Doctor interaction behavior, patient participation in value co-creation and patient satisfaction: cross-sectional survey in a tertiary-level hospital from Guangzhou, China

In addition to the medical services and skills provided by doctors, patients’ active participation is also essential for disease treatment⁸. Value co-creation emphasizes the participation and interaction of suppliers and customers, with the objective of reaching an outcome that is beneficial to both parties⁴. The principal participants in the treatment process are the doctors and patients. Doctors’ interaction and patients’ participation can result in the generation of beneficial outcomes, such as increasing the quality of medical care that benefits both sides⁴. It is beneficial to introduce value co-creation into the medical field. The concept of value co-creation has its origins in the commercial field. And relevant studies in the healthcare field is limited. In this study, we developed hypotheses, namely Hypothesis 1(H1): Doctor interaction behavior is positively related to patient satisfaction, Hypothesis 2(H2): Patient participation in value co-creation may increase patient satisfaction, and Hypothesis 3(H3): Patient participation in value co-creation mediates the influence of doctor interaction behavior on patient satisfaction. To initially explore the veracity of these research hypotheses, a cross-sectional survey was conducted in a tertiary-level hospital. Relevant strategies and suggestions were proposed to stimulate doctors’ interaction behavior and patients’ participation to increase patient satisfaction and the quality of medical care. After adjusting covariates, the analysis results indicated that all the hypotheses were supported. This demonstrated that it is appropriated to introduce value co-creation theory into the medical field. Meanwhile, when patient perceived doctor’s interaction behavior it could increase their satisfaction, and patient participation in value co-creation mediated this relationship. Meanwhile, different kinds of doctor interaction behavior that perceived by patients had different influence on patient participation in value co-creation. Among them, dimensions of access, risk assessment, and transparency could stimulate patient participation in value co-creation.

The analysis results showed that Hypothesis 1(H1) was confirmed, namely, doctor interaction behavior perceived by the patient was correlated with positively patient participation in value co-creation and could improve patient satisfaction. These results were consistent with previous studies^{10,12,14,15,16,20,21}. It has been demonstrated that when doctors pay more attention to patients, provide care and explanations that address patients’ feelings and needs, and communicate information about treatment clearly and patiently, patients’ comprehension is enhanced, leading to an improvement in their satisfaction over the course of treatment^35,36. Furthermore, doctor interaction behavior, including the provision of alternative treatment plans and the solicitation of patients’ needs, concerns, and advice, can facilitate patient to participate in value co-creation, such as positive communication, feedback, treatment adherence, and self-management³⁷. Meanwhile, these could be seen as the important component of person-centred care that includes providing patients with greater decision-making power, more choices and integrating the environment with patients’ unique physical, psychosocial, cultural, and emotional needs³⁸.

The results of the study demonstrated that patient participation in value co-creation was positively related to patient satisfaction, thereby confirming Hypothesis 2 (H2). It is consistent with the findings of related studies^4,10,20,21. Patients who participate in treatment, such as engaging in treatment discussion or care decisions with doctors, communicating personal preferences, needs, or feedback to doctors, conducting good self-monitoring, and so on, is associated with good health outcomes, such as reducing mortality, increasing physical and mental health, and reducing healthcare costs^39,40.

Patient participation in value co-creation played as a mediator between the relationship of patient perceived doctor interaction behavior and patient satisfaction. Hypothesis 3(H3) was confirmed. The results of this analysis provide further insight into the reasons behind the positive influence of doctor interaction behavior on patient satisfaction. There is a discrepancy between the perception of patients and the self-rated behavior of doctors^14,37. Patients would be stimulated to participate in treatment actively when they perceive positive interaction attitude or behavior from their doctors, then gain satisfied treatment experience and improve their satisfaction^10,15. The analysis results demonstrated in this study indicated that during treatment, both doctors and patients work or corporate together could get satisfied consequences. Meanwhile, the standardized value of the indirect effect is 0.092, which is smaller than the direct effect (standardized effect values = 0.549). Probably because during treatment, patient perceived doctor interaction has the stronger and more direct relationship with patient satisfaction. Furthermore, additional factors or variables may exert an influence on patient satisfaction during treatment, which may have a confounding influence with each other and can be further explored in the future studies. Moreover, it is important to acknowledge that that not all patients are capable or willing to participate in value co-creation or disease treatment. It is related to patients’ ability, awareness or self-efficacy. It has been demonstrated in related studies that patients who search for medical information or knowledge in advance can increase their confidence and active participation in disease treatment or management⁴¹. High self-efficacy is also contributed to patient’s active self-management and participation in disease treatment^42,43. Consequently, patients may enhance their capacity for active involvement in their own care and disease treatment by acquiring or learning further health or medical knowledge.

