essay on service delivery

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Service Delivery and Customer Experience - Analytical Essay

Introduction.

Ensuring that customers get what they want is called a service quality. Managing service delivery is the single most effective mean for differentiation among companies. Technologies and travel industry development bring people and products even closer. Service operations managers should make increasing customer participation in quality service delivery a major goal if they want to stay competitive on the market. The impact of customer participation in service delivery on perception of the quality of the product is not absolutely researched yet. There is a tendency that increased level of customer participation in the services that are familiar for customer, will lead to higher perceived quality of service delivered.

Service Delivery and Customer Experience

Rapid developments of self – service technologies are becoming the main service delivery channel in recent years. The customer participation is service process is quickly increasing due to this reason. Service operations managers need to decide to which extend the customer is involved into delivery process. It is expected that in nearest future only two extreme formats of delivery will prevail: complete employee service and complete self – service. The mixture of these two extremes is still present in businesses today, even though the increasing self-service delivery will change the situation.

Customer’s involvement is usually mandatory, obligatory for the delivery processes. However, the service operations manager needs to know very well the specifics of service product: the level of necessary customer involvement will vary depending on this. There are cases when customers provide only minimal assistance throughout the process: they stay passively preoccupied. Nevertheless, in most cases customers substitute employee service with the self-service: they play active roles. Especially recently, customers tend to be more active in self – service.

Increasing customer involvement has a lot of benefits as practice has shown. For example, Internet auctions and Internet banking are all self – serviced. Such new business models (aimed at using full customer self – service) have great success in establishing their market position and achieving greater market share. There is a growing competition between these emerging self – service based companies and traditional employee based service companies.

For example, Internet stock trading companies – customer trading stocks successfully competes against traditional brokerage companies – employee trades for customers. In this example, the outcome of the competition is obvious - the workload between the company and customer (serf – service) is a decisive factor. The expenses for hiring new employees for service delivery are absent. The company gets pure income. This is another reason why service operations manager should try to increase customer participation as much as possible.

The difference in the proportion of workload which is outsourced tot eh customer or end user influences the company’s service delivery process and infrastructure as well as costs’ reduction. In addition, the impact of increased customer participation in the delivery process on the service quality is defined by the self – service level. Customer’s self –service is an important, sometimes even bigger, part of the service. Productivity and customer efficiency also has influence on service quality and expected demand. When a customer participates in the process, the perceived value of the service is increased many times, because customer himself has done something by himself.

As a result, customers increasing participation in the service processes will bring changes on the market with high competition level. There are many questions to be answered before the company decides to use full self – serviced delivery. Among them are: Will the self – serving companies be able to gain enough of market share to be competitive on the market compared to traditional approaches? How will this result be achieved by self – serviced companies? Who will be the leader: new approaches to delivery or traditional ones? What are the advantages and disadvantages of each service delivery approach? These questions can be answered only by the service mangers that have tried both approaches and found out which one is better.

The role self – service and customer in the process of delivery is very important, because the customer creates the value of the service by himself. He is the one responsible for the delivery quality and there is nobody else to blame for faults. Outsourcing delivery of service to customers gives competitive advantage to the company. People like to be involved in the process which will bring benefit to them; they are doing it not for somebody else but for themselves.

Service manager needs to decide what services can be outsourced or what amount of this service delivery can be handles by customers. If the service is not very complicated or difficult to do and does not require highly specialized skills it can be outsourced to customers. In addition, even if some knowledge and expertise is required in service delivery it still can be outsourced: customer needs to be provided with certain information on how to accomplish the task.

There was a mathematical model developed on how to calculate profit levels of two companies: one using full self – service delivery and the other using full –service. The research resulted in the interesting finding that the optimal, the best proportion of the workload to be outsourced is 0% or 100%. If the number is somewhere in between, the company may even encounter minimization of the profit figure. The service operations managers, therefore, have a choice of two options: to outsource as much of service delivery as possible or continue using traditional service delivery approaches. Also research has shown that companies with self – service had higher income rations than the ones with full service due to the absence of expenses for having employees to deliver this service to customer.

The key characteristic of the service delivery is the combination of simultaneous production and consumption. Customers get involved in the process so they influence the outcome of the quality of service delivery and the satisfaction by it. Before the service transaction can be completed, the customer needs to contribute some information or effort. The quality, therefore, depend on this information or effort of the customer.

Because services are intangible, there is always a risk associated with the service delivery. Introducing self - servicing, attributes part of this risk to customer’s role. For this reason, the service operations manager needs to try to increase the level of customer participation. However, the service provides will always risk in this situation in the control over the encounter cannot be ensured with relying on customers to perform the task of delivering service.

The most important issue of the customer participation are the roles which customers take in the service delivery. It is important for service managers to remember that customer comes to a service encounter with an idea in mind about what their role should be in this cooperation. This idea might have been derived from previous experience with similar services. Most often customer knows what to do because he has seen it in the advertising, on television or heard through word – of – mouth. It is also important for service manager to know and make necessary adjustments, that not all customers will come with correct and the same understanding of their roles. Necessary facilities need to clearly explain what should occur.

Roles also have important involvement of control issues. Clear communication of the information and mutual understanding of the roles which each party needs to perform will clarify the amount of control each party has. It is a proven fact that this mutual understanding between parties resulted in higher satisfaction received from service if both parties understood beforehand what their roles should be. There are a couple of strategies proposed which help service managers to manage customer participation. For example, telling customers in advance what are their expected roles. The customer needs prior training in operational procedures – this will increase the satisfaction level of service delivered.

Although there has been a lot of discussion in the literature about the customer participation in service delivery, the definition and management of the roles needed in the participation are still unexplored. However, it is a fact that if individuals have no necessary information about their roles and roles of service provider, they will get involved in coping others that can result in anxiety and higher dissatisfaction level.

The control that customers feel during their participation in service encounters influences the level of satisfaction they receive from service. Service operations manager needs to know how to increase this satisfaction. One way is to offer alternatives, choices within the servicing setting. For example, remote availability of electronic resources, photocopying of printed materials and self – servicing facilities, reference consultation on – site or by telephone.

The problems in service encounter usually appear because of the conflicts: who has more control in the service interactions. Both customer and provider of service have a need for control. It is generally accepted that customer participation has positive impact on both providers and customers. Here questions start to appear: how this positive participation can be stimulated and managed? Service manager needs to know how to manage customer participation in service encounters to have beneficial outcomes for both sides. Service providers must develop mechanisms and find ways to make sure that customers know what is expected from them and put effort to facilitate the outcome.

Customers need to be empowered to co-produce their own experience. Increasing customer involvement brings cost and convenience benefits for organization and customer himself. Service manager needs to remember that the greater the involvement of the customer in the service delivery, the greater the likelihood that this experience will meet expectations of both company and customer. If it does not happen, the customer also bears the part of responsibility and the service provider is not the only part to put guilt on.

Introducing self – serving methods of service delivery, company will gain loyalty from those customers who think of themselves as part of the organizational family. Moreover, through communicating with customers, service provider may directly learn defects of service and have immediate feedback about what should be done to improve.

It is important to understand that service is a not just a delivery of product, it is a process, a deed, a performance and effort from both provider and customer. It goes beyond the first encounter with a customer; it builds relationship between the company and society represented by this customer. Service operations manager should be aware that they do not only create the economic value for the firm but also social value for the customers. Customers have expectations that their rights are respected and the company needs to stick to ethical standards and contribute to the development.

It is impossible to quantify the value of service delivered, but the value of quality it adds to the company is obvious. The managing delivery quality is equally important as increasing customer participation in the process. It has a significant impact on whether this person, this customer will deal with the company again, use its service or not. It is not a secret for anybody that negative word - of – mouth is the strongest factor that can lead to very high loses of company. It is very hard to recover from negative image, it needs big investment (additional expenses) and a lot of time of top management (time is money). That is why service managers are primary responsible for creating the positive image through higher involvement of customers into service delivery process.

Effective service delivery is not only the process of exchanging values, the performance of other supporting activities is even more important. Among these activities are provision of information and advice, responsiveness to customer needs, handling complaints and common courtesy. It is understandable, that all these activities are easier to perform when delivery is full – serviced or at least half- serviced. When participation of customer is increased the involvement of trained personnel is limited to minimum. In this situation customer must have access to information they need, way to express complains and give recommendation if they have one in their mind.

Each good service manager should understand how customers derive utility form the service. These are factors underlying service delivery: (1) understanding how the organization can produce and deliver this utility tot eh ultimate consumer, (2) understanding how the organization needs to be managed to add value to the service delivered (increasing customer satisfaction), and (3) enabling the organization to meet its objectives to both customers and company itself.

