由於醫療業的專業性，因此醫療服務提供者在執業前，需要接受完整的醫學教育訓
練，讓醫療服務提供者可以面對高風險的環境，而這也讓醫療服務提供者與消費者(病患)
之間形成權力不對稱的情形，因為醫療服務提供者往往是決定治療方向的人。但是隨著
消費者的智識改變，目前消費者的權力已有所提升，這也讓病患除了獲得治療結果與建
議外，也會想嘗試了解造成疾病的原因與醫師診斷過程等其他的資訊，由於共創行為帶
來的正面影響，因此了解促進共創行為的因子就變得更為重要，因此，本研究欲了解在
病患權力的改變下，對其共創行為的影響。
本研究以權力的接近/抑制理論為基礎建立模型架構與理論假設，並以醫院的門診
病患作為主要的研究對象，本研究共收集了491 份有效問卷，爾後以 Smart PLS 3.3.2 軟
體進行資料分析，在研究結果方面，病人的感知權力正向影響心理安全感，而心理安全
感會正向影響到病患的共創行為，然而在特質焦慮對於前述關係的干擾效果皆不顯著。
本研究結合權力理論與共創，發現可以正面促進共創行為的因子，同時也加入心理
安全感作為中介因子，有別於過去增加感知利益以促進共創行為的論點，提供一個新穎
且完整的研究架構。在實務貢獻方面，透過本研究將有益於未來醫療業提供服務時，將
本研究結果納入參考，以提升病患共創的行為。

Healthcare industry has been classified as a professional service given that service providers such as physicians and nurses are required to receive extensive professional medical training to develop the skills, knowledge and judgments in order to not only cure patients but also tackle with many high-risk situations. Yet, patient’s feeling of power that may affect their subsequent value co-creation behavior, such as making effort to understand their symptoms and/or taking medicine as request. That is, when patients do not feel physicians’ knowledge power stronger than themselves, their value co-creation behavior may be enhanced. Value co-creation is getting more important to the healthcare industry because it critically affects patients’ treatment decision and the effectiveness of recovery from the illness.
Based on the Approach/Inhibition Theory of Power, this study explores the relationships between patients’ sense of power, psychological safety, and co-creation. This study proposes that sense of power positively influences psychological safety. Then patient’s psychological safety positively impacts their co-creation. Furthermore, trait anxiety is considered as a moderator that affects the aforementioned relationships (H3). This study collects data via face-to-face survey at a local hospital in Taiwan. Total 491 questionnaires were collected to test the proposed research model and hypotheses.
This research used smart PLS version 3.3.2 to analyze the measurement model, structural model. The result shows that the H1 and H2 are supported, H3a and H3b are rejected. A further explanation is in the conclusion part.
This study contributes to the literature and the practice in several ways. First, little has been done in understanding the effect of power on co-creation. This research provides an alternative view of the psychological process that impacts co-creation. Second, previous research explores the direct effect of psychological safety about employees, yet less has investigated the role of psychological safety on consumer behavior. As consumers are viewed as co-producers in the process of co-creation, it is critical to investigate the effect of psychological safety on consumer behavior. Finally, these findings would benefit the service providers, let them know the factors that enhance patients’ engagement during the treatment.

Anderson, C., & Berdahl, J. L. (2002). The experience of power: Examining the effects of power on approach and inhibition tendencies. Journal of Personality and Social Psychology, 83(6), 1362-1377.
Anderson, C., & Galinsky, A. D. (2006). Power, optimism, and risk‐taking. European Journal of Social Psychology, 36(4), 511-536.
Anderson, C., John, O. P., & Keltner, D. (2012). The Personal Sense of Power. Journal of Personality, 80(2), 313-344.
Appelbaum, N. P., Dow, A., Mazmanian, P. E., Jundt, D. K., & Appelbaum, E. N. (2016). The effects of power, leadership and psychological safety on resident event reporting. Medical Education, 50(3), 343-350.
Bani-Melhem, S., Shamsudin, F. M., Abukhait, R. M., & Quratulain, S. (2021). Paranoid personality and frontline employee’s proactive work behaviours: a moderated mediation model of empathetic leadership and perceived psychological safety. Journal of Service Theory and Practice, 31(1), 113-135.
Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182.
