Ecosystem failure archetypes and resource disintegration in public healthcare: A constructivist grounded theory study

Abstract

The literature on Service Failure and Recovery (SFR) has traditionally focused on commercial, dyadic, and firm-centric perspectives on failure, all of which view failures as discrete transaction failures. Public healthcare systems, by contrast, are complex, multi-actor, and resource-constrained service systems in which failures are systemic, emergent, and profoundly influenced by institutional frictions (Vargo & Lusch, 2004, 2016; Osborne et al., 2013). This empirical study, based on service-dominant logic (SDL) and constructivist grounded theory (CGT; Charmaz, 2014), examines public healthcare service failures in District Mansehra, Pakistan. This paper uses the four primary Healthcare Complexes (District Headquarters Hospital Mansehra and Rural Health Centers Shinkiari, Khaki, and Baffa) for in-depth interviews. It identifies and conceptually suggests six different types of Ecosystem Failure Archetypes, namely: (1) Displaced-Record Failure, (2) Medicine-Access Failure, (3) Authority-Queue Failure, (4) Referral-Bridge Failure, (5) Digital-Eligibility Failure, and (6) Complaint-Absorption Failure. These archetypes reflect systemic resource misintegration, institutional gatekeeping, and structural misalignment among heterogeneous actors, and differ from commercial service failures resulting from individual provider errors (Batalden et al., 2016; Plé & Chumpitaz Cáceres, 2010). The study offers a scientifically solid basis for understanding public healthcare collapses, as well as strategic policy recommendations for institutional reconfiguration and the resilience of services.