Configurations of Care Work: Fragile Partnerships in the Co-Production of Long-Term Care Services

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Focus for the article is volunteers as co-producers of care work in public long term care services and what are the experiences when the ideological goals and principles of co-production are translated into practice. The empirical data is from a qualitative study combining site visits and in-depth interviews in eight Norwegian municipalities. In the article data from two of these eight cases are picked out to illustrate and explore practical experiences with the co-production process.

The article shows convincingly challenges the practical implementation of ambiguous or "magic concepts" (Pullit & Hupe 2011) like co-production encounter. And the authors document solid overview of the literature. Still, I have some comments I think the authors should consider.

There are good reasons for doing a selection of the cases to fit the material into the format of an article. However, I miss a further explanation for why these cases are selected. Do they illustrate typical dilemmas, or do they differ from the other cases? Are they picked out because they give illustrations of special interest?

I also wonder why there are no data directly from the volunteers in the empirical examples. When the authors account for the material and method in the study, they explain that they have carried out interviews with front-line managers in long-term care and activity leaders from voluntary sectors responsible for operating the activities. In the two selected cases they explain that the analyses involve actors from the voluntary organisations and professional employees. However, in case 2 the data are partly from the manager of the nursing home and partly from a part time coordinator for volunteers. The coordinator was funded by the nursing home and had formal education in management and third sector involvement. What this involvement implied and how his/her relation to the volunteers in the municipality was, remains unclear. In the same way, the data in case 1 is basically from a part time coordinator funded by the municipality. Also here, his/her background and relations to the volunteer sector is unclear.

In the theoretical presentation of co-production the authors explain that they particularly follow the tradition of Elinor Ostrom. Then, in the discussion part, they introduce and discuss the concepts "co-creation of value" and "co-destruction of value". This is a relevant move. However, while co-production and co-creation to a large extent are used interchangeably, co-creation of value has its roots from a different theoretical tradition. The Ostrom approach has its background in public administration, while co-creation and co-destruction of value has its roots in service innovation and what is defined a service-dominant logic. The authors could preferably have gone deeper into the different traditions in the theoretical part of the article.

Finally, a minor comment: In case 2, the authors introduce a "new type of volunteers", characterised by new and other motives than the "old type volunteers". The authors could shortly have explained what in contrast, are the distinctive characteristics of the old type.

All in all, I think my objections could be followed up by relatively small efforts from the authors. Still, I think the comments represent some fundamental arguments and that a major revision therefore is advisable.

Author Response

Reply to the reviewers, September 27^th, 2023

 

First, we wish to thank the reviewers for valuable comments and recommendations to our article. Below we add our replies point by point as they appear from the reviewers. We had added our comments in bold writing, so it is easier to follow the replies and comments.  

 

Reviewer1

Focus for the article is volunteers as co-producers of care work in public long term care services and what are the experiences when the ideological goals and principles of co-production are translated into practice. The empirical data is from a qualitative study combining site visits and in-depth interviews in eight Norwegian municipalities. In the article data from two of these eight cases are picked out to illustrate and explore practical experiences with the co-production process.

The article shows convincingly challenges the practical implementation of ambiguous or "magic concepts" (Pullit & Hupe 2011) like co-production encounter. And the authors document solid overview of the literature. Still, I have some comments I think the authors should consider.

REPLY: Thank you.

There are good reasons for doing a selection of the cases to fit the material into the format of an article. However, I miss a further explanation for why these cases are selected. Do they illustrate typical dilemmas, or do they differ from the other cases? Are they picked out because they give illustrations of special interest?

REPLY: Thank you for this comment and we can understand that an elaboration about the selection of cases is needed.  We have expanded our explanation about why we selected the two cases in the article under the heading Material and Method page 4, line 152 onwards. During the thematic analysis for overall interviews, we noticed that unsuccessful partnerships and lack of understanding of each other’s context and motivations could hamper well-intended measures to increase the contribution from volunteers. Efforts to build new partnerships across different backgrounds, seems to rest on full understanding and agreement between the co-operating agents. Our two cases highlight this point from two different perspectives; partnerships can be organised differently but if they are driven top down (case 1, municipal coordinator pushing volunteer on a nursing home) or bottom up (case two, a nursing home that despite solid preparations fails as the volunteers stay in the role short time)  -  both may fail in adding value due to lack of understanding of each’s other context, frames and reasons to contribute in the partnership. 

I also wonder why there are no data directly from the volunteers in the empirical examples.

In this study we did not interview volunteers. This research project focused on how voluntary work was initiated, organised, and managed through the experiences of leaders running the voluntary activities and managers in the long-term care services. We think that a further study would benefit from the direct voices of the contributing volunteers themselves, and we hope to continue the work and include volunteers in next step of our research.       

