Co-Production and Health System Reform - From Re-Imagining To Re-Making (original) (raw)
Related papers
2015
Introduction Our society is marked by a permanent state of crisis, characterized by a high level of uncertainty and the need for deep organizational and political changes (OECD, 1995, 2000; Pollitt and Bouckaert, 2003; Kotler and Caslione, 2009). Consequently, the pace of public sector reform is globally accelerated; thus, several governments aim to make the services they provide more efficient and productive than ever, adopting flexible policies and involving citizens in service design and provisioning. Over the past decades, institutions and public organizations have been involved in a lively debate about the real meaning of "governance", the role of public and private organization, and even about the real influence of citizens on public services definition (Bourgon, 2008). In some countries, this debate has led to important reforms mainly oriented to functions and services' privatisation, government decentralisation, or even to deregulation process. In public sector, the increasing participation of citizens in public policies and service provisioning reflects governments' aims to make their offering as responsive and accountable as possible. Consequently, institutions are somewhat obliged to involve civil society in every different stage of public services' life cycle, such as public decision-making, service design and provisioning (Matei and Matei, 2011). Therefore, public services seem to be strictly related to value co-creation model that involves users, partners and, in our case, citizens in value creation and of course in service co-production (Freire and Sangiorgi, 2010). Furthermore, the emergence of such process is mainly related to the shift from "Value-chain" to "Value-Constellation Model" (Norman and Ramirez, 1994). In fact, according to the first model value creation is a progressive process open to the participation of different suppliers; on the other hand, in the constellation model value creation is based on coproduction logic, involving different actors in "a non-linear set of activities and interactions" (Freire and Sangiorgi, 2010, p.1). In recent times, user's role has radically changed passing from being considered a "destroyer of value, to source of value, and finally to co-creator of value" (Ramirez and Mannervik, 2008, p.36). This evolution has been also observed in healthcare, where citizens' participation is increasingly common; thus, healthcare services have been often based on a Value-Constellation Model (Normann and Ramirez, 1994), according to which value creation is a more distributed process, open to citizens' participation that makes them co-creators of their own wellbeing. Civic participation in public services' design and provisioning is also influenced by those emergent technologies that are changing the traditional economic and social paradigms. These technologies (e.g., ICT, social media, mobile tools etc.) let organizations have a better understanding of users' characteristics, needs, and demands (Ghulam et al., 2006). Going over, in healthcare these emergent technologies can positively affect the achievement of better clinical outcome (Kern and Jaron, 2002) and patients' direct involvement in every stage of service development (Freire and Sangiorgi, 2010). This study aims to investigate citizens' participation not only in healthcare service design and provisioning, but also in their redesign , a process that point 2. Clarifying the concept of service: from Service Theory to Service Dominant Logic Over the last decades we have assisted to an increasing participation and commitment of citizens in governments and public organizations activities (Irvin and Stansbury, 2004; Emerson and Baines, 2011). In fact, citizens are increasingly involved in services design, redesign , and even provisioning, a phenomenon that can be read according to co-production logic. In literature, according to one of the most accepted definition, a service is considered a specific form of product that consists of activities, benefits or satisfactions, offered for sale that are essentially intangible and do not result in the ownership of anything (Kotler and Armstrong, 2006). Going over, the main service's characteristics are the intangibility (cannot be seen, tasted, felt or smelled before purchasing), the inseparability (consumed when it is provided and cannot be separated from the provider), the variability (quality depends on who provides), and the perishability (cannot be stored or resold) (Parasuraman et al., 1985). Therefore, a service can be also considered as the application of resources for the benefit of another (Vargo and Lusch, 2006) or as the provisioning of assistance and expertise based on a provider-client interaction, which make possible value creation and capturing in business, education, government, and personal endeavours. Concluding, a service can be also defined as the "interaction between entities in a reticular system to improve value co-creation outcomes under a win-win logic inside interrelated processes" (Granovetter, 1985). In public administration literature, a service has been considered a social entity, made up of structures and activities depending on public communities and relevant for public sphere (Chevallier, 2003), which is characterized by the same peculiar attributes of general services (Kotler and Armstrong 2006). Consequently, if a service firm has been defined as an organization that offers an intangible item, arousing form some sort of interaction between buyers and sellers, a public service organization is generally oriented to provide public value through service delivery excellence (Davies, 2006). However, "a public service organization is typically labor intensive and produces services such as education and health care services. Others provide public works and utilities services, combining technology, information, physical infrastructure and human resources to meet service users' needs, taking political and other objectives into account" (Valkama et al., 2013, p.4). Going over, services are also at the roots of the so-called Service Theory, mainly focused on value to the client, how service should satisfy clients and the pivotal role that client plays in value production (Ramirez, 1999). Consequently, modern Service Theory is based on value co-creation, a process according to which value emerges from cooperation between customers and service providers (Lovelock and Gummesson, 2004; Vargo and Lusch, 2004). Co-production is
