Summary of Article
Journal of Operations Management 42-43 (2016) 52e61 Contents lists available at ScienceDirect Journal of Operations Management journal homepage: www.elsevier.com/locate/jom Professional service supply chains* Jean Harvey Montr School of Management, Universit e du Qu ebec a eal, Case postale 8888, succursale Centre-Ville, Montr eal, Qu ebec H3C 3P8, Canada a r t i c l e i n f o a b s t r a c t Article history: Available online 4 April 2016 Professional service (PS) exchanges are seldom narrowly bounded in time and space. This conceptual paper discusses prolonged PS sequences involving different professionals and different types of professionals. It is framed by the dual concepts of service episodes, representing the client’s perspective and experience, and PS supply chains, that is, organized sequences of professional, clerical, and technical services explicitly set up to provide specific results, such as producing a financial product, designing a house, or replacing a hip. Four illustrative, empirically inspired situations are used to characterize episodes and supply chains. Each exemplar, two each from the health and social work sectors, is real and draws on publicly available data. The richness of the public information is a reflection of the fact that each is some form of failure or “disaster” (Altay and Ramirez, 2010). This dual conceptualization leads to a holistic perspective obtained by using the complex adaptive systems framework (Dooley and Van de ven, 1999, Levin, 1998) as a lens. The paper concludes with a discussion of the dynamics of such service systems and some proposals for a research agenda. © 2016 Elsevier B.V. All rights reserved. Accepted by Mikko Ketokivi Keywords: Professional services Supply chain Complexity science Adaptive systems Interprofessional interface Service experience Service episode Catastrophic failure 1. Introduction This conceptual paper is motivated by two observations regarding our current understanding of PS operations. First, the paper emphasizes that PS exchange is rarely narrowly bounded in time and space. Rather, participants engage in protracted PS episodes (henceforth “episodes”), made up of multiple interactive exchanges. Second, and building on this idea of stretched boundaries, although the majority of PS research has adopted an organizational or individual unit of analysis (Kaiser and Ringlstetter, 2011; Løwendahl, 2005), the idea of interacting professionals e a PS supply chain as it were e is frequently a more accurate description of PS practice and, critically for this special issue, offers a promising angle from which to (re)conceptualize the domain. Consider how a patient with back pain may interact with a general practitioner, a physiotherapist, an orthopedist, a pharmacist, an acupuncturist, and a chiropractor over the course of many months or years. These professionals will also interact, to a greater or lesser extent, with each other. A pharmaceutical company building a new plant will need the services of architects, various types of engineers, chemists, and pharmacists. Insurance underwriters, accountants, * The author gratefully acknowledges funding support received from the RBC Chair in Financial Services Management. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.jom.2016.03.002 0272-6963/© 2016 Elsevier B.V. All rights reserved. tax specialists, and lawyers are likely to be involved as well, interacting with various people inside the company and with each other over a period of years, face to face or otherwise. The challenges of normative control in a PS setting are well documented. Indeed, it is understood that management efforts aimed at enforcement and compliance can be counterproductive (Goodale et al., 2008; Von Nordenflycht, 2010). If we now extend traditional supply chain notions of agency and exchange governance to the examination of a network of interacting professionals (plus overlapping employers, professional bodies, etc.) they are likely to be inadequate in the face of emergent complexity. As a result, after exploring the two framing issues in more detail, the paper turns to the complex adaptive system paradigm (Levin, 1998; Dooley and Van de ven, 1999) to better understand these Professional Service Supply Chains (PSSC). We first review the relevant literature and then explore four illustrative situations in two different PS settings. Each exemplar is real and draws on publicly available data. The richness of the public information is a reflection of the fact that each is some form of failure or “disaster” an area of increasing interest to operations management (OM) researchers; e.g., Altay and Ramirez (2010). Disasters, and particularly manmade disasters, have long been of significant scholarly interest, in large part because they can lead to “alternative interpretations of events” (Gephart et al., 1990, p. 30). Weick (1993), for example, used his analysis of the 1949 Mann Gulch fire to “re-examine our thinking about temporary systems, J. Harvey / Journal of Operations Management 42-43 (2016) 52e61 structuration, non-disclosure intimacy, intergroup dynamics, and team building” (p. 628). As mentioned, another aspect of such serious events is that they often generate extensive public domain reports that serve as the basis for organizational research (e.g., Gephart, 1993; Turner, 1976). The paper discusses these exemplars using the complex adaptive system framework and then, building on the discussion of episodes and PSSC, proposes a holistic representation of Complex Adaptive Service Systems (CASS) and concludes with some proposals for a research agenda. 53 individual experiences (Voss et al., 2008). Accordingly, we propose to define an episode as the series of events, decisions, and activities that take place from the time a need for a service arises until no further service is provided to meet this need. This is an extension of the customer corridor concept (Mosley, 2007; Meyer and Schwager, 2007), defining the professional servicescape, if we may extend Bitner’s (1992) concept to virtual spaces, where the PS experience takes place (Stuart and Tax, 2004). 2.2. Professional service supply chains 2. Literature review This review is structured around two topics. We first discuss the customer’s perspective and experience of PS as a series of professional interventions take place. We then turn to the sequences or chains of professional work products that flow across PS systems. 