Berdahl, J. L., & Martorana, P. (2006). Effects of power on emotion and expression during a controversial group discussion. European Journal of Social Psychology, 36(4), 497-509.
Bugental, D. B., & Lewis, J. C. (1999). The paradoxical misuse of power by those who see themselves as powerless: How does it happen? Journal of Social Issues, 55(1), 51-64.
Carmeli, A., & Gittell, J. H. (2009). High‐quality relationships, psychological safety, and learning from failures in work organizations. Journal of Organizational Behavior, 30(6), 709-729.
Chan, K. W., Yim, C. K., & Lam, S. S. (2010). Is Customer Participation in Value Creation a Double-Edged Sword? Evidence from Professional Financial Services Across Cultures. Journal of Marketing, 74(3), 48-64.
Cortina, J. M. (1993). What is coefficient alpha? An examination of theory and applications. Journal of Applied Psychology, 78(1), 98-104.
Cossío-Silva, F.-J., Revilla-Camacho, M.-Á., Vega-Vázquez, M., & Palacios-Florencio, B. (2016). Value co-creation and customer loyalty. Journal of Business Research, 69(5), 1621-1625.
DEBoNo, K. G., & McDermott, J. B. (1994). Trait Anxiety and Persuasion: Individual Differences in Information Processing Strategies. Journal of Research in Personality, 28(3), 395-407.
Edmondson, A. (1999). Psychological Safety and Learning Behavior in Work Teams. Administrative Science Quarterly, 44(2), 350-383.
Fornell, C., & Larcker, D. F. (1981). Evaluating Structural Equation Models with Unobservable Variables and Measurement Error. Journal of Marketing Research, 18(1), 39-50.
French, J. R., Raven, B., & Cartwright, D. (1959). The bases of social power. Studies in social power, 150-167.
Füller, J., Mühlbacher, H., Matzler, K., & Jawecki, G. (2009). Consumer Empowerment Through Internet-Based Co-creation. Journal of Management Information Systems, 26(3), 71-102.
Galinsky, A. D., Gruenfeld, D. H., & Magee, J. C. (2003). From Power to Action. Journal of Personality and Social Psychology, 85(3), 453-466.
Galinsky, A. D., Magee, J. C., Inesi, M. E., & Gruenfeld, D. H. (2006). Power and Perspectives Not Taken. Psychological Science, 17(12), 1068-1074.
Hair, J. F., Ringle, C. M., & Sarstedt, M. (2011). PLS-SEM: Indeed a Silver Bullet. Journal of Marketing Theory and Practice, 19(2), 139-152.
Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2-24.
Henseler, J., Ringle, C. M., & Sarstedt, M. (2015). A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the Academy of Marketing Science, 43(1), 115-135.
Hirschi, A. (2009). Career adaptability development in adolescence: Multiple predictors and effect on sense of power and life satisfaction. Journal of Vocational Behavior, 74(2), 145-155.
Hoyer, W. D., Chandy, R., Dorotic, M., Krafft, M., & Singh, S. S. (2010). Consumer Cocreation in New Product Development. Journal of Service Research, 13(3), 283-296.
Hu, L. t., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal 6(1), 1-55.
Joseph-Williams, N., Edwards, A., & Elwyn, G. (2014). Power imbalance prevents shared decision making. BMJ, 348.
Kahn, W. A. (1990). Psychological Conditions of Personal Engagement and Disengagement at Work. Academy of Management Journal, 33(4), 692-724.
Kazadi, K., Lievens, A., & Mahr, D. (2016). Stakeholder co-creation during the innovation process: Identifying capabilities for knowledge creation among multiple stakeholders. Journal of Business Research, 69(2), 525-540.
Keltner, D., Gruenfeld, D. H., & Anderson, C. (2003). Power, approach, and inhibition. Psychological Review, 110(2), 265-284.
Kim, E., Tang, L., & Bosselman, R. (2019). Customer Perceptions of Innovativeness: An Accelerator for Value Co-Creation. Journal of Hospitality & Tourism Research, 43(6), 807-838.
Kok, L., Sep, M. S., Veldhuijzen, D. S., Cornelisse, S., Nierich, A. P., van der Maaten, J., . . . Vinkers, C. H. (2016). Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients. Journal of Affective Disorders, 206, 216-223.
