Introduction

This chapter offers new perspectives on front-line managers and workers as potential social innovators, detailing how co-creation transforms their identities, roles and relationships. Taking its point of departure in the metaphor of a sandcastle the chapter illustrates how in different national contexts achieving readiness for co-creation, rather than building sandcastles, requires new approaches to governing the collaborations across professional and organisational boundaries and managing cultural change. The chapter also highlights how service professionals and first-line managers work with reconceptualising their roles and relationships in welfare services to achieve greater social justice for the targeted individuals. It argues how co-creating meaningful service value may take much more in terms of efforts and time than pure organisational, administrative or technical changes which are rather seen as the outcomes of an (ongoing) shift in the approaches and mindsets about service delivery and management.

Reporting from a Swedish municipality in which a Co-creation of Service Innovation in Europe (CoSIE) pilot moved personal assistance (PA) services for people with functional and cognitive impairments towards co-creation culture, it illustrates co-creative approaches and strategies harnessed to transform disabling narratives. Emphasis is placed on the importance of change conversations and learning dialogues, where collective sense-making takes place, and on the role of facilitators to lead the transformative change. Touching also on an Italian pilot engaging families, civil society, and managers and service professionals in addressing a complex child obesity issue, the authors draw attention to key findings and learnings regarding co-creative strategies of managers and front-line professionals as change actors and approaches to facilitate such asset-based working.

The shifting roles of managers and professionals

The expanding literature on facilitating public service co-creation is still heavily focused on the citizen side which has consequences for understanding the role of the public sector in sustaining co-creation culture (Bassi and Fabbri, 2022). The literature that dwells on public governance, management and co-creation highlights the role of senior or mid-management and elected politicians in leading the change (Gioia and Chittipeddi, 1991; Lüscher and Lewis, 2008; Iveroth and Hallencreutz, 2016; Torfing et al, 2016; Sörensen and Torfing, 2022) or increasingly digitalised platforms and techniques to support co-creation (Jalonen and Helo, 2020). Meanwhile, the changes required in professional identities, roles and relationships of those actors in public or private organisations, whose interactions with citizens are crucial for co-creating or co-destroying the service value, are still largely overlooked. The role of service professionals or front-line managers when shifting service cultures to co-creation is often taken for granted, leaving a major gap in the literature (Osborne and Strokosch, 2013; Bassi, 2022). Empirical studies of the strategies of service professionals and lower level managers and the support provided by senior management in such a systemic change (Torfing et al, 2016; Narbutaité Aflaki, 2021) are still scarce.

Co-creation entails a distinct perspective and a major shift regarding roles and guiding principles in public service design, delivery and improvement by focusing on collaborative logics. As discussed in Chapter 2, a body of theoretical work associates co-creation with New Public Governance (NPG), although the argument in this book is that co-creation is in principle a new normative approach to public service delivery and as such requires rethinking the NPG as a new paradigm (see also Ansell and Torfing, 2021). NPG, with its focus upon inter-organisational relationships and trust, is seen as a reaction to shortcomings of New Public Management (NPM), which during the 1980s and the 1990s overruled (at least partially) older traditional public administration (TPA) (Hartley, 2005). NPG integrates some of the key principles of the alternative models such as striving for fairness under TPA and cost efficiency under NPM. Co-creation logic thus reinterprets, expands and shifts some of the key principles guiding public services. This leaves public managers and professionals with new tasks and a complex set of sometimes competing principles to guide their relations to citizens but also peers, democratically elected decision makers and other stakeholders. No wonder it has encountered some resistance.

Table 4.1 provides a synthesised overview of how the roles of public managers and professionals and the ethical principles for their engagement shift across the three models of governance and public management, TPA, NPM and NPG. For example, fairness under TPA implies service user treatment through standardised solutions, while NPM translates fairness into services tailored to specific individual or group needs in market-like interactions. While elements of co-creation can be found in NPG and TPA (Ansell and Torfing, 2021), expanded co-creation under NPG transgresses pure methodological knowledge and implies rethinking relationships towards citizens in service delivery. On a deeper level, this requires transforming the mindsets of service workers/professionals and their managers. These actors are ‘street-level bureaucrats’, meaning individuals with the power to exercise discretion over daily decisions affecting citizens’ lives. Understanding co-creation requires awareness of how interactions between service workers, their peers, other stakeholders and citizens may affect service production process and its outcomes, and subsequently the value associated with those.

