Service design, culture and performance: Collusion and co-production in health care

Where there is emerging evidence to suggest that (organizational) culture can affect the performance and quality of health services, little attention has been directed at how these relationships might be mediated, facilitated or attenuated by aspects of service design (i.e. those arrangements that combine facilities, staff and service users in the co-production of care). Using two case studies set in mental health services, this article explores how both culture and performance may be viewed as emergent properties of service design configurations. Thus central to ideas of service re-design should be notions of service users as the co-producers (with staff) of both organizational culture and organizational performance, as well as a clearer understanding of how such co-production processes are modulated by specific design configurations.