Value creation and co-production in nonprofit welfare services: A case study of conditions, mechanisms, and effects in Bräcke diakoni
This project focuses on value-creation and co-production in nonprofit welfare services. As welfare is becoming increasingly pluralistic in Sweden, for example in relation to the role of citizens and nonprofit organizations, co-production has experienced a revival. The aim of the research is to contribute both to previous research related to co-production, and to identify areas for development in nonprofit welfare services and practice. The project is delimited to conditions, mechanisms and effects of value-creation and co-production, including motives for co-production, the groups that participate, how co-production is organized, as well as the impact on quality and participation. Using neo-institutional theory as an analytical framework and the case study as a method Bräcke diakoni's operations will be studied and analyzed as a relevant empirical case of value-creation and co-production. Results and contributions include identifying development areas for practice and research, for example in terms of employee motivation for co-production, structural conditions and mechanisms, as well as related to how co-production affects quality, democracy, participation, and accountability.
Final report
The aim and developments over time
The aim of the project was to contribute to previous research on co-production in welfare, and to develop and improve Bräcke diakoni's practices regarding co-producion. Originally, the project focused on investigating the extent to which Bräcke diakoni worked with co-production. In dialogue with Bräcke diakoni, the project was directed over time more towards contributing to and studying the organization's work on developing co-production in the organization.
About the implementation of the project
The project was carried out in the form of research, learning and exchange within the framework of the Flexit-employment at Bräcke diakoni, and collaboration between academia and practice. The research was carried out in the form of four studies:
- a literature review of previous research (Segnestam Larsson, 2023);
- a survey aimed at managers in Bräcke diakoni (Segnestam Larsson, O, Forsberg, C, and Schneider, T, 2021);
- a comparative study of public, non-profit and private elderly homes (Segnestam Larsson, O, Forsberg, C, and Schneider, T, 2022); and
- a participatory study of one of Bräcke diakoni's training and development programs (Segnestam Larsson, O, Forsberg, C, and Schneider, T, forthcoming).
Examples of learning and exchange within the framework of the Flexit-employment included:
- compiling an anthology on procurement (Segnestam Larssson, O (ed) 2019);
- conducting and participating in seminars, lectures and trainings;
- contributing to developing and improving the development and training program Förbättringskraft;
- contributing to developing Bräcke diakoni's research strategy; and
- working with Bräcke diakoni's welfare strategy, analyzing procurement results, and developing an application for cancer rehabilitation.
The project was also carried out in the form of a broader collaboration between academia and practice, including:
- participating in and contributing to the Swedish Association of Local Authorities and Regions' initiative on Patient contracts (Schneider, T., Forsberg, C., and Segnestam Larsson, O., 2020), and
- coordinate collaboration between Ersta Sköndal Bräcke University College and the college's four principals: Bräcke diakoni, Ersta diakoni, Stora Sköndal and Stockholms sjukhem.
Contribution to increased collaboration
In the spirit of Flexit, the project strived to co-produce the research together with employees from Bräcke diakoni and colleagues from Ersta Sköndal Bräcke University College. For example, Ola Segnestam Larsson collaborated with both colleagues such as Thomas Schneider and Charlotte Forsberg from Bräcke diakoni and with colleagues such as Victor Pestoff and Johan Vamstad from Ersta Sköndal Bräcke University College. The majority of the publications have been co-produced and authored together with colleagues from Bräcke diakoni. The research has been co-produced, however, to a low degree with users/patients/clients due to, among other things, research ethical requirements and that the research had a different focus. The quality and independence of the research have been ensured through customary academic activities. For example, the application was reviewed by external experts. Furthermore, drafts of publications have been presented and commented on at academic seminars at Swedish universities, several international conferences, and by anonymous reviewers for journals and anthologies.
The project's three most important results
One result concerned contributions to research on non-profit organizations, co-production, and welfare. For example, the literature review analyzed the distinctiveness and added value of non-profit organizations in relation to co-production. The second study showed that managers in Bräcke diakoni have a very positive attitude towards co-production, but that co-production permeates organizational activities to a lesser extent. In the third study, it emerged that there were few differences between non-profit, private and public elderly homes in terms of co-production.
