Healthcare services and the co-production challenge : insights for engaging unwilling patterns

The need to reconcile effectiveness with shrinking budgets is pushing contemporary health services to develop co-production practices. But the patient is often an unwilling client and patient engagement with both their therapy and the relative organizational system remains largely unexplored. The article analyzes an Italian hospital\u2019s co-production initiative and uses the results to reflect on what key factors impact the efficacy and the efficiency of healthcare co-production. The empirical evidence indicates that a) the socio-organizational conditions of both the patients and the relevant actors must be taken into account to achieve the truly meaningful engagement of the patient, as opposed to merely symbolic acceptance in co-production practices, as opposed to just their symbolic acceptance; b) no divide exists between organizational production and client co-production, rather, it is a relationship of interdependence that in turn raises critical issues; and c) to take a significant step forward in our understanding of co-production and its managerial challenges we must perforce combine the use of public management studies and health psychology studie