Beter samen? Een exploratie van publieke waarde co-creatie in publieke dienstverlening

Over the past decades, governments and public service providers have increasingly embraced the idea of co-creation, the collaboration between different public and private stakeholders in public service provisioning. This approach is built on the belief that combining different perspectives, experiences, and resources can produce better, more legitimate, and more sustainable public services. Co-creation can take many forms, from citizens helping to plan a new playground, to jointly running a community centre, to collaborating with professionals in health and social care provision. In theory, such collaboration can improve service quality, strengthen trust between citizens and government, and enhance democratic legitimacy. Yet co-creation is not without challenges. Critics point to "dark sides" such as blurred accountability, higher transaction costs, reinforced inequalities, or emotional burdens for participants. Some processes attract only the "usual suspects" (better educated, more affluent citizens), while others place heavy demands on people's time and energy. In practice, co-creation does not always entail improved outcomes. This raises a pressing question: is it really better together? This dissertation addresses that question by focusing on the outcomes of co-creation. It frames these outcomes as public values: normative ideals that public services should promote, such as effectiveness, fairness, trust, inclusion, and legitimacy. Building on and expanding previous research, these values are grouped into three categories: (1) service-related values (e.g. quality, efficiency, access), (2) relationship-related values (e.g. trust, reciprocity, consideration of needs and capacities), and (3) democratic quality values (e.g. participation, accountability, social cohesion). Here the concept of public value co-creation comes in. Despite growing research on co-creation, the outcomes literature remains fragmented. This dissertation identifies two overarching research questions: How can the outcomes of co-creation be conceptualised? Which factors impact the outcomes of co-creation, and how? To answer these questions, the study adopts a mixed-method design inspired by pragmatic philosophy, which values methodological flexibility and problem-driven research. This approach combines qualitative and quantitative evidence, allowing for both rich contextual understanding and broader generalisation. The first empirical chapter conducts a systematic literature review of 88 scholarly works to map the public values associated with co-creation and the contextual factors linked to their enhancement or obstruction. The review confirms that co-creation can generate benefits across all three categories of public values, but also reveals that negative outcomes are possible, particularly in the relational domain, where issues of trust, power imbalances, and unmet expectations sometimes arise. The second chapter explores whether co-creation produces different outcomes in different service domains, using a qualitative embedded case study. Comparing initiatives in health, social care, recreation, mobility, and urban planning, it finds that sector-specific logics and governance arrangements shape what kinds of public value can realistically be achieved. For example, domains characterised by networks and demanding interaction (such as healthcare) may more easily foster trust and responsiveness, whereas domains with complex regulatory environments may prioritise efficiency or legitimacy. The third chapter applies fuzzy-set Qualitative Comparative Analysis (fsQCA) to 20 co-created care projects in Flanders, identifying combinations of organisational factors that lead to public value outcomes. The results show there is no single recipe for success: instead, different configurations, such as an adequate organisational culture paired with adequate resources, or an adequate organisational structure paired with adequate resources, can each be effective. The analysis highlights that adequate resources are necessary for public value co-creation. The fourth chapter uses large-scale vignette experiments to compare citizens' perceptions of co-created versus regular public services. Respondents evaluated a co-design or regular design and a co-delivery or regular delivery scenario in terms of service, relationship and democratic quality public values. The findings show that co-created services are often rated more positively, especially in relational and democratic terms, in comparison to regular services. Enhanced outcome perceptions are associated with higher levels of internal and external efficacy, trust and perceived ease of participation. The chapter furthermore reveals that respondents with some participatory experience perceive lower outcomes for regular service design and delivery than respondents without such experience. The fifth chapter focuses on the sustainability of co-creation, again through vignette experiments. Here, sustainability refers to durable outcomes (services that continue to deliver value over time) and to sustainable processes (arrangements that can be maintained without exhausting participants or resources), as well as to the capacity built through co-creation in terms of skills and knowledge. The study finds that citizens generally perceive co-created services as more sustainable than regular services. Similar to the findings of chapter 4, internal and external efficacy, and trust impact the sustainability perceptions of citizens with regards to co-creation. Across the empirical chapters, several key insights emerge. First, public value is multi-dimensional, and improvements in one dimension do not automatically lead to gains in others. Public value co-creation is often a balancing act: a process might yield more efficient services, but thereby fail to increase inclusion, another might be able to increase relationships but no concrete service improvements. Practitioners must therefore make conscious choices about which values to prioritise, recognising possible trade-offs. Second, the age-old 'context matters' is also applicable to public value co-creation. The same design choices may work well in one setting but poorly in another, depending on factors such as existing trust levels, community capacity, organisational culture, and political support. Sectoral logics across different service domains should be accounted for, as people-oriented domains reveal more breadth in the public values realised through co-creation, while more technical domains seem to achieve performance-oriented public values. This means that "best practices" must be adapted rather than simply transferred. This dissertation offers insights into different factors that impact public value co-creation, offering an adaptable toolkit to organise public value co-creation across different contexts. Third, combinations of enabling conditions, rather than single factors, are what make co-creation succeed in enhancing public values. Trust, resources, facilitation, and role clarity often reinforce each other, and different configurations can lead to similar outcomes. Most importantly, adequate organisational financial, knowledge and human resources are necessary for public value co-creation. Fourth, citizens' prior experience and motivations shape their perceptions of the outcomes and sustainability of co-creation. Those who already feel connected to their community or confident in their ability to contribute are more likely to see co-creation as valuable. This underlines the importance of designing processes that are accessible and supportive for less experienced or more vulnerable participants. The dissertation makes several contributions to theory. It offers a refined categorisation of public values in co-creation, validated through systematic review and empirical application. It demonstrates the utility of configurational methods (fsQCA) for uncovering multiple causal pathways in complex governance settings. It also shows how combining qualitative case studies, comparative analysis, and experiments strengthens causal inference while retaining contextual sensitivity. In terms of practical contributions, the work provides a conceptual and diagnostic framework for assessing public value outcomes, helping practitioners identify which values they aim to enhance and which enabling conditions they may need to strengthen. It highlights the need to invest in both the capacity of professionals (to facilitate inclusive collaboration) and the capacity of citizens (to engage meaningfully), while stressing the differences in public value outcomes across different service domains and revealing that a different recipes of organisational factors (structures, culture, resources) can enable public value co-creation. The overall conclusion is that co-creation can deliver on its promise, but only if it is deliberately and contextually designed to do so. Success depends on understanding which public values are being pursued, ensuring the right combination of enabling conditions, and adapting processes to the realities of the service domain and the people involved. Co-creation is not a panacea, but when done well, it can indeed make public services better together.