背景:联合生产的创新正在塑造世界各地不同背景下的公共服务改革。虽然许多创新是本地的,其他人随着时间的推移而扩大和发展。我们知道的很少,然而,关于联合生产的实施和演变过程。这项研究的目的是探索采用,实施和吸收三种与结构弱势群体共同生产公共服务的方法。
方法:我们对涉及弱势群体的三个联合生产的公共服务创新进行了为期4年的纵向多案例研究(2019-2023年):延雪平地区的ESTHER,瑞典涉及具有多种复杂需求的人(案例1);在邓迪实现恢复,苏格兰有严重精神疾病的人(案例2);和曼尼托巴省的学习中心,加拿大(案例3),还涉及患有严重精神疾病的人。数据来源包括对战略决策者的14次访谈和文件分析,以了解与每个案例有关的历史和环境因素。三个框架为案例研究协议提供了信息,半结构化面试指南,数据提取,演绎编码与分析:实施研究的综合框架,创新模型的扩散与Lozeau理解同化的兼容性差距。
结果:采用涉及结构脆弱人群的共同生产是案例1和案例3中现有改进工作的显着演变,同时由外部变更机构推动,社区组织之间现有的合作努力,在案例2中,有机会告知新的市政精神卫生政策引发了采用。在所有情况下,共同生产的创新围绕着一个中心理念,重视生活经验与共同生产过程中的专业知识。这种哲学取向为当地环境提供了灵活性和适应性,因此,与更多定义的编程相比,便于实现。据告密者说,避免合作风险的努力取得了成功,导致新思维方式和共同生产过程的同化,并举例说明了这是如何导致变革性变化的。
结论:在探索与结构脆弱群体共同生产的创新时,我们的研究结果提出了在应用现有理论框架时需要考虑的几个额外因素.这些包括创新的哲学性质,需要研究创新本身随着时间的推移而演变的过程,更多关注合作过程作为现有权力结构的破坏者,并强调推动组织文化的转型变革。
BACKGROUND: Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups.
METHODS: We conducted a 4 year longitudinal multiple
case study (2019-2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping Region, Sweden involving people with multiple complex needs (
Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (
Case 2); and Learning Centres in Manitoba, Canada (
Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision-makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the
case study protocol, semi-structured interview guides, data extraction, deductive coding and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model and Lozeau\'s Compatibility Gaps to understand assimilation.
RESULTS: The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organizations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change.
CONCLUSIONS: In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures and an emphasis on driving transformational change in organizational cultures.