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study takes into account client involvement, being a distinguishing feature of service
production in general (e.g. Sampson and Froehle, 2006) and healthcare provision
in particular (e.g. Lanseng and Andreassen, 2007). Furthermore, the underlying
reasoning of Duray et al. (2000) provides a dynamic view on modularity, showing
how mass customized products come into existence in the production cycle. As
suggested by Menor et al. (2002), starting our data analysis from goods modularity
enables us to consider the use of modularity in care and related service provision
and, from there, advance theory on modularity beyond manufacturing.
Below, we present an overview of our field of research, the literature on product and
service modularity, and the methodology for case study research. Thereafter, the case
study findings are first described and then discussed in the light of modularity theory.
Conclusions, including consideration of the implications of the research complete the
paper.
5.2 Setting the scene: care and service provision to inde-
pendently living elderly
Figure 5.1 presents a brief overview of the healthcare sector. The present study focuses
on the field of home care rather than on cure or residential care.
The needs and requirements of independently living elderly people differ from those of
patients in a hospital or other institutional settings (e.g. a psychiatric clinic or nursing
Figure 5.1 Healthcare sector and focus of the current research (i.e. boxes printed bold)
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93
home). Elderly people want to live independently as long as possible, even when they
need care and support (Schols, 2004). Therefore, the issues surrounding care provision
are extensive, involving many aspects of life such as health, welfare services, housing,
and support services (e.g. Van Campen and Woittiez, 2003, Leichsenring et al., 2005).
Furthermore, the provision of care and services to old people will be mostly long-term,
since full recovery from most functional impairments is often impossible. Over time,
needs might alter as a result of changing health conditions that, generally speaking,
will deteriorate (e.g. Van Bilsen, 2008). Thus, the degree to which independently living
elderly are able to take care of themselves and their household decreases over time,
whereas the amount and intensity of home care to be provided by an organization
increases.
Home care refers to care provided at home by professional home-nursing organizations
and home-help services. Home help includes services like housekeeping assistance,
moral support and psychosocial support. Home nursing includes services such as
hygienic and other personal care (e.g. helping with showering), technical nursing
activities (such as wound care) and psychosocial activities. Welfare services (such as
counseling activities, meals-on-wheels and alarm systems) are complementary services
intended to support elderly people to live at home independently. Furthermore,
domestic services (such as handrails, grab bars, easy-access bathrooms and kitchens,
zero-step entrance) can modify the physical features of houses and make it easier
and safer to carry out daily activities like bathing, cooking and climbing stairs (Van
Bilsen, 2008).
Demand-based provision of care to independently living elderly implies that dissimilar
and heterogeneous services in the domains of housing, welfare and care should be
combined into a single package. Furthermore, each package as a whole should be
tuned to the specific needs and requirements of each individual elderly client. Because
older people differ from each other in several ways, they are very heterogeneous in
their requirements, needs and preferences in the domains of housing, welfare and
care (Luijkx and De Blok, 2007). Traditionally, however, organizations (and even
organizational departments) providing services in housing, welfare and care to
independently living elderly, work autonomously and separately from each other. It is
currently felt, however, that this supply-oriented approach is not optimal as each entity
provides only partial help whereas the elderly client, having multiple needs, should be
served in an integrated fashion (Meijboom et al., 2004). Still, the heterogeneous and
long-term character of care and services provided by the various providers makes the
joint provision of such services relatively dynamic and complex.
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odular car
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or independen
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5.3 Principles of modular production
5.3.1 Product modularity and production cycle view
In the broadest sense, modularity is an approach for organizing complex products and
processes efficiently by decomposing complex tasks into simpler activities so they can
be managed independently (Baldwin and Clark, 1997, Mikkola and Gassmann, 2003).
The key to successful product modularization is product architecture: the scheme by
which the functional elements of a product are assigned to independent components
(Ulrich, 1995). A modular product architecture includes a one-to-one mapping of
functional elements to physical components of the product (Fixson, 2005). One of the
key characteristics of modularity is related to creating flexibility through mixing-and-
matching of components, thus creating product variety (Hsuan and Skjøtt-Larsen, 2004,
Pine, 1993, Sanchez and Mahoney, 1996, Schilling, 2000). A large number of product
variations may be obtained from a relatively simple product architecture decomposed
into a few components that are available in a limited number of variations (Sanchez,
1999), thus allowing for repetitive manufacturing. Hence, it is suggested that modular
production can facilitate mass customization by enlarging the number of products or
product features available while at the same time preventing a rise in costs (e.g. Starr,
1965, Ulrich, 1995, Duray et al., 2000, Fixson, 2005).
Traditionally, research on modularity has largely focused on the design of products
(e.g. Ulrich, 1995). However, the total flow of components and goods from suppliers
to final customers encompasses more activities. Some take an operations perspective
on modularization by relating the concept to different stages of the production
cycle. This provides insight into where and how in the production process modular
products can be realized and product customization can be achieved (e.g. Baldwin
and Clark, 1997, 2000, Duray et al., 2000). Whereas Baldwin and Clark posit that
three types of modularity can be related to three stages of the production cycle,
Duray et al. (2000) provide more advanced and empirically validated knowledge on
modularity from a production cycle viewpoint. To enable customization by means of
modularity, organizations must find a way to include each customer’s specifications
in the product. By distinguishing between early and late stages in the production
cycle, Duray et al. (2000) identify different types of modularity based on the point of
customer involvement. The authors argue that, if customers are involved in early stages
of the production cycle, a product can be highly customized. If customer preferences
are included only in the final stages, the degree of customization will be less. This
is related to the degree of product differentiation allowed by modularity. Customer
involvement in early phases allows for customized manufacturing or alteration of
components based on customer specifications. These customized components are
then assembled into a highly differentiated final product. When involvement takes
Modular Care Provision
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