Transformative value co-creation in healthcare services in the COVID-19 era

OVID-19 seems to have projected us all into that social and temporal dimension that anthropologists call “liminality”. The pandemic suspended all ordinary activities and identities. We no longer act from a project perspective but only in the contingency of the very short term. For example, in this period, attention has been focused on COVID-19 patients, while patients with other diffused and chronic pathologies, such as cardiac disease and diabetes, were neglected. Non-COVID-19 patients instead seem to have disappeared from social communication, as if their illnesses were also suspended. Unfortunately, however, they are not, though in many cases the clinics have been closed and appointments postponed. Even as activity in hospitals resumed, patients have been afraid of getting closer. This phenomenon has not only occurred in Italy but also in the rest of the world. Among chronic diseases, cardiovascular diseases (CVDs) are the leading cause of death globally, according to World Health Organization (WHO) data (2020), taking an estimated 17.9 million lives each year and accounting for approximately 31% of all deaths worldwide. CVDs are a group of disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease and other conditions. Four out of five CVD deaths occur in people under 70 years of age due to heart attacks and strokes. One-third of these deaths occur prematurely. In Italy, there are 240,000 victims of heart disease per year; cardiovascular diseases are responsible for 44% of all deaths, and those who survive a heart attack become a chronic patient. During the lockdown, the scenario in Italy changed because of the rapid reorganization of hospitals and the increased burden on the emergency system due to the pandemic. People with cardiovascular diseases preferred to stay home also a severe case. Based on the numbers of the first Italian multicentre study (De Rosa et al. 2020) conducted in 54 hospitals, the Italian Cardiology Society stated that during the COVID-19 emergency, mortality from heart attacks tripled and in most cases were linked to non-treatment or late treatment. About 7.5 million Italians suffer from cardiovascular diseases: during this pandemic, a reduction of more than 50% in hospitalizations for heart attacks has been registered. Hospitalizations for heart failure, heart rhythm abnormalities and dysfunction of pacemakers and defibrillators are down by about a third. Given this scenario, it is necessary to re-consider the service ecosystem in healthcare and how digital health could represent, in this process, a long-term strategy for the healthcare system. Since the pandemic has boosted the use of digital technologies to address the need for social distancing, actors involved in the healthcare service ecosystem are moving towards transforming the crisis into a great moment of rethinking the organizational and relational models of care based on these types of technologies. In cardiology, remote monitoring of electronic cardiovascular devices, such as defibrillators and cardiac resynchronization systems implanted in patients with severe arrhythmias or heart failure, already exists, and during the COVID-19 pandemic this use could be implemented in a more effective way. Information concerning both the state of the device and the patient’s clinical condition moves periodically through a secure and protected system from the patient’s home to computer platforms that are reviewed by cardiology technicians and cardiologists in the hospital. The research aims at investigating how digital health impacts the evolution of the Italian healthcare service ecosystem in a transformative way, in particular during and after this epidemic era, how transformative value is co- created, who are the actors involved and how the resource integration mechanisms and logics are changing.