Increasing customer involvement into process of service delivery will become number one objective for service managers it the companies that wants to stay competitive on the market when new technologies are developing very quickly. As this paper has shown customer participation has many benefits not only for the company but also for the customer himself. Decreasing labor costs for provider and increasing user satisfaction are the most important factors.

Fitzsimmons, J.A. & Fitzsimmons, M.J. (2004). Service Management Operations, Strategy and Information Technology, 4th ed, McGraw-Hill, USA

Bateson, J. E. G. (1985). “Perceived Control and the Service Encounter.” J. A. Czepiel, C. A. Surprenant, & M. R. Solomon (Eds.), The Service Encounter: Managing Employee/Customer Interaction in Service Businesses (pp. 68-72). Lexington: Lexington Books.

Dean, A. (1997). “The Impact of Consumer Participation on Perceived Service Quality”. Monash Working Paper Series, (24), Melbourne: Monash University,. Department of Management.

Dellande, S. & Gilly, M. (1998). “Gaining Customer Compliance in Services.” T. A. Swartz, D. E. Bowen & S. W. Brown (Eds.), Advances in Services Marketing and Management: research and practice. (v. 7, pp. 265-292). Greenwich, Conn., JAI Press

Faranda, W. T. (1994). Customer Participation in Service Production: An Empirical Assessment of the Influence of Realistic Service Previews. Unpublished doctoral dissertation, Arizona State University, Tempe, Arizona.

File, K. M., Judd, B. B., & Prince, R. A. (1992). “Interactive Marketing: the Influence of Participation on Positive Word-of-Mouth and Referrals.” Journal of Services Marketing, 6(4), 5-14.

Mills, P. K., & Morris, J. H. (1986). “Clients as 'Partial' Employees: Role Development in Client Participation.” Academy of Management Review, 11(4).

Mohr, L. A., & Bitner, M. J. (1991). “Mutual Understanding Between Customers and Employees in Service Encounters.” Advances in Consumer Research, 18

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Home › News › Op-Ed › Poor service delivery deprives people of dignity and their basic human rights

Poor service delivery deprives people of dignity and their basic human rights

Service delivery protests have long been part of South Africa’s fabric. It is a constitutional right in this country to protest, and for many it feels like the only way they can get the government to sit up and take notice of the service delivery issues in their communities.

The South African Police Service (SAPS) Incident Registration Information System (IRIS) documented 909 service delivery protests that took place between August 2020 and January 2021, with the COVID-19 pandemic doing little to stop them. Almost every week, the media reports more and more incidents of service delivery protests across the country. Yet, protests seem to do little in the way of prompting the government into action to improve service delivery.

Recently we saw escalating violence in Harrismith where residents are fed-up and angry about the state of service delivery. Many reported protests in the Eastern Cape have been around poor sanitation – from sewage overflowing , to residents required to relieve themselves in bushes due to the lack of sanitation infrastructure and pigs eating their excrement .

Amnesty International South Africa’s team held a brainstorming discussion on the topic of service delivery in the country. Some of the thoughts and phrases captured were: people suffering; failure by government; lazy officials; corruption; ineffectiveness; inequality; bad quality; and as George Orwell wrote: “all animals are equal, but some are more equal than others”.

Nationally, service delivery leaves much to be desired. Access to basic services in South Africa is largely crippled by the mismanagement of public funds, a lack of prioritisation by government, and a legacy of spatial segregation and unequal development, at the local level.

With a housing backlog growing at a rate of 178,000 per year, the announced budget cut for the Department of Human Settlements of R486.9 million over the next three years is frightening.

According to the National Water and Sanitation Plan , in some municipalities, only 50% of residents have access to adequate sanitation facilities; sanitation facilities in at least 26% of households within formal areas do not meet the required standard due to crumbling infrastructure; over 3 million people do not have access to basic water supply; and only 64% of households have access to a safe and reliable water supply. In a world battling a deadly pandemic, where water and sanitation is crucial for the protection of human health , these figures are a stark reminder of the increased risk millions of people are faced with due to basic service delivery failures.

With frustration, disappointment and desperation growing day-by-day and spilling over into both peaceful and violent service delivery protests, when will the government take heed? Does it take a multi-million-rand company leaving an area after years of service delivery issues for local government to finally spring into action, as is the case with the Clover factory currently moving its operations from Lichtenburg in the North West to Queensburgh in eThekwini? Are the voices of their constituents not enough? Is their oath to “solemnly promise to perform [their] functions and duties as a Councillor of [municipality] to the best of my ability”, as well as their constitutional mandate to “promote a safe and healthy environment”, not enough for them to take action and develop functioning municipalities fit to live in?

The demands are simple – water, housing, sanitation, road repairs, electricity, and street lighting. Is this too much to ask for, when people living in South Africa are constitutionally entitled to have their basic needs met?

At AISA, we went back to basics to ask ourselves why service delivery is important. The answers — it is to live a life with dignity; to live in a safe environment; for people to access and realise their basic human rights enshrined in international and national legislation; to reduce poverty; to raise the living standards of the poor majority; and for greater equality.

While this is not an exhaustive list by any means, it is for these reasons (and more) that we must remind duty bearers that, not only do they have a constitutional mandate to uphold in providing effective service delivery, but a moral and ethical one too.

Local government officials must take their oath seriously and fulfil their constitutional mandate to provide basic human rights and services, such as housing, water and sanitation, so that all who live in South Africa can live a life of dignity, equality and safety.

With local government elections currently scheduled to take place on 27 October this year, we have an opportunity to make our voices heard. AISA is launching a campaign this week, to call on the Department of Cooperative Governance and Traditional Affairs, as the body overseeing municipalities, to ensure that all municipalities fulfil their constitutional mandate to provide basic services to everyone in South Africa.

Through the campaign we will be highlighting the current status of service delivery as it pertains to housing, water and sanitation; failures by local government to live up to their promises; and calling for transparency in the management of public funds and decision making, accountability to commitments made to ensure equitable delivery of basic services, and access to information to promote active citizenry, to be prioritised by municipal officials.

The delivery of basic services is directly correlated to the attainment of basic human rights. It is time for us to take a stand and ensure that elected officials truly represent their constituents’ needs and that human rights are being upheld.

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Service Delivery

Service delivery is the complex of decisions, solutions, policies and actions aimed at the on time and quality delivery of the production to the client. Naturally, when someone orders goods in the Internet, he expects to receive them as quick as possible and for the most affordable price.

Nowadays it is quite easy and probably the Internet buys are the most frequent and widespread purchases nowadays. Years ago the problem of service delivery was also urgent and this practice already existed in the 19th century.

The courier’s services were very popular already at that time and goods were delivered by these special firms. With the run of time the situation has changed and companies have decided to deliver their production themselves. The well-organized sphere of logistics is supposed to organize the work of the firm, especially its material supply and delivery of its production. When the client orders a product, the company strives to deliver it professionally and safely. The greatest requirement of every customer is the affordable price, short terms and total safety of the delivery.

It is obvious that the price and quality of the service delivery depends on the type of the chosen transportation. Delivery by plane is supposed to be very fast but a bit expensive and other types of delivery (by train, car, etc) are longer but cheaper. The major aim of every service is to maintain the quality of the delivery and to avoid any incidents like damage of the product during transportation, its stealth or other problems.

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A prestigious and responsible firm refunds all the problems which have occurred with the product during the transportation and delivers a new example of the item purchased by the client for free. This attracts client’s attention and improves the customer’s loyalty towards the firm.

Service delivery is the important component of the effectiveness of the company’s work. The student who is writing a research proposal should pay attention to the structure of the paper and the explanation of the choice of the topic. One should prove that the problem on service delivery is really interesting and worth detailed analysis. The student is able to share his ideas concerning the problems of service delivery and suggest the alternative solutions to the existing poor sides of this policy.

The most complicated thing related with the process of research proposal writing is the lack of the student’s experience on the convincing writing. The student has the opportunity to look through a free example research proposal on public service delivery and get to know about the way of writing and analysis of the topic. The most valuable advice of a free sample research proposal on customer service delivery is the instruction of the logical presentation of the facts, demonstration of the methodology and analysis of the sources chosen for the investigation of the issue.

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Service Delivery in South Africa at a Glance

Introduction

Back in 2009, the Constitutional Court stipulated “[w]ater is life. Without it, nothing organic grows. Human beings need water to drink, to cook, to wash, and to grow their food. Without it, we will die.” [i] Fast-forward ten years and sustainable access to sufficient and adequate water is still a major concern for many within South Africa. As a result, some are forced to approach the courts for assistance.

