Introduction: The radical efficiency model has been proposed as a way of obtaining different, better and lower cost public services. Engaging citizens in design and production of services and utilizing their knowledge, creativity and resources is a core part of the model. "Daily living rehabilitation" has been introduced in Danish municipalities as an innovative way of improving elderly citizen's abilities to independently perform activities of daily living. The objectives of the daily living rehabilitation programmes are increased self-reliance, improved quality-of-life and lower costs. Research Question: As an example of radical efficiency the daily living rehabilitation programmes are the study objects. Three research questions guide the analysis: How can co-creation and co-production within the daily living rehabilitation programmes create self-reliance and consequently reduce the need for compensating care. Which organizational barriers exists for the use of co-creation / co-production as a part of the implementation of daily living rehabilitation, and what is their impact on opportunities to improve cost-effectiveness. How can increased use of co-creation or co-production contribute to further development of daily living rehabilitation programmes with a view to achieving greater self-reliance and less need for compensating care? Theory: Within a social constructivist view the governance/network perspective guides the analysis. Neo-institutional theory understands organizations within institutional fields as guided by institutionalized, organizational myths and developing isomorphic characteristics in order to be seen as legitimate. Organizations may apply decoupling/loose coupling/organizational hypocrisy in order to accommodate inconsistent expectations. Different strands of co-creation and co-production theory developed within marketing, strategic management and public service analysis are reviewed. No single, clear and consistent understanding of and definition of co-creation and co-production emanates from the review. In broad adherence to an emerging convergence of theoretic understandings, co-creation and co-production are defined as two separate concepts. Methods and data: two municipalities with active daily living rehabilitation programmes situated in Region Zealand are selected as cases. The selection of respondents was stratified, selecting in each case the responsible director and a programme manager/project manager for semistructured, qualitative interviews aiming to understand the socially constructed knowledge of respondents. Data were extracted and condensed from interview minutes using sound recordings for clarifications, and then categorized guided by theoretical characteristics and constructs. Analysis first clarified the respondents own understandings and interpretations, and then applied a teory-based interpretation. Results: Co-creation, in the form of dialogue between citizen and front-line staff on what is important for the citizen, is a crucial precondition for the citizen's motivation for active participation (co-production), and achieving co-created value creation. Value creation for the citizen is mainly focused on dignity and freedom, and for the municipality on cost reduction. The potentials of involving relatives and networks are largely untapped. Daily living rehabilitation in the Danish organizational elderly care field is now a relatively well-established rational myth and an institutio-nalized practice characterized by mimetic and normative isomorphism. The institutionalization of the daily living rehabilitation concept is at the same time an opening for the dissemination of the limited form of co-production and co-creation, built into the Fredericia model of daily living rehabilitation, and at the same time a possible organizational barrier to the dissemination of the broader understanding of co-creation and co-production that underlie broader civil society strategies such as radical efficiency. Coping strategies of front-line staff in the form of rejection of citizens based on expected rehabilitation potential and delaying rehabilitation can both act as organizational barriers to co-creation and co-production being initiated. Case-studies from abroad indicate that more radical co-creation/co-production models, facilitated by the government, but run by citizens, has the potential for more cost-effective solutions to welfare challenges. If this is true, also for daily living rehabilitation with more co-creation/co-production than in current models, then we have an untapped potential to create more cost-effective solutions by promoting more extensive co-creation and co-production. Radical efficiency can be seen as an idea that is traveling and undergoing translation, thus providing the foundation for yet another rational myth. Only testing and evaluation will reveal whether "Daily living rehabilitation 2.0" with increased focus on co-creation and co-production can improve results. Municipalities that engage in more co-creation must be aware that the benefits in the form of broader value creation can be followed by less controllability from the point-of-view of the municipality. Better municipal facilitation of co-creation and co-production may be linked in part to the recognition that some useful and relevant tasks should not be carried out by professional staff, and partly to strategic thinking regarding what motivates the citizen to co-creation and co-production, and how the municipality can increase citizen motivation, e.g. by active use of nudging.
|Uddannelser||Master i Offentlig Ledelse, (Masteruddannelse) Afsluttende afhandling|