Public Participation in Health and Social Care: Exploring the Co-production of Knowledge
Frontiers in Sociology
Efforts to advance public participation in health and other policies have been associated with the production of many models and how-to-do-it guides for change. While these may have a helpful part to play in improving public and patient/user involvement in research, in this article it will be suggested that they tend to oversimplify things. Instead it is argued that an essential first step to advancing public participation in health is to put it in the context of developing modern democracy more generally. This article will seek to do this by identifying four key stages in the development of public participation in health and social care. These phases will be headlined as:-Working for universal suffrage in representative democracy and the achievement of social rights, like the right to decent housing, education and health;-Provisions for participatory democracy and community development;-Specific provisions for participation in health and social care;-State reaction and service user-led renewal as conflicts and competing agendas develop. While the proposed article will look particularly at UK developments to do this, it will also draw upon international experience and highlight the wider relevance of these phases of development. It will make connections between the extension of representative and participatory democracy, considering the different locations in which efforts to extend participation have helpfully developed, for example, in learning and training, and research and knowledge production. It will also consider how efforts to extend participation have also been undermined by pressures to tokenise and co-opt them; the continuing barriers discriminating against some groups and, ways in which service users and allies have nonetheless sought to overcome these difficulties to take forward more inclusive and diverse participation in health and social care. It will focus on some particularly promising areas of development internationally in order to do this in which co-production and the development of user-led knowledge are key.
Public administration, 2011
The causes and effects of marketization of public services have been analysed extensively in the literature, but there is relatively little research on how those policies impact on the development of new forms of governance, and the role of users in these new arrangements. This study reviews examples of competition, freedom of choice and personalized care in health and social services in England and Sweden, in order to examine the type of relationships emerging between the user/consumer vis-à-vis market driven providers and various agencies of the state under the marketized welfare. The article focuses on the possible roles users might assume in new hybrid arrangements between markets, collaborations and steering. A user typology: namely, that of a consumer, citizen, co-producer and responsibilized agent in various governance arrangements, is then suggested. The article concludes by arguing that pro-market policies instead of meeting the alleged needs of post-modern users for individualized public services are likely to promote a new type of highly volatile and fragile partnerships, and create a new subordinated user who has no choice but to 'choose' services they have little control over.
Varieties of Co-production in Public Services: Time banks in a UK Health Policy Context
Critical Policy Studies, 2012
Time banking is a third-sector initiative that enacts principles of co-production and offers a model with which to understand how users can become actively involved with professionals and other stakeholders in the delivery of public services. This article explores possible lines of tension between principles that underpin time banking practices and principles informing the health policy field in the United Kingdom. We develop a framework rooted in the logics approach to critical policy analysis with which to track shifts in conceptions of co-production at three nodes situated along the full length of the public service chain: (1) service provision and distribution; (2) service delivery; and (3) service governance. Our analysis reveals discrepancies in the way co-production principles can be defined, interpreted, and linked to broader notions of social justice: recognition-based interpretations with a transformative accent, and choice-based interpretations with an additive accent. We conclude that the health care regime, if understood as a ‘regime of choice’, will invariably prove to be a rather inhospitable environment for time banks, whose co-production principles are much more in tune with what we call a ‘regime of recognition’.
Co-production in healthcare: rhetoric and practice
International Review of Administrative Sciences, 2015
Co-production in healthcare is receiving increasing attention; however, insight into the process of co-production is scarce. This article explores why hospitals involve patients and staff in co-production activities and hospitals’ experiences with co-production in practice. A qualitative study with semi-structured interviews ( N = 27), observations (70 hours) and document analysis was conducted in five Dutch hospitals, which involved patients and staff in order to improve services. The results show that hospitals have different motives to involve patients and staff and have adapted existing methods to involve patients. Interestingly, areas of improvement proposed by patients were often already known. However, the process of co-production did contribute to quality improvement in other ways. The process of co-production stimulated hospitals’ thinking about how to realize quality improvements. Quality improvements were facilitated by this process as seeing patients and hearing their ...
