‘If Only They Were More Careful’: The role of counterfactuals and emotions in customer coping with health service failures (An Abstract): The Role of Counterfactuals and Emotions in Customer Coping with Health Service Failures (An Abstract)

Service failures are recurrent problems faced by firms. When services fail, firms endeavour to deliver service recovery. Notwithstanding, service recovery is often inefficacious in lowering customer discontent and leads to double deviations, whereby both the service and recovery fail. The recovery strategies may not be perceived as effective as desired by the firms due to counterfactual thoughts triggered by service failures, whereby customers imagine alternative actions the organisation could or should have taken in order to handle the failure. Counterfactual thoughts, in turn, can impact how customers cope with a service failure. Understanding customer counterfactual thoughts and subsequent coping mechanisms is crucial for understanding the reason why customers perceive seemingly effective service recovery strategies as unsatisfactory. Despite its managerial importance, research evidence in the area is lacking. Counterfactual thoughts are prompted by highly negative, stressful and emotion-laden events, such as failures in the health services. Health service failures, such as medical errors and delays in access to diagnostic tests, occur frequently, with negative consequences for patient health and the finances of service providers. Drawing on the norm theory, this study investigates the role of counterfactual thoughts in shaping customer coping with double deviations in health services. Specifically, it examines how the two dimensions of counterfactuals—direction and structure—impact customer problem-focused and emotion-focused coping differentially. Further, the study considers how failure-elicited emotions contribute to explaining customer coping with health service failures. The study employed a scenario-based experiment including five conditions: structure (additive vs. subtractive) and direction (upward vs. downward) plus a control group. The scenarios depicted a customer experience of double deviation with a healthcare service provider. An online, self-administered questionnaire was used for data collection. At the pilot stage, realism and manipulation checks confirmed the ecological and internal validity of findings (n = 45). The main study included a convenience sample of UK consumers who regularly use health services (n = 250). For data analysis, the dummy variable approach to partial least squares structural equation modeling (PLS-SEM) was employed. The study’s findings reveal that counterfactual thoughts influence customer coping with double deviations in health services. Specifically, upward and additive counterfactuals lower planful problem solving and confrontative coping. That is, customers avoid confrontation when imagining alternative actions the service provider could have taken that would have led to better failure resolution. Downward and subtractive counterfactuals, on the other hand, lower mental and behavioural disengagement, as well as support seeking, whilst enhancing self-control. Hence, customers regulate their emotions and avoid asking for moral support if they imagine how the situation could have turned out even worse. Emotions were found to amplify the above effects. The study makes three novel theoretical contributions. First, examining service recovery through the lens of counterfactual thinking provides an explanation that why seemingly effective recovery strategies may be considered inefficacious by customers. Second, the study demonstrates how the direction and structure of counterfactuals differentially impact customer coping with health service failures. Third, the dual lens of coping and counterfactual theories offers useful insights on customer responses to double deviations. The results suggest that customer emotions heighten the following health service failures. In such events, therefore, actions aimed at lowering customer negative emotions are crucial. Health service providers should invest in providing bespoke solutions addressing customer coping mechanisms. Service providers should endeavour to understand customers’ counterfactuals in order to augment their service recovery strategies.