significance of each model depending on their core business structures and key resources. Many of the success senior enterprises interviewed choose to develop businesses in home-care and in place systems. This may be influenced by Chinese culture that most elderlies want to age in a familiar environment, such as their homes. However, nowadays more and more elderlies accept residential care and co-residence services [17]. From the community e-business experience model and the virtual and physical portable device model, we found that the elderlies or their caregivers’ proactive seeking of products or services would drive the application of technologies in the senior industry to create innovative services, which in return attracts the customers to shopping. Our findings support the thoughts of Chesbrough [18]. The elderlies can also empower and encourage their peers to participate in and promote interactions between the supply and demand sides, and achieve value co-creation through their own contributions in a way that meets their own demands, which echoes a recent study [19]. The application of Internet platforms in assisting customers with the use of portable and mobile devices can enhance the physical and mental wellbeing of the elderlies. Enterprises that adopt this model often have a website and chain services for their physical stores to overcome issues regarding traveling distance, which is the main concern for elderly [20–22]. Due to different lifestyles among different cities, there is a need to consider such issues in future studies to understand elderly needs and the necessarily extended service models [23]. As metropolitan and rural lifestyles may require different industry types, the needs of the elderly rural society and the relatively young urban society also vary, and may even develop into different adaptive product and service models. Therefore, the innovative service model may also be concealed with a localized operational testing model, hoping to gain relevant operational experience to serve as the basis for replication and expansion, and seeking international development opportunities to serve the middle- to older-aged adult groups [24, 25]. These value‐added strategies were accomplished through analyzing key resources, integrating with key partners and figure approaches out to empower consumers. These results exemplify how the degree of clicks-and-mortar and elderly residing, particularly the emergence of key partner cooperatives, can be employed as strategic factors in developing a competitive approach in a newly developing industry such as senior health business. Different models have been concluded from our study. Besides single business models, we suggest that researchers can explore the possibilities to generate multiple hybrid models. Limitations Qualitative methodology was selected in this study because our purpose was to investigate CEO’s perspectives about their quality senior health services and summarized it into strategy models. Qualitative methodology is appropriate for these aims because it allows for the open-ended generation of ideas and yields conceptual frameworks. The qualitative investigation is also time-consuming and resource intensive. As is the case with any research project, this study has limitations that should be considered. First, while the qualitative methodology can provide useful insights, it has limitations on generalizability and inter-subjectivity. The participants we interviewed are from quality enterprises and not representing the industry. More investigation in both quantitative and qualitative approaches is needed to infer empirical operations of senior health business. In addition, a follow-up study on long-term outcomes of enterprises adopted each model for adopting value-added strategies is suggested. Conclusions Population sharply rising in the elderly sector as affected by the era of baby boomers has generated a unique sector with massive consuming capabilities and huge health needs. Our objective for this study was to analyze different strategies to provide excellent quality services in senior health enterprises. Our study interviewed CEOs of 33 selected quality senior health enterprises in Taiwan in 2013. We classified these enterprises by degree of clicks-and-mortar of services and residing situation and summarized four categories of strategy models for senior enterprises that there were meeting diversified lifestyles and substitutive needs for the elderly and their caregivers. It is expected that future research will further explore the opportunities for the senior industry and innovative service models, and investigate on the various designs for products/services and the capabilities of product design and service export. Future research can also further the study on and promote the value co-creation between the supply and demand sides, so as to help increase the quality of life of the elderlies, to discover new business opportunities for the industry, to overcome the health care barriers, and lastly, to achieve satisfaction and happiness for the elderlies. Funding This research was financially supported by a grant from the Golden Dream Project (grant number 105-6100-001-400) launched by TaiShang Resource International Group. Our interpretation and conclusions contained herein do not represent those of the funding body. References 1 World Population Ageing 2013. United Nations, 2013 December. http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf (13 July 2015, date last accessed). 2 Green G. Age-friendly cities of Europe. J Urban Health  2013; 90 Suppl 1: 116– 28. doi:10.1007/s11524-012-9765-8. Google Scholar CrossRef Search ADS PubMed  3 Roberts K. Across the health-social care divide: elderly people as active users of health care and social care. Health Soc Care Community  2001; 9: 100– 7. Google Scholar CrossRef Search ADS PubMed  4 Yang YT, Hsu YE, Chen YM et al.  . Observations on quality senior health business: success patterns and policy implications. 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International Journal for Quality in Health CareOxford University Press

Published: Jun 20, 2017

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