The history of service delivery, or lack of it, in South Africa has been troublesome to say the least. A few weeks ago a general news search of service delivery or local municipalities would have revealed many articles by irate residents about the failures of their municipalities to deliver basic services. Now there is an intriguing High Court judgment in a case involving a local municipality in the North West, the Kgetlengrivier Local Municipality. Residents have finally won. [ii]

Kgetlengrivier Concerned Citizens v Kgetlengrivier Local Municipality

In a case that offers hope to exasperated residents around South Africa, the High Court of South Africa North West Division, Mahikeng granted the Kgetlengrivier Concerned Citizens control of the water and sewage works after an urgent application was launched regarding intermittent water supply and raw sewage running into the Koster and Elands rivers. [iii] The High Court found that the Kgetlengrivier Local Municipality was in breach of “its obligations to prevent contamination of the environment whilst allowing raw sewage to spill”. In addition, the Court found that both the local municipality as well as the district municipality, Bojanala Platinum District Municipality, were in breach of their “constitutional obligations for providing potable water sustainably”. [iv]

This is not the first time the Kgetlengrivier Concerned Citizens have taken control [v] but hopefully this will be the last time. An agreement was reached, and made a court order on 12 January 2021, that an implementing agent must be appointed to run the water and sewage works. [vi] In terms of this agreement Magalies Water has been appointed for the “operation and maintenance of water and wastewater treatment plants for a period of three years”. [vii]

What about residents in other municipalities?

What does this mean for dissatisfied residents in other municipalities? Some residents’ associations are considering, or have implemented, a tax diversion policy, whereby the residents withhold or refuse to pay the rates and taxes to the relevant municipality until such time as that municipality provides the basic services. [viii] One such resident association is the Umdoni Action Group, from Scottburgh. [ix]

As tempting as this approach may seem, it would be inadvisable given the Constitutional Court’s ruling in Rademan v Moqhaka Local Municipality . [x] In this case, the Constitutional Court found that a municipality may consolidate the different components of a resident’s account and as such the resident’s electricity supply may be cut where payment of rates and taxes have been withheld despite the electricity account having been paid. [xi] Notwithstanding the Court providing that “[t]here is no obligation on a resident, customer or ratepayer to pay the municipality for a service that has not been rendered” [xii] a resident would have to be able to show that no services were rendered by the municipality at all. Since the writing of this brief, it has come to the HSF’s attention with great sadness that Mrs Olga Rademan, a citizen activist who refused to stay quiet in the face of her municipality’s failures, has unfortunately passed away. She must be remembered for her commitment to standing up for what is just.

In Pietermaritzburg, emboldened by the success of the Kgetlengrivier Concerned Citizens, the Msunduzi Association of Residents, Ratepayers and Civics has indicated that they are considering their available options, including approaching the courts, given the state of degradation of service delivery in the area. [xiii] Their position may be justified. The South African Human Rights Commission launched a court application last year over the Msunduzi Municipality’s control and management of the New England Road Landfill Site being a violation of the “right to an environment that is not harmful to their health or well-being” as contained in section 24 of the Constitution. [xiv] Not to mention that the municipality has been paying the salary of 121 “employees” who are either dead or who have resigned. [xv]

Similarly, the Centre for Good Governance and Social Justice, a newly formed NGO in the North West, has tried nearly every avenue at its disposal to hold the Mamusa Local Municipality to account for its consistent failures and degradation. Frustrated with the total lack of regard that the municipality has for its citizens, the Centre has approached the President as well as the South African Human Rights Commission for assistance. It has also instituted action against the municipality to remove the newly appointed municipal manager who, despite his previous removal from the post and a legal opinion finding he was unqualified, was reappointed to the position. Not leaving a stone unturned, the Centre has indicated that it is currently considered legal action similar to that as was taken in Kgetlengrivier. [xvi]

Recently, the South African Human Rights Commission has released a 100 plus page report wherein it finds that the Emfuleni Local Municipality is guilty of violating multiple human rights in its failure to prevent raw sewage from contaminating the Vaal River and Dam. [xvii] This includes a violation of the right to dignity, [xviii] freedom and security of the person, [xix] the environment, [xx] property; [xxi] health care, food, water and social security; [xxii] children; [xxiii] and just administrative action. [xxiv] These findings, like that of the Kgetlengrivier case, indicate that there is an urgent need to address failures in service delivery.

In this report the South African Human Rights Commission recommends administration [xxv] . However as can be seen from Kgetlengrivier case, where the whole province is already under administration, [xxvi] this may not always be an adequate solution.

Local municipalities have faced a tough few weeks with findings of violations and reports of service delivery failures being repeatedly highlighted in the media. Whether other residents of failing municipalities will be able to achieve similar results is unknown, but it is not hard to imagine, given current reports, that there are other areas in comparable, if not identical, situations to those faced by the Kgetlengrivier Concerned Citizens. While it may not be as simple as merely approaching the court for an order as the precedent currently set means only the North West High Court is bound by the previous decision, but the case can definitely be considered to have persuasive value. But something needs to change. And until such time as local municipalities are able to deliver adequate services there seems little recourse other than legal action.

Chelsea Ramsden Legal Researcher [email protected]

[i] Mazibuko v City of Johannesburg [2009] ZACC 28 para 1.

[ii] See C Ryan “North West Residents Take Matters into Their Own Hands, and Get Court’s Blessing” (9 February 2021) available at https://www.moneyweb.co.za/news/south-africa/north-west-residents-take-matters-into-their-own-hands-and-get-courts-blessing/; P du Toit “Friday Briefing Taking Charge: How North West Residents Took on a Municipality and Won” (19 February 2021) available at https://www.news24.com/news24/opinions/fridaybriefing/friday-briefing-taking-charge-how-north-west-residents-took-on-a-municipality-and-won-20210219.

[iii] The Kgetlengrivier Concerned Citizens were, in terms of the court order dated 18 December 2020, entitled to take control of the water and sewage works if the local municipality failed to rectify the sewage spillage and provide potable water within ten week days of the order. The Kgetlengrivier Concerned Citizens took control on 7 January 2021.

[iv] Court order dated 18 December 2020 paras 4 and 13 respectively.

[v] Ryan note ii above that provides that urgent court orders were obtained in June 2018 and February 2020 granting the community control of the plants until they were up and running again.

[vi] Court order dated 12 January 2021 para 2.

[vii] Statement of MEC Mmoloki Cwaile on Kgetlengrivier Local Municipality Court Order (14 January 2021) available at https://www.gov.za/speeches/mec-cwaile-kgetlengrivier-local-municipality-court-order-14-jan-2021-0000#.

[viii] C Ryan “The Revolt of the Ratepayers” (10 February 2021) available at https://www.moneyweb.co.za/news/south-africa/the-revolt-of-the-ratepayers/.

[x] [2013] ZACC 11. See the HSF’s previous brief by K Premhid “Service Delivery: What Does the Constitutional Court Say?” available at https://hsf.org.za/publications/hsf-briefs/service-delivery-what-does-the-constitutional-court-say.

[xi] Rademan paras 32-3.

[xii] Ibid para 42.

[xiii] T Magubane “Msunduzi Ratepayers Threaten Legal Action Over Poor Service Delivery” (2 February 2021) available at https://www.iol.co.za/mercury/news/msunduzi-ratepayers-threaten-legal-action-over-poor-service-delivery-84abb798-3523-4797-9910-bae058c547a4 . See also Ryan note vii above.

[xv] T Magubane “Msunduzi Council Haunted by More Than 100 Ghost Employees” (25 February 2021) available at https://www.iol.co.za/mercury/news/msunduzi-council-haunted-by-more-than-100-ghost-employees-f1426fec-01d0-4e42-b45d-9fda08aa667b.

[xvi] C Ryan “Another Citizen Group Takes its Local Municipality to Court” (26 February 2021) available at https://www.moneyweb.co.za/news/south-africa/another-citizen-group-takes-local-municipality-to-court/.

[xvii] Final Report of the Gauteng Provincial Inquiry into the Sewage Problem of the Vaal River (17 February 2021) available at https://www.sahrc.org.za/home/21/files/The%20Vaal%20Inquiry%20Final%20Report_17022021.pdf.

[xviii] Ibid para 11.3.1. See the Constitution, section 10: “Everyone has inherent dignity and the right to have their dignity respected and protected.”

[xix] Ibid para 11.3.2. See the Constitution, section 12(e): “Everyone has the right to freedom and security of the person, which includes the right not to be treated or punished in a cruel, inhuman or degrading way”.

[xx] Ibid para 11.3.3. See the Constitution, section 24(a): “Everyone has the right to an environment that is not harmful to their health or well-being”.

[xxi] Ibid para 11.3.4. See the Constitution, section 25(4)(b): “property is not limited to land”.

