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Individual patients' explanations of a refractive surgical procedure are very time consuming. Forming groups can highly reduce explanation time. However, the potentials of interactivity must be managed carefully. Negative interactivity can easily influence the necessary attitude for integration, or even cancel the contract. Small groups and shaped groups can lower the risk of potential negative interactivity. The following picture illustrates the change in respect to Donabedian.
Figure 12: Further Modification Towards the Model of Meyer
fourth step: process quality in the Model of Meyer
In the process of service, the service provider is applying his performance on the customer (e.g. or his objects). The customer integrates himself in this production process in a unique manner, either to his advantage orto his disadvantage. Thereby the potentials on both sides will be realised. The potentials of the customer in integration and in interactivity can strongly influence the process. In the case of a patient, the lack of assistance can even hinder the proceeding of the process. The process quality will be the result of many interactions between the service provider and the customer. The contact potentials of the service provider now play an important part. How do the personnel act towards the patient? The atmosphere of the institution, its lighting, air-condition and style greatly influence the behaviour of the customer, that is to say his integration and interactivity. The management of contact can greatly improve the integration of the customer and the interactivity in- between customers. This ability of partly controlling the patient's behaviour is demonstrated by the two arrows inside the ring representing the process quality, in the picture further down.
The behaviour of the patient should be followed continuously to prevent an undesirable development. Further actions must be adapted to the customer situation. Knowing how to manage the contact the patient can usually be kept in the planning process. However, sometimes actions need to be changed or even cancelled.
Fifth step: outcome quality in the Model of Meyer
Outcome can be divided into two areas of quality in respect to time. The direct process outcome and the quality of consequence outcome. The former can be fixated to a certain point of time, shortly after the service. The latter, however, will cover a long period of time. Usually it can only be measured and realised when the quality has gone. For instance, you only realise the success of a break repair in a car until the breaks stop working. Years after surgery a patient can suddenly suffer some undesired consequences. This consequence quality is also part of the stability definition in the system theory mentioned in the second chapter. The Model of Meyer has now been completely built, having taken the Model of Donabedian as a starting base. The following picture will illustrate the completed Model of Meyer.
Figure 13: The Complete Model of Meyer
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