Table A1 Illustrative data supporting...

Table A1

Illustrative data supporting qualitative interpretation

Identified theme	Representative quotes
Aligning diverse interests
Raising system improvement to the strategic agenda	Realizing that compensation for disability days was the biggest cost category
	Actually, the biggest cost item was loss of earnings, it was not care costs … [ ] … then we found that rapid care episode is a key for everything. – CEO of Pohjola Insurance Services
	Insurance company's decision to increase control of treatment chain
	Launching an own hospital was a natural solution. Existing providers focused too much on their own part of the chain. – CEO of the new hospital
Developing easy-to-measure system level indicators	Strengthening customer value instead of clinical outcomes as a measure for success
	Rapid recovery of customer to work (1) and the Net promoter score (2) were set as priority strategic measures for success in a new hospital
	It was the third time I went to the board meeting. They said that because I'm still so eager, I can found a new hospital but keep it as far as possible from the Pohjola brand. Do not destroy this brand … Two measures, customer experience and length of care episode, were set. And, of course, you cannot be unprofitable. The hospital should make small operating profit but not maximize it. – CEO of Pohjola Insurance Services
	Pohjola Hospital was our opening in health care services. Hospital's operating model, in which the customer is in the center of everything and treatment episode is as short as possible, has already shaped the whole sector. Our geographic expansion to serve the whole country and extension to new services strengthen our position as a forerunner in the health care market. – CEO of OP Financial Group (excerpt from a press release)
Aligning actors' interests through joint bodies and HR policies	Recruiting physicians that accept the joint goal and business idea of the new hospital
	It was important to find physicians who engage with these targets. In recruiting discussions, we went through the hospital's business idea. The idea is that your patients recover to work as well as possible. And the other issue was customer experience. – Chief physician of the new hospital
	We even suggested that would it be fine, [physician N.N], that when you work for us, your rental percentage is based on how much you sign sick leave. Less sick leave means smaller rental percentage. This was so radical suggestion, that it was shot down by all, in physicians' opinion it was not good, and neither by the Pohjola insurance. – Chief physician of the new hospital
	Strategic customer-value based metrics as KPIs were highlighted and communicated in doctor evaluation and training
	So if I think my own mission to work in this kind of place, so it is that I can lengthen the work career [of patients] in the middle. – An orthopedist of the new hospital
	There are different personalities among us orthopedists. Some of us are very surgery-oriented who just see that every patient should be operated. We do not have that kind of persons, but more like critical and pondering whether it is useful to operate. We do not have those omnipotent physicians who think that there are next to the God. – An orthopedist of the new hospital
Improving operations
Focus on certain patient groups and conditions	Economy of scale was aimed to be achieved in high-volume patient groups by concentrating operations to specialized surgeons
Focus on certain patient groups and conditions	The hospital produces over 3,000 ambulatory surgeries in orthopedics and hand surgery. I suppose that even the university hospitals have not that big volumes, even not Helsinki University Hospital – An orthopedist of the new hospital
Standardizing practices among specialists	Standard diagnostic criteria and indications for surgery are implemented and continuously discussed in weekly meetings
	We have weekly problem-solving meetings … [ ] … and there we try to define common care guidelines, so that nobody can deviate from them, and treatment follows nationally set guidelines. – Chief physician of the new hospital
	Weekly meetings with physicians and physiotherapists
	It is more communal here, we have a lower limb team which has a meeting every Friday. I started it in 2014 for this my lower limb team and in the beginning there was just me, N.N [chief physician], and couple of physiotherapists. But soon there was more and more people. I now we have a room full of people. And we ponder also just basic issues, but also very challenging, like how you would treat this patient. – An orthopedist of the new hospital
	Using recently published research about unnecessary knee and shoulder surgeries to change the mindset among physicians toward conservative treatment
	We wanted to have specialists who are committed to these Current Care Guidelines, because the idea of these guidelines is to help people best to recover. – Chief physician of the new hospital
Introduction of tailored treatment chains	Initial sick leave periods were shortened, and telephone service was launched to communicate with the patient about his/her ability to return to work or the need to extend sick leave
	After two sick leave periods, it is then my duty as a chief physician to call the patient and negotiate about the situation. – Chief physician of the new hospital
	In rehabilitation, we all aim at individual system. How often and how physiotherapy, for example, is taken to support the treatment. – Orthopedist of the new hospital
Signaling superior customer experience
Integrating operations of payor and provider	Customers that first contacted the occupational health or public emergency units were persuaded to contact the insurer's hospital for rapid imaging examinations
	We informed public emergency hospitals that they should direct their patients to contact us if the case is related to occupational trauma. – Chief physician of the new hospital
	Care, rehabilitation, and insurance compensation are combined and offered as a one-stop service in the new hospital
	Insurance compensation can be handled at the same hospital visit. Their door is just next to our doctors' doors. – Business controller of the new hospital
Contractual incentives for high customer experience	Nurses and care masters receive bonuses based on the Net Promoter Score
Contractual incentives for high customer experience	We have no salaried physicians; they are practitioners. But those who are salaried, care masters and nurses, they have customer experience in their bonus system. – Chief physician of the new hospital
Employing new customer-oriented professions	Employing Care Masters
	In the very beginning, we launched the care master service which has unquestionably improved service experience during hospital visits.” – Head nurse of the new hospital
	Employing Work Masters
	We realized that it would be better if the orthopedist could focus on the trauma treatment. And let's launch this work master beside, whose task is specifically to accumulate knowledge about what patient is doing at work. – Chief physician of the new hospital
	The idea is that after two weeks of sick leave, patient is directed to one of our work masters. We can consult doctors or employers, and the contact with patient lasts until return to work. – Work master of the new hospital

