Conceptual Development of Service Safety and Empirical Explorations in Health Care

Abstract

The overall aim of this research is to enhance understanding of service safety, which plays a key role in safeguarding customers’ individual well-being. While Berry et al. (2020) proposed four service safety domains (physical, emotional, financial, information safety), the concept ‘service safety’ has not been clearly defined nor sufficiently developed. Three objectives guide this research: (1) To conceptually develop the concept of service safety; (2) To empirically explore the concept based on customers’ perceptions of service safety in health care; (3) To develop a template to evaluate, manage and enhance service safety.

First, based on a multi-disciplinary literature review, this research conceptually develops the concept of service safety and delineates differences between service safety and related concepts (e.g., risk, service failure/recovery). Second, this research empirically explores service safety in health care by analyzing patient comments from three large survey datasets from different service contexts: hospital (N = 68,727); outpatient office (N = 56,900), and emergency department (N = 32,350). A combination of a deductive (building on the four domains of service safety) and an abductive approach (to discover the subthemes) was used in the coding process. We extracted subthemes within the four service safety domains that represent different aspects of service safety in health care, which can further enhance understanding and management of service safety.

Based on our findings, we define service safety and propose a conceptual framework that clarifies the theoretical foundations of the concept. Second, the preliminary findings of the empirical research confirm, expand, and detail the four domains of service safety specified by Berry et al. (2020). The four domains and their subthemes found in the inpatient dataset are as follows: Physical Safety (misdiagnosis, medication errors, provider error, lack of cleanliness), Emotional Safety (lack of compassion, positive emotional support, scared/fear), Financial Safety (billing error, stolen property, affordability), and Information Safety (withheld information/miscommunication, lack of coordinated communication, didn’t listen to patient, confidentiality violations). Moreover, our findings indicate that the four domains of service safety are interdependent. Analyses of the two other datasets (i.e., hospital and emergency department) are ongoing.

This paper contributes to service research by developing the concept of service safety and empirically exploring customer perceptions of service safety based on customer feedback in three different health care contexts. While the concept was introduced in 2020, it has not been conceptually developed nor empirically explored, which hampers its theoretical development and practical implications. The main limitation of this research is the exploration of service safety in the context of health care in the United States.

This is – to the best of our knowledge – the first study that conceptually and empirically develops the concept of service safety first advanced by Berry et al. (2020). Given that service safety plays a key role in safeguarding customers’ individual well-being, this research brings new insights to Transformative Service Research.