The insight that value is co-created with the citizen in an ongoing circular process and through multiple interactions related to different service ‘stages’ or aspects (see Table 4.1) – from assessment, design or redesign to changes in service delivery – turns on its head the self-perceptions or identities of street-level bureaucrats. This includes their sense of power or powerlessness, responsibilities and roles in implementing this cultural shift. Yet, pressures for change without adequate support might also evoke alienation or resistance. Co-creation overall entails a new approach and value priorities in managing the necessary organisational adaptations.

Notwithstanding expectations of the ‘magic’ of co-creation (Ansell and Torfing, 2021), the behaviours and practices of first-line managers and professionals may reflect the attitude that their role is to provide value ‘for’ the citizens as end users. This way of thinking is tightly interlinked with TPA and NPM and relies on what has come to be called as the public sector dominant logics (Osborne, 2018). These professional patterns are often highly engrained, not least due to the prevalent incitement systems based on prioritising professional expertise and vertical accountability lines towards senior managers and elected representatives. Particularly in highly technical services, such as health or social care, increasingly, the service value is associated with technical knowledge. This includes handling big data generated based on simplified algorithms from citizen interactions with services (Falk, 2021). Also, while service professionals and care workers enjoy the trust placed upon them by service users, they also have to cope with their interventions being assessed against legal requirements of standardised services and predefined policy goals or organisational objectives. Both these aspects make services more ‘inward looking’ and prevent openness for lay or citizen knowledge (Boyle and Harris, 2009; Bassi, 2022). What is more, that may challenge the professional ethics and the need for adequate discretion, in turn effecting de-professionalisation (Taylor and Kelly, 2006) and alienation (Tummers, 2012).

It is often forgotten that expectations of particular roles and relationships also need to be meaningful to the policy-implementing professionals and managers (Narbutaité Aflaki and Lindh, 2021). For example, when policies rhetorically put the citizen in the centre but service delivery practices are guided primarily by economic rather than relational values this may result in a value clash and professionals and managers start alienating themselves from their true professional ethical standards (Tummers, 2012). When they lack meaning and experience threat to their power or fear becoming ‘redundant’ (Narbutaité Aflaki and Lindh, 2021), service professionals and first-line managers may resist the new relational logics of co-creation. This is because no matter how strictly professionals are governed by new service values and goals, they still retain some power – derived primarily from their professional knowledge (Lipsky, 1980) – over the operational values and tasks in implementing policy and service reforms (Taylor and Kelly, 2006). In sum, when new policies for citizen inclusion and influence in decision making or co-determination, or similar terms associated with co-creation, offer little guidance and resources for implementation there is a risk that street-level bureaucrats will get alienated and neglect implementing policy goals.

In reality, co-creation is being introduced to an organisational world inhabited by a hybrid governance and management logics to various degrees incorporating principles from NPM and TPA. In such contexts, all manager levels are crucial for leading and facilitating a shift to co-creation culture. The stance and decisions of senior public managers and elected politicians have a major role in legitimising and sense-making about such a shift with mid and first-line managers and service professionals who undertake major transformation work and grapple with their identities. The senior management are crucial in, for example, shifting service focus from short-term to long-term impacts and from overemphasising formal rule adherence to greater citizen role in service input and meaningful output. This includes transforming the use of information and communication technologies (ICT) to enhance collaboration with citizens (Torfing et al, 2016) and abilities to work with moving targets rather than set goals. They may also undertake key leadership roles to forge organisational silos or stakeholders together in a joined learning process.

Mid- and first-line managers are core actors in implementing cultural change (Alvesson and Sveningsson, 2015; Narbutaité Aflaki and Lindh, 2021). Being seen as the last chain to implement change, first-line managers are expected to undertake leadership or facilitation towards the implementing professionals providing support and guidance, while mid-managers provide legitimacy and support to first-line managers. Sometimes such facilitatory roles are delegated to neutral actors outside the organisations to help structure the processes and bring in fresh perspectives.

Co-creation of value may take place at all policy or service development stages, and along several dimensions such as governance, management or maintenance. Table 4.2 provides an overview of what roles (tasks and activities) public managers and professionals usually engage in from the perspective of a co-creative logic, and what are their underpinning principles.