Kuo, C.-C., Ye, Y.-C., Chen, M.-Y., & Chen, L. H. (2019). Proactive personality enhances change in employees’ job satisfaction: The moderating role of psychological safety. Australian Journal of Management, 44(3), 482-494.
Laslo-Roth, R., & Schmidt-Barad, T. (2020). Personal sense of power, emotion and compliance in the workplace: a moderated mediation approach. International Journal of Conflict Management, 32(1), 39-61.
Leach, S., & Weick, M. (2020). Taking charge of one's feelings: Sense of power and affect regulation. Personality and Individual Differences, 161, 109958.
Lee, J. (2010). Perceived power imbalance and customer dissatisfaction. The Service Industries Journal, 30(7), 1113-1137.
Leroy, H., Dierynck, B., Anseel, F., Simons, T., Halbesleben, J. R., McCaughey, D., . . . Sels, L. (2012). Behavioral integrity for safety, priority of safety, psychological safety, and patient safety: A team-level study. Journal of Applied Psychology, 97(6), 1273-1281.
Liang, H., Saraf, N., Hu, Q., & Xue, Y. (2007). Assimilation of Enterprise Systems: The Effect of Institutional Pressures and the Mediating Role of Top Management. MIS Quarterly, 31(1), 59-87.
Lin, X., Chen, Z. X., Herman, H., Wei, W., & Ma, C. (2019). Why and When Employees Like to Speak up More Under Humble Leaders? The Roles of Personal Sense of Power and Power Distancee. Journal of Business Ethics, 158(4), 937-950.
Liu, W., Tangirala, S., Lam, W., Chen, Z., Jia, R. T., & Huang, X. (2015). How and when peers’ positive mood influences employees’ voice. Journal of Applied Psychology, 100(3), 976-989.
Locander, W. B., & Hermann, P. W. (1979). The Effect of Self-Confidence and Anxiety on Information Seeking in Consumer Risk Reduction. Journal of Marketing Research, 16(2), 268-274.
Lovelock, C. H. (1983). Classifying Services to Gain Strategic Marketing Insights. Journal of Marketing, 47(3), 9-20.
Maner, J. K., Gailliot, M. T., Menzel, A. J., & Kunstman, J. W. (2012). Dispositional Anxiety Blocks the Psychological Effects of Power. Personality and Social Psychology Bulletin, 38(11), 1383-1395.
Marteau, T. M., & Bekker, H. (1992). The development of a six‐item short‐form of the state scale of the Spielberger State—Trait Anxiety Inventory (STAI). British Journal of Clinical Psychology, 31(3), 301-306.
May, D. R., Gilson, R. L., & Harter, L. M. (2004). The psychological conditions of meaningfulness, safety and availability and the engagement of the human spirit at work. Journal of Occupational and Organizational Psychology, 77(1), 11-37.
McColl-Kennedy, J. R., Hogan, S. J., Witell, L., & Snyder, H. (2017). Cocreative customer practices: Effects of health care customer value cocreation practices on well-being. Journal of Business Research, 70, 55-66.
Morrison, E. W., See, K. E., & Pan, C. (2015). An Approach-Inhibition Model of Employee Silence: The Joint Effects of Personal Sense of Power and Target Openness. Personnel Psychology, 68(3), 547-580.
Nembhard, I. M., & Edmondson, A. C. (2006). Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. Journal of Organizational Behavior, 27(7), 941-966.
Newman, A., Donohue, R., & Eva, N. (2017). Psychological safety: A systematic review of the literature. Human Resource Management Review, 27(3), 521-535.
Ortega, A., Van den Bossche, P., Sánchez-Manzanares, M., Rico, R., & Gil, F. (2014). The Influence of Change-Oriented Leadership and Psychological Safety on Team Learning in Healthcare Teams. Journal of Business and Psychology, 29(2), 311-321.
Peng, J., Xiao, W., Yang, Y., Wu, S., & Miao, D. (2014). The Impact of Trait Anxiety on Self-frame and Decision Making. Journal of Behavioral Decision Making, 27(1), 11-19.
Podsakoff, P. M., MacKenzie, S. B., Lee, J.-Y., & Podsakoff, N. P. (2003). Common Method Biases in Behavioral Research: A Critical Review of the Literature and Recommended Remedies. Journal of Applied Psychology, 88(5), 879-903.