[xxii] Ibid para 11.3.5. See the Constitution, section 27(1)(b): “Everyone has the right to have access to sufficient food and water”.

[xxiii] Ibid para 11.3.6. See the Constitution, section 28(1)(d): “Every child has the right to be protected from maltreatment, neglect, abuse or degradation”.

[xxiv] Ibid para 11.3.7. See the Constitution, section 33(1): “Everyone has the right to administrative action that is lawful, reasonable and procedurally fair”.

[xxv] Ibid paras 12.10-11.

[xxvi] A Makinana “Government Extends its North West Intervention by Another Three Months” (15 February 2021) available at https://www.timeslive.co.za/politics/2021-02-15-government-extends-its-north-west-intervention-by-another-three-months/.

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Service delivery

SERVICE DELIVERY

According to the American Marketing Association, service(s) are “products, (such as a bank loan or home security), that are intangible or at least substantially so. If totally intangible, they are exchanged directly from producer to user, cannot be transported or stored, and are almost instantly perishable…They comprise intangible elements that are inseparable; they usually involve customer participation in some important way; they cannot be sold in the sense of ownership transfer; and they have no title.” (AMA)

The core attributes of services are their relative intangibility and their simultaneous production and consumption. (Mayer, Ehrhart, & Schneider, 2009)

Service is comprised of many facets of risk. (McManus, 2009)

As is now part of the accepted knowledge in marketing, the cost of attracting new customers is higher than the cost of retaining existing ones. The key to customer retention is customer satisfaction leading to customer loyalty. This in turn, in service situations, depends largely on service delivery and the interaction of the consumer with the organisation at various touch points. (Vijayadurai, 2008)

Thus, the quality of service delivery is of prime importance in service operations management.

Service Quality and Performance

While quality may be defined as value, conformance to requirements or fitness for use, in the context of services, the commonly accepted definition is that of meeting customers’ expectations and the totality of the characteristics of the service that bear on its ability to satisfy stated or implied needs. (Vijayadurai, 2008)

The service quality gap is the difference between customers’ expectations from the service and the actual delivery received. Measuring service quality poses a difficult task as before a possible measurement, certain issues need to be addressed such as – what indicators yield an appropriate value for measuring the quality of a service; which stakeholders should provide the analysis etc. Also, measurement of service quality requires affective judgment which is hard to measure in an unbiased manner. (Jiang, Klein, Tesch, & Chen, 2003)

While some factors that contribute to service performance are understood well, others like client experience, feel good factor and service reliability are more qualitative in nature and are harder to measure. (McManus, 2009)

Service marketing works on the broad assumption that better service quality leads to more satisfied customers. However, research into the details of the service delivery process tells us that simply increasing investment on service delivery will not produce desired results. Investments and energies spent on improving service delivery need to be channelized according to various factors. Few of these factors have been analysed below:

I. TYPE OF INTERACTION

The service delivery triangle.

To understand the intricacies of service delivery, let us study the service delivery triangle. Service delivery involves three different entities namely the customer, the service organisation and the service provider (the person who delivers the actual service).

Service delivery in this triangle is not always homogeneous. During service delivery, two types of interactions can take place – service encounters and service relationship. Within these interactions, two types of linkages can occur – tight or loose.

Service encounters occur when the interaction between the customer and the service provider tends to be short-term with no expectations for the future. There is minimal interaction and therefore lack of personal involvement. Thus, a loose linkage exists between the service provider and the customer. e.g. buying fast food at a chain on a long road trip.

Service relationships are formed when a customer and service provider have an on-going, long-term interaction. This type of situation usually involves a high degree of interaction between the customer and service provider and, therefore, results in a personal relationship. e.g. that with the family doctor, lawyer etc. Service relationships are characterized by tight linkages.

While tight linkages between organization and customer represent customer retention, loose linkages suggest that the customer may not care who really provides the service. Organisations need to decide the investment to be made on the interactions with their customers based on the service being provided and also the exact point in the service delivery chain. For example, in an apparel retail outlet, the time a customer spends and the involvement with the salesperson (who acts as a fashion assistant) is not the same as with the person at the billing counter. Hence, tracking customer interactions across the service delivery process can help channelize investments more effectively.

(Gutek, Groth, & Cherry, 2002)

II. SERVICE CLIMATE

In their paper on service climate Mayer, Ehrhart and Schneider say that in today’s service-based economy, several aspects of the organisational design play a role in satisfying consumers. Research has also revealed a significant relationship between return on investment, operational profits and customer satisfaction.

One such crucial aspect of organisational design is service climate. Service climate is the “employees’ perceptions of the practices, policies, procedures, and behaviours that get rewarded, supported, and expected regarding meeting customers’ needs effectively”. Research has found consistent and positive correlation of service climate with customer satisfaction and customers’ perception of service quality.

In their paper, Mayer, Ehrhart, and Schneider have studied where all this correlation is the maximum and where the least. Their research analyses three variables that affect service delivery: (1) the frequency of customer contact with service employees, (2) the intangibility of the service, and (3) the amount of interdependence among service employees needed for them to deliver high-quality service.

Services can vary based on these criteria on a continuum of those having high to low customer contact, high to low intangibility and high to low interdependence.

An important attribute of services is that the customer is present and potentially involved in the production of the service he/she receives. This contact point is where a lot of inefficiencies creep in during the process of service delivery. As the frequency of contact increases so does the unpredictability.

The intangibility of a service refers to its experiential nature or the extent to which it can be assessed using the basic senses�that is, touched, tasted, felt. As the service becomes more intangible, changes in the service delivery may be necessary to suit every customer. Also, the more intangible a service, the more difficult it is to control the experience and the greater ambiguity customers would face in determining the quality of the service exchange.

Service employee interdependence comes into picture as services are not delivered by individuals but by teams working together who need to coordinate for a holistic experience. There can be two types of services – (a) where multiple employees work together to deliver the service e.g. in healthcare, physicians, nurses, therapists etc. work together for patients to receive quality care; all individuals here interact with customers and are interdependent during service delivery in such a way that if one of them does not do his or her part, the outcome suffers. (b) where there are few customer contact employees and the rest support them but do not necessarily interact directly with customers. The service climate would need to play a stronger role in the first case scenario as, again, the chances and scope for error are higher there. When a service depends on more than one person, a breakdown by any of the employees involved negatively impacts service quality.

Mayer, Ehrhart, and Schneider argue that the more a service is truly a pure service�that is, it requires more-frequent customer contact, is more intangible, and requires service employees to work interdependently to deliver increasingly complex services and support the service delivery process �the more critical service climate is for managing the service encounter. The rationale behind this argument is that the service climate can help reduce uncertainty as the service increasingly becomes more intangible and its delivery more complex. Their study goes on to prove the above hypothesis.

Another interesting finding is that “when customer contact frequency is low, it is easier to create a consistent, reliable experience for customers because such experiences are going to be more homogeneous”. Implications of findings also suggest that customer contact can influence not just the employee attitudes and behaviour but also the customer attitudes.

For marketers, the findings of the above study would mean that organizations should be selective when investing resources into developing a high service climate. When the service is not highly intangible, the customer contact frequency is low and the interdependence among customer facing employees is low, money should be spent judiciously on creating a high service climate.

(Mayer, Ehrhart, & Schneider, 2009)

III. FRONTLINE SERVICE DELIVERY STAFF

Service excellence is determined to a large extent by customers’ perceptions of how services are delivered by frontline service staff. This means that organisations need to communicate effectively with employees to motivate and enable them to interact better with their customers.

Work Environment

Workers who come in contact with the consumers of service shape external perceptions of service quality during service encounters. The front-line workers’ perceptions of their capability to deliver high quality service are strongly influenced by the work environment in which they perform. Research is now providing evidence that customer-oriented work climates produce superior service quality and customer satisfaction.

Here, High-Performance Work Systems “represent a mutually reinforcing constellation of core workplace attributes including involvement, empowerment, trust, goal alignment, training, teamwork, communications, and performance-based rewards”.

Their research shows that in high customer contact environments, customer orientation has a critical role to play in the service relationship whereas in low-contact situation, high-performance alone influenced service-quality perceptions and customer orientation played an insignificant role. This customer orientation comes directly from the work environment. Another important issue is that work stress negatively affects service performance and delivery at the contact point. Thus, the HR policies and employee objectives while clear and focussed must not be unrealistic so as to over-burden employees.

(Scotti, Harmon, & Behson, 2009)

Implicit and Explicit Communication

In the service industry, how the organisations’ human resource is managed is one the most important determinant of competitive advantage and effective management of employees is dependent to a large extent on effective communications which can be both explicit and implicit communications. Explicit communication is in the form of training, company directives, objectives, policies etc. while implicit communication comes from the organisation’s culture, the way employees are treated etc. Often, implicit communication is contrary to the explicit communication sent out. This not only renders the explicit communication ineffective, but it might also lead to employee cynicism and dissatisfaction.