Another result was about learning and exchange within the framework of the Flexit-employment at Bräcke diakoni. For example, the fourth study contributed to increasing the degree of co-production in practice by developing, implementing and studying Förbättringskraft, an internal development and training program.
An additional result concerned broader collaborations between practice and academia. Examples of contributions included a report on co-production in relation to the Swedish Association of Local Authorities and Regions' initiative on Patient contracts. The anthology has also been used by Bräcke diakoni as a starting point for seminars, debate articles, debate and new collaborations, for example with other non-profit organizations and Upphandlingsmyndigheten. Collaboration between Ersta Sköndal Bräcke University College and the college's four principals (Bräcke diakoni, Ersta diakoni, Stora Sköndal and Stockholms sjukhem) has also been developed and strengthened.
New research questions
The research has given rise to a number of new research questions. The results from the literature review call for research that explores the potential distinctive contributions to co-production within welfare from different types of organizations. The study of managers in Bräcke diakoni points to the importance of deepening the understanding of differences between attitudes to and implementation of co-production in health and social care. The results from the comparison of non-profit, private and public elderly homes should be explored within other welfare areas, countries and time periods, and especially from users' and professionals' perspectives.
Dissemination of research and collaboration on dissemination
The research results have been disseminated through publications and participation in lectures, seminars and conferences. Examples of participation in lectures and seminars include:
- Att skapa tillsammans – samskapande, Bräcke diakoni, 2020;
- Är ideella organisationer bättre på samskapande? Bräcke diakoni, 2019;
- Upphandling, Bräcke diakoni, 2019;
- Samskapande, Bräcke diakoni, 2019;
- Upphandling, Bräcke diakoni, 2019;
- Upphandlad, Famna och Forum, 2019;
- Vilken roll kan brukarkunskap ha i upphandlingar?, Leva & fungera, 2019;
- Att arbeta strategiskt med offentlig upphandling, Famna, 2019;
- Medskapande, Bräcke diakoni, 2018;
- Att hantera upphandlingar, Bräcke diakoni, 2018;
- Civilsamhälle, särart och uppdrag, Bräcke diakoni, 2018;
- Upphandling av välfärd: Är ideella organisationer missgynnade och politiserade?, Bräcke diakoni ,2018;
- Upphandling av välfärd: Är ideella organisationer missgynnade och politiserade?, Bräcke diakoni, 2018; och
- Co-production in non-profit welfare services, Jönköping högskola, 2018.
The final Flexit-seminar was carried out in collaboration with Bräcke diakoni and Gothenburg University in the form of dedicating one day of KunskapsArenan 2021 to non-profit organizations, co-production and welfare. Ersta Sköndal Bräcke University College hosted the event. Among the participants were Lehn Benjamin, Associate Professor, Lilly Family School of Philanthropy, Indiana University, Bjarne Ibsen, Professor, Research Centre for Sports, Health and Civil Society, University of Southern Denmark, and Sara Riggare, PhD-student and patient researcher, Uppsala University.
List of publications
Articles
- Segnestam Larsson, O (2023) “The role of non-profit organizations in the co-production of welfare services: A systematic literature review”, in Journal of Public and Nonprofit Affairs. (Open Access: https://www.jpna.org/index.php/jpna/article/view/685/501)
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (2022) “Comparing co-production in public, for-profit, and non-profit organizations: A survey of homes for elderly in Sweden”, in Nordic Journal of Wellbeing and Sustainable Welfare Development, 1(1): 51-66. (Open Access: https://www.idunn.no/doi/epdf/10.18261/njwel.1.1.5)
Anthology
- Segnestam Larssson, O (red) (2019) Upphandlad: Forskarperspektiv på offentlig upphandling inom vård och omsorg. Stockholm: Idealistas förlag.
Book chapters
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (forthcoming) Can training bridge the gap between the rhetoric and practice of co-production? Lessons learned from promoting co-production in a non-profit welfare service provider in Sweden, in Lundgaard Andersen, L. et al. (eds.) “The Collaborative Turn in the Nordic Welfare States: Critical Perspectives on Policies, Civil Society and Institutional changes.
