Traditional approaches to customer value: assumptions, strengths, limitations and relevance for health care
| Approach | Core concept | Key value dimensions | Strengths | Limitations | Relevance for health care |
|---|---|---|---|---|---|
| Benefit – sacrifice trade-off (Gale and Wood, 1994; Monroe, 1990; Zeithaml, 1988) | Value is a ratio of benefits received relative to sacrifices made (price, time, effort) | Functional utility, performance, monetary and non-monetary costs | Simple, managerially intuitive; suitable for benchmarking | Overly rational; ignores emotions, vulnerability, context; typically treated as stable and assessed at discrete points rather than across evolving experience | Cannot capture fear, anxiety, uncertainty or vulnerability, which dominate pre-service and in-encounter healthcare experiences |
| Means – end hierarchy (Gutman, 1982; Woodruff, 1997) | Value arises from links between service attributes, use consequences and higher-order goals | Attributes → consequences → personal values | Connects service design to personal meaning; goal-oriented | Linear and cognitively structured; underrepresents emotion, embodiment and temporal reinterpretation | Misaligned with emotionally charged and non-linear patient journeys; patients often cannot articulate goal hierarchies during stress or illness |
| Multidimensional models (Holbrook, 1994; Sheth et al., 1991; Sweeney and Soutar, 2001) | Value comprises functional, emotional, social, epistemic and conditional elements | Functional, emotional, social, epistemic and experiential dimensions | Captures symbolic, experiential and affective dimensions | Conceptually broad; operationalisation challenges; typically applied cross-sectionally, offering limited insight into how value is revised over time | Captures some emotional elements but fails to address evolving interpretations, temporality and post-service meaning-making critical in health care |
| Approach | Core concept | Key value dimensions | Strengths | Limitations | Relevance for health care |
|---|---|---|---|---|---|
| Benefit – sacrifice trade-off ( | Value is a ratio of benefits received relative to sacrifices made (price, time, effort) | Functional utility, performance, monetary and non-monetary costs | Simple, managerially intuitive; suitable for benchmarking | Overly rational; ignores emotions, vulnerability, context; typically treated as stable and assessed at discrete points rather than across evolving experience | Cannot capture fear, anxiety, uncertainty or vulnerability, which dominate pre-service and in-encounter healthcare experiences |
| Means – end hierarchy ( | Value arises from links between service attributes, use consequences and higher-order goals | Attributes → consequences → personal values | Connects service design to personal meaning; goal-oriented | Linear and cognitively structured; underrepresents emotion, embodiment and temporal reinterpretation | Misaligned with emotionally charged and non-linear patient journeys; patients often cannot articulate goal hierarchies during stress or illness |
| Multidimensional model | Value comprises functional, emotional, social, epistemic and conditional elements | Functional, emotional, social, epistemic and experiential dimensions | Captures symbolic, experiential and affective dimensions | Conceptually broad; operationalisation challenges; typically applied cross-sectionally, offering limited insight into how value is revised over time | Captures some emotional elements but fails to address evolving interpretations, temporality and post-service meaning-making critical in health care |