The role of business model-building and model-changing in driving healthcare value: A physiotherapy primary healthcare organisation perspective

The general purpose of this thesis is to gain insights into business model-building and model-changing related to healthcare value for physiotherapy primary healthcare organisation (PTPHO) within the context of Dutch PTPHOs.

Physiotherapy provides services that develop, maintain and restore people’s maximum movement and functional ability at any stage of life when movement and function are threatened by ageing, injury, diseases, disorders or environmental factors. As in other Western countries, a significant proportion of physiotherapy services in the Netherlands is provided by PTPHOs. These micro (<10 employees) organisations are located in neighbourhoods close to where people live and work. Interaction with local neighbourhoods is important for PTPHOs, to attain and sustain healthcare value. The healthcare market in which Dutch PTPHOs operate is characterised by managed competition. With managed competition, business principles have been introduced. PTPHOs still struggle to make impact in this healthcare system approach.

To enable PTPHOs to manage their organisation a ‘Healthcare value for PTPHOs framework and definition, was presented. Healthcare value for PTPHOs is “to continuously attain PTPHO-centred outcomes in coherence with patient- and stakeholder-centred outcomes, leveraged by an organisation’s capacity for change”.

Concerning business model-building, it may be advisable for a PTPHO to apply a planned strategy, encourage organisational double-loop learning orientation and proactive market orientation and, business model novelty. It may also be desirable for a PTPHO to have interfaces in place for the use of internal organisation and external environment information. Regarding business modelchanging, it is suggested that a PTPHO may conduct business model change over-time that link the internal organisation and external environment by concurrent short-, medium- and long-term exploitation and exploration. Such a simultaneous approach may allow a PTPHO to adapt to a changing market in both an incremental and radical way. To stimulate transitions in healthcare, healthcare policy and health insurers could encourage PTPHO business model-building and model-changing.

The combination of persistent use of health insurer-driven managed competition contracts and naturally efficient PTPHOs may have left too few means for these organisations to contribute to healthcare reforms and to attain and sustain healthcare value. Markedly, the insights gained in this dissertation suggest that PTPHOs may want to shift their attitudes toward new routines, business model novelty instead of efficiency, and business model change.