Dreaming the impossible dream? An exploratory study on the expectations of Dutch clients with multiple problems concerning the co‐production of public services

Abstract

Currently, many policymakers try to encourage client involvement during the public service delivery process and make it a co-production. Clients are encouraged to act as active agents and embrace an integrated approach to address their problems to empower them. However, different studies have raised questions regarding to what extent these ambitions are appropriate for clients with vulnerabilities, such as clients with multiple problems. Aiming to further explore this issue, we studied the expectations of clients with multiple problems concerning the co-production of public services. We interviewed 46 clients with multiple problems at the start of their support trajectory. All 46 participants lived in five districts in Rotterdam, the Netherlands, and were recruited via community-based primary care teams. Our study indicates that co-production ambitions might not resonate with clients with multiple problems.The study shows that these clients' expectations are driven by their feelings of being overwhelmed and stressed out by their situation, feelings of being a victim of circumstances, bad experiences with public services in the past, their evaluation of what counts as a problem and the envisioned solutions. These clients expect public service providers to take over, fix their main problem(s) and not interfere with other aspects of their lives (not an integrated approach). Although participants seek a 'normal' life with, e.g., a house, work, partner, children, holidays, a pet, and no stress (a white picket fence life) as ideal, they do not feel that this is attainable for them. More insight into the rationale behind these expectations could help to bridge the gap between policymakers' ambitions and clients' expectations. K E Y W O R D SClients with multiple problems, co-production, clients, perspectives, integrated care What is known about the topic• Co-production is seen as an innovative way to emancipate clients and reduce the demand for public resources | e241REINHOUDT-DEN BOER ET al.

How do clients with multiple problems and (in)formal caretakers coproduce integrated care and support? A longitudinal study on integrated care trajectories of clients with multiple problems

“… 4 , 10 Consequently, clients' impact on the establishment and outcomes of integrated care may be overlooked. 10 …”

“…4,7 With the main focus on these levels of integration, clients often seem to be implicitly conceptualized as passive recipients of care, not as active coproducers of services. 4,10 Consequently, clients' impact on the establishment and outcomes of integrated care may be overlooked. 10 In recent years, there is an increasing call in the literature on integrated care for stimulating coproduction.…”

“…Many studies have focused on the barriers, difficulties and effects of cross‐sectoral, cross‐organizational and interprofessional collaboration 4,7 . With the main focus on these levels of integration, clients often seem to be implicitly conceptualized as passive recipients of care, not as active coproducers of services 4,10 . Consequently, clients' impact on the establishment and outcomes of integrated care may be overlooked 10 …”

“…4,10 Consequently, clients' impact on the establishment and outcomes of integrated care may be overlooked. 10 In recent years, there is an increasing call in the literature on integrated care for stimulating coproduction. Coproduction in this context is described somewhat 'idealistic' as 'engaging clients, their families and communities in the design, implementation and improvement of services through partnership in collaboration with professionals and providers'.…”