2.1. Customer service episode In the course of personal or professional activities, individuals and organizations occasionally need jobs done to resolve problems or pursue opportunities; in the process, they try to reduce pain and secure as much gain as possible (Bettencourt and Ulwick, 2008; Christensen et al., 2007; Osterwalder et al., 2015). When this requires professional capabilities, the customer or his situation is processed by experts, often as part of an episode that includes technical and clerical services as well, executed under the direction or based on the opinions of these experts. In their discussion of experience-centric service design, Voss et al. (2008) proposed the notion of service as destination. Indeed, the tourist experience starts when one enters the airport at one’s destination and ends when one leaves it. It is the result of numerous interactions with service providers, in different environments, to address a host of different jobs that the tourist needs done at different points in the tourism episode. Tourism authorities and associations are increasingly aware that this is what determines the outcome, and that the ability to make these experiences memorable makes or breaks the reputation (Gnoth, 2002) of their destination. In most PS, no such authority exists. While customer requirements and quality of PS have been studied (see for example Harte and Dale, 1995; Patterson et al., 1996), the coordination of PS in extended episodes has not. Here is a generic need statement that an enlightened client with a substantial problem might formulate with respect to this critical aspect of quality, speaking in the first person: “I need to find an expert whom I can rely on to help me deal with this situation. I want this trusted person to understand that her contribution is just one of several that I will require in the course of the episode, and thus, guided by best practices and evidence, she should actively engage with other professionals to produce the best outcome that synergistically combined professional capabilities can create. This is not about ego, it is about my situation. I don’t want her to sell to me or dictate to me or tell me what I want to hear: I want her to lead me.” This is compatible with most codes of ethics (see for example Blank (2002)), although it takes a broader view of the episode, including the need for rich, focused interaction with trusted colleagues (Rashid and Edmondson, 2011), and fiduciary relationship with the client (Bitran and Hoech, 1990; Von Nordenflycht, 2010). While other formulations are possible, lacking better data, we will use this as a starting point in our discussion of customer requirements regarding interprofessional coordination. The customer experience is the holistic (rational, social, emotional and physical) result of a diversity of activities and interactions with various service providers during the episode (Verhoef et al., 2009; Gentile et al., 2007). It is more than the sum of From the providers’ perspective, various expert capabilities are brought to bear on clients’ needs in several different ways during these episodes, through one or more processes, by one or more organizations, in more or less structured series of interactions. We will refer to this set of capabilities as the service system accessed by the client. While much attention has rightly been devoted to understanding the interface between professionals and their clients (see for example Yin, 2013; Van birgelen et al., 2002), little research has sought to better understand interprofessional interfaces. They have been discussed in the context of technological change (Harvey et al., 1993), multidisciplinary teams (Lalayants, 2013; Andreu et al., 2012), individualized service plans (Casanueva et al., 2008), and the just-in-time philosophy (Harvey, 1989). When professionals and managers disagree about the appropriate course of action, because of either poor communication or irreconcilable differences of opinion, the respective power of the various actors comes into play (Lewis and Brown, 2012). Thus, how professional interfaces are designed and managed, in light of the particular power vectors at play in the situation, is a critical determinant of the outcome. Several authors identify the power to defend its turf against interlopers as a defining feature of a profession (Freidson, 1988; Abbott, 1988). Harvey (1990) proposed a typology of PS based on the respective power of three key categories of actors: clients, professionals, and managers. As Lewis and Brown (2012) suggested, we need to reconceptualize supply chains to deal with PS. According to Harland (1996), supply chain management relates to “the management of a network of interconnected businesses involved in the ultimate provision of product or service packages required by end customers” (p. S64). Service supply chains in general have been discussed in the service OM literature (Voss et al., 2008; Kim et al., 2007; Akkermans and Vos, 2003). We define a PSSC as a systematic sequence of professional, clerical, and technical services explicitly set up to provide specific services, such as producing a financial product, designing a house, or replacing a hip. Because of the nature of PS and the inherent uncertainty of each intervention, flows may not follow ideal sequences. A major difference from a product supply chain, say that of a cell phone, is that in the latter value is created in use when the product is assembled and activated, while in a PSSC value creation (or destruction) begins with the very first encounter (think of the back pain episode) and continues until the cessation of treatment, whatever the outcome. There is no service package per se in this case. Whatever this particular client received in the end was never designed by any one individual and is the unpredictable result of a series of events and branching decisions made either separately or jointly by several different experts, managers, and stakeholders. From the client’s perspective, the visit to the chiropractor occurred downstream of the appointment with the acupuncturist, but the two visits could well have taken place in a different sequence. Processes that take place within the same organization may be better connected than others, and subject to formal norms, standards, control systems and cultural influences. Feedback mechanisms might exist within a hospital 54 J. Harvey / Journal of Operations Management 42-43 (2016) 52e61 environment, for instance, to provide for adjustments, learning and process improvement over time, though that would seem to be more the exception than the rule (Tucker and Edmondson, 2003). Supply chain management has proven to be a fertile research field in OM. The same could be true of PS delivery chains in the future. They are undoubtedly an important aspect of value creation in PS and are poorly understood. 