| [Purpose]Existing research on health resource integration lacks a systematic "resource view" and "resource integration theory" that can penetrate the macro,meso,and micro research levels and comprehensively describe resources and resources integration processes.The goal of this study is to explore and describe the law of stroke service resource integration,by re-defining the concept of resource and resource integration,establishing a theoretical framework for resource integration,building a conceptual model and scale of stroke service resource integration.[Methods]1)The historical context of the research on resource perspectives was analyzed through literature analysis.The new concept of resource was proposed,drawing on information philosophy,ecosystem perspectives,and network resource perspectives.The concept of resource integration in this research and the theoretical issues of resource integration was defined.2)A theory integration pathway assisted by bibliometric methods was used to construct a theoretical framework for resource integration.A total of 6,839 English literatures(with 199553 cited references)and 6002 Chinese literatures on service-dominant logic,value co-creation,symbiosis theory,and competitive advantages based on resources or capabilities,were bibliometrically analyzed.A total of 185 Chinese keywords,77 English subject categories,2086 highly cited literatures,and 642 burst references were extracted.The theoretical elements such as concepts,and propositions that are of reference significance were extracted for theory integration.3)A model of stroke service resource integration was constructed through multiple case studies.Semi-structured interviews,field observations,second-hand data collection,and questionnaire surveys were conducted on typical stroke services networks in three cities in Hubei Province for nearly 4 years,with a total of 17 on-site investigations,104 in-depth interviewes and 770,000 recorded words.The subject and environmental characteristics,resource models,and resource integration mechanisms in different cases were explored.4)Based on the stroke service resource integration model,a scale for stroke service resource integration was developed through theoretical analysis,literature research,and questionnaire surveys.Group verification methods were used to test the reliability and validity of the scale in stroke prevention,acute treatment,and rehabilitation services.A total of 751 medical staff from 27 medical institutions in 3 cities were investigated.Among them,124 medical staff participated in various aspects of stroke services.A total of 867 valid questionnaires were collected.Among them,488 were about stroke prevention services,211 were about acute stroke services,and 168 were about stroke rehabilitation services.The overall recovery rate of the questionnaire was 97.2%.[Results]1)Resources refer to the materials and information that can be used to realize the value of the subject,corresponding to operand resources and operant resources,respectively.Among them,operant resources are the mediators of value creation,including ontological information,epistemological information and social information.Resource integration refers to a series of activities to identify and obtain the resources required for value creation,remove barriers to resource sharing and resource fusion.2)The theoretical framework of resource integration includes three basic elements of resource subject,resource environment and resource model,and three resource integration mechanisms of networking,liquefaction and differentiation.Among them,the resource subject is the basic unit involved in resource integration in the service ecosystem;the resource environment is the subject and resource network in which the resource integration activities embedded;the resource model refers to the interaction form of resources in the service ecosystem.Resource networking is the process by which the main body cooperates with the new resource subject to improve the quality,type,and quantity of the resource pool;resource liquefaction is the process of releasing resource use rights through resource unbundling,or building resource channels to achieve resource flow;Differentiation is the process of achieving resource interaction and integration through repeated exchanges between subjects to create new resources.3)The results of multiple case studies on the integration of stroke service resources show that after the integration of resources,the interdependence between the subjects become closer,and the types of resources increased significantly,achieving sustainable growth in value creation.The changes in the resource model were reflected in the following three aspects: the rapid increase in the number and diversity of cooperative network connections and the emergence of cross-border associations in cooperative networks;the breadth,depth,efficiency,and symmetry of resource sharing increased significantly;the form of resource fusion changed from discontinuous interactions to integrated interactions.In the process of stroke prevention resource integration,resource subjects were guided by their respective values,based on their own resource characteristics,including new subjects and resources through networking,sharing resources through resource liquefaction,forming new resources through resource differentiation,and ultimately achieving service innovation and value creation.Among them,resources networking mainly exists in the form of cooperation between subjects,driven by policies,technologies or norms and benefits.Resource liquefaction mainly includes unbundling resources through benefit sharing and sharing channels through informationization.Resource differentiation mainly includes a series of activities to establishment of trust and stable interactions between subjects and the process of resources on information platforms.4)The stroke resource integration scale includes three dimensions of resource expansion,resource sharing and resource fusion,with 11 variables and 26 items.The results of the scale verification study show that the stroke service resource integration scale has high reliability and validity.Specifically,the standardized load of all measurement items is statistically significant,the item reliability is more than 0.5,the construction reliability of the three first-order factors is greater than 0.6,and the construction scale reliability coefficient of the total table is between 0.843 and 0.923.In the meantime,the corresponding Cronbacha ? coefficient value and CR value of each latent variable are close to or greater than 0.7;confirmatory factor analysis results show that the model fits well,RMSEA is between 0.032 and 0.061,and GFI is between 0.907 and 0.975.In the meantime,AGFI is between 0.916 and 0.953,NFI is between 0.921 and 0.974,and CFI is between 0.966 and 0.984.[Conclusions]1)Resources can be divided into two categories: operand resources and operant resources.Operant resources are the intermediary of value creation,which can be transformed through resource integration activities,thus constitute the core of service innovation and value creation.2)From the perspective of service ecosystem,resource integration includes three basic elements of resource subject,resource environment and resource model,and three resource integration mechanisms of networking,liquefaction and differentiation.This theoretical perspective lays the foundation for systematically studying the causes,foundations,processes,and influencing factors of resource integration activities.3)Resource integration significantly changed the value and resource characteristics of the subject of stroke services,and contributed to the evolution of the resource model and the sustainable growth of system value.The keys were to create a good policy and institutional environment,make full use of the driving force of benefits and technology,form a close cooperative relationship based on trust interaction,build an efficient resource sharing and transformation platform,and promote the networking,liquefaction and differentiation of resources.4)The stroke service resource integration scale constructed in this study has good reliability and validity in the measurement of stroke prevention,acute treatment and rehabilitation.The validity of the concept of stroke service resource integration passed the test.[Innovation and Deficiency]1)The innovations of this study include the following 3 aspects.First,the concept of resources and resource integration was restructured,and it was pointed out that operant resources and their transformation are the key to establishing a systematic resource view and resource integration theory.A theoretical framework for resource integration was established through systematic theoretical research;Secondly,with the help of multiple case analysis,a conceptual model for the integration of stroke service resources was constructed,and the key concepts such as the goals,foundations,processes,and results of the integration of stroke service resources were described,which laid the theoretical foundation for further in-depth exploration of the law of integration of stroke service resources.Third,a "theoretical integration path assisted by bibliometric methods" was established to provide evidence-based and repeatable methodological support for the theoretical innovation of interdisciplinary subjects.2)The deficiencies of this study mainly include the following two aspects.First,this research focuses on some new concepts and propositions.Although we have tried our best to explore and discuss these concepts and propositions in an evidence-based manner,we cannot achieve a comprehensive and in-depth test in this thesis.Second,This study focuses on the providers of stroke services,taking the governors as the environment builder,and the stroke patients as the service recipients.However,in practice,they are all important and equal participants in value creation,especially in services such as stroke prevention and rehabilitation that emphasize patient and family involvement. |
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