be used for a number of end products or client groups (e.g. Starr, 1965, Ulrich, 1995,
Fixson, 2005) which allows to achieve low cost and consistent quality associated with
repetitive manufacturing (Duray et al., 2000). In care and service modularity, however,
repetitive execution of components might not automatically lead to advantages in
efficiency. Components in care and services will not be provided in a standardized and
routine manner all the time. Since each component has to be performed in interaction
with every single customer, the execution of care and service components is influenced
by human behavior. Furthermore, adaptation of the components is relatively easy.
Especially in care delivery to independently living elderly, homecare professionals have
the freedom to shape their own ideas and methods concerning good care provision
since they work autonomously in the homes of their clients (Vulto and Morée, 1996).
To reduce mental workload, increase standardization and, thus, overcome the potential
loss of efficiency advantages, scripts on how to perform care and service components
can be useful (Tansik
and Smith, 1991).
Although the achievement of efficiency advantages in care
and service modularity is
not straightforward, other types of advantages can be gained through a modular set-up
of service supply. For example, components in care and services can be used for several
clients or client groups. In this way modularity encourages organizations to exploit
analogies among clients. Service organizations often offer a large diversity of services
and provide variations of the same service to serve their total client group (Safizadeh
et al., 2003). Following a modular set-up of service packages, however, providers might
reduce the large number of service variations while offering differentiated packages.
This can result in more effective customization.
The comprehensive specification process, as identified in this research, seems to be
a prerequisite for the creation of care and related service packages for independently
living elderly. Both a-priori and on-the-job specification are required to combine
standard components from multiple domains and, subsequently, to adapt these to the
specific requirements of elderly clients. For providers of other types of health care or
other types of services, however, it may not be necessary or desirable to go through
all stages of the specification process. When designing their process for component
specification and package construction, service and healthcare providers seem to have
a choice as to what part of the process to emphasize.
Instead of emphasizing both a-priori and on-the-job specification, a provider can
decide to primarily focus on a-priori specification, thereby allowing client involvement
early in the production cycle. Based on client needs, standard components can be
combined from a menu of choice options; however, these cannot be adapted later on
in the production cycle. For example, in an outpatient clinic, the treatment of a patient
suffering from a chronic condition such as hypertension is based on the outcomes of
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a standard questionnaire that the patient fills out early in the specification process.
Based on the outcomes, treatment is decided upon and may include a combination
of components such as weight control, diet modification, drug therapy, stress control
and on-going surveillance. Each intervention is standard and allows for efficiency
gains; however, each patient is treated as unique because each can receive a different
combination of these interventions (Bohmer, 2005).
Alternatively, providers of services can decide to primarily focus on the on-the-job
phase in package specification. When needs and requirements of clients or client
groups are highly predictable, packages of service components can be preassembled.
As such, client involvement can be extended until late in the production cycle, where
based on specific client needs and requirements these components can be adapted
to customize the package. For example, travel agencies offer holiday packages which
include services such as transportation, accommodation and leisure activities. However,
before or during an individual client’s holiday, the components can be fully or partly
adapted to match the unique requirements of the vacationer.
In sum, instead of focusing on a comprehensive specification process for the creation
of modular service packages, healthcare and service providers can choose to focus on a
specific stage of the process. Based on, for example, the type of service provided or the
degree of customization desired, they can determine the intensity of client involvement
allowed and the type of modularity to apply.
5.7 Conclusions
This study aimed to advance modularity theory beyond manufacturing by investigating
the specification and construction of modular care and service packages in the field
of elderly care. To achieve this, we took the widely cited work of Duray et al. (2000)
on manufacturing modularity as a starting point. These authors argue that client
involvement early in the production cycle allows for component adaptation on the
basis of client needs, thereby leading to high customization of the final product.
Conversely, client involvement late in the production cycle allows for a combination
of standard components only and thereby leads to low product customization. For our
empirical research, four case studies in the field of elderly care provided insight in the
production cycle where appropriate care and related service components are specified
and assembled into packages for individual clients. Our case results show that early
client involvement allows for a combination of standard care and service components,
leading to a low level of package customization. Conversely, client involvement late in
the production cycle allows for components to be adapted on the basis of client needs,
thereby leading to a high level of customization of the final care and service package.
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