Coordination across healthcare system levels is a global imperative to ensure efficient resource utilization and provide high-quality care. The substantial body of research on coordination in healthcare mainly concerns coordination across professional and organizational domains. Consequently, there is a dearth of empirical research aimed at delineating the determinants of coordination across healthcare system levels. This paper describes and analyses the barriers and enablers of healthcare coordination across national, regional, and local system levels in a populous Swedish region. Individual interviews and focus group discussions, encompassing a total of 63 individuals, were conducted with managers, administrators, and politicians. The findings of the paper underscore that the barriers identified were most often of a structural or institutional character, whereas the enablers of the studied cross-level coordination were mostly relational. Therefore, we propose that future research should aim to further delineate the prerequisites for personal relationships to emerge, as well as how they may act as enablers of coordination across healthcare system levels.

Citizens may seek to co-create value during interactions with the provider (co-production), by contributing with improvements of existing services (co-design), or by inventing new services impacting the overall service system (co-innovation). Three empirical cases from Sweden and the UK suggest that disvalue is as likely an outcome as value creation, and that both outcomes need to be recognized at three levels: for the individual citizens themselves, their peer groups, and the broader society. The article contributes to the literature by questioning the assumption that value is inevitably created by theorizing and providing empirical cases that recognize disvalue to be an equally likely outcome in attempts to create value.

På senare tid har ett bekant begrepp återvänt i modern tappning: samskapande. När varken det offentliga eller marknaden kan lösa samhällsutmaningarna bjuds brukare och medborgare in att planera, designa, utföra och utvärdera tjänster tillsammans med företrädare för offentliga verksamheter. Boken är avsiktligt ifrågasättande och kritisk och vänder sig mot den dominerande synen på samskapande som något ensidigt positivt, där det tas för givet att värde skapas för individ, organisation och samhälle. Oreflekterat utfört kan samskapandet göra mer skada än nytta genom att befästa och förstärka ojämlikhet och utanförskap i samhället, förskjuta ansvar från det offentliga till den enskilde och underminera politikers och tjänstemäns legitimitet. I förlängningen riskerar välfärden att urholkas. Samskapandet har emellertid en viktig roll att spela, men det förutsätter att det sker reflekterat och att offentliga verksamheter särskilt involverar representanter från förfördelade grupper vid samskapandet av vår gemensamma välfärd.

Co-production between public administrators and citizens has attracted renewed interest in recent years. Co-production is predominantly perceived as something desirable and is claimed to improve service efficiency and outcome and user satisfaction, at the same time as addressing democratic ideals. Drawing from interviews with public administrators and patients in a Swedish healthcare context, this paper seeks to nuance the often overly positive notion of co-production by understanding these micro-level practices as being embedded in a macro-level societal context. Theorizing the empirical material based on three features of contemporary society –individualization, marketization, and de-politicization –we argue that co-production risks placing a burden and responsibility on individual users and creating a (welfare)market in which better-off people are recruited and benefitted. In this sense, co-production may consolidate or reinforce inequalities. Through de-politicization, political issues may appear as value-free; however, as long as market-logics prevail, the welfare system and practices of co-production will, in some respects, be impotent to address crucial societal issues. Co-production as a collective practice targeting democratic standards is called for, rather than an efficiency focus, preferably by taking the recruitment of those in the greatest need seriously –scaffolded by a revitalized public service ethos of public administrators and their organizations.

It is increasingly argued that public management should build on a service logic instead of the prevailing manufacturing logic of New Public Management (NPM). Drawing from three cases in Swedish public healthcare, key features of a service logic such as value creation, co-production, and collaboration are prominent in formal documents and everyday talk. However, the 67 interviews in this study reveal that the service logic ideal is practically unreachable in a context impregnated by NPM. Instead, we suggest that street-level bureaucrats often need to address service logic expectations (public values, relationship-building, etc.) using an NPM logic (measurements, control, etc.). 

Purpose – This article aims to examine how users’ involvement in value co-creation influences thedevelopment and orchestration of well-being ecosystems to help tackle complex societal challenges. Thisresearch contributes to the public management literature and answers recent calls to investigate novel publicservice governances by discussing users’ involvement and value co-creation for novel well-being solutions.

Design/methodology/approach – The authors empirically explore this phenomenon through a case studyof a complex ecosystem addressing increased well-being, focussing on the formative evaluation stage of alongitudinal evaluation of Sweden’s first support centre for people affected by cancer. Following an abductivereasoning and action research approach, the authors critically discuss the potential of user involvement for thedevelopment of well-being ecosystems and outline preconditions for the success of such approaches.

Findings – The empirical results indicate that resource reconfiguration of multi-actor collaborations provides aplatform for value co-creation, innovative health services and availability of resources. Common themes include the needfor multi-actor collaborations to reconfigure heterogeneous resources; actors’ adaptive change capabilities; the role ofgovernance mechanisms to align the diverse well-being ecosystem components, and the engagement of essential actors.

Research limitations/implications – Although using a longitudinal case study approach has revealedstimulating insights, additional data collection, multiple cases and quantitative studies are prompted. Also, theauthors focus on one country but the characteristics of users’ involvement for value co-creation in innovativewell-being ecosystems might vary between countries.

Practical implications – The findings of this study demonstrate the value of cancer-affected individuals,with “lived experiences”, acting as sources for social innovation, and drivers of well-being ecosystemdevelopment. The findings also suggest that participating actors in the ecosystem should utilise widerknowledge and experience to tackle complex societal challenges associated with well-being

Using six focus groups with frontline employees within the Swedish sick-leave service, this article explores the co-creation/destruction of value. The article both adheres to and questions the public service logic by utilizing an empirical case in which frontline staff represents not one, but multiple, public service organizations. Moreover, as value creation/destruction is not restricted to one beneficiary, and several beneficiaries can be tied to one single service, the research builds upon this notion and distinguishes between four levels of value creation/destruction.

Customers are vital to any organization and system, and must therefore be considered when seeking to improve. However, how to improve with regard to the customer, is not clear, and the knowledge is spread over several research fields, making it difficult for researchers and practitioners to comprehend. The purpose of this literature review is to show how customer-related improvements are described in the literature and how the research is performed. 666 articles were screened, resulting in 99 coded and analysed articles. The study concludes that there is a lack of understanding when it comes to the process of how to improve and that both practitioners and academics should focus more on the system level. It is also seen that by involving the customer in the improvement process, the improvement is more likely to succeed. The article concludes that there is a need for future research which are conceptual, longitudinal, and are addressing actual improvements, not just potential. From the practitioners’ point of view, the article is proposing an increased focus on customer-related improvements which address aspects concerning people, such as employee competence and work environment, and reward systems, rather than strategy and processes to improve the potential benefits.