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (2021) Micro conditions for co-production: A comparison of values, degrees, and levels of co-production among units in a non-profit welfare organization, in Ibsen, B. (ed.) “Voluntary and public sector collaboration in Scandinavia”, Cham: Palgrave MacMillan.
- Segnestam Larsson, O (2019) Små och missgynnade eller bara förbisedda?, i Segnestam Larssson, O (red) “Upphandlad: Forskarperspektiv på offentlig upphandling inom vård och omsorg”. Stockholm: Idealistas förlag.
- Segnestam Larsson, O (2019) Perspektiv på offentlig upphandling, i Segnestam Larssson, O (red) “Upphandlad: Forskarperspektiv på offentlig upphandling inom vård och omsorg”. Stockholm: Idealistas förlag.
Conference papers
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (2022) Can training bridge the gap between the rhetoric and practice of co-production? Lessons learned from promoting co-production in a non-profit welfare service provider in Sweden. NOS Explorative Workshops.
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (2021) Can training bridge the gap between the rhetoric and practice of co-production? NOS Explorative Workshops.
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (2020) Training for co-production: Lessons learned from a participatory case study of promoting co-production in a non-profit welfare service provider. NOS Explorative Workshops.
- Segnestam Larsson, O., Forsberg, C. & Schneider, T. (2019) Comparing co-production in public, for-profit, and non-profit welfare service providers: A survey of homes for elderly in Sweden, ARNOVA, San Diego, USA, 2019.
- Segnestam Larsson, O., Forsberg, C. & Schneider, T. (2019) Micro conditions for co-production: A comparison of values, degrees, and levels of co-production among units and projects in a non-profit welfare organization. Samspillet mellem den frivillige og den kommunale sektor, Köpenhamn, Danmark, 2019.
- Segnestam Larsson, O (2019) Enabling favourable conditions for co-production: A systematic literature review of the role of non-profit organizations in the co-production of welfare, IIAS Study Group on Co-production of Public Services, Leuven, Belgium, 2019.
- Segnestam Larsson, O (2018) The role of non-profit organizations in the co-production of welfare services: A systematic literature review. ARNOVA, Austin, USA, 2018.
Report
- Schneider, T., Forsberg, C., och Segnestam Larsson, O. (2020) Samskapande i idéburen vård och omsorg - en testbädd i Patientkontrakt. Göteborg: Bräcke diakoni.
The aim of the project was to contribute to previous research on co-production in welfare, and to develop and improve Bräcke diakoni's practices regarding co-producion. Originally, the project focused on investigating the extent to which Bräcke diakoni worked with co-production. In dialogue with Bräcke diakoni, the project was directed over time more towards contributing to and studying the organization's work on developing co-production in the organization.
About the implementation of the project
The project was carried out in the form of research, learning and exchange within the framework of the Flexit-employment at Bräcke diakoni, and collaboration between academia and practice. The research was carried out in the form of four studies:
- a literature review of previous research (Segnestam Larsson, 2023);
- a survey aimed at managers in Bräcke diakoni (Segnestam Larsson, O, Forsberg, C, and Schneider, T, 2021);
- a comparative study of public, non-profit and private elderly homes (Segnestam Larsson, O, Forsberg, C, and Schneider, T, 2022); and
- a participatory study of one of Bräcke diakoni's training and development programs (Segnestam Larsson, O, Forsberg, C, and Schneider, T, forthcoming).
Examples of learning and exchange within the framework of the Flexit-employment included:
- compiling an anthology on procurement (Segnestam Larssson, O (ed) 2019);
- conducting and participating in seminars, lectures and trainings;
- contributing to developing and improving the development and training program Förbättringskraft;
- contributing to developing Bräcke diakoni's research strategy; and
- working with Bräcke diakoni's welfare strategy, analyzing procurement results, and developing an application for cancer rehabilitation.
