Consider the following service episode: a person suffering from knee pain consults a physiotherapist at a nearby clinic. Dissatisfied with results after several sessions, he decides to seek the counsel of a general practitioner at a medical clinic, who injects cortisone to no avail. The general practitioner therefore refers him to an orthopaedist at a local hospital. The orthopaedist requests situation-specific images produced under the direction of a radiologist at another clinic. At the time of the next visit with the orthopaedist, the person and the physician agree to surgery which is later performed at a specialized hospital by a resident under the supervision of another orthopaedist. Physiotherapy treatments are subsequently prescribed and performed at the hospital. Home exercises are also prescribed but never carried out. After a certain time, still dissatisfied with results, the patient is treated successively by a chiropractor, physiatrist, physiotherapy technician (as opposed to professional) and acupuncturist before concluding that the situation is unlikely to improve and giving up. The above sequence includes eight different processes ranging from physiotherapy at a local clinic to examination by a general practitioner and subsequent action. The sequence of services is shaped by a combination of patient decisions, professional advice received, intra- and inter-organizational connections, and rules governing the transfer from one professional to another. Another patient with the exact same symptoms may well follow a totally different sequence and obtain radically different results. The “supply chain” is quite a different notion in complex services.
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