3. Approach Focusing on disaster brings our lens to bear on periods of effervescence or disruption intense enough to drive the system into catastrophic failure mode. We cannot use common research methods to study disasters, as such events cannot be experimentally manipulated or predicted (Gephart, 1993). Since researchers cannot decide to go and observe a disaster, they have to study one that has already taken place (see for example Brown, 2005; Weick, 1993; Gephart, 1993; Hayward and Hofer, 2001). Thorough investigations into the causes of highly visible failures are common. They can be very revealing about the inner workings of a system. However, making sense of these events, or sensemaking as it is called, can be very challenging (see for instance Brown et al., 2015; Weick, 2012). Weick’s (1993) study of the Mann Gulch fire disaster based on reading Maclean’s (1992) book about the event shows how “sensemaking involve turning circumstances into a situation that is comprehended explicitly in words” (Weick et al., 2005, p. 409) and contribute to the process of theorizing. Other examples of such use of “tertiary” data, i.e. using reports and cases prepared by other scholars, include Neustadt et al.’s (1978) analysis of the swine flu immunization campaign and Yin and Heald’s (1975) survey of published urban decentralization cases. Like these authors, our purpose is not to second-guess investigators or seek the ultimate truth about what happened, if such a thing exists. Rather, we merely use these situations as an empirically inspired context to explore the applicability and usefulness of the framing concepts of this paper and see what insight can be gained into the challenges presented by PS design and operation. For that purpose, the best available narrative and analysis of the disaster suffices. Human errors have been studied extensively (see for example Reason, 1990), as have their organizational (Reason and Reason, 1997) and systemic (Anderson and Webster, 2001) causes. Turner (1976) revealed some generic phases in the development of a disaster, and Krieger (2008) proposed a model including proximal and distal causes as central constructs. In PS, the consequences of failures can be very serious, even fatal. Such studies have mostly been conducted in hospitals, not only because wrongful death is the ultimate service failure, but also because data are accessible, given that hospitals are held accountable and have means to take action (Weingart et al., 2000; Hayward and Hofer, 2001). Inter-sector comparisons are sorely needed in PS to enhance “the validity and, crucially, generalizability of any findings” (Lewis and Brown, 2012, p10). In that spirit, we have selected two sectors (or service spaces) e health and wellness (HW) and social services (SW) e where good narratives can be found. We used two illustrations per sector to provide some perspective within each. We found the exemplars through a keyword search in the Scopus database and used the most widely quoted articles published in learned journals as sources (see Table 1). This constitutes a convenient sample, sufficient to provide some grounding for this conceptual paper. We now turn to an exploration of these four exemplars. 4. Service episodes and supply chains in different PS In this section, we analyze the situations using our central concepts of episode and PSSC. We discuss the two sectors in turn, distilling elements of a conceptual framework along the way. 4.1. Health and wellness HW1 e Episode and PSSC. Situation HW1 is a snapshot (no more than a minute or two) of the last moments in an episode of which little else is known. The patient had absolutely no control over the outcome of that encounter. The scene takes place at the intersection of three flows: the patient’s episode, the surgical supply chain, and the training supply chain. For the first two, this is the end point. For the third, it is a turning point. To get the job done, the patient had to trust a surgeon with his life. As a participant in the training PSSC, the surgeon then had to trust the resident with the life of his patient and with his professional reputation as a participant in the surgical PSSC. The case presents an abrupt and unexpected turning point (i.e., a significant variation) that must certainly have triggered a post-incident PSSC (a search for a specific cause) and a legal liability suit PSSC. HW2 e Episode. In HW2, a patient was worried about a lesion on his temple. At some point, his anxiety reached a point where he decided that he needed a job done: be reassured or have a trusted expert take appropriate action. He went to see a dermatologist with whom he had a long-term relationship. The various glimpses we have of this episode take him back to the dermatologist’s office three weeks later, when he was told that the lesion had to be urgently removed. He must have been relieved later that same day when another expert, an independently practicing plastic surgeon, whom the dermatologist was willing to trust with his patient’s life, told him that it was probably benign, that it might go away on its own, and that watchful waiting was the best course of action. The next six months involved appointment scheduling, delays, cancellations, and rescheduling, ultimately delaying the potentially lifesaving surgery until the situation had reached a point where no professional capability could save his life. HW2 e PSSC. During the first link in the PSSC, the first encounter with the dermatologist, the latter did the right thing by taking a biopsy. The pathologist analyzed the sample at his colleague’s request. His opinion is indicative of the gray areas in which physicians must operate: “a squamous cell carcinoma [SCC] could not unequivocally be ruled out” (Kels and Grant-Kels, 2012: p. 616). The pathologist recommended a course of action to his colleague (take a deeper biopsy). Upon seeing his patient again, however, the visible evolution of the situation (i.e., dynamic environment) led the dermatologist to take immediate and urgent action, making a phone call to a surgeon. The value thus made possible was destroyed that same day, however, as a colleague with a different mental schema reached a different diagnosis and opted for a different e and with the benefit of hindsight, inappropriate e course of action. The follow-up letter sent by the surgeon did not reflect any sense of urgency, and the confusion about who “owned” the case at that point precluded the active engagement (see need statement in 2.1 above) among committed professionals that could have ensured that the job got done. Scheduling problems completed the sequence of events that would prove fatal. Flows in PSSCs appear to be fraught with uncertainty. Another surgeon, for instance, might well have concurred with the dermatologist. Nonprofessional (administrative and clerical) processes, such as scheduling, can also be critical. J. Harvey / Journal of Operations Management 42-43 (2016) 52e61 55 Table 1 Short descriptions of the four situations, together with their sources and the types of professionals involved in each one. Ref# Disaster Short description Reference HW1 A patient dies (Kels and Grant-Kels, 2012) HW2 A patient dies SW1 A family is traumatized SW2 A child dies A resident surgeon, acting under the supervision of an attendant surgeon, cut at the wrong place. The patient lost all his blood and died. A dermatologist diagnosed a dangerous type of cancer, but the biopsy was ambiguous. As the situation took a turn for the worse, he urgently referred the patient to a surgeon, who reached a different conclusion and opted for watchful waiting. The dermatologist was only advised of this discussion later by letter, and did not take further action. The patient eventually died and both physicians had to pay heavy compensation. A well-known physician did not recognize a rare skin disease and attributed lesions found on a four-year-old child to sexual abuse. The situation was reported to child protection services, who went to court to seek a short-term protective court order, and the child was kept at the hospital. Many professionals were involved in the inquiry that followed: social workers, psychologists, a police surgeon and the family physician. It took four visits with the latter to convince him to challenge the distinguished physician, and push for a second opinion. The ordeal lasted several years, causing severe trauma to the family. A seven-year old child with borderline intellectual abilities and behavioral problems developed type 1 diabetes. When she was treated in a specialized hospital department (psychiatry and pediatrics) for six months, the problem was brought under control and she was able to function normally. The mother, however, was non-compliant and hostile. When the child returned home, she became very sick. The hospital sought a court order, but child protection services disagreed and won the day in court. The situation dragged on for years, with periods of successful care in a foster home. The child died at home six years later. 4.2. Social work SW1 e Context. During a fight with her older brother (SW1), a five-year old girl was hurt in the pubic area, and a bleeding lesion appeared. When the mother took her daughter to the hospital, the job she needed done was to have the lesion looked at. All the child wanted was for the pain to go away and to go back home to her family. This is not what happened. Children do not always know what is good for them. Generally their parents do, but this is not always the case either. Thus, society takes it upon itself to enact legislation to protect children and offer, or if necessary impose, services to ensure that these laws are enforced. Various professionals are thus empowered to act as proxies and take appropriate action in this pursuit. The senior doctor who examined the child (first node in the PSSC) at the request of her mother suddenly transformed himself into a representative of the state, and thus of the child’s best interest, when he concluded that the lesion was the result of sexual molestation, and jumped to the conclusion that this was the result of parental abuse. By filing a report, he activated several PSSCs in ostensible pursuit of the partly irreconcilable benefits of the child, the mother, the father, the siblings, and “the best interest of the child.” SW1 e Episode. The child’s episode took her to different hospitals, under a succession of interim care orders, and eventually back to a now dysfunctional family. The father’s episode included emotional outbursts at the hospitals and hours of questioning by numerous social workers, physicians, and psychologists. It took him into police custody for an apparently “hard” interrogation, and to court. The job that the parents needed done changed from treating their daughter to exonerating themselves from the accusations, and trying to mobilize other professionals in the power struggle. The “best interest of the child” was entrusted to a Guardian Ad Litem,1 by the court. It took five years for the accusations to be withdrawn and the family to be left alone. By that time, the family system and its status in the community (a dynamic system as well) had been altered, and the lives of its members had taken a turn for the worse (i.e., dynamic environment). Contrary to the two health examples, a client system is involved 1 A person named by the court to represent the child’s interest. (Kels and Grant-Kels, 2012) (Prosser, 1995) (Geffken et al., 1992) rather than a single client, namely the family member, the family unit, as a distinct social entity, “the best interest of the child” as defined and operationalized by societal mechanisms, and society as a whole. These clients are related to each other in complex and evolving ways, and their needs, demands, and modus operandi often conflict. Thus, at times, the service is imposed, forcibly if necessary, on one or the other of the clients, whose personal needs are then subordinated to those of other clients. SW1 e PSSC. Several related PSSCs are activated during this episode. A medical diagnosis is produced and medical treatment is applied. A child protection intervention is initiated by the social work agency. The law enforcement chain is activated as well, involving its own medical, legal, and psychological experts, interacting with all the other parties to discharge its responsibilities to protect society. As the case quickly escalates into a confrontation, a judicial PSSC is triggered, whereby all parties have to work through lawyers to ensure that their points of view are duly represented in court. The seeking of second and third expert opinions brings parallel medical PSSCs to intersect with the child protection and judicial PSSCs. Courts are the servicescape where all points of view confront each other, following tightly scripted procedures. The judge’s decision amounts to a switching point where specific actors are empowered to act while others are disempowered, and specific PSSCs are activated or deactivated in ways that cannot be predicted with any confidence, with potentially determinant effects on outcomes. SW2 e Episode. The child’s episode lasted seven years, from the age of 7e14. She lived with her mother and had psychological and behavioral problems. She developed diabetes and had learning problems that caused her to fail her second and fourth years of school. When she was admitted for six months to a specialized treatment center, her health and school performance improved markedly. When the child was on