The project was also carried out in the form of a broader collaboration between academia and practice, including:
- participating in and contributing to the Swedish Association of Local Authorities and Regions' initiative on Patient contracts (Schneider, T., Forsberg, C., and Segnestam Larsson, O., 2020), and
- coordinate collaboration between Ersta Sköndal Bräcke University College and the college's four principals: Bräcke diakoni, Ersta diakoni, Stora Sköndal and Stockholms sjukhem.
Contribution to increased collaboration
In the spirit of Flexit, the project strived to co-produce the research together with employees from Bräcke diakoni and colleagues from Ersta Sköndal Bräcke University College. For example, Ola Segnestam Larsson collaborated with both colleagues such as Thomas Schneider and Charlotte Forsberg from Bräcke diakoni and with colleagues such as Victor Pestoff and Johan Vamstad from Ersta Sköndal Bräcke University College. The majority of the publications have been co-produced and authored together with colleagues from Bräcke diakoni. The research has been co-produced, however, to a low degree with users/patients/clients due to, among other things, research ethical requirements and that the research had a different focus. The quality and independence of the research have been ensured through customary academic activities. For example, the application was reviewed by external experts. Furthermore, drafts of publications have been presented and commented on at academic seminars at Swedish universities, several international conferences, and by anonymous reviewers for journals and anthologies.
The project's three most important results
One result concerned contributions to research on non-profit organizations, co-production, and welfare. For example, the literature review analyzed the distinctiveness and added value of non-profit organizations in relation to co-production. The second study showed that managers in Bräcke diakoni have a very positive attitude towards co-production, but that co-production permeates organizational activities to a lesser extent. In the third study, it emerged that there were few differences between non-profit, private and public elderly homes in terms of co-production.
Another result was about learning and exchange within the framework of the Flexit-employment at Bräcke diakoni. For example, the fourth study contributed to increasing the degree of co-production in practice by developing, implementing and studying Förbättringskraft, an internal development and training program.
An additional result concerned broader collaborations between practice and academia. Examples of contributions included a report on co-production in relation to the Swedish Association of Local Authorities and Regions' initiative on Patient contracts. The anthology has also been used by Bräcke diakoni as a starting point for seminars, debate articles, debate and new collaborations, for example with other non-profit organizations and Upphandlingsmyndigheten. Collaboration between Ersta Sköndal Bräcke University College and the college's four principals (Bräcke diakoni, Ersta diakoni, Stora Sköndal and Stockholms sjukhem) has also been developed and strengthened.
New research questions
The research has given rise to a number of new research questions. The results from the literature review call for research that explores the potential distinctive contributions to co-production within welfare from different types of organizations. The study of managers in Bräcke diakoni points to the importance of deepening the understanding of differences between attitudes to and implementation of co-production in health and social care. The results from the comparison of non-profit, private and public elderly homes should be explored within other welfare areas, countries and time periods, and especially from users' and professionals' perspectives.
Dissemination of research and collaboration on dissemination
The research results have been disseminated through publications and participation in lectures, seminars and conferences. Examples of participation in lectures and seminars include:
- Att skapa tillsammans – samskapande, Bräcke diakoni, 2020;
- Är ideella organisationer bättre på samskapande? Bräcke diakoni, 2019;
- Upphandling, Bräcke diakoni, 2019;
- Samskapande, Bräcke diakoni, 2019;
- Upphandling, Bräcke diakoni, 2019;
- Upphandlad, Famna och Forum, 2019;
- Vilken roll kan brukarkunskap ha i upphandlingar?, Leva & fungera, 2019;
- Att arbeta strategiskt med offentlig upphandling, Famna, 2019;
- Medskapande, Bräcke diakoni, 2018;
- Att hantera upphandlingar, Bräcke diakoni, 2018;
- Civilsamhälle, särart och uppdrag, Bräcke diakoni, 2018;
- Upphandling av välfärd: Är ideella organisationer missgynnade och politiserade?, Bräcke diakoni ,2018;
- Upphandling av välfärd: Är ideella organisationer missgynnade och politiserade?, Bräcke diakoni, 2018; och
- Co-production in non-profit welfare services, Jönköping högskola, 2018.