When the authors account for the material and method in the study, they explain that they have carried out interviews with front-line managers in long-term care and activity leaders from voluntary sectors responsible for operating the activities. In the two selected cases they explain that the analyses involve actors from the voluntary organisations and professional employees. However, in case 2 the data are partly from the manager of the nursing home and partly from a part time coordinator for volunteers. The coordinator was funded by the nursing home and had formal education in management and third sector involvement. What this involvement implied and how his/her relation to the volunteers in the municipality was, remains unclear.

Thank-you for pointing this out. We have been slightly inaccurate in how we have described the actors involved in the cases.  Our aim has been to analyse cases where the actors involved in co-production have different positions vis a vis the nursing home where the voluntary activities take place. The coordinator in case 2 was responsible for recruiting volunteers on behalf of the nursing home, give them training, guidance and organise the activities the volunteers were involved in. Besides taking this role, the coordinator was an active member in a voluntary organisation working to in introduce more social and cultural activities at the nursing home.  We have added this to the article on p. 6 line 293 and onwards.

In the same way, the data in case 1 is basically from a part time coordinator funded by the municipality. Also here, his/her background and relations to the volunteer sector is unclear.

Reply: The coordinator in case 1 had led voluntary activities over years. He was also an active spokesperson from both the local church and a voluntary organisation in addition to this role as a coordinator in the municipality.   We have added this information about the background of the coordinator on page 5, line 207 and onwards.

In the theoretical presentation of co-production the authors explain that they particularly follow the tradition of Elinor Ostrom. Then, in the discussion part, they introduce and discuss the concepts "co-creation of value" and "co-destruction of value". This is a relevant move. However, while co-production and co-creation to a large extent are used interchangeably, co-creation of value has its roots from a different theoretical tradition. The Ostrom approach has its background in public administration, while co-creation and co-destruction of value has its roots in service innovation and what is defined a service-dominant logic. The authors could preferably have gone deeper into the different traditions in the theoretical part of the article.

Reply: This is a valid and much appreciated point. We have partly rewritten the theoretical part of the article in order to bring in the idea of public value and clarify the different theoretical traditions of co-production and the concepts of value co-creation and value co-destruction. See line 91 and onwards on page 3. We think this has improved the overall reasoning of the article. We have also added new references to support our elucidation of this point. The references are:

Alford J. Co-Production, Interdependence and Publicness: Extending public service-dominant logic. Public Management Review. 2016 May 27;18(5):673-91.

Osborne SP, Nasi G, Powell M. Beyond co‐production: Value creation and public services. Public Administration. 2021 Dec;99(4):641-57.

Engen M, Fransson M, Quist J, Skålén P. Continuing the development of the public service logic: a study of value co-destruction in public services. Public Management Review. 2021 Jun 3;23(6):886-905.

Jaspers S, Steen T. Realizing public values: enhancement or obstruction? Exploring value tensions and coping strategies in the co-production of social care. Public Management Review. 2019 Apr 3;21(4):606-27.

Finally, a minor comment: In case 2, the authors introduce a "new type of volunteers", characterised by new and other motives than the "old type volunteers". The authors could shortly have explained what in contrast, are the distinctive characteristics of the old type.

REPLY: By “new” type of volunteers we mean volunteers who are less attached to organisations, and more motivated by personal development. We have elaborated around this turn in the discussion page 9, line 442 and onwards. We have inserted “new” in quotation marks in the article page 7, line 347. The reference 55 (Wollebæk and Sivesind, 2010) is attached to discussing the changes in the pool of volunteers.

All in all, I think my objections could be followed up by relatively small efforts from the authors. Still, I think the comments represent some fundamental arguments and that a major revision therefore is advisable.

Reviewer 2 Report

Comments and Suggestions for Authors

In the conclusions, it would be advisable to clarify a little more the role that each of the co-producers should play.

It would be recommended that the article describe the differences between the initial objectives of the “new co-producer” and the objectives achieved. in term of activities and its impact on the well-being of users, whether positive, negative, or null. Thus, the evaluation of the results obtained in the research would lead to the criticisms made in the article about the problems in the co-production of services,

Author Response

Reviewer 2

In the conclusions, it would be advisable to clarify a little more the role that each of the co-producers should play.

REPLY: Our argument is that full understanding between the cooperating partners will enhance the partnerships in co-production of long-term care services and not as so much what roles each should play. For this comment we also refer to our conclusion.

