Citizens’ participation in healthcare services re-design. How Public Health Providers perceive their contribution. A. BOTTI, S. COSIMATO, C. TORRE, O. TROISI Department of Management & Information Technology, University of Salerno, Italy abotti@unisa.it scosimato@unisa.it ctorre@unisa.it otroisi@unisa.it 1. Introduction Our society is marked by a permanent state of crisis, characterized by a high level of uncertainty and the need for deep organizational and political changes (OECD, 1995, 2000; Pollitt and Bouckaert, 2003; Kotler and Caslione, 2009). Consequently, the pace of public sector reform is globally accelerated; thus, several governments aim to make the services they provide more efficient and productive than ever, adopting flexible policies and involving citizens in service design and provisioning. Over the past decades, institutions and public organizations have been involved in a lively debate about the real meaning of “governance”, the role of public and private organization, and even about the real influence of citizens on public services definition (Bourgon, 2008). In some countries, this debate has led to important reforms mainly oriented to functions and services’ privatisation, government decentralisation, or even to deregulation process. In public sector, the increasing participation of citizens in public policies and service provisioning reflects governments’ aims to make their offering as responsive and accountable as possible. Consequently, institutions are somewhat obliged to involve civil society in every different stage of public services’ life cycle, such as public decision-making, service design and provisioning (Matei and Matei, 2011). Therefore, public services seem to be strictly related to value co-creation model that involves users, partners and, in our case, citizens in value creation and of course in service co-production (Freire and Sangiorgi, 2010). Furthermore, the emergence of such process is mainly related to the shift from “Value-chain” to “Value-Constellation Model” (Norman and Ramirez, 1994). In fact, according to the first model value creation is a progressive process open to the participation of different suppliers; on the other hand, in the constellation model value creation is based on co- production logic, involving different actors in “a non-linear set of activities and interactions” (Freire and Sangiorgi, 2010, p.1). In recent times, user’s role has radically changed passing from being considered a “destroyer of value, to source of value, and finally to co-creator of value” (Ramirez and Mannervik, 2008, p.36). This evolution has been also observed in healthcare, where citizens’ participation is increasingly common; thus, healthcare services have been often based on a Value- Constellation Model (Normann and Ramirez, 1994), according to which value creation is a more distributed process, open to citizens’ participation that makes them co-creators of their own wellbeing. Civic participation in public services’ design and provisioning is also influenced by those emergent technologies that are changing the traditional economic and social paradigms. These technologies (e.g., ICT, social media, mobile tools etc.) let organizations have a better understanding of users’ characteristics, needs, and demands (Ghulam et al., 2006). Going over, in healthcare these emergent technologies can positively affect the achievement of better clinical outcome (Kern and Jaron, 2002) and patients’ direct involvement in every stage of service development (Freire and Sangiorgi, 2010). This study aims to investigate citizens’ participation not only in healthcare service design and provisioning, but also in their re-design, a process that point