Service design, culture and performance: Collusion and co-production in health care Paula Hyde and Huw T.O. Davies ABSTRACT While 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 perform- ance 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. KEYWORDS co-production  health care  organizational culture  organizational design  organizational performance  service users Leaders in almost all organizations have abiding concerns about organiz- ational effectiveness, performance or quality. This poses particular problems in the public sector, which lacks market signals (such as profit or share price) to indicate organizational ‘success’. Because of these difficulties, and linked to ideological preconceptions over ‘inefficiencies’ in public services, recent 1407 Human Relations DOI: 10.1177/0018726704049415 Volume 57(11): 1407–1426 Copyright © 2004 The Tavistock Institute ® SAGE Publications London, Thousand Oaks CA, New Delhi www.sagepublications.com at Durham University on January 8, 2015 hum.sagepub.com Downloaded from