Using co-production theory to understand the implementation and impact of digital technology in public services

Digitalization and technology within public services and healthcare are perceived to have potential to deliver more efficient and effective services. However, in practice, technological implementation can be difficult and... [ view full abstract ]

Digitalization and technology within public services and healthcare are perceived to have potential to deliver more efficient and effective services. However, in practice, technological implementation can be difficult and produce less benefits than anticipated. Healthcare services are adopting new digital tools that use a technological interface to facilitate consultations and interactions between staff and service users, which may fundamentally alter service provision and relationships. This paper presents a framework that integrates co-production and implementation theories, to support the evaluations of these digital tools. It builds on public and service management theory that conceptualises co-production as inherent to services (Osborne and Strokosch 2013) and illustrates how services are co-produced through the interactions between organisations and service users (Osborne et al. 2016). It also draws on the concept of ‘touchpoints’ (Radnor et al. 2014), points of contact and interaction through a service process, to understand how digital tools shape staff and service user experiences. 

Examples from two evaluations of healthcare digital tools are used to illustrate how this framework can help us explore acceptability and impact from staff and service user perspectives. The first evaluation explored the implementation of online consultations within primary care, as an alternative to face-to-face consultations. The study examined how an online consultation system was implemented and changed the way that general practitioner (GP) services were produced and experienced from patients and practice staff perspectives. Methods included analysing: electronic medical records, patient survey data, and in-depth staff interviews. The second case evaluated a pilot of the introduction and use of a co-designed care pathway tool (CPT) within mental health services that aimed to enable service users to co-produce care plans, crisis plans and progress notes on a mobile tablet. The research examined whether the CPT facilitated working in co-production with service users, and enabled the recording and sharing of service user co-produced care planning and progress records. Methods involved semi-structured interviews with staff in recovery support roles, registered mental health professionals, and managerial staff. 

Results illustrate how analysing touchpoints of digital tools can provide insights into how staff and service users respond to digital prompts and technological design. Understanding the service process as a co-production between staff and service users enables an analysis of how the digital tools affected staff and service user behaviours, service interactions, and resulting satisfaction or dissatisfaction with the digital tools. Case examples are given of digital touchpoints supporting relationships between staff and service users, and where they were less helpful. Such understandings are vital to be able to further develop technology that meets the needs of both staff and service users. Implications of the tools on possible inequalities issues are examined. 

Conclusions show how this framework, that integrates co-production and implementation theories, might be applied to other studies of digital tools in public services. This can enable further understandings of how digitalisation can influence public service delivery and the relationships between staff and service users.