It would be recommended that the article describe the differences between the initial objectives of the “new co-producer” and the objectives achieved. in term of activities and its impact on the well-being of users, whether positive, negative, or null. Thus, the evaluation of the results obtained in the research would lead to the criticisms made in the article about the problems in the co-production of services,

REPLY:  In this article we have not studied the outcomes of voluntary activities. We have rather aimed to elaborate on the challenges that arise when actors with different perspectives, incentives and backgrounds come to co-produce services in long-term care of the elderly.

Reviewer 3 Report

Comments and Suggestions for Authors

This is a very good paper with new theory analysing the provision of long-term care. The results of qualitative part need more topic sentences to guide the readers. 

Author Response

Reply to the reviewers, September 27^th, 2023

 First, we wish to thank the reviewers for valuable comments and recommendations to our article. Below we add our replies point by point as they appear from the reviewers. We had added our comments in bold writing, so it is easier to follow the replies and comments.  

Reviewer 3

This is a very good paper with new theory analysing the provision of long-term care. The results of qualitative part need more topic sentences to guide the readers.

REPLY: Our results are structured around the two cases, and we wish to avoid fragmenting the flow of the presentation of the cases by adding more topic sentences.

Reviewer 4 Report

Comments and Suggestions for Authors

The article aims to investigate the phenomenon of co-production in care services. This is a highly relevant topic because several proposals of reform for the Social Services involve a certain level co-production.

However, as the authors indicate, the concept is loaded: “co-production as belonging to a group of omnipresent concepts frequently used in public administration called “magic concepts”. Magic concepts are characterized by their overwhelmingly positive connotations, which make them hard to oppose.”

Many good things are expected from co-production in Social Services, but empirical research on its daily practice and outcomes is scarce. This article aims to provide empirical data on co-production cases. I think this is very useful information for practitioners and for the academic debate on future developments for Care and Social Services.

The authors use a qualitative methodology based on compared case studies. This seems to fit the objective of the research quite well. The logic for the selection of cases is adequately described:

“A qualitative study combining site visits and in-depth interviews was organized in eight  municipalities in various parts of Norway. We selected cases with activities run by volunteers in nursing homes that required communication and coordination between volunteers and professionals and left out activities where volunteers operated autonomously. We prioritized the inclusion of activities that had been in operation for more than a year in order to gain the insights of experience. The activities included in the study consisted of cultural, social and physical activities offered to residents in nursing homes.”

However, the number of interviews see a bit scarce if one wants to understand 8 different cases of co-production. “twenty-one qualitative interviews were carried out with front-line managers in long-term care and activity leaders from voluntary organizations responsible for operating the activities”. This means that, in each municipality, only two or three interviews were made, and that for the most part the volunteers and care workers have not been interviewed. Authors need to explain this decision and justify how they can understand each particular case using only two interviews (i.e. two points of view). In qualitative terms, this is a too small sample of interviews to get a grasp of what is going on. Authors indicate that “The managers put forward their own thoughts and opinions in response to the questions as well as the views of their staff and volunteers that had been shared with the managers in both formal and informal meetings”. But of course, the discourse of the managers about what the staff think can not be equated with what the staff think.

However, authors could argue that two-three interviews by case are enough because they have 8 case studies and what they want is really to compare across cases. But then, in this article only two of the eight cases are presented. Why is this? Authors need to explain why they use only two cases, and what value does this material has. Two cases with only 2-3 interviews by case is really too little to sustain an argument.

I like a lot the description of the two cases presented, but all the info seems to be derived from very few interviews. There is no reference to the “site-visits” mentioned in the Methodology. If the authors did some kind of ethnographic observation, its results should be more clearly exposed.

Discussion and conclusions are based only on these two cases, what I consider too little empirical ground.

I suggest that authors use material from all 8 cases to sustain their conclusions. If they want to maintain the logic of a two-case study, then each case needs more information and justification. A study based on only two cases needs to carefully select the two cases for some reason (why it is interesting to compare precisely these two cases?)

Overall, I find the article very promising.

Author Response

Reply to the reviewers, September 27^th, 2023

 

First, we wish to thank the reviewers for valuable comments and recommendations to our article. Below we add our replies point by point as they appear from the reviewers. We had added our comments in bold writing, so it is easier to follow the replies and comments.  

Reviewer 4

 

The article aims to investigate the phenomenon of co-production in care services. This is a highly relevant topic because several proposals of reform for the Social Services involve a certain level co-production.

However, as the authors indicate, the concept is loaded: “co-production as belonging to a group of omnipresent concepts frequently used in public administration called “magic concepts”. Magic concepts are characterized by their overwhelmingly positive connotations, which make them hard to oppose.”

Many good things are expected from co-production in Social Services, but empirical research on its daily practice and outcomes is scarce. This article aims to provide empirical data on co-production cases. I think this is very useful information for practitioners and for the academic debate on future developments for Care and Social Services.