home visits, the mother did not comply with staff requests and the child’s situation deteriorated. When staff members raised the issue, the climate became confrontational, thereby precluding a helping relationship. At that point, “the best interest of the child” became a preponderant client, as the center filed a report for neglect. The child, however, remained with her mother for another year. At the end of that year, the mother took the child back to the center and gave up custody. The child’s health and performance recovered. A suitable 56 J. Harvey / Journal of Operations Management 42-43 (2016) 52e61 placement was found with a great-aunt, where she remained healthy and functioned normally. Unfortunately, the social work agency soon returned her to the care of her mother, against the advice of the center’s psychological and medical staff. Her health quickly deteriorated and she died. The client system is just as complex here as in SW1. The experiences and outcomes of this episode are also quite different for all the different clients. “For this patient, the system designed to protect her failed” (Geffken et al., 1992: p. 330). SW2 e PSSC. A medical PSSC was activated early in the child’s life. She had been admitted to the hospital 13 times before being admitted for residential treatment at the center. The social work PSSC was triggered into action by the center’s filing of a report for neglect. Caseworkers acting on the basis of different mental schemas from those of medical professionals, and using different criteria to determine the best interest of the child, disagreed. This triggered the judicial PSSC into action and a new actor, the Guardian Ad Litem, entered the system. The medical PSSCs, mostly within the center, and the social service PSSC, mostly within the agency, acted at cross-purposes during most of the episode. It appears that the caseworker had a helping relationship with the mother, whose relationship with the center was confrontational. The guardian sided with the center from the beginning, while the agency seems to have given more weight than the center to the mother’s need and to the potential benefit the child might get from living with her mother. 4.3. Modeling the episode and the PSSC On our path to a better understanding of the two central concepts of this paper, visual representations of episodes and PSSC can be a useful stepping stone. The episode (see Fig. 1) can be represented as a series of interactions between the client system, the situation giving rise to the need for PS, and different PSSCs. Using SW2, for instance, the client system in this case includes the child and her mother, the family as a social unit, and the abstract concept of “best interest of the child,” as potentially distinct from any notion the child or the parent may have of it. The clients interact with each other and evolve dynamically. Their experiences are linked but vastly different, and so are their respective outcomes. The “situation” is a state reached by the client system that causes a PSSC to be activated. In this case, the mother’s concern with the child’s health triggered a medical PSSC into action, and the center’s conclusion that the mother could not be made to comply with the treatment later triggered the child protection PSSC into action. The situation evolves as a result of changes in the client system, the effects of the cocktail of PS provided, the evolving relationship between the professionals, as well as its own dynamics (i.e., the inner dynamics Fig. 1. The protracted PS episode: three-way interaction between client system, situation giving rise to PS need, and PSSCs. of the child’s diabetes and behavioral problems). In the health sector, as illustrated by HW1 and HW2, the client can be a single person. It can also include the family unit if it is involved in the situation. Fig. 2 is also inspired by SW2 as a specific instantiation, although the detailed flow is merely illustrative. PSSCs are represented by connected chains of processes. Two processes are connected when systematic mechanisms exist to transfer the output of one as an input into the other. Interprofessional interfaces involve the flow of professional work products, such as diagnoses and opinions, between professionals. Each individual situation processed is different and many different routes are possible. The actual path that a case takes depends on a host of factors. It is unpredictable and determined dynamically. Within organizational boundaries, standards and transfer rules may exist. Professionally defined transfer protocols, respected or not, may also exist within and between organizations. Fig. 2 would also provide an apt description of the other three cases. This dual representation of PS fails to capture the dynamic interplay of the episodes and the PSSCs. It is also incomplete in that it fails to show the role of adjacent systems, such as the medical training system in HW1, the judicial system in HW2, and the law enforcement system in SW1. Professional autonomy, status, and aversion to controls (Von Nordenflycht, 2010), together with the need for the intervention of several professionals from different fields to resolve the situation, introduce uncertainty and unpredictable variations into the flow of cases, cycle time, cost, experience, outcome, and throughput. Complexity theory may be of use in our quest for a more holistic understanding of such services. 5. Complexity In this section, we build on the two frameworks elaborated above to take a second look at the situations through the broader prism of complex adaptive systems. The flow of clients and their evolving situations through connected service systems is subject to irreducible uncertainty. Such systems are neither designed nor controlled: they evolve (or emerge) in unpredictable yet nonrandom ways. How the system responds to change and how order is re-created after a significant disturbance (Mckelvey, 2004) is particularly important from an OM perspective, as it impacts all aspects of performance (quality, cost, productivity, cycle time, and throughput). Different authors have defined and characterized complexity in slightly different ways (see for instance Dooley and Van de ven, 1999; Choi et al., 2001; Gallopin et al., 2001; Mckelvey, 2004; Anderson, 1999; Paraskevas, 2006; Zadeh, 1973). The underlying dynamics of such systems involve internal mechanisms that cause them to change over time, a dynamic environment with many possible suboptimal equilibria, and coevolution between the system and its environment, with evolving boundaries and nonlinear relationships. They can be analyzed at different scales, from the micro system (client-professional interaction), to a mezzo level (process or chain) to a global perspective. Table 2 presents a summary of the essential features of complex adaptive systems together witch respective sources, as well as the particular form these features may take in a CASS. We also provide illustrations drawn from our four exemplars. Referring to these features, to the four situations discussed above, and to Figs. 1 and 2, a generic visual representation of PSSCs and episodes within a CASS framework can be attempted (see Fig. 3). Various PSSCs within the service system (central image, simplified from Fig. 2) are activated when a situation arises in the client system (from Fig. 1) that somehow triggers them into action. J. Harvey / Journal of Operations Management 42-43 (2016) 52e61 57 Fig. 2. Illustrative PSSCs in child protection services: processes, interfaces, and organizational boundaries. Adjacent systems, themselves complex systems, interact with the service systems accessed during the episode. Intersystem boundaries are fluid and shifting (Ng and Andreu, 2012). Flows in the PSSCs are subject to irreducible uncertainty as professional work products resulting from a diverse field of different, often incompatible, abstract knowledge systems (Abbott, 1988) somehow combine to determine the action. Flows across different organizational cultures (not to mention national cultures in global systems), rules, protocols, priorities, and resource allocation schemes unavoidably create noise and bottlenecks in a system that results more from self-adjustment and emergence than from any formal design. The situation evolves throughout the episode, as the services provided affect its inner dynamics and those of the client system. The four cases show that episodes jumped unpredictably from one chain to another, often with dire consequences. Note that the situation can be processed simultaneously (i.e. parallel paths through the service system) by different PSSCs. Our quest for further specification and use of this framework is impaired by the limitations of the convenient illustrations we used. 6. Discussion and research agenda The CASS lens presents a different perspective on PS from which to reconceptualize the domain. However, it raises more questions than it answers. The discussion in this section is organized around three themes that also constitute a research agenda to address some of these questions. 6.1. The flow of professional work products in PSSCs Complex systems are characterized by flows. “It is such flows that provide the interconnections between parts, and transform the community from a random collection of species into an integrated whole, an ecosystem” (Levin, 1998, p433). As the four cases illustrate, PS systems are crisscrossed by streams of professional work products (e.g., expert opinions, diagnoses, instructions, and decisions) that are processed (debated, acted upon, rejected, modified, or altogether ignored) and play a determinant role in salient operational features of PS. The forces at play at these interfaces e or professional moments of truth, as we could call them e are many and varied. Lewis and Brown (2012) concluded that “the types of professions, and type of professionals, matters in understanding PSOM.” In three of our four exemplars, how professionals considered the opinions of other professionals in dealing with the situation at hand proved determinant (HW1 involved a fault in execution). Problems at interprofessional interfaces have been identified between accountants and lawyers (Schwarcz, 2008), architects and engineers (Herbert, 1998), social workers and psychiatrists (Lalayants, 2013), and in the health sector e.g., Makowsky et al. (2009). Yet little is known about the operational impact of such loosely connected and unpredictable flows. We need to go beyond modes of contact, which have been discussed in the service OM (Chase, 1981) and marketing (Van birgelen et al., 2002) literature, to better understand how expert opinions are produced, flow and collide, creating or destroying value during the course of extended episodes. Any OM practice that does not consider the forces at work at the various interfaces is likely to be blind to leverage points where the right pressure, adroitly applied at the right time and place, could bring about desired change. Shortsighted OM approaches are bound to be ineffective and counterproductive. While power has been studied in this context by sociologists (see for example Crozier and Friedberg, 1977), within organizational routines (Feldman and Pentland, 2003) or in the context of micropolitical games (Mintzberg and Walters, 1985), it is not a construct that is used 58 J. Harvey / Journal of Operations Management 42-43 (2016) 52e61 Table 2 Distinctive features of complex adaptive systems, description, corresponding meaning in CASS, and illustrations. Feature Description Agent and schema Professionals within the system act on the SW2 e The caseworker’s disregard basis of mental models based on abstract of apparently solid medical opinion knowledge defined and evolving outside and unshakeable preference for reuniting the child with her mother the system. These actions determine the system’s dynamics and service outcomes. Professionals have enough autonomy and HW1 e The resident’s mistake Entities within the system have power to counteract outside pressure significant room for action to aimed at controlling them. Clients and constitute an important factor in the regulatory agencies may also have system’s dynamics. considerable leverage on the system. SW1 e The radically different The actions of independent autonomous While the system is complicated, no conclusions of three experts professionals are an important source of amount of simplification can eliminate important sources of uncertainty that make variations that influence the behavior of the whole system. it unpredictable. HW2 e The plastic surgeon’s The system’s response to changes Numerous variables affect a unpredictable conclusion after in any variable can be disproportionate. professional’s diagnosis, some visual inspection of the lesion of which are very subtle, and there are many gray areas. When an outcome depends on diagnoses reached independently by different professionals, minute changes can trigger radical system responses. HW2 e The dermatologist’s Clients and their information may The system is characterized by jumbled, referral to this specific colleague take a number of different paths unpredictable flows. Consequently, based on unpredictable actions spontaneous contacts between many and decisions by various agents, parts of the system are possible. thereby impacting system performance. Dimensionality Irreducible uncertainty Nonlinearity Network connectivity