This is where the role of internal marketing comes. Internal marketing involves “formal and informal mechanisms to generate information about the wants and needs of employees, dissemination of this information throughout the firm and modifying work conditions to better satisfy the wants and needs of employees”.

The impact of implicit communication on employee behaviour is not straightforward and can influence employees’ overall attitudes to the firm and towards customers. It is important to enhance what the employees feel for the organisation, their loyalty and sense of belonging as these then translate into behaviours while dealing with the company’s customers. Research has shown that employees who like their jobs and feel a sense of affective loyalty or ‘liking’ towards their employers are more likely to display positive behaviours, in turn, to customers. Affective commitment is more important than simply behavioural loyalty (reflected in staff retention) which can come from several factors such as lack of opportunities to leave or simple inertia and may not necessarily translate into positive customer behaviour.

(Lings, Beatson, & Gudergan, 2008)

Employee Satisfaction and Motivation

Wherever employees are expected to provide customized service, the chances of uncertainty increase. Studies have proved that employee involvement and satisfaction are two of the most important drivers of continuous improvement. As said by Eskildsen & Dahlgaard (2000), the concept of total quality management also argues that satisfied employees are highly motivated, have good work morale, and work more effectively and efficiently. Therefore, employee satisfaction directly influences process quality which in turn determines the cost of quality and customer satisfaction.

According to Kano’s model, there are three factors that affect employee satisfaction:

basic factors (dissatisfiers)
excitement factors (satisfiers) and
performance factors (hybrid factors) that are determined by employee motivation

Also, motivation can either be external or inner drive. The external motivators mirror the employer’s actions or what the outside world offers in response to the inner drives. It a person’s inner drive that pushes employees towards a particular job or career. Intrinsic motivation is a desirable attribute for an employee in any work context, especially while dealing with customers. However, intrinsic motivation depends on the fit between an employee’s views of interesting and challenging work and what is provided and also on how relationships with other employees are structured.

Therefore, while it is difficult to alter the inner drive of employees, it is a challenge for employers to accomplish since studies performed show strong relationship between intrinsic motivation and high level of performance. On the other hand, simply providing extrinsic motivation like remuneration don’t have that great an influence on performance.

The study by Adomaitiene and Slatkeviciene shows that empowerment, perception on personal learning, perception of personal contribution to the organization and pride in working for an organization contribute heavily to job satisfaction in service situations.

Sergeant & Frenkel (2000) have said that employees treat customers the way they are treated by the management. Hence, employee motivation is critical to successful management.

Ultimately, “it is up to the employer to develop a good system of company communications, employee relations, training and development that will lead to an environment of openness, cooperation, teamwork, and motivation that will benefit all the parties involved”.

(Adomaitiene & Slatkeviciene, 2008)

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Sutton M, Garfield-Birkbeck S, Martin G, et al. Economic analysis of service and delivery interventions in health care. Southampton (UK): NIHR Journals Library; 2018 Feb. (Health Services and Delivery Research, No. 6.5.)

Economic analysis of service and delivery interventions in health care.

Introduction

Some of the most important decisions that are made in health care are those concerning how services should be configured and delivered. These decisions include how resources should be distributed between areas, populations, programmes of care and settings; the location and accessibility of services; payment systems and incentives; the size, composition and skills of the workforce; methods to improve compliance with safety and effectiveness guidelines; and service specialisation, co-ordination and integration. Collectively, these decisions constitute ‘service and delivery interventions’. For brevity, we refer to these as ‘service interventions’ for the remainder of this essay.

Recommended methods for the economic analysis of service interventions are less well articulated than for other types of interventions and there are no comprehensive guidelines. The National Institute for Health and Care Excellence (NICE) produced an interim methods guide for developing service guidance in 2014, 1 which provided recommendations on how services should be organised around clinical interventions that have been deemed clinically effective and cost-effective. Existing Medical Research Council (MRC) guidance on complex interventions 2 and natural experiments 3 are primarily focused on evaluating effectiveness and pay relatively little attention to economic issues. Other guides to economic appraisal are focused on high-level policy evaluations. 4 , 5

Several essays within this collection discuss pertinent issues for the economic analysis of service interventions. Watson and Lilford (Essay 1 from Raine et al. 6 ) explain how multiple forms of evidence along proposed causal pathways can be synthesised to link service interventions to outcomes. Barratt et al. (Essay 2 from Raine et al. 6 ) highlight how trial methods have been developed to facilitate evaluation of complex interventions and large-scale transformations of services. Gillies et al. (Essay 3 from Raine et al. 6 ) describe the battery of methods that can be used to model causal effects and address bias in observational data, many of which emanate from econometrics.

In this essay, we focus on additional opportunities and challenges specifically for the economic analysis of service interventions. We begin by highlighting the distinctive issues involved in the economic analysis of service interventions. Many of these issues are also germane to economic analysis of diagnostics, clinical interventions and public health initiatives, but loom larger for service interventions. We then describe some challenges that these distinctive issues pose for economic analysis. Following this, using a range of examples, we highlight recent methodological developments in the economic analysis of service interventions. We conclude by identifying the key challenges and priorities for future research.

Scope and role for economic analysis

Health economics contains a wide range of topics. A recent classification of topics in health economics is provided by Wagstaff and Culyer, 7 based on an analysis of the main content of four decades of health economics papers ( Box 1 ). These include papers focusing primarily on the measurement and valuation of health, methods for the economic evaluation of interventions, defining and measuring efficiency and equity, demand for health care, supply of health services, human resources and equilibrating mechanisms such as market mechanisms and waiting times. Many papers, of course, consider more than one topic. In tackling each of these topics, health economists have developed a wide range of techniques that could be drawn on for the economic analyses of service interventions.

Twelve topics in health economics identified by Wagstaff and Culyer

Overall, the purpose of such analyses is to guide decisions regarding efficient and fair resource allocation to achieve social objectives, including enhancing overall population health and its distribution. Based on the MRC framework for complex interventions, 3 we can envisage four stages at which economic analysis can support decision-making. These are the:

design stage
implementation stage
evaluation stage
translation stage.

These stages will not necessarily be sequential and will often interact. In some instances, the evaluation stage may be very broad and involve implementation and translation elements, alongside the more standard evaluation elements of effects estimation, evidence synthesis, assessment of trade-offs and analysis of uncertainty.

At the design stage, economics is one of the disciplines that can contribute to the development of service interventions. There are, for example, interventions that derive primarily from economic theory, such as the form of health care financing 8 and the design of financial incentives for care providers. 9 Economic analysis can contribute to the setting of prices in pay-for-performance systems. 10 Financing and payment design requires an understanding of the motivations of agents in the health-care system and how these agents will respond to incentives and constraints. Payment design also requires an understanding of the production process in health care, specifically which inputs are required, in what combinations and to what scale, to produce desired outcomes. To put it more broadly, a deeper understanding of the production process and the behaviour of agents in the care system should feed into the design of service and delivery interventions.

At the implementation stage, the focus is on how the intervention will be introduced initially. Economic analysis can contribute to clarifying the expected costs and benefits of the chosen intervention, identifying where the key evidence gaps are and where prospective measurement should focus, and evaluating the cost-effectiveness of different implementation strategies. 11 , 12 At this stage, the ‘headroom method’ 13 of economic analysis can be used to calculate the potential value of an intervention. 14 In addition, there are other approaches to providing an ex ante evaluation of the option value of a proposed intervention.

At the evaluation stage, economic analysis can contribute to the specification and weighting of the elements that will determine the overall cost-effectiveness of the intervention and to the estimation of the cost and benefit consequences, and how these compare with opportunity costs (benefits that could be achieved through alternative uses of the same resources). This may involve translating impacts on intermediate end points into health gains [such as quality-adjusted life-years (QALYs)], incorporating other relevant consequences (e.g. for equity) and identifying and measuring cost consequences. It will also involve a formal assessment of uncertainty in the evidence and implications for decisions and the value of further research, to inform considerations of scaling up and rolling out.

At the translation stage, the focus is on the implications of study results identified in one context for service design in another context. The concern is with wider roll-out and embedding the intervention in other health systems. This will make use of evidence to assist in this extrapolation, such as baseline data and relative risks in the original and future context. It will also make use of information on the use of inputs in natural unit rather than resources used at the context-specific unit costs. More broadly, the purpose of economic analysis at this stage is to inform considerations of how the service intervention will affect, and be affected by, the wider care system in which it will be introduced when adopted by other sites or at different times. This will include considering resource constraints in practice, the unintended consequences, spillovers onto other services and people, and the effects of changes in the use of inputs in other contexts.

