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Purpose
The purpose of this paper is to investigate purchasing practices in service triads by exploring the link between ex ante contracting and ex post contract management and how these practices influence the satisfaction of buyers and suppliers (in concessionary arrangements) with their relationship in terms of meeting the needs of the buyer's customers.


Design/methodology/approach
An in-depth exploratory multiple case study was carried out in a shop-in-shop context. Multi-method and multi-source data collection included interviews, documents and the contracts between buyer and supplier, providing evidence of the formal and relational structures in both the contracting and contract management stages.


Findings
The case findings provide evidence that behavioural standards established in a social contract are important prerequisites for the establishment and subsequent management of a formal contract. Second, this study shows that, when outsourcing core services in a service triad, a combination of performance-oriented and behavioural-oriented contract terms, covering a mix of topics related to both the customer-experience and to buyer-supplier-oriented aspects, contribute to aligning the buyer's, suppliers' and customers' interests. The main findings are presented in a causal model and formulated as propositions.


Originality/value
This paper is one of the first studies to explore how core services are outsourced in a service triad. It provides evidence that the social contract between buyer and supplier influences the establishment of the formal contract as well as contract management, and a mix of contract topics, some related to the customers' experience and others purely buyer-supplier oriented, contribute to the alignment of buyer's, suppliers' and customers' interests.

AbstractHumanitarian aid workers increasingly experience pressure to professionalize their services in order to ensure more efficient and effective assistance to disaster victims. Particularly for logisticians, this pressure is also the result of increasingly tough regulations imposed by host governments. This causes a dilemma for aid workers: Professionalization can be at odds with their humanitarian values and principles, such as providing unhindered assistance, without discrimination, to whoever needs it. This research explores how humanitarian logisticians experience and deal with this dilemma. In particular, how they reconcile humanitarian values and principles on the one hand with their (developing) professional standards and practices on the other. Theoretical concepts on professionalization, social identity, and so‐called boundary work are used to analyze the problem. Results show that individual logisticians adopt one of four distinct identities when approaching reconciliation, namely: Professional‐dominance, intersection, union, or humanitarian‐dominance identities. The associated approaches inform how they engage with stakeholders and make decisions. Each approach has its benefits and shortcomings in various operational settings. This implies there is a need to further establish the settings in which each approach delivers the best logistics performance.

Humanitarian aid workers increasingly experience pressure to professionalize their services in order to ensure more efficient and effective assistance to disaster victims. Particularly for logisticians, this pressure is also the result of increasingly tough regulations imposed by host governments. This causes a dilemma for aid workers: Professionalization can be at odds with their humanitarian values and principles, such as providing unhindered assistance, without discrimination, to whoever needs it. This research explores how humanitarian logisticians experience and deal with this dilemma. In particular, how they reconcile humanitarian values and principles on the one hand with their (developing) professional standards and practices on the other. Theoretical concepts on professionalization, social identity, and so-called boundary work are used to analyze the problem. Results show that individual logisticians adopt one of four distinct identities when approaching reconciliation, namely: Professional-dominance, intersection, union, or humanitarian-dominance identities. The associated approaches inform how they engage with stakeholders and make decisions. Each approach has its benefits and shortcomings in various operational settings. This implies there is a need to further establish the settings in which each approach delivers the best logistics performance.

Humanitarian aid workers increasingly experience pressure to professionalize their services in order to ensure more efficient and effective assistance to disaster victims. Particularly for logisticians, this pressure is also the result of increasingly tough regulations imposed by host governments. This causes a dilemma for aid workers: Professionalization can be at odds with their humanitarian values and principles, such as providing unhindered assistance, without discrimination, to whoever needs it. This research explores how humanitarian logisticians experience and deal with this dilemma. In particular, how they reconcile humanitarian values and principles on the one hand with their (developing) professional standards and practices on the other. Theoretical concepts on professionalization, social identity, and so-called boundary work are used to analyze the problem. Results show that individual logisticians adopt one of four distinct identities when approaching reconciliation, namely: Professional-dominance, intersection, union, or humanitarian-dominance identities. The associated approaches inform how they engage with stakeholders and make decisions. Each approach has its benefits and shortcomings in various operational settings. This implies there is a need to further establish the settings in which each approach delivers the best logistics performance.