The authors use a qualitative methodology based on compared case studies. This seems to fit the objective of the research quite well. The logic for the selection of cases is adequately described:

“A qualitative study combining site visits and in-depth interviews was organized in eight  municipalities in various parts of Norway. We selected cases with activities run by volunteers in nursing homes that required communication and coordination between volunteers and professionals and left out activities where volunteers operated autonomously. We prioritized the inclusion of activities that had been in operation for more than a year in order to gain the insights of experience. The activities included in the study consisted of cultural, social and physical activities offered to residents in nursing homes.”

Reply: Thank you.

However, the number of interviews see a bit scarce if one wants to understand 8 different cases of co-production. “twenty-one qualitative interviews were carried out with front-line managers in long-term care and activity leaders from voluntary organizations responsible for operating the activities”. This means that, in each municipality, only two or three interviews were made, and that for the most part the volunteers and care workers have not been interviewed. Authors need to explain this decision and justify how they can understand each particular case using only two interviews (i.e. two points of view). In qualitative terms, this is a too small sample of interviews to get a grasp of what is going on. Authors indicate that “The managers put forward their own thoughts and opinions in response to the questions as well as the views of their staff and volunteers that had been shared with the managers in both formal and informal meetings”. But of course, the discourse of the managers about what the staff think can not be equated with what the staff think. However, authors could argue that two-three interviews by case are enough because they have 8 case studies and what they want is really to compare across cases. But then, in this article only two of the eight cases are presented. Why is this? Authors need to explain why they use only two cases, and what value does this material has. Two cases with only 2-3 interviews by case is really too little to sustain an argument. I like a lot the description of the two cases presented, but all the info seems to be derived from very few interviews.

 

Reply: Thank you for this comment. We have now elaborated on the rationale for choosing two cases (Please see the materials and methods section) Our article rests on the first overall 21 qualitive interviews carried out in eight cases. For a qualitative study, 21 interviews are quite a good number to explore a topic. The focus of the study was directed around the same relations in all eight cases– so the perspective is kept consistent around initiation and partnerships. The thematic analysis guided our attention into a deeper exploration of two cases in order to present more profound details. We have added an explanation of the direction of the study as well as added a clarification of the selection of the two cases.

We think that individual interviews with the volunteers would be interesting in a future study.

There is no reference to the “site-visits” mentioned in the Methodology. If the authors did some kind of ethnographic observation, its results should be more clearly exposed.

Reply: The observations during the site visits were directed at activities in the nursing home. The data from the site visits is therefore not relevant for the analysis that was done for this article.

Discussion and conclusions are based only on these two cases, what I consider too little empirical ground. I suggest that authors use material from all 8 cases to sustain their conclusions. If they want to maintain the logic of a two-case study, then each case needs more information and justification. A study based on only two cases needs to carefully select the two cases for some reason (why it is interesting to compare precisely these two cases?)

REPLY: We appreciate this comment and we have chosen to add information and justification for the two cases. To give a comprehensive presentation of eight cases would be too extensive for a research article with word limitations. A main consideration in this article was to contribute with in depth empirical research to the field which is somethings that has been requested in the contemporary debate on co-production.

 

Overall, I find the article very promising.

Thank you, and many thanks for your helpful comments.

 

 

 

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

My comments to the former version have been considered in a satisfactory way. I have just one comment to the new version which I hope the authors will reflect upon. In the theoretical part they introduce the concept “public value”. They state that public services are concerned with the production of public value, and they quote the criticism against the PAM for focusing more on production than on the creation of value. However, public value is either not an unambiguous concept, but might point in different directions. Jørgensen & Bozeman (2007) found for instance 72 different public values that could be hierarchical, compatible, competing, or causal. (Public values: an inventory. Administration & Society 39(3): 354-381).  The authors write that public value is a normative concept, but I will challenge them to include this ambiguity in their theoretical presentation. It could perhaps be done by changing the structure of the theoretical part, for instance first introducing the co-production concept and then the criticism, including the discussion of what “public value” could include.

 

Author Response

Thank you very much for the valuable comment regarding value . We agree to the point made and we have changed the structure of the theoretical part - and introducing the co-production concept first and followed by the criticism,  and afterwards we have addressed "public value”. We have also inserted two new references: 

Moore, M. H. (2014). Public value accounting: Establishing the philosophical basis. Public Administration Review, 74(4), 465-477.

Jørgensen TB, Bozeman B. Public values: An inventory. Administration & society. 2007;39(3):354-81.

Reviewer 3 Report

Comments and Suggestions for Authors

This paper now is fine for publishing.

Author Response

Thank you for helpful comments.