Distinctive issues in the economic analysis of service interventions

It is tempting to envisage a spectrum based on the level and scale of intervention from clinical interventions to service interventions to policy interventions. This may suggest that the well-developed methodological guidance on economic evaluation for clinical interventions could be carefully adapted for service interventions. Economic analyses within clinical studies, for example, have included many of the features pertinent to service interventions, including analysing the determinants of costs and outcomes using regression analyses, eliciting preferences using economic approaches (such as discrete choice experiments) and investigating economic issues affecting implementation.

Several papers have considered the extent to which economic evaluation of different forms of intervention differ from a ‘typical Health Technology Assessment (HTA)’. These include public health, 15 social care, 16 antimicrobials, 17 diagnostics, 18 medical devices 19 and genetics. 20 Together, these papers highlight that there is no typical HTA and, instead, there is a spectrum of challenges facing any form of evaluation. No challenge is unique to service interventions and there are lessons that can be learned across the spectrum of challenges facing analysts focusing in different areas.

This highlights that there is no clear demarcation between clinical interventions, service interventions and policy interventions. But there are differences in emphasis and the degree to which particular challenges are salient and have to be dealt with. There are a number of features that appear distinctive for service interventions ( Box 2 ) and affect the focus of the analysis required. Lilford et al. 21 emphasise that, although there are some service interventions that are focused on specific processes, more generic service interventions and policy interventions have the potential to have an impact on several processes and hence exhibit more diffuse effects across multiple outcomes. Watson and Lilford (Essay 1 from Raine et al. 6 ) show how such causal chains can be modelled.

Distinctive features of service and delivery interventions

These more generic service interventions are likely to have multiple effects on large patient populations, which may each be small in size but aggregate to substantial effects. The difficulties of detecting and measuring multiple small effects pose even more of a challenge for service interventions that affect multiple providers, such as network or system interventions. The difficulty of detecting and measuring effects for large populations often makes primary data collection prohibitively costly. As a result, there is often a reliance on observational data sets with the concomitant challenges of attribution and causality and a need to synthesise multiple sources of evidence.

The consequences of service interventions at the level of the health-care provider are often more substantial than for clinical interventions. The associated changes in costs are therefore more complex. It is more frequently noted in the case of service interventions that they may free up resources for other use but do not reduce expenditure. This is exactly the rationale for considering opportunity costs in an economic evaluation rather than financial implications. Nonetheless, the usual assumption of using cost-weighted utilisation as a means of estimating relevant opportunity costs may be too simplistic for some service interventions. Average unit costs may not be accurate proxies for the implications of non-marginal changes in resource utilisation.

Any form of intervention is likely to have wider system impacts. They may divert resources away from other patients and/or free up resources for potential use by other patients. Beyond these direct effects on costs, interventions may affect costs and benefits indirectly. They may generate spillovers onto other people or other interventions if the tasks involved are substitutes or complements. They may also influence both the demand side and the supply side of the production process. On the demand side, it is necessary to understand patient preferences and how current and potential patients may respond to reconfigured services. On the supply side, it is necessary to consider the capacity of the system in terms of the availability of the required inputs. If it takes time for staff to be recruited or retained, there may be a period in which demand exceeds supply and a lag before the system comes to an equilibrium. We know relatively little about how different levels of labour input affect the capacity of the system in general. Moreover, the effects on some inputs, especially labour, are behavioural. Little is known about how staff will respond to increases or decreases for the demand for their input. There is substantial literature on the interaction between supply and demand, often known as ‘supplier-induced demand’. 22

A further set of distinctive features for service interventions relate to the heterogeneity of implementation, context and impact between places and over time. Heterogeneity exists in the implementation and delivery of the intervention, what sort of care the intervention is designed to replace and in the context into which the service innovation is introduced. Although these heterogeneity issues are also relevant for clinical interventions, the narrower scope, tighter protocols and eligibility criteria for recruitment limit their pertinence. Service interventions are not always clearly defined, they often evolve over time, and they may not use strict criteria to define their target population. Consequently, the extent of variation between organisations in how they implement service interventions is more substantial than clinical interventions. Context is more important for service interventions as this affects impact. This may lead health-care organisations to negotiate a range of variations and prices with providers for a given type of intervention, such as was found in a recent study of electronic prescribing systems. 23 The changing environment in which service interventions take place, the dynamic nature of service interventions and the less formalised decision-making process in service interventions are also distinctive features. The other essays in this collection 6 (especially Essays 6–8 from Raine et al. 6 ) have also highlighted these issues.

Challenges for economic analysis of service interventions

Although randomised controlled trial (RCT) designs have been developed to evaluate complex interventions and large-scale transformations of services (Essay 2 from Raine et al. 6 ), economic analyses of service interventions have tended to rely on non-experimental designs and observational data for practical reasons of implementation and prohibitively high data collection costs. Gillies et al. (Essay 3 from Raine et al. 6 ) emphasise the challenges involved, including the requirements for risk adjustment and matching in comparative evaluations. Nonetheless, these approaches based on observational data have advantages of generalisability, more accurate reflection of routine practice and more comprehensive coverage than many RCTs. It is likely that combinations of experimental and observational data will be the most informative. 24 Irrespective of study design, it is important to seek a comprehensive understanding of how an intervention works. Theoretical understanding can aid judgements concerning both the internal validity of findings and their applicability to other contexts. 21 , 25 In order to acquire or enhance such theoretical understanding, it is desirable to collect information across a causal chain linking an ‘upstream’ intervention to its effect at the patient level ‘downstream’ (Essay 1 from Raine et al. 6 ).

The issue of how to allocate scarce resources and the notion of opportunity cost are ubiquitous to all forms of intervention. Therefore, economic evaluations should also be fundamental to economic analyses of service interventions. The fact that studies of clinical interventions are more often undertaken using study designs with greater internal validity (e.g. multicentre RCTs) has enabled economists to focus on the comparison of costs and benefits. Because evaluations of service interventions have tended to involve more challenging non-experimental designs, economists have tended to focus on attribution and causality and made important contributions to the robust estimation of impact. This is a matter of custom and practice, but also capacity. Nonetheless, the questions of how service changes affect costs and patient benefits remain important for service interventions and should be given more attention.

Evaluations of service delivery interventions often take place in a context where the service as a whole is taking measures to improve the relevant aspect of care. The result is a secular trend or ‘rising tide’ that might obscure the effects of an intervention in an evaluative study. 26 Promising interventions that have produced null results in such circumstances for which the system as a whole was undergoing rapid improvement included the Safer Patient Initiative in the UK, 27 , 28 the ‘Matching Michigan’ study to reduce bloodstream infections 29 and the Medical Early Response, Intervention and Therapy (MERIT) study to improve recognition of deteriorating patients on the ward. 30 In all these cases, there was evidence that the system on a whole was improving alongside the introduction of the service intervention.

Service interventions frequently have consequences for the demand side of the health-care system. Patient preferences, knowledge and constraints affect their choices and their behaviour. Service changes can affect what is offered to patients and the costs they incur in accessing care. These can have knock-on consequences for their use of services, for their families and carers 31 and for their health behaviours. 32 – 34 All of these considerations contribute to the impact and the costs of service interventions and affect the generalisability of evidence from one setting to another.

In considering the total cost of the intervention, it is important to distinguish the set-up costs, that are incurred just once and may include research-only costs, from the running costs that would be expected in perpetuity. Many service interventions, especially at the organisational level, incur high upfront or set-up costs. These costs pose challenges for evaluation because they would ideally be shared over all users, which means making decisions about the lifetime of the intervention and the number of patients affected over the long term. They also pose a challenge for implementation because, even if the average cost per patient is acceptable, commissioners or providers might not have the resources to meet the high upfront costs.

There are also additional cost issues. The cost consequences may differ substantially between organisations, for example because different amounts of time from different types of staff may be devoted to the intervention. We may be interested in the impact that the scale of implementation has on costs. Finally, there are likely to be cost consequences across organisations (e.g. from secondary to primary care) and there may be differences between these organisations in their capacity to absorb additional costs.

Studies of service interventions often consider different study questions than whether or not the intervention is better than usual care. In many cases, there is a focus on whether or not an evaluation of a service intervention will provide generalisable evidence about whether or not a change to inputs or organisation causes changes in delivery and/or outcomes. Thus, there is less desire for evidence on ‘if it worked’ and more on the identification of causal relationships that can inform the design and implementation of future interventions, as policy and practice will have moved on. This is in part because there is no requirement prior to adoption to prove cost-effectiveness and less potential for roll-out of the same service in all contexts. Therefore, the focus is not about informing a discrete decision and providing evidence to support wider adoption, but on furthering understanding of the care system to inform future service changes.