Background: Practicing safe behavior regarding patients is an intrinsic part of a physician's ethical and professional standards. Despite this, physicians practice behaviors that run counter to patient safety, including practicing defensive medicine, failing to report incidents, and hesitating to disclose incidents to patients. Physicians' risk of malpractice litigation seems to be a relevant factor affecting these behaviors. The objective of this study was to identify conditions that influence the relationship between malpractice litigation risk and physicians' behaviors. Methods: We carried out an exploratory field study, consisting of 22 in-depth interviews with stakeholders in the malpractice litigation process: five physicians, two hospital board members, five patient safety staff members from hospitals, three representatives from governmental healthcare bodies, three healthcare law specialists, two managing directors from insurance companies, one representative from a patient organization, and one representative from a physician organization. We analyzed the comments of the participants to find conditions that influence the relationship by developing codes and themes using a grounded approach. Results: We identified four factors that could affect the relationship between malpractice litigation risk and physicians' behaviors that run counter to patient safety: complexity of care, discussing incidents with colleagues, personalized responsibility, and hospitals' response to physicians following incidents. Conclusion: In complex care settings procedures should be put in place for how incidents will be discussed, reported and disclosed. The lack of such procedures can lead to the shift and off-loading of responsibilities, and the failure to report and disclose incidents. Hospital managers and healthcare professionals should take these implications of complexity into account, to create a supportive and blame-free environment. Physicians need to know that they can rely on the hospital management after reporting ...

Abstract Background Practicing safe behavior regarding patients is an intrinsic part of a physician's ethical and professional standards. Despite this, physicians practice behaviors that run counter to patient safety, including practicing defensive medicine, failing to report incidents, and hesitating to disclose incidents to patients. Physicians' risk of malpractice litigation seems to be a relevant factor affecting these behaviors. The objective of this study was to identify conditions that influence the relationship between malpractice litigation risk and physicians' behaviors. Methods We carried out an exploratory field study, consisting of 22 in-depth interviews with stakeholders in the malpractice litigation process: five physicians, two hospital board members, five patient safety staff members from hospitals, three representatives from governmental healthcare bodies, three healthcare law specialists, two managing directors from insurance companies, one representative from a patient organization, and one representative from a physician organization. We analyzed the comments of the participants to find conditions that influence the relationship by developing codes and themes using a grounded approach. Results We identified four factors that could affect the relationship between malpractice litigation risk and physicians' behaviors that run counter to patient safety: complexity of care, discussing incidents with colleagues, personalized responsibility, and hospitals' response to physicians following incidents. Conclusion In complex care settings procedures should be put in place for how incidents will be discussed, reported and disclosed. The lack of such procedures can lead to the shift and off-loading of responsibilities, and the failure to report and disclose incidents. Hospital managers and healthcare professionals should take these implications of complexity into account, to create a supportive and blame-free environment. Physicians need to know that they can rely on the hospital management after reporting an incident. To create realistic care expectations, patients and the general public also need to be better informed about the complexity and risks of providing health care.

Professionals are expected to justify their actions to clients, disciplinary committees and courts in multiple accountability systems. Although developed to reflect professional standards, is it possible that these systems induce proactive behaviours that counteract their goals and instead serve to protect the professional? This article examines the types of stimuli professionals acquire from the public and professional accountability contexts and how these stimuli motivate engagement in specific proactive behaviours. An interpretive grounded theory study was conducted; it included 31 in-depth interviews with physicians from eight hospitals. The study revealed that accountability systems trigger and motivate professionals to engage in self-serving, proactive job-crafting behaviours. Professionals simultaneously manage their perceived accountability pressures and their personal interests. Context-specific factors that motivate individuals to craft their jobs are identified, and we reveal four distinct stimuli–motivation–job-crafting patterns that are linked to specific performance episodes (i.e. work stages). Our findings emphasize the importance of taking specific work contexts (i.e. accountability) and work stages into account when studying job-crafting behaviours. This study contributes to understanding professionals' motivations and behaviours in the context of accountability, which is essential, as the quality and safety of their work are matters of public concern.

