Exploring the Role of Ownership Structures in the Results of Professional Health Care Franchises from a Multi-Actor Perspective

This paper explores how the ownership structure of professional health care franchises contributes to the achievement of positive results with franchising for the franchisor, the franchisee, professional service provider, and clients. We conducted a comparative embedded case study with three health care franchises in the Netherlands using data from 101 interviews, observations, and document analyses. We show that different ownership structures at the system-level (i.e., plural form, pure franchise, cooperative franchise) and the unit-level (i.e., stand-alone versus fractional, active versus passive, single versus multi-unit) have different effects as perceived by franchisors, franchisees, and professionals.
Moreover, we reveal how this variation in experienced effects can be explained
by differences in dynamics in regard to management, decision making, control, steering, support, interests, learning, and adaptation. Based on these analyses, we develop new typologies of ownership structures and show how combinations of system-level and unit-level structures can have mutually weakening or strengthening effects.