Identified theme	Representative quotes
Aligning diverse interests
Raising system improvement to the strategic agenda	Realizing that compensation for disability days was the biggest cost category
	Actually, the biggest cost item was loss of earnings, it was not care costs … [ ] … then we found that rapid care episode is a key for everything. – CEO of Pohjola Insurance Services
	Insurance company's decision to increase control of treatment chain
	Launching an own hospital was a natural solution. Existing providers focused too much on their own part of the chain. – CEO of the new hospital
Developing easy-to-measure system level indicators	Strengthening customer value instead of clinical outcomes as a measure for success
	Rapid recovery of customer to work (1) and the Net promoter score (2) were set as priority strategic measures for success in a new hospital
	It was the third time I went to the board meeting. They said that because I'm still so eager, I can found a new hospital but keep it as far as possible from the Pohjola brand. Do not destroy this brand … Two measures, customer experience and length of care episode, were set. And, of course, you cannot be unprofitable. The hospital should make small operating profit but not maximize it. – CEO of Pohjola Insurance Services
	Pohjola Hospital was our opening in health care services. Hospital's operating model, in which the customer is in the center of everything and treatment episode is as short as possible, has already shaped the whole sector. Our geographic expansion to serve the whole country and extension to new services strengthen our position as a forerunner in the health care market. – CEO of OP Financial Group (excerpt from a press release)
Aligning actors' interests through joint bodies and HR policies	Recruiting physicians that accept the joint goal and business idea of the new hospital
	It was important to find physicians who engage with these targets. In recruiting discussions, we went through the hospital's business idea. The idea is that your patients recover to work as well as possible. And the other issue was customer experience. – Chief physician of the new hospital
	We even suggested that would it be fine, [physician N.N], that when you work for us, your rental percentage is based on how much you sign sick leave. Less sick leave means smaller rental percentage. This was so radical suggestion, that it was shot down by all, in physicians' opinion it was not good, and neither by the Pohjola insurance. – Chief physician of the new hospital
	Strategic customer-value based metrics as KPIs were highlighted and communicated in doctor evaluation and training
	So if I think my own mission to work in this kind of place, so it is that I can lengthen the work career [of patients] in the middle. – An orthopedist of the new hospital
	There are different personalities among us orthopedists. Some of us are very surgery-oriented who just see that every patient should be operated. We do not have that kind of persons, but more like critical and pondering whether it is useful to operate. We do not have those omnipotent physicians who think that there are next to the God. – An orthopedist of the new hospital
Improving operations
Focus on certain patient groups and conditions	Economy of scale was aimed to be achieved in high-volume patient groups by concentrating operations to specialized surgeons
Focus on certain patient groups and conditions	The hospital produces over 3,000 ambulatory surgeries in orthopedics and hand surgery. I suppose that even the university hospitals have not that big volumes, even not Helsinki University Hospital – An orthopedist of the new hospital
Standardizing practices among specialists	Standard diagnostic criteria and indications for surgery are implemented and continuously discussed in weekly meetings
	We have weekly problem-solving meetings … [ ] … and there we try to define common care guidelines, so that nobody can deviate from them, and treatment follows nationally set guidelines. – Chief physician of the new hospital
	Weekly meetings with physicians and physiotherapists
	It is more communal here, we have a lower limb team which has a meeting every Friday. I started it in 2014 for this my lower limb team and in the beginning there was just me, N.N [chief physician], and couple of physiotherapists. But soon there was more and more people. I now we have a room full of people. And we ponder also just basic issues, but also very challenging, like how you would treat this patient. – An orthopedist of the new hospital
	Using recently published research about unnecessary knee and shoulder surgeries to change the mindset among physicians toward conservative treatment
	We wanted to have specialists who are committed to these Current Care Guidelines, because the idea of these guidelines is to help people best to recover. – Chief physician of the new hospital
Introduction of tailored treatment chains	Initial sick leave periods were shortened, and telephone service was launched to communicate with the patient about his/her ability to return to work or the need to extend sick leave
	After two sick leave periods, it is then my duty as a chief physician to call the patient and negotiate about the situation. – Chief physician of the new hospital
	In rehabilitation, we all aim at individual system. How often and how physiotherapy, for example, is taken to support the treatment. – Orthopedist of the new hospital
Signaling superior customer experience
Integrating operations of payor and provider	Customers that first contacted the occupational health or public emergency units were persuaded to contact the insurer's hospital for rapid imaging examinations
	We informed public emergency hospitals that they should direct their patients to contact us if the case is related to occupational trauma. – Chief physician of the new hospital
	Care, rehabilitation, and insurance compensation are combined and offered as a one-stop service in the new hospital
	Insurance compensation can be handled at the same hospital visit. Their door is just next to our doctors' doors. – Business controller of the new hospital
Contractual incentives for high customer experience	Nurses and care masters receive bonuses based on the Net Promoter Score
Contractual incentives for high customer experience	We have no salaried physicians; they are practitioners. But those who are salaried, care masters and nurses, they have customer experience in their bonus system. – Chief physician of the new hospital
Employing new customer-oriented professions	Employing Care Masters
	In the very beginning, we launched the care master service which has unquestionably improved service experience during hospital visits.” – Head nurse of the new hospital
	Employing Work Masters
	We realized that it would be better if the orthopedist could focus on the trauma treatment. And let's launch this work master beside, whose task is specifically to accumulate knowledge about what patient is doing at work. – Chief physician of the new hospital
	The idea is that after two weeks of sick leave, patient is directed to one of our work masters. We can consult doctors or employers, and the contact with patient lasts until return to work. – Work master of the new hospital

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