As a consequence, there are two overall purposes for economic analysis of service interventions. As with other forms of intervention, economic analysis has an important role to play in providing a guide to decision-making by comparing costs and benefits and assessing relevant opportunity costs. But, in the case of service interventions, economic analysis also provides descriptive analysis alongside decision-making to help to understand processes rather than to evaluate decisions.

Recent developments

In this section we highlight some recent examples of methodological developments in the field of economic analyses of service interventions.

Ex ante modelling of expected costs and benefits is an important aid to decision-making, 13 the design of service interventions and the design of future evaluations. Impact assessments were, for a period, routinely undertaken by the Department of Health. 35 They were a useful part of the policy formation process but are, regrettably, no longer required. The analysis of the policy of introducing 7-day hospital services by Meacock et al. , 36 Brown and Lilford’s 37 evaluation of a government directive to wash hospital wards, and the evaluation of a proposed service to improve handover of patients between hospital and home by Yao et al. 14 are examples of this approach. Such ex ante assessments should be more routinely produced for proposed service interventions.

Broadly speaking, there are two approaches to producing summative assessments of the costs and benefits of entire programmes. The first involves direct estimation of the summative impacts through exploitation of some experiment or other source of variation in implementation. The second involves modelling the causal chain through component processes to derive an aggregate measure where direct estimation is not feasible.

A recent example of the first, direct approach was undertaken for the reconfiguration of stroke services. Morris et al. 38 used observational data and difference-in-differences techniques to examine the mortality and length-of-stay changes associated with reconfiguration of stroke services in London and Manchester. Hunter et al. 39 constructed decision-analytic models using data from population-based stroke registers, audits and published sources to show the service intervention reduced mortality for a reduced cost per patient, predominantly as a result of reduced hospital length of stay. Meacock et al. 40 showed how a similar approach could be taken for the Advancing Quality pay-for-performance programme 41 adopted in the North West of England. They translated the mortality reductions identified by Sutton et al. 41 into gains in QALYs using a discounted and quality-adjusted life-expectancy tariff, and compared these to the costs to reach conclusions on the scheme’s cost-effectiveness. This was later developed with survival analysis to obtain more accurate estimates of the QALY gains. 42

Watson and Lilford (Essay 1 from Raine et al. 6 ) explain how the second approach can be parameterised. This can involve evidence synthesis and analysis of large observational data sets to derive parameters to be plugged into economic models. As an example, Elliott et al. 43 combined adherence improvement and intervention costs from a trial with Markov models for diseases targeted by the New Medicines Service tracking the effect of increased adherence on patient outcomes and health-care costs. Bayesian network approaches have also been developed. 44 There is potential value in combining the direct and modelling method processes. 21 Modelling outcomes of economic interest is a topic of increasing interest and lessons will be learned from the ongoing advances in decision-analytic modelling being developed by the International Society for Pharmacoeconomics and Outcomes Research. 45

There have also been advances in the measurement of patient and professional preferences that can further our understanding of demand-side and supply-side responses to service interventions. Discrete choice experiments have risen in popularity in a variety of applications, 46 including examining patient aspects, such as whether or not convenience matters, 47 and professional preferences for location 48 and other aspects. 49 There is renewed focus on their external validity. 50 – 52 An alternative is to model revealed preferences when available. 53 In an innovative combination of data on stated preference and revealed behaviour, Scott and Sivey 54 have shown that a general practitioner’s strength of preference for income is correlated with their response to competition.

Recent work has begun to analyse how variations in historic data on care expenditure and population outcomes can help us to understand the value of resources that may be affected by service interventions. The recent work on the cost-effectiveness threshold by Claxton et al. , 55 for example, has produced estimates of opportunity costs based on previous patterns of expenditure across the NHS in England. These supply-side estimates can be contrasted with the demand-side values proposed by NICE. Coupled with the analysis of variations in productivity across organisations by Castelli et al. , 56 this has the potential to provide us with organisation-specific estimates of the opportunity costs of additional investments required for service interventions.

Another area in which there have been recent advances is in the economics of implementation in health care. This literature is relevant to all interventions, but especially service interventions, which often incur high upfront costs and may not be straightforward to implement, even if shown to be cost-effective. For example, the literature on ‘policy cost-effectiveness’ argues that decision-makers should consider both the costs and effectiveness of implementation as well as the cost-effectiveness of the innovation to be implemented. 57 , 58 This was applied to the Quality and Outcomes Framework by Walker et al. 59

Future challenges and priorities

In this section we highlight gaps in the current methods and suggest what we need to focus on in future research.

Economic evaluation is one of the key contributions of health economics to decision-making. Methods for the health economic evaluation of medical devices and technologies, including pharmaceutical products, are well developed and integrated into the process of clinical commissioning and decision-making through bodies such as NICE. 60 However, economic evaluation has not been incorporated in such a way for other important questions concerning health service expenditure such as staffing policies, primary and secondary care organisation and integration, and patient safety interventions. It is debatable whether guidelines for economic analysis of service interventions are feasible or appropriate. Regardless, it will not be a simple issue of adapting the existing HTA methods to the evaluation of service interventions.

In Box 3 , we set out an initial list of questions that analysts should consider when considering service interventions. These affect the analyses that can be performed and whether or not the nature of the service innovation suggests that special issues need to be considered. This list of questions could be developed into a more systematic list of considerations.

Questions for the economic analysis of service interventions

A challenge common to economic evaluation of all forms of interventions is whether or not we need to consider wider ‘outcomes’ beyond patient health, as captured by the QALY. Additional potential issues include access, quality, patient experience, sustainability, equity, capability and population engagement. It is widely accepted that these aspects are important, but it is less clear as to whether they are of value in themselves or because they affect patient outcomes, how they should be measured and how they should be traded off against health outcomes to derive a composite measure of programme benefit that can also be reflected in terms of opportunity cost.

Another common challenge is developing advanced methods for evaluating impacts in a non-experimental setting. This is the area of economic analysis of service interventions that is most advanced (Essay 3 from Raine et al. 6 ), but there remains a need for a better understanding of the assignment mechanism for programme evaluation. We need to understand why some organisations and professionals tend to participate and others do not. This is key to developing robust comparators for non-experimental evaluations. Economists should be involved at the earliest stage of decisions about the implementation (such as phased roll-out) of service interventions to ensure that the important end points are collected.

The key components of an economic evaluation are identification, measurement and valuation of the costs and benefits. The identification stage is intended to produce a comprehensive list of potential costs and benefits, but this has tended not to be systematic, with economists focusing primarily on the challenging issues of measurement and valuation. There is potential for complementary, parallel investigations to identify (1) variables that are likely to be affected, (2) potential impacts elsewhere in a complex system, (3) proposed mechanisms that might, for example, support the robustness of the approach to identify causal effects, (4) heterogeneity in engagement by different groups of patients and professionals, and (5) the boundaries of generalisability for a particular analysis. These will be best achieved by more active engagement in interdisciplinary research.

There is a belief that the potential for financial profit has driven the faster development of guidelines for the economic evaluation of medical devices and pharmaceuticals. The guidelines have sought to safeguard the NHS from products that are not cost-effective. A similar impetus may emerge for the evaluation of service interventions as the provider sector becomes more diverse.

There is a more basic challenge of how to capture the opportunity costs of service interventions, which are likely to comprise the costs of implementing the service intervention, the costs of delivering the service intervention and the impact that the service intervention has on consequent care costs. Further challenges are that these costs may differ between organisations and over time, and that service interventions are sufficiently large to cause non-marginal changes in resource use. Therefore, there is scope for methodological work on evaluating the impact of service interventions on costs.

More fundamentally, there is a need for economic analysis of service interventions to further our understanding of (1) the production process and (2) the behaviour of agents in care systems. These considerations should feed into how evaluations are undertaken, future ex ante analyses and how service interventions should be co-designed in the future. Service interventions provide an opportunity to generate additional evidence on these issues by offering a purposive source of variation in care delivery. Through these ‘experiments’, there is scope to develop and collate generalisable knowledge on the mechanisms operating within the care system.

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Cite this Page Sutton M, Garfield-Birkbeck S, Martin G, et al. Economic analysis of service and delivery interventions in health care. Southampton (UK): NIHR Journals Library; 2018 Feb. (Health Services and Delivery Research, No. 6.5.) Essay 9.
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Herald, Foster's, News-Letter, Union and York Weekly mail delivery starts April 1

Starting April 1, the U.S. Postal Service will begin delivering the Portsmouth Herald, Foster's Daily Democrat, Hampton Union, Exeter News-Letter and York Weekly newspapers.

