Transition through co-creation in social and healthcare services?

There is an urgent need to focus on the world’s biggest problems that are not easy to solve. Strategies and solutions need to be designed to fit the characteristics of modern societies, such as unpredictability and rapid change. The public sector has its role in answering the grand challenges. The paradigm of New Public Governance promotes public policymaking, highlighting relationships and partnerships in complex societies and co-creation as the service model. These issues are studied in the context of social and healthcare services in Finland, where the factors such as the aging population, decreased tax revenues, digitalization of society, and high expectations of users toward personalized services have challenged systems’ sustainability. Social and healthcare services provide a good example of a field where the services are intangible and fundamentally co-produced, the current system is highly complex and path dependent, and there is a need for a paradigmatic change. However, experiments in introducing co-creation have been scattered, and a transition toward the use of co-creation in service production on a wider scale has not happened. What has been missing is the systemic view of the change and how it could be promoted.

This dissertation studies whether co-creation can truly renew public sector social and healthcare services in Finland and is based on four published peer-reviewed articles. The results show that the system can be reformed, but there is a need for systemic changes to utilize the potential of co-creation. Required systemic changes have been identified from the previous literature, and new knowledge has been produced based on empirical studies that are introduced in Papers 1 and 2. The results indicate the need to promote learning and how to co-create with users, initiate long-term policy actions, and understand change as a constellation of different changes in the system.

In addition, the dissertation studies whether the change toward co-creation can be promoted. For this purpose, a research stream of transition studies was included in the dissertation to study whether its theoretical and practical frameworks of multi-level perspective, transition management, and strategic niche management could provide tools to understand and promote the change. Transition studies claim that the social and healthcare system should be understood from the systemic perspective and viewed as a constellation of interconnected elements. Transition is seen to come about when the dynamics at the levels of landscape, regime, and niche level link up and reinforce each other. In the dissertation, it is argued, based on Papers 3 and 4, that co-creation of Finnish social and healthcare services could be understood and promoted by the use of transition studies and provides examples of promoting double-loop learning and supporting policymakers to evaluate the impacts of change.