Value Co-Creation through Patient Engagement in Health Care: A micro-level approach and research agendaPublic Management Review


Wendy Hardyman, Kate L. Daunt, Martin Kitchener
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Value Co-Creation through

Patient Engagement in Health

Care: A micro-level approach and research agenda

Wendy Hardymana, Kate L. Daunta & Martin Kitchenera a Cardiff Business School, Cardiff University, Cardiff,


Published online: 07 Feb 2014.

To cite this article: Wendy Hardyman, Kate L. Daunt & Martin Kitchener (2015)

Value Co-Creation through Patient Engagement in Health Care: A micro-level approach and research agenda, Public Management Review, 17:1, 90-107, DOI: 10.1080/14719037.2014.881539

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D ow nl oa de d by [Y or k U niv ers ity

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A micro-level approach and research agenda

Wendy Hardyman, Kate L. Daunt and Martin Kitchener

Wendy Hardyman

Cardiff Business School

Cardiff University




Kate L. Daunt

Cardiff Business School

Cardiff University




Martin Kitchener

Cardiff Business School

Cardiff University





Patient engagement has gained increasing prominence within academic literatures and policy discourse. With limited developments in practice, most extant academic contributions are conceptual, with initiatives in the

National Health Service (NHS) concentrating at macro- rather than at micro-level. This may be one reason why the issue of ‘value co-creation’ has received limited attention within academic discussions of patient engagement or policy pronouncements.

Drawing on emerging ideas in the services marketing and public management literatures, this article offers the first elucidation of the importance of studying ‘value co-creation’ as a basis for further empirical analysis of patient engagement in micro-level encounters.

Key words

Patient engagement, value co-creation, service-dominant logic, micro-level approach © 2014 Taylor & Francis

Public Management Review, 2015

Vol. 17, No. 1, 90–107,

D ow nl oa de d by [Y or k U niv ers ity

L ibr ari es ] a t 0 7:4 0 2 7 D ec em be r 2 01 4


Patient engagement (also commonly referred to as ‘participation’ or ‘involvement’) in the planning, development, and analysis of health care has received increasing attention in the last decade (Armstrong et al. 2013; Bate and Robert 2006). It has variously been proposed as a vehicle for maintaining the sustainability of the National Health Service (NHS); delivering safer health care, managing long term conditions, and improving accountability, health care delivery, and health equity (Coulter 2012; Ocloo and Fulop 2012; Francis 2013; Department of Health 2002; Renedo and Marston 2011). Despite the increasing concern for patient involvement in health care, improvements to practice remain slow and variable (Ward et al. 2011; Ward and Armitage 2012; Ocloo and

Fulop 2012; Hor et al. 2013). Additionally, the research evidence base underpinning patient engagement in health care is limited, with the results being difficult to assess or generalize (Staniszewska, Herron-Marx, and Mockford 2008).

In the United Kingdom, there has been an emphasis within the NHS on developing individuals’ capacities for patient engagement. The application of this approach has typically ignored the contextual and relational barriers and facilitators to involvement (Renedo and

Marston 2011). Academic analysis and practical development of patient engagement has also been hampered, to date, by factors including a lack of agreement about what ‘participation’ means in practice and when it may be necessary, debates concerning both policy and theoretical rationales for involvement (who to involve, why, and how), varying levels to apply engagement (macro-, meso-, or micro-level), competing perspectives on the validity of knowledge of those involved (e.g., expert vs. lay knowledge), the relationship between professional providers of services and the public they serve, and the number of possible roles that users may assume (Renedo and Marston 2011; Martin 2008a, 2008b, 2009; Greenhalgh, Humphrey, and Woodward 2011; WHO/Europe 2013; LéGaré,

Stacey, and Forest 2007; Gibson, Britten, and Lynch 2012; Fotaki 2011).