"The move from driver delivery to postal service delivery is another step in Seacoast Media Group's evolution from a print-first to a digital-first news and marketing source," said Executive Editor Howard Altschiller. "Our unwavering commitment to the Seacoast communities and readers we serve remains rock solid. Readers looking for the latest Seacoast news, sports and advertising can count on Seacoastonline , Fosters.com and our printed newspapers to deliver."

Like many other newspaper publishers, Gannett Co. Inc., which operates more than 200 daily newspapers, including Seacoast Media Group's papers in New Hampshire and Maine, has already successfully introduced the switch from driver delivery to mail in dozens of markets across the country, and is expanding the initiative.

The markets which have switched to mail delivery report high customer satisfaction rates. While the paper will arrive later in the day with the mail, it will arrive consistently in the same place at the same time. In recent years it has been a challenge to adequately staff the delivery force needed to hand deliver papers across the Seacoast region of New Hampshire and Maine.

Papers will be delivered to local post offices early enough each morning to allow same-day delivery. Because there is no mail delivery on Sunday, Seacoast Sunday will arrive in mailboxes on Saturday. The digital replica of the Sunday paper, the eNewspaper , will post to Seacoastonline and Fosters.com on Sunday morning.

Delivery of non-Seacoast newspapers like the Wall Street Journal and New York Times, previously handled by Seacoast Media Group drivers, has been taken over by a new company. Questions regarding delivery of non-Seacoast papers should be directed to those other newspapers.

The change to postal delivery will not impact subscription rates.

“For many years now, the printed newspaper has served as a culmination of the stories that will become our collective history, while our websites and mobile apps deliver the news of the day,” said Michael A. Anastasi, vice president of local news for Gannett. “We know that by the time our informed readers pick up the paper, they know what happened yesterday — the print newspaper should provide additional context, to help readers better understand their community and the world around them.”

Readers can also visit Seacoastonline.com and Fosters.com to access the eNewspaper at seacoastonline.com/enewspaper and fosters.com/enewspaper .

Subscribers with questions or concerns can visit help.seacoastonline.com/contact-us and help.fosters.com/contact-us.

Emilie Nilsson

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South Africa: What Does "Service Delivery" Really Mean?
A version of this post appeared on the World Policy Blog. "Service delivery" is a common phrase in South Africa used to describe the distribution of basic resources citizens depend on like ...
Service Delivery and Customer Experience
In addition, the impact of increased customer participation in the delivery process on the service quality is defined by the self - service level. Customer's self -service is an important, sometimes even bigger, part of the service. Productivity and customer efficiency also has influence on service quality and expected demand.
Service delivery essay
In order to ensure quick service delivery and deracialize public administration, the New Public Management (NPM) was executed as. an initiative in both the more advanced domains and local municipalities (Ntliziywana 2017: 2). The below essay will explain what service delivery is and elaborate its relevance to South Africa's public administration.
Poor service delivery deprives people of dignity and their ...
The South African Police Service (SAPS) Incident Registration Information System (IRIS) documented 909 service delivery protests that took place between August 2020 and January 2021, with the COVID-19 pandemic doing little to stop them. Almost every week, the media reports more and more incidents of service delivery protests across the country.
Progress and Challenges of Service Delivery in South Africa Since 1994
a public service delivery approach and philosophy of Batho Pele (meaning people first in the native Sotho language). Russell and Bvuma, (2001:243) further note, that an increase in partnerships between public sector agencies and private sector entities was observed. In return, there was a realization of alternative service delivery avenues and
(PDF) The impact of service delivery system effectiveness on service
The delivery of highquality service is an important pursuit for service providers who seek to create and provide value to their customers (Lodorfos et al., 2015). The model also refers to how ...
Service Delivery: Articles, Research, & Case Studies on Service
by Ryan W. Buell, Kamalini Ramdas, and Nazlı Sönmez. Shared service delivery means that customers are served in groups rather than individually. Results from a large-scale study of glaucoma follow-up appointments at a major eye hospital indicate that shared service delivery can significantly improve patients' verbal and non-verbal engagement.
Service Delivery Essays: Examples, Topics, & Outlines
PAGES 2 WORDS 586. Service Delivery Model. Baderman esort. Effects of the Conference on the Annual Operating Plan. Conferences, conventions, and other types of events can play an important role on hospitality companies' success and business development. The effects of such large events, but also the resources required in order to organize large ...
Service Delivery Free Essay Example
Download. Essay, Pages 2 (479 words) Views. 355. Service delivery is the complex of decisions, solutions, policies and actions aimed at the on time and quality delivery of the production to the client. Naturally, when someone orders goods in the Internet, he expects to receive them as quick as possible and for the most affordable price.
Service Delivery in South Africa at a Glance
The history of service delivery, or lack of it, in South Africa has been troublesome to say the least. A few weeks ago a general news search of service delivery or local municipalities would have revealed many articles by irate residents about the failures of their municipalities to deliver basic services. Now there is an intriguing High Court ...
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Service Delivery Essays. City Agency Service Improvements. Abstract Exploring a leadership problem faced by the head of a large city-government department responsible for serving new immigrants in an ethnically diverse community is what his essay does. According to their findings, a required audit conducted by an independent expert exposed long ...
Improving government service
Governments have begun to further improve services by moving away from traditional department-based service delivery and toward a life-event approach. A life-event trigger does two critical things: First, it starts service delivery without the citizen necessarily needing to be involved.
(PDF) Causes of Poor Service Delivery and the Feasibility of
The study therefore, concludes that outsourcing could be a feasible option to use to improve service delivery by local authorities. Discover the world's research 25+ million members
Service Delivery College Essays Samples For Students
In this open-access directory of Service Delivery College Essay examples, you are provided with a thrilling opportunity to discover meaningful topics, content structuring techniques, text flow, formatting styles, and other academically acclaimed writing practices. Exploiting them while composing your own Service Delivery College Essay will ...
Service delivery
Their research analyses three variables that affect service delivery: (1) the frequency of customer contact with service employees, (2) the intangibility of the service, and (3) the amount of interdependence among service employees needed for them to deliver high-quality service. Services can vary based on these criteria on a continuum of those ...
Essay On Service Delivery Process
Essay On Service Delivery Process. 1598 Words 7 Pages. The process is another element of the extended marketing mix, which looks at the systems used to deliver the service. Process means procedures, mechanism and flow of activities by which service is acquired. Process decisions radically affect how a service is delivered to customers.
Essay 9
At the design stage, economics is one of the disciplines that can contribute to the development of service interventions. There are, for example, interventions that derive primarily from economic theory, such as the form of health care financing 8 and the design of financial incentives for care providers. 9 Economic analysis can contribute to ...
What Is Service Delivery in Business?
Service delivery processes typically aim to provide the client with increased value by setting standards, policies, principles and constraints to guide all aspects of their business and customer interactions. Sometimes service delivery may involve a third-party or outsourced supplier besides the provider and the client.
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Get your free examples of research papers and essays on Service Delivery here. Only the A-papers by top-of-the-class students. Learn from the best!
Essay On Service Delivery
2.1 Service delivery. According to Fox & Meyer (1995:165) defines "service delivery as the provision of public activities, benefits or satisfactions to citizen". This is actually the provision of a service or product by the government, to the citizens as expected by the citizens and mandated by Acts of Parliament.
Service Delivery Essay Example For FREE
Service Delivery. Methodology: This is a good process when applied at the beginning as it may be an important part of the viability and reliability. This section reveals the type of verification collected and kind of reality, it is proposed to demonstrate. A qualitative descriptive design was used. Data were collected in 2013.
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Mail delivery of Herald, Foster's, weekly papers begins April 1
Starting April 1, the U.S. Postal Service will begin delivering the Portsmouth Herald, Foster's Daily Democrat, Hampton Union, Exeter News-Letter and York Weekly newspapers. "The move from driver ...
Essay About Service Delivery
Betty Chen. Essay About Service Delivery. A professional essay writing service is an instrument for a student who's pressed for time or who doesn't speak English as a first language. However, in 2022 native English-speaking students in the U.S. become to use essay help more and more. Why is that so? Mainly, because academic assignments are ...

Service Delivery and Customer Experience - Analytical Essay

Service Delivery and Customer Experience

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Service Delivery in South Africa at a Glance

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Service Delivery Essays

Essay: Service delivery

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SERVICE DELIVERY

Service Quality and Performance

I. TYPE OF INTERACTION

II. SERVICE CLIMATE

III. FRONTLINE SERVICE DELIVERY STAFF

Work Environment

Implicit and Explicit Communication

Employee Satisfaction and Motivation

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Economic analysis of service and delivery interventions in health care.

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