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Table 1 Description of the cases

From: Creating advantages through franchising in healthcare: a qualitative, multiple embedded case study on the role of the business format

 

System 1

System 2

System 3

Background information

Service

Mental healthcare

Hospital care (eye-care)

Care for the intellectually disabled

Year of establishment

2004

Franchise since 2007, system started in 2003

2003

Motive for franchising

Gain stronger position in more competitive market through high-quality, efficient care

Gain stronger position through provision of high-quality, efficient care in increasingly competitive market

Founded by a father who was highly dissatisfied with the quality of regular care for his intellectually disabled son

Type of franchise

Fractional: a portion of the care delivery of mental healthcare organizations is franchised.

Fractional: eye care departments of general hospitals are franchised.

Stand-alone: two care professionals operate a small-scale full-time living facility.

Number of units

26, owned by 4 franchisees. Units are daily operated by employed managers.

14, of which 11 franchised and 3 owned by the franchisor

107, of which 99 franchised and 8 owned by the franchisor

Payment method of care provided in units

(Obligatory) health insurance reimbursement, complemented with personal contribution of clients.

(Obligatory) health insurance reimbursement, complemented with personal contribution of clients

Personal budget of clients provided by governmental regional care offices following the Exceptional Medical Expenses Act

Contractual payments

All franchisees are shareholder of the franchise. All costs are proportionally divided and paid.

Fixed initial fee for quick scan/research before joining franchise. Ongoing annual fee comprising fixed base fee + variable fee per FTE ophthalmologist.

Fixed initial fee and fixed annual ongoing fee.

Business format: positioning

Positioning toward customers

Specialized evidence-based ambulatory care provision to adults with an optimistic approach visible through office-like interiors, a specialized focus and excellent accessibility

Providing the entire spectrum of ophthalmology care in an excellent manner through regional and national cooperation, competent people, hospitable attitude, modern and smooth operations, and fine communication.

Providing care and living in a small-scale beautiful house with family-like atmosphere where disabled individuals can live as normal a life as possible with ample opportunities to do pleasant activities and receive love and attention

Business format: support services

Support services provided to units

Branding, logo, website, folders, intranet, shared access system, operations manual (process improvement), routine outcome measurement (measure client progress), benchmarking, training, knowledge sharing/development structures

Branding, logo, intranet, website, publicity, frequent advisory support of franchisor representative to implement the operations manual with many ideas about process improvement, benchmarking, training, possibilities for shared purchasing, structures for knowledge sharing/development

Branding, logo, intranet, website, other publicity, facilitation of care building, facilitation of a loan, administration system, benchmarking, initial training, advisory support/coaching, lobby government, structures for knowledge sharing/development

Business format: level of control

Initial control

Low

Low to medium

Medium, initially low

Level of standardized operating instructions in the franchise

• Care processes: medium to high

• Care processes: low, moving to medium

• Care processes: low to medium

  o fixed treatment programs, standardized intake (became looser), standardized pathways in treatment programs

  o Protocols of professional bodies; currently works on certification of care pathways (e.g., which treatments, control moments)

  o standardization of some boundary conditions: no. of customers allowed; guidelines about day-time care, medication lists, fixation

• Non-care processes: medium to high (became looser)

• Non-care processes: low, tries to move to medium

• Non-care processes: medium

Level of centralized decision-making

• Care: now low on franchisee level (four franchisees are together franchisor), was more centralized at start), low-medium centralized from unit perspective

• Care: low

• Care: low

• Non-care: now medium centralized from unit perspective; level differs per franchisee.

• Non-care: relatively low (almost all aspects that impact the franchisees are decided in consultation or by the hospital)

• Non-care: medium