There is a difference or gap between patient perception and doctor self-evaluation. Relevant research found that doctors evaluate themselves in the high score about promoting patient participation, whereas patients reported the low level¹⁴. A study of doctors’ service attitudes revealed that 83.27% of doctors self-evaluated that they would provide their patients with clear explanations until they fully understand. However, only 63.49% of patients believed that doctors would conduct this behavior⁴⁴. Additionally, 64.73% of patients reported that they received encouragement from their doctors, whereas doctors’ self-evaluated this rate was 82.21% ⁴⁵. Self-developed Doctor Interaction Behavior Evaluation Scale was used in this study, it included four dimensions, namely Dialogue, Access, Risk assessment, and Transparency. Patients evaluated their doctors’ behavior in accordance with their actual perception. We analyzed the relationship between different dimensions of doctor interaction behavior and patient participation in value co-creation in order to find out which kinds of doctor interaction behavior perceived by patient can positively stimulate patient participation in value co-creation. The results of the analysis demonstrated that the dimensions of access, risk assessment, and transparency of doctor interaction behavior were associated with positive patient participation in value co-creation, and their standardized coefficients were similar. However, no statistically significant association was found between the dimension of dialogue and patient participation in value co-creation. In our study, the dimensions of access, risk assessment, and transparency not only emphasize the communication of daily treatment and the sharing of information from doctor to patient, but also focus on the communication of detailed treatment information and the opportunity for patients to participate in discussions about their treatment with one another³⁰. For example, the doctor designs the treatments plans based on the patient’s need and provides patient the opportunity to choose in access dimension; doctor encourages patient to follow treatment prescription and informs the negative influence if not in risk assessment dimension; the doctor tells patient about the reasons and costs if large-scale inspections are needed or expensive medications are needed during treatment in transparency dimension. The dimension of dialogue mainly focus on daily treatment communication process, such as doctor guiding patient to provide appropriate information, explaining the disease condition clearly³⁰. The analysis results also showed that with the improvement of living standard and health awareness, patients pursue high-quality medical service in addition to the disease treatment, such as receiving positive service attitude and behavior from medical staff and having positive medical experience⁴⁵.

In light of the findings of the analysis we propose related strategies and measures to promote doctor interaction behavior and enhance patient participation in value co-creation. The development of effective communication skills is an essential component of becoming a good doctor⁴⁶. For the doctors’ part, in addition to medical skill training, they should undergo training in clinical and communication skills in order to ensure that patients feel respected and cared for. This could facilitate patient satisfaction, participation and cooperation^46,47. For instance, the doctor communicates or explains medical knowledge and detailed information to patients more understandably and patiently; shows kind and empathy towards patients when they have questions or concerns about disease treatment; designs the treatment plans based on patients’ needs and situations and invites them to discuss together. Furthermore, patients should take the initiative to collect and understand knowledge related to disease treatment through the Internet, news, and health lectures to empower themselves to participate in discussing treatment plans with doctors. Patients should also take the initiative to consult their doctors to verify the accuracy of information that learned by themselves above and improve their ability to identify and deal with diseases with confidence, as medical information obtained through online platforms may not be accurate⁴⁸.

Strengths and limitations

Our study introduced value co-creation theory into the healthcare field and explored the relationship between doctor interaction behavior, patient participation in value co-creation and patient satisfaction. The analysis results revealed that all hypotheses were confirmed, which indicates that it is appropriate to introduce value co-creation into the medical field. Doctors interact with patients and stimulate patients to participate in disease treatment. The cooperation between doctors and patients can improve the treatment effect. Meanwhile, we also analyzed which kinds of doctor interaction behavior were beneficial to stimulate patient participation in value co-creation. Relevant strategies were proposed based on the analysis results. The value co-creation theory and the DART model provide guideline for doctors on how to interact with patients and patients on how to participate in value co-creation. Doctors can improve communication skills and deliver detailed information and give the chance for patients to participate in treatment discussions. For example, doctors can design treatments plans based on patients’ needs and provide patients the opportunity to choose(Access); doctors encourage patients to follow treatment advice and inform the negative influence if not (Risk assessment); doctors tell patients about the reasons and costs if large-scale inspections need to be conducted or expensive medications need to be used (Transparency), which can help to stimulate patient participation in value co-creation. Meanwhile, patients should learn about health or medical knowledge actively to increase their health awareness and literacy and then empower themselves to participate in communication and discussion with doctors during treatment. However, this study has a few limitations. First, a large scale research or cohort study should be conducted to fully confirm the hypotheses and the relationship between doctor interaction behavior, patient participation in value co-creation, and patient satisfaction in the future study. As this research was a cross-sectional study and was confirmed based on a single tertiary-level hospital in Guangzhou, China, which cannot confirm the causal relationship. Second, we initially explored the relationship between doctor interaction behavior, patient participation in value co-creation, and patient satisfaction. However, it is possible that these three variables may interact with or exert a reverse influence on one another. In the future studies, more related variables could be included based on a systematic theoretical structure to explore their relationship fully, and representative items or measurement tools could be used to measure related variables systematically. Moreover, this study was primarily based on patient self-reported or self-perceived data. However, future research could also incorporate doctor self-evaluation to gain a more comprehensive understanding of the relationship between the variables and to reduce information or recall bias between patients and doctors.