In what follows, we exemplify with two cases from Sweden and Italy how public organisations and service networks or ecosystems may go about supporting the transformation towards co-creation culture in a way that is meaningful and sustainable, and how managers and professionals perform their new roles and tasks (Italy) and grapple with sense-making about them (Sweden).

Engaging first-line managers in cultural change: evidence from Sweden

In this section, we illustrate how a transformative cultural change towards co-creation in service delivery might be facilitated within a municipal organisation, a key social service provider, by shifting management approach and strategies to empower managers and professionals at the street level. Jönköping municipality, Sweden, a partner in the CoSIE project and home for circa 120,000, inhabitants serves as an example. Since 2012, its social services reform programme, and particularly disability services covering 2,098 users and circa 1,400 permanent staff, have been the targets of cultural change. In our longitudinal study conducted during 2018–2020 we sought to disclose the theory of cultural change where the municipal organisation has taken a systemic grip to empower the street level in co-creating social service value. The study has been conducted in the Disability Services Department and especially PA services and relied on participant observations (9), interviews with managers (34) and document analysis. Importantly, it studied how first-line managers were sense-making of the cultural change and testing new practices in a pilot action facilitated by a hired action researcher.

The Jönköping case stood out in the CoSIE project with its favourable legislative and policy environment. The national legislation and policy aspirations since 1993 have been increasingly geared towards enhancing service users’, especially those with various impairments, influence in social service delivery. This has contributed to initiating a major shift in the discourse about people with physical or psychosocial impairments by allowing them greater influence in local service delivery with the aim of creating more meaningful and valuable interventions to promote their autonomy and wellbeing. Nevertheless, the reform still faced challenges in securing user participation and influence at the start of the CoSIE project.

Jönköping municipality has been strategically selected to illustrate a case of long-standing organisational commitment to enhance social service value by working with constant improvements through dialogues with lower level management and users. Such commitment is an outcome of years of systematic developmental work with strategic management reform called DIALOGEN (the Dialogue), supported by municipal political boards. Economic austerity and raising citizen awareness of their democratic rights to influence individual social service delivery have also fuelled the necessity of the reform. Since 2012, the organisation has been striving to find ways to support especially its first-line managers in leading their personnel towards a culture of service improvements and innovations that are meaningful for citizens. Disability services require regular interactions with citizens assisted by the services thus providing apt opportunities for co-creation. Yet, co-creation is especially demanding due to individual varieties of physical or cognitive impairments and there was confusion about its practical implementation or sometimes lack of acceptance among both street-level professionals and citizens. By 2018, after several years of extensive work on service improvement, the commitment to the reform and co-creative culture among lower level managers and street-level professionals was still uneven. The senior management has learned that the key challenge is that of shifting the mindsets of first-line managers and personnel in the context of pressing service circumstances, including relatively low pay and low status of care workers, a tendency not to stay in the jobs for long, and the isolated nature of their day-to-day work based in the homes of service users. Through piloting service improvement cases senior managers came to realise that it had to do with strengthening the incitements and competencies at the street level, which required both building on the already existent tacit knowledge and de-learning, as well as continuously adjusting organisational recourses to support new practices. Next, we consider some key support strategies illustrated with the studied piloting case.

First, senior management has had a key role in reframing overall social service culture towards more citizen-oriented and health-promoting values, marking a shift from a culture more heavily reliant on professional judgement. The senior management did not believe that purely reorganising roles and responsibilities will be sufficient for implementing a cultural change. Instead, they actively and persistently engaged in intra-organisational dialogues to convey the key role of citizen-centred values and started to rely on a supportive, more trust-based management style across all managerial levels (see Ferlie and Ongaro, 2015). They put much effort into reframing the engrained transactional approach to service production with the dominant narrative of street-level professionals seen as ‘solely responsible for satisfying service user needs’ towards a more interactive, relational approach. This included abandoning a user identity as a passive recipient with very limited, sporadic and uneven participation and influence in service implementation decisions for an identity as a more active service co-creator whose knowledge, experiences, abilities, networks and other resources are to be used, where appropriate, within the set legal boundaries, to enhance service value.

The senior management steering took a shape of meta- or transformative governance (Torfing et al, 2016), by either initiating or supporting platforms for multiple dialogues on change initiatives across the manager levels and individual departments, sometimes including citizens. The early manager dialogues have led towards