The final Flexit-seminar was carried out in collaboration with Bräcke diakoni and Gothenburg University in the form of dedicating one day of KunskapsArenan 2021 to non-profit organizations, co-production and welfare. Ersta Sköndal Bräcke University College hosted the event. Among the participants were Lehn Benjamin, Associate Professor, Lilly Family School of Philanthropy, Indiana University, Bjarne Ibsen, Professor, Research Centre for Sports, Health and Civil Society, University of Southern Denmark, and Sara Riggare, PhD-student and patient researcher, Uppsala University.
List of publications
Articles
- Segnestam Larsson, O (2023) “The role of non-profit organizations in the co-production of welfare services: A systematic literature review”, in Journal of Public and Nonprofit Affairs. (Open Access: https://www.jpna.org/index.php/jpna/article/view/685/501)
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (2022) “Comparing co-production in public, for-profit, and non-profit organizations: A survey of homes for elderly in Sweden”, in Nordic Journal of Wellbeing and Sustainable Welfare Development, 1(1): 51-66. (Open Access: https://www.idunn.no/doi/epdf/10.18261/njwel.1.1.5)
Anthology
- Segnestam Larssson, O (red) (2019) Upphandlad: Forskarperspektiv på offentlig upphandling inom vård och omsorg. Stockholm: Idealistas förlag.
Book chapters
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (forthcoming) Can training bridge the gap between the rhetoric and practice of co-production? Lessons learned from promoting co-production in a non-profit welfare service provider in Sweden, in Lundgaard Andersen, L. et al. (eds.) “The Collaborative Turn in the Nordic Welfare States: Critical Perspectives on Policies, Civil Society and Institutional changes.
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (2021) Micro conditions for co-production: A comparison of values, degrees, and levels of co-production among units in a non-profit welfare organization, in Ibsen, B. (ed.) “Voluntary and public sector collaboration in Scandinavia”, Cham: Palgrave MacMillan.
- Segnestam Larsson, O (2019) Små och missgynnade eller bara förbisedda?, i Segnestam Larssson, O (red) “Upphandlad: Forskarperspektiv på offentlig upphandling inom vård och omsorg”. Stockholm: Idealistas förlag.
- Segnestam Larsson, O (2019) Perspektiv på offentlig upphandling, i Segnestam Larssson, O (red) “Upphandlad: Forskarperspektiv på offentlig upphandling inom vård och omsorg”. Stockholm: Idealistas förlag.
Conference papers
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (2022) Can training bridge the gap between the rhetoric and practice of co-production? Lessons learned from promoting co-production in a non-profit welfare service provider in Sweden. NOS Explorative Workshops.
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (2021) Can training bridge the gap between the rhetoric and practice of co-production? NOS Explorative Workshops.
- Segnestam Larsson, O, Forsberg, C, and Schneider, T (2020) Training for co-production: Lessons learned from a participatory case study of promoting co-production in a non-profit welfare service provider. NOS Explorative Workshops.
- Segnestam Larsson, O., Forsberg, C. & Schneider, T. (2019) Comparing co-production in public, for-profit, and non-profit welfare service providers: A survey of homes for elderly in Sweden, ARNOVA, San Diego, USA, 2019.
- Segnestam Larsson, O., Forsberg, C. & Schneider, T. (2019) Micro conditions for co-production: A comparison of values, degrees, and levels of co-production among units and projects in a non-profit welfare organization. Samspillet mellem den frivillige og den kommunale sektor, Köpenhamn, Danmark, 2019.
- Segnestam Larsson, O (2019) Enabling favourable conditions for co-production: A systematic literature review of the role of non-profit organizations in the co-production of welfare, IIAS Study Group on Co-production of Public Services, Leuven, Belgium, 2019.
- Segnestam Larsson, O (2018) The role of non-profit organizations in the co-production of welfare services: A systematic literature review. ARNOVA, Austin, USA, 2018.
Report
- Schneider, T., Forsberg, C., och Segnestam Larsson, O. (2020) Samskapande i idéburen vård och omsorg - en testbädd i Patientkontrakt. Göteborg: Bräcke diakoni.