Dynamic environments Corresponding meaning in CASS The actions of several entities within the system, applying their own rules, can have a significant impact on the course of events. Environments are unstable. They are characterized by frequent changes and turbulence that force the system to react and adjust. Absence of a No entity controls the complete system. global controller Many levels of Systems are parts of more global systems. analysis or scales They can also be decomposed into subsystems, which are full-fledged systems in their own right. Analyzing a system requires choosing a scale of analysis. At the wrong scale, a diagnosis is impossible. Self-organization As a result of the above features, and emergence the system adapts, responds, and adjusts, unpredictably but non-randomly, to evolving internal and external pressures, through the joint effect of often inchoate adaptation mechanisms. Illustration References (Zadeh, 1973; Anderson, 1999; Choi et al., 2001; Gallopin et al., 2001) (Choi et al., 2001; Gallopin et al., 2001) (Zadeh, 1973; Choi et al., 2001; Gallopin et al., 2001) (Zadeh, 1973; Anderson, 1999; Choi et al., 2001; Gallopin et al., 2001; Mckelvey, 2004) (Zadeh, 1973; Anderson, 1999; Choi et al., 2001; Gallopin et al., 2001; Mckelvey, 2004; Paraskevas, 2006) (Choi et al., 2001; Gallopin et al., 2001; Mckelvey, 2004) Legal, regulatory, political, social, SW2 e The mother’s change ecological, scientific, and technological from fighting to keep her environments are constantly changing. daughter to willingly giving So are other adjacent systems, and up custody the boundaries are fluid. All cases e No oversight of episode. (Choi et al., 2001; Complex adaptive systems are not Mckelvey, 2004) No detection or action taken in the confined within organizational face of obviously inconsistent actions. boundaries and no one can effectively control them. (Choi et al., 2001; HW1 e About 1 min, two actors, The significant scale for a client Gallopin et al., 2001; face to face. SW2 e seven years, is the one that includes all the Mckelvey, 2004; more than ten different professions services that may contribute to the Paraskevas, 2006) satisfaction of her need. From an organizational or government perspective, the relevant scale may be quite different. Not observable within the scope (Choi et al., 2001; There is no explicit system-wide of the selected illustrations Gallopin et al., 2001; response plan when a new law is Mckelvey, 2004; passed or a scientific breakthrough Paraskevas, 2006) occurs. The system’s response to this stimulus, appropriate or not, is an unknowable function of the adjustments effected in each subsystem and by each agent, including feedback and feedforward loops thus triggered. frequently in OM or considered by OM scholars as essential or even relevant to their trade. The same can be said about trust: “The willingness to take risk or be vulnerable to another person when there is something of importance to be lost” (Mcgrath and Zell, 2009, p75). Because PS play an increasingly important role in creating value in advanced societies, this may have to change if OM is to maintain its prominent role. A better understanding of interprofessional interfaces would go a long way toward a better understanding of PSSCs, and thus of CASSs. 6.2. CASS framework: validation, generalization, and typology In this paper, we used four cases drawn from two sectors to develop a conceptual model. Gaining depth and breadth of coverage of these two important sectors is a good place to start in validating this model. Its generalizability to other sectors needs to be verified as well. For instance, what does an episode look like in financial services? What does an accounting PSSC look like? How do architecture-engineering service systems behave? We elaborate briefly on these three indicative questions in the next paragraphs. SW1 and SW2 illustrate how a client system can be complex in its own right. This would also be the case, but in a different way, when the client is an organization using PS during an acquisition project or an initial public offering. Various units and persons within the organization would have related but different experiences during an episode. Many financial services, mortgage loan origination and securitization for example (with the subprime mortgage meltdown disaster coming to mind; (Hellwig, 2009)), are J. Harvey / Journal of Operations Management 42-43 (2016) 52e61 59 Fig. 3. Complex adaptive service delivery system: Protracted service episode involving several PSSCs and different adjacent service systems. intermediation services, thus serving two types of clients (borrowers and investors) with different needs, going through entirely different episodes. This involves a wide range of professionals: mortgage brokers, credit officers, financial analysts, tax experts, lawyers, accountants, stockbrokers, financial advisors, and portfolio managers. There are many borrowing clients at one end and many lending clients at the other, with many intermediate clients in between. These are connected by a set of PSSCs which a priori present many of the features presented in Table 2 and illustrated in Fig. 3. At a first glance, the model seems to be an apt representation of accounting services as well. Preparing financial statements is a PSSC involving internal accountants, auditors and consultants. So is the interpretation of legislation and jurisprudence and the formulation of the organization’s accounting and financial strategy. If we use the Enron-Andersen disaster to illustrate this point, we see that the global effect of the local actions of various agents in this system, applying accounting schemas within a legally acceptable zone of discretion (even though some fraudulent actions was involved), brought the system into catastrophic failure mode (Benston and Hartgraves, 2002). There was no global controller to detect this emergent behavior and apply appropriate leverage to bring the system back into normal operating mode. Referring to Fig. 3, the client system, involving shareholders and the many users of accounting information, the legal system, the regulatory system, and the financial system, for instance, are adjacent to and interact dynamically with the accounting system. Accounting is also an intermediation service, between “operators” (organizations) and users of financial information regarding these operations. Thus, there are two types of clients here as well, with different needs and priorities, going through different episodes. A summary exploration of the Kansas City Hyatt walkways collapse (Luth, 2000; Moncarz and Taylor, 2000; Pfatteicher, 2000) shows the way the work of different professionals, sometimes