Creating or Destructing Value in Use? Handling Cognitive Impairments in Co-Creation with Serious and Chronically Ill Users

Abstract

Theoretically based on public service logic (PSL), this article addresses how users’ cognitive impairments can affect co-creation processes and value outcomes in a public sector environment, and how the service providers can handle this issue. It directs attention to value creation in the context of vulnerable and unwilling service users and contributes to understanding how cognitive gaps between public health care services and users inhibit value co-creation. Based on qualitative interview data, findings substantiate that cognitive impairments reduce the users’ health literacy and therefore affect both their ability and willingness to participate in co-creation. The study recognizes that there is a built-in asymmetry between the involved actors and that failing to reduce this asymmetry through adequate facilitation by the service providers, can result in co-destruction of value in use. It is acknowledged that the users might not be cognitively able to determine whether they actually come better or worse off in the end. Therefore, it is suggested that the service provider might need to play a larger role in determining what is positive or negative value in use. Hence, this article adds to PSL by clearly emphasizing the key role played by public service organizations (PSOs) in facilitating the value creation process, which takes place during service delivery.

Value Creation in the Public Service Ecosystem: An Integrative Framework

“…In particular, it requires that they develop novel ways of communicating both with marginalized communities and/or vulnerable service users. For such groups, the balance between the co‐creation and co‐destruction of value is even keener than for most public service users (Larsen and Caswell 2020; Scarli 2021a). Fourth, our approach suggests that the evaluation of public services must embrace value creation and that indicators of public service performance need to be evolved that truly capture the dimensions of value creation/co‐creation through public service delivery.…”

Public service logic and the creation of value propositions through framing

“…PSL research has thus far mainly assessed the enactment of value propositions at the service level and examined whether they serve the intended purpose of facilitating users' value creation (Hardyman, Daunt, and Kitchener 2015;Hardyman, Kitchener, and Daunt 2019;Skarli 2021a;Engen et al 2021). Conversely, the creation of value propositions, or service offerings, has gained less attention (but see Eriksson et al 2020;Skålén et al 2018).…”

“…So far, these research dialogues have not been connected to PSL, but they have the potential to illuminate and inform the design stage of service production (Osborne, Nasi, and Powell 2021). Connecting these research dialogues could contribute to more holistic portrayals and understandings of the value creation process in public services (Hodgkinson et al 2017), bringing attention to the creation of value propositions preceding the value creation and not merely the dynamics in 'consumption', on which the literature has mainly focused thus far (Skarli 2021a(Skarli , 2021bHardyman, Daunt, and Kitchener 2015;Hardyman, Kitchener, and Daunt 2019;Engen et al 2021). Our analysis is centred on how framing and reframing processes are present in service design projects seeking to develop new value propositions, including in cases where it is not pursued as an explicit design strategy.…”

“…Still in its relative infancy, the PSL literature has focused primarily on value creation during consumption, with empirical studies examining both the co-creation and co-destruction of value during service interactions (Hardyman, Daunt, and Kitchener 2015;Hardyman, Kitchener, and Daunt 2019;Skarli 2021aSkarli , 2021bEngen et al 2021).…”

New development: ‘Appreciate–Engage–Facilitate’—The role of public managers in value creation in public service ecosystems

“…This is most obviously concerned with value creation/destruction for the individual service user, but it can also include other key stakeholders (family, friends and carers) and service staff, as well as both citizens who are not service users but who accrue value from the public service delivery process (perhaps as volunteers-see Musso et al, 2019) and service users who are not citizens (such as asylum seekers-see Strokosch & Osborne, 2016). It can also involve value creation for service users with significant cognitive impairments and/or social vulnerabilities (Scarli, 2021). Theoretically, it draws on PSL (Osborne, 2021).…”