Shared Service Delivery Can Increase Client Engagement: A Study of Shared Medical Appointments

Abstract

Problem Definition: Clients and service providers alike often consider one-on-one service delivery to be ideal, assuming — perhaps unquestioningly — that devoting individualized attention best improves client outcomes. In contrast, in shared service delivery, clients are served in batches and the dynamics of group interaction could lead to increased client engagement — which could improve outcomes. However, the loss of privacy and personal connection might undermine engagement.

Practical Relevance: The engagement dynamics in one-on-one and shared delivery models have not been rigorously studied. To the extent that shared delivery may result in comparable or better engagement than one-on-one delivery, service providers in a broad array of contexts may be able to create more value for clients by delivering service in batches.

Methodology: We conducted a randomized controlled trial with 1,000 patients who were undergoing glaucoma treatment over a three-year period at a large eye hospital. Using verbatim and behavioral transcripts from over 20,000 minutes of video recorded during our trial, we examine how shared medical appointments (SMAs) — in which patients are served in batches — impact engagement.

Results: Patients who experienced SMAs asked 33.33% more questions per minute, made 8.63% more non-question comments per minute, and exhibited higher levels of non-verbal engagement across a wide array of measures (attentiveness, positivity, head wobbling or `talai taḷḷāṭṭam’ in Tamil — a South Indian gesture to signal agreement or understanding — eye contact and end-of-appointment happiness), relative to patients who attended one-on-one appointments.

Managerial Implications: These results shed light on the potential for shared service delivery models to increase client engagement and enhance service performance.

Note: Funding: Funding for this research was provided in part by Institute of Innovation and Entrepreneurship at London Business School, the Wheeler Institute for Business and Development at London Business School, and Harvard Business School.

Conflict of Interests: None to declare.

Ethical Approval: This study was approved by the ethics committees of Harvard Business School, London Business School and Aravind Eye Hospitals. Attached you can find approval letters from the associated institutions.

Trial Registration: The trial registration number for our trial is: CTRI/2018/02/011998. Below you can find the related e-mail from the CTRI (Clinical Trial Registry in India).

Keywords: client engagement, shared service delivery, shared medical appointments, healthcare operations, behavioral operations