Prahalad, C. K., & Ramaswamy, V. (2000). Co-opting Customer Competence. Harvard Business Review, 78(1), 79-90.
Prahalad, C. K., & Ramaswamy, V. (2004). Co‐creation experiences: The next practice in value creation. Journal of Interactive Marketing, 18(3), 5-14.
Rahim, M. A. (1989). Relationships of Leader Power to Compliance and Satisfaction with Supervision: Evidence from a National Sample of Managers. Journal of Management, 15(4), 545-556.
Revilla-Camacho, M. Á., Vega-Vázquez, M., & Cossío-Silva, F. J. (2015). Customer participation and citizenship behavior effects on turnover intention. Journal of Business Research, 68(7), 1607-1611.
Roggeveen, A. L., Tsiros, M., & Grewal, D. (2012). Understanding the co-creation effect: when does collaborating with customers provide a lift to service recovery? Journal of the Academy of Marketing Science, 40(6), 771-790.
Rucker, D. D., Galinsky, A. D., & Dubois, D. (2012). Power and consumer behavior: How power shapes who and what consumers value. Journal of Consumer Psychology, 22(3), 352-368.
Sawhney, M., Verona, G., & Prandelli, E. (2005). Collaborating to create: The Internet as a platform for customer engagement in product innovation. Journal of Interactive Marketing, 19(4), 4-17.
Schallehn, H., Seuring, S., Strähle, J., & Freise, M. (2019). Defining the antecedents of experience co-creation as applied to alternative consumption models. Journal of Service Management.
Schaninger, C. M. (1976). Perceived Risk and Personality. Journal of Consumer Research, 3(2), 95-100.
Sembada, A. (2018). The two sides of empowering consumers to co-design innovations. Journal of Services Marketing, 32(1), 8-18.
Sembada, A., Tsarenko, Y., & Tojib, D. (2016). The Positive Effects of Customers’ Power on Their Behavioral Responses After Service Failure. Journal of Service Research, 19(3), 337-351.
Shin, H., Perdue, R. R., & Pandelaere, M. (2020). Managing Customer Reviews for Value Co-creation: An Empowerment Theory Perspective. Journal of Travel Research, 59(5), 792-810.
Sweeney, J. C., Danaher, T. S., & McColl-Kennedy, J. R. (2015). Customer Effort in Value Cocreation Activities: Improving Quality of Life and Behavioral Intentions of Health Care Customers. Journal of Service Research, 18(3), 318-335.
Tost, L. P., Gino, F., & Larrick, R. P. (2013). When Power Makes Others Speechless: The Negative Impact of Leader Power on Team Performance. Academy of Management Journal, 56(5), 1465-1486.
Van Kleef, G. A., De Dreu, C. K., Pietroni, D., & Manstead, A. S. (2006). Power and emotion in negotiation: Power moderates the interpersonal effects of anger and happiness on concession making. European Journal of Social Psychology, 36(4), 557-581.
Vargo, S. L., & Lusch, R. F. (2004). Evolving to a New Dominant Logic for Marketing. Journal of Marketing, 68(1), 1-17.
Virlée, J. B., Hammedi, W., & van Riel, A. C. (2020). Healthcare service users as resource integrators: investigating factors influencing the co-creation of value at individual, dyadic and systemic levels. Journal of Service Theory and Practice, 30(3), 277-306.
Virlée, J. B., Van Riel, A. C., & Hammedi, W. (2020). Health literacy and its effects on well-being: how vulnerable healthcare service users integrate online resources. Journal of Services Marketing, 34(5), 697-715.
Walumbwa, F. O., & Schaubroeck, J. (2009). Leader personality traits and employee voice behavior: mediating roles of ethical leadership and work group psychological safety. Journal of Applied Psychology, 94(5), 1275-1286.
Yi, Y., & Gong, T. (2013). Customer value co-creation behavior: Scale development and validation. Journal of Business Research, 66(9), 1279-1284.
Zhang, Y., Fang, Y., Wei, K.-K., & Chen, H. (2010). Exploring the role of psychological safety in promoting the intention to continue sharing knowledge in virtual communities. International Journal of Information Management, 30(5), 425-436.