Sting, the musician and father of six once defined: “You can only be as happy as your unhappiest child”. This thought encapsulates the very essence of our being and wellbeing; our existence is in constant interaction with our social surroundings and our wellbeing is in relation with the wellbeing of others around us. Our lives are intertwined with the lives of others.

The intertwined nature of our lives also makes us vulnerable – especially when we or our loved ones fall ill or suffer from decreased functional abilities. This has (or at least should have) implications on certain services, such as nursing and healthcare services. It is not only the patients who are exposed to vulnerabilities when using these services but also their loved ones may be in a vulnerable state. A serious illness or injury burdens the whole family. This is why it is essential to recognize that beyond a vulnerable customer there may be several individuals suffering from secondary vulnerability. This suggests that family members should also be considered as customers – they could be regarded as secondary customers with patients being the primary customers.

A rising endeavour in service research is to expand the understanding on customer behaviour and customer experience by acquiring a more profound understanding on customer ecosystems. Customer-dominant logic, for instance, suggests that value is embedded in the customer’s dynamic, shared and collective realities outside service actions. Also research on customer experience calls for a holistic perspective in order to understand the total experience of a customer. Yet, in many service contexts it still seems to remain unclear who should actually be considered as customers and whose needs should be served.

In this study a multidisciplinary literature review was compiled to detect how secondary customers’ existence and needs are taken into account in research concerning nursing or healthcare services. The needs were mostly related to psychosocial support, quantity and quality of information and communication as well as cultural sensitivity. What is significant is that by recognising these customers and meeting their needs – or not – the service provider can substantially affect the customer’s life, even outside the service encounter. Hence, the inclusion of their needs in the service design should be enhanced. This could be promoted by granting them a customer status.

It seems evident that the customer concept needs to be used and studied with an expanded mindset. The existing definitions for secondary customers view them as outsiders of the service process but this study suggests them to be viewed as an integral part of the process: The process should consist of interactive and co-operative activities created to serve both the primary and secondary customers, yet recognising and addressing their differing needs in the service design.

How is this related to the domain of IB, then?  Especially as the number of elderly people needing health-care and nursing services is rapidly rising in many different populations, so is the number of family members under the influence of these services. Hence the phenomenon is cross-national. Also the service providers are often multinationals that should be able to take into account the culture-specific customer needs in order to produce wellbeing for their customers. Especially the nature of family relations and care traditions can vary widely in different countries, having impact on customer needs.

As final words I would like to recommend further research on vulnerable customers (primary as well as secondary) but simultaneously emphasising the absolute need to approach these vulnerable subjects with high delicacy and by first ensuring the ethical code of conduct.


Read the full article Secondary but significant: secondary customers’ existence, vulnerability and needs in care services. Journal of Services Marketing, 2017. Henna Leino  [link:]

 This research is part of the KULTA project (2017-2019) which studies the latent bond-related needs of consumers. More about KULTA project at

Henna Leino
Doctoral Candidate