PurposeThe purpose of this paper is to investigate the impact of three different dimensions of customer‐induced uncertainty and task uncertainty on the mix of physicians' coordination practices.Design/methodology/approachAn improvement and research project are combined resulting in 16 case studies in different departments from one university hospital. The paper relies mainly on patient data from hospitals' registration systems and on 140 dialogues between two physicians reflecting on their coordination practices.FindingsHospital units rely on time‐structured oral communication supplemented with feedback in cases of high levels of input variety, whereas severity of illness and service intensity increase the use of unstructured oral coordination practices. High levels of customer‐induced uncertainty reduce coordination by standardization of work processes. Supplementing verbal communication with written medical records has become an inherent part of coordination practices. Non‐surgical units rely mostly on time‐structured meetings, whereas surgical units use both time‐structured and unstructured meetings to deal with customer‐induced uncertainty.Research limitations/implicationsThe empirical part of this paper is limited to hospital units that are functionally organized. A further refinement and extension of measures for the contingency factors could help to better understand coordination practices.Practical implicationsThe paper offers hospitals in‐depth understanding of how customer‐induced uncertainty and task uncertainty affect physicians' coordination practices.Originality/valueThe paper contributes to the knowledge on medical coordination from a contingency perspective. Further, the paper contributes to alternative methodologies in terms of data gathering as dialogues between organizational members are the main data source.

This study examines the consequences for medical specialists of participating in multidisciplinary medical team meetings in terms of perceived clinical autonomy, domain distinctiveness, and professional accountability. These consequences may influence their willingness to cooperate and the quality of teamwork. The authors hypothesized that multidisciplinary medical team meetings would be more of a threat to the professional identity of surgical specialists than to the professional identity of nonsurgical and supporting specialists. A survey among 1,827 Dutch medical specialists supported the authors' hypotheses. However, a few specific specialties had response patterns that deviated from our expectations. The results are related to specialty choice, to the training of medical specialties, and to having a role in leading team meetings.

PurposeThe purpose of this paper is to explore how functional and appropriateness arguments influence the adoption of modularity principles during the design of a professional service architecture.Design/methodology/approachAction design research was conducted to examine the design process of a modular service architecture for specialised elderly care by a multi-professional group. Data collection methods included, partly participatory, observations of the interactions between professionals during the design process, interviews and document analysis. Data analysis focussed on the emerging design choices and the arguments underlying them.FindingsA wide range of both functional and appropriateness considerations were enlisted during the design process. The three core modularity principles were adapted to varying degrees. In terms of the design outcome, the interdependencies between the modularity principles necessitated two trade-offs in the modular design. A third trade-off occurred between modularity and the need for professional inference where services were characterised by uncertainty. Appropriateness was achieved through the professionals reframing and translating the abstract modularity concept to reconcile the concept's functionality with their professional norms, values and established practices.Originality/valueThe study adds to service modularity theory by formulating three trade-offs that are required in translating the core modularity principles into a functional set of design choices for a multi-professional service environment. Moreover, the inherent intertwinedness of the core modularity principles in professional services requires an iterative design process. Finally, the authors saw that the ambiguity present in the service modularity concept can be used to develop a design that is deemed appropriate by professionals.

Purpose– Applying "modularity" principles in services is gaining in popularity. The purpose of this paper is to enrich existing service modularity theory and practice by exploring how services are being decomposed and how the modularization aim and the routineness of the service(s) involved may link to different decomposition logics. The authors argue that these are fundamental questions that have barely been addressed.Design/methodology/approach– The authors first built a theoretical framework of decomposition steps and the design choices involved that distinguished six decomposition logics. The authors conducted a systematic literature search that generated 18 empirical articles describing 16 service modularity cases. The authors analysed these cases in terms of decomposition logic and two main contingencies: modularization aim and service routineness.Findings– Only three of the 18 articles explicitly addressed the service decomposition by reflecting on the underlying design choices. By unravelling the decomposition in each case, the authors were able to identify the decomposition logic and found four of the six theoretically derived logics: single-level process oriented; single-level outcome oriented; multilevel outcome oriented; and multilevel combined orientation. Although the authors did not find a direct relationship between the modularization aim and the decomposition logic, the authors did find that single-level decomposition logics seem to be mainly applied in non-routine service offerings whereas the multilevel ones are mainly applied in routine service offerings.Originality/value– By contributing to a common understanding of modular service decomposition and proposing a framework that explicates the design choices involved, the authors enable an enhanced application of the modularity concept in services.