Stakeholder Salience in Public eHealth Value Co-Creation 

Abstract

This doctoral research investigates public value co-creation within China’s eHealth services. By adopting the stakeholder salience theory, the dissertation addresses three key research questions: Who are the salient stakeholders in public eHealth services? What values do these stakeholders perceive from eHealth services? How do they co-create value through their interactions? To answer these questions, five datasets were constructed and examined across four empirical chapters: two datasets scraped from websites, one dataset collected through two years of online observation, and two large-scale survey datasets.

The first part, which includes Chapters 1 and 2, serves as the foundation of the entire thesis. Chapter 1 sets the stage for the dissertation by providing an overview of the research background. This chapter outlines the motivations behind the study, and presents a roadmap for the entire dissertation. Chapter 2 serves as an investigation to identify the salient stakeholders within the public eHealth sphere and establishes the conceptual framework for the study. To determine which stakeholders have the greatest salience, I employed an online ethnographic approach combined with Natural Language Processing (NLP) techniques for big data collection and text mining. During the analytical phase, the conceptual framework was developed and refined by effectively integrating data-driven insights with theoretical constructs. This involved a two-tier coding process: the first-order codes identified key themes and their frequency; and the second-order codes were then applied to form aggregate dimensions based on the stakeholder salience theory (Mitchell, Agle, and Wood 1997). By conducting this analysis, Chapter 2 addresses research questions 1 and 2. First, it identifies key stakeholders involved and then narrows the focus on the three most prominent ones for further study in the thesis, namely e-patients, healthcare professionals, and third-party platforms. Second, it defines the perceived values these stakeholders prioritize which are service quality, self-worth, and accountability.

The second part of this dissertation includes three empirical chapters. Each chapter is designed based on the findings from Chapter 2 and aims to address the third research question: How do stakeholders co-create value through their interactions?

Chapter 3 focuses on e-patients, stakeholders with a high level of urgency due to their immediate healthcare needs and their significant influence on the reputation of online healthcare services. These stakeholders assess the value of eHealth primarily in terms of service quality and their perceived satisfaction. This chapter employs the expectancy-disconfirmation model (EDM) to explore the factors on e-platforms that influence citizen satisfaction during their interactions with online healthcare professionals. This chapter provides five main contributions: First, by integrating electronic word-of-mouth (eWOM) within the EDM framework thereby providing marketing insights into research on citizen satisfaction in public administration while also charting a new course for eWOM studies. The comprehensive analysis of online accessible data within the EDM framework shifts the focus away from previous marketing studies that concentrated on isolated determinants of eWOM. Second, the findings provide innovative insights into how normative and empirical expectations differ in their impact within the context of e-services, supplementing the body of research on the different types of expectations in EDM. Third, this study pioneers the use of machine learning tools to enhance our understanding of EDM within an e-service environment, moving beyond the traditional survey approach. Fourth, by implementing sentiment analysis with a custom-designed LSTM neural network, this study addresses the endogeneity issues commonly observed between “expectations” and “perceived performance” in the EDM model. Fifth, by integrating eye-tracking technology to validate findings derived from big data analysis advances are made to the understanding of the dynamics in “flat” e-platform services, which facilitate straightforward encounters with all kinds of information and challenge the traditional assumptions on expectations.

Chapter 4 examines online healthcare professionals who, according to stakeholder salience theory, possess high legitimacy due to their expertise, norms, and values in healthcare service delivery. A survey experiment was implemented to explore the causal relationships between organizational behaviours (types of ownership and marketing strategies employed) and the resulting work-related outcomes for online healthcare professionals. This chapter provides three main contributions to behaviour public administration (BPA): First, it addresses the call for greater methodological rigor in BPA research by rigorously integrating and substantiating the covariate’s dual role as both mediator and moderator within the framework of experimental treatment effects. This integration is crucial for a nuanced understanding of the average treatment effects in BPA experiments, not only from a statistical perspective but also from a theoretical one. Second, the study is at the forefront of exploring the interaction effects of organizational factors on individuals’ Public Service Motivation (PSM) and job outcomes. By focusing on the interactions of organizational variables, it addresses a gap in BPA research that has largely overlooked the complex influence of institutional factors until now. Third, this study advances a comprehensive analysis of the psychological construct PSM within a robust and authentic professional sample. These healthcare professionals have unique identities as they are affiliated with public hospitals, serving as street-level bureaucrats, while also legally registered to work with private e-services as online doctors on a pay-for-performance basis. Examining their dual roles helps to enrich the study of PSM and advance the generalizability of related theoretical propositions.

Chapter 5 examines the last salient stakeholder group, third-party platforms, and probes their accountability. These platforms control essential aspects of eHealth services such as e-infrastructure design, user experience (including online search functions and feedback systems), and service access. This chapter presents a survey experiment to explore citizen blame attribution and perceived accountability within cross-sector collaborations on third-party platforms, particularly when online services fail. This experiment makes three key contributions: First, it extends the theoretical and empirical understanding of Hood’s (2010) theories on blame diffusion in collaborative partnerships. It demonstrates that blame and accountability can be dispersed vertically through the hierarchical structure of the collaborating sectors, occurring regardless of which sector is directly identified as at fault. This insight enhances our understanding of how responsibility is assigned and managed in complex organizational arrangements. This chapter also investigates whether clearly defined roles can mitigate sector bias, thereby initiating a dialogue with Hood’s argument regarding the impact of ambiguous accountability. Second, this study is pioneering in distinguishing between operational and ethical service failures within e-services, leading the investigation into how different types of failures influence public perceptions of blame and accountability in cross-sector collaborations. Third, this study addresses a significant gap in the literature on cross-sector collaboration by focusing on service failures within virtual partnerships from the citizen’s perspective, an area that has been largely overlooked. Fourth, this study challenges the conventional understanding of sector bias as posited by Hvidman (2019), by examining it within an autocratic regime. Contrary to the common belief held in Western societies—that anti-public sector bias stems from incessant exposure to negative messaging about the public sector (Marvel 2015a)— findings in Chapter5 reveal that in an autocratic context like China’s, long-term exposure to pro-public sector propaganda fosters a unique psychology among the public. These findings provide invaluable insights for researchers who are looking to generalize results beyond Western contexts.

The final part of this dissertation is Chapter 6. This chapter summarizes the main findings and theoretical contributions of the dissertation. In this chapter, I discuss the scholarly contributions I made across several domains: public value co-creation, stakeholder salience theory, expectancy-disconfirmation theory, debates on experimental randomization, public service motivation, the politics of blame avoidance, and accountability literature. Furthermore, the chapter examines the generalizability of the findings beyond the specific context of China. Finally, I discuss the potential policy implications and acknowledge the research’s limitations and conclude by outlining future research plans related to this topic.

Date of Award	30 Aug 2024
Original language	English
Awarding Institution	City University of Hong Kong
Supervisor	Richard M WALKER (Supervisor)