Co-production dynamics and public value in multi-level governance settings: The case of a health and social elderly care program

One of the main challenges identified in the literature on the co-production of public services is to get a better understanding of who are involved in the process, how they operate, and with which outcomes for the general... [ view full abstract ]

One of the main challenges identified in the literature on the co-production of public services is to get a better understanding of who are involved in the process, how they operate, and with which outcomes for the general public. On the one hand, recent calls have underlined the need for further research on the role of co-producers who are working within public services, namely the professionals who interact with public service users, called service profesionals (Loeffler & Bovaird, 2016; Osborne, Radnor, & Strokosch, 2016). On the other hand, there is a need to develop our knowledge of co-production in contemporary configurations of public action, which tend to be more complex and heterogeneous because of the multiple actors involved at different levels (Sicilia, Guarini, Sancino, Andreani, & Ruffini, 2016). The paper intends to provide a better understanding of how co-production and public values are articulated, using an empirical approach of public value (Alford & O’Flynn, 2009), in a context of multi-level and multi-actors governance policy.

Using qualitative data, we studied the first two-years of the implementation of a new health and social care program for elderly frail people that has been experimented in nine territories in France since 2014. The program, which aims at supporting elderly frail people and their families, as well as health care practitioners and social care workers, is made of different components and target several public values. The paper shows, first, that because of the locally based governance of the program, the co-production process leads to the formation of very different service co-designs across territories; second, that it is difficult to evaluate value co-creation on a the basis of one national single framework.