mediated by drafting processes, flows among architects and engineers, and across organizational boundaries. Since reputations and profits are at stake, pressure can be exerted and professional ethics may give way. Much of this takes place below the project manager’s radar (i.e., no global controller). The presence of turbulent systems around the architectureengineering system, such as the competitive hospitality marketplace and the construction industry, makes it a priori compatible with the CASS paradigm as well. The foregoing discussion, from finance to accounting, to architecture and engineering, illustrates the challenges we face in distilling knowledge from such a broad and uncharted servicescape. Research is unlikely to make much progress until we develop an appropriate classification scheme (or schemes) for PS systems. Almost all studies of PSOM are limited to one type of PS, much of it in the health sector. Research must now move to another level, inducing general features of PS systems from detailed comparative groundwork (Lewis and Brown, 2012). Systematic inter-sector comparative analyses, as challenging as they are methodologically, are required to move forward. Since classification is the beginning of knowledge, it is fair to say that we have not begun our learning journey, for lack of proper pigeonholes (Mintzberg, 1993) where we can anchor our knowledge, and progress through comparisons and generalizations. An implicit question in this quest has to do with what services should be included under the umbrella of PS (or is “complex services” a more appropriate label?), for OM purposes. It makes intuitive sense to talk of some services as being more complex than others. Choi and Krause (2006) proposed three modulating 60 J. Harvey / Journal of Operations Management 42-43 (2016) 52e61 variables for supply base complexity. Developing a complexity scale would facilitate the search for better-adapted and more discriminating approaches to OM and contribute to the development of contingent models. Based on our model, potential modulating variables include those related to professionals (number of different professions, relative power), clients (number and types of different stakeholders, conflicts), organizations (number of organizations, extent of coordination), environment (power of regulators, scientific uncertainty, dynamism), and the situation and needs (factual uncertainty, dynamism of the situation). 6.3. Emergence, control, and influence CASS’s property of self-adjustment and emergence is particularly important to OM’s concern with efficiency, effectiveness, and control. It depends on the non-synchronized but related actions of powerful agents holding different, often divergent, worldviews to resist or circumvent control measures that they perceive as undue interference in their work (Von Nordenflycht, 2010). Better understanding this phenomenon may offer a way out of the control vs. “gentle nudges” (Goodale et al., 2008) quandary. A broader perspective is required to study this than that offered by our limited and convenient exemplars. Case studies such as the welldocumented subprime mortgage meltdown (Hellwig, 2009; Swift, 2011) and Enron-Andersen disaster, which we hinted at above, may be far more useful in that respect. Indeed, at times, complex systems are subject to “strange attractors” (Pascale et al., 2000) that systematically distort the way experts use their discretion e they often succumb to inherent moral hazards e and unwiitingly trigger adverse systemic effects. Thus, systems meant to protect investors become instrumental in cheating them, similar to what we saw in SW1 and SW2 for child protection services. Regulators have much responsibility and formal authority but insufficient understanding and little practical means to wield it effectively. They have proven particularly inept in finance and accounting (Benston and Hartgraves, 2002). More OM-oriented research in this promising area could provide substantial benefits for society. What a CASS perspective brings to OM is the caveat that systemic effects may be at play, confounding efforts to correctly diagnose what may be perceived as localized problems, and find appropriate countermeasures. A control measure that may seem appropriate from a process or an organizational perspective may be counterproductive from a system-wide perspective. It has been suggested that simple rules may be the best way to manage complexity (Eisenhardt and Sull, 2001; Sull and Eisenhardt, 2012). Simple, well-designed rules may leave untouched professionals’ sense of autonomy and control, and therefore be better suited for PS than controls. The latter are bound to be perceived as, and may actually constitute, arbitrary management diktats and interference, and thus, legitimately or not, effectively resisted. A simple rule change that appears to be having a major impact in surgical blocks is the introduction of a time-out before surgery when the team goes through a pre-surgery checklist (Gawande, 2009; Pronovost and Vohr, 2010). It triggered a chain reaction in hospitals around the world e.g., Levin (2012) Taussky et al. (2010). Allowing pharmacists to adjust the dosage of some prescribed medications (Martinez et al., 2013) can create ripples through the system that only a systemic mindset may be able to fathom. Sometimes such new rules are formulated in the wake of major catastrophes or watershed events, such as the requirements that audit and consulting firms operate at arm’s length (Benston and Hartgraves, 2002; Albring et al., 2014) following the EnronAndersen disaster or the development of a code of ethics for civil engineers adopted after the Kansas City Hyatt Regency collapse (Pfatteicher, 2000). These examples merely hint at an avenue that his better adapted to the PS environment than controls, and more effective than “gentle nudges.” 7. Conclusion This initial attempt to apply the complex adaptive system framework to PSSCs through post-hoc analysis of four empirically inspired exemplars resulted in the development of an initial conceptual framework for the field. Unlike many OM techniques, complexity theory does not come with a practical application guide. Yet it allows one to comprehend phenomena, knowledge of which is essential to avoid disasters, achieve results, learn and continuously improve this important class of services. Limiting one’s perspective to the boundaries of an organization or to specific encounters in PSOM is an impediment to learning (Currie and Suhomlinova, 2006; Trochim et al., 2006). This may be an unsettling notion, which may partially explain the relative neglect of this sector by OM researchers. 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