This report sets out the findings of a major research study into the role of co-production between citizens and professionals in the delivery of public services in five EU states. It draws on data from a representative citizen survey in five European countries, including Czech Republic, Denmark, France, Germany and the United Kingdom in May 2008 and from expert focus groups undertaken in those countries in early 2008. It is intended to contribute to the debate on how public agencies can deliver public services which best meet the needs of service users, citizens and taxpayers and the challenges for improving the future quality of public services. 2 Increasingly, we are seeing greater involvement of citizens in service delivery.Some of these developments have been driven by advances in ICT, particularly the internet, but there are also instances where citizens have begun to share with professionals some of the key service delivery tasks. It has also become clearer to service professionals over recent years that effective public services require the active contributions of both parties. Consequently, more and more service providers in the private and public sectors are seeking to co-operate with service users in order to tailor services better to their needs and to cut costs. 3 As a result, the relationship between service users and service professionals has changed profoundly, making service users less dependent, while, at the same time, giving them more responsibility. This has raised new interest in issues of co-production, a concept that is closely related to the inherent character of services. In particular, the literature on co-production highlights that production and consumption of many services are inseparable, which implies that quality in services often occurs during service delivery, usually in the interaction between the customer and provider, rather than just at the end of the process. Therefore, the concept of co-production is a useful way of viewing the new role of citizens as active participants in service delivery. Various objectives are being pursued by means of co-production, including improving public service quality by bringing in the expertise of the service user, and often that of their families and communities as well, into providing more differentiated services and increased choice, and making public services more responsive to users. The definition of co-production used in this study is the “involvement of citizens in the delivery of public services to achieve outcomes, which depend at least partly on their own behaviour”. 4 Clearly, there is a wide range of citizen co-production roles in service delivery – from ‘hero’ to ‘zero’. Therefore, a citizen survey was undertaken to explore the level of this co-production between citizens and the public sector. However, to set this in context, the survey also explored the extent to which citizens sometimes become engaged in improving outcomes without any involvement with public sector agencies. In particular, the survey focussed on the following issues: o How big is the role which citizens play in delivering public services? o How does the involvement of citizens change their attitudes and expectations towards public services? o Is the role of citizens in public service delivery likely to be more important in the future than at present? What are the obstacles and drivers of co-production in the public domain? 5. The survey was conducted by telephone from April 16 to May 5, 2008, among a representative random sample of 4,951 adults (18 years of age or older), with about 1,000 interviews in including Czech Republic, Denmark, France, Germany and the United Kingdom. The countries were chosen in order to get a wide range of different administrative cultures. The results presented in this report are sweighted according to each country’s representation in the European Union. In all the cases where we compare results across sectors or countries, the differences highlighted are statistically significant. Furthermore, the study focused on three different sectors which reflect distinctly different types of government functions: o Community safety, as an example of coercive action on the part of the state o Local environment, as an example of the regulatory function of the state o Public health, as an example of the welfare improvement function of the state. 6. One key result of the survey is that, contrary to the assumptions made by focus group participants, there are significant levels of co-production by citizens in the five countries studied in all three sectors. Citizens are particularly active in taking steps to look after the local environment (index score 61), to a somewhat lesser degree in health improvement initiatives (index score 52) and considerably less active in prevention of crime (index score 45).
Activating Citizens to Participate in Collective Co-Production of Public Services
Journal of Social Policy, 2014
User and community co-production of public services first became topical in the late 1970s, both in private and public sectors. Recent interest has been triggered by recognition that the outcomes for which public agencies strive rely on multiple stakeholders, particularly service users and the communities in which they live. Extra salience has been given to the potential of co-production due to fiscal pressures facing governments since 2008. However, there has been little quantitative empirical research on citizen co-production behaviours. The authors therefore undertook a large-sample survey in five European countries to fill this gap. This article examines an especially significant finding from this research – the major gulf between current levels of collective co-production and individual co-production. It explores the drivers of these large differences and examines what the social policy implications would be if, given the potential benefits, the government wishes to encourage g...