Progetto PSR (2025) Linea 8-Sottomisura B- Dott.ssa Martina PISARRA (Tutor: Prof. Marsilio Marta) - Missione a Glasgow

Between the bright and dark side of sustainable public value co- creation: the paradox of co-assessment in the (digital) healthcare sector Object of the project: Recent scholarship has increasingly embraced a romanticized view of sustainable public value co-creation through citizen involvement (Jasper & Steen, 2021; Sancino et al., 2023). However, a “dark side” of co-production also exists, leading to tensions and even value co-destruction (Steen et al., 2018; Jaspers, 2019). Drawing on paradox theory, this study explores the coexistence of bright and dark sides of public value co- creation in digital and non-digital healthcare. Paradoxes— contradictory yet interrelated demands—emerge under conditions of plurality, change, or scarcity (Smith & Lewis, 2011). They can trigger either vicious cycles, when actors suppress one pole, or generative outcomes, when actors adopt integrative ‘both-and’ responses (Lewis & Smith, 2022; Berti & Cunha, 2022). We examine value co-creation as a paradox through the lens of co-assessment—citizen involvement in evaluating public services (Nabatchi et al., 2017). Although retrospective, co- assessment can be leveraged prospectively to improve service quality (Bovaird & Loeffler, 2012). Our research addresses two questions: (1) How do tensions in co-assessment relate to the co-creation paradox? We conduct a multiple case study of two Italian and Scottish PHOs engaged in long-standing co-assessment initiatives. Data come from interviews with lay and state actors, and document analysis. This study contributes by identifying paradoxes in co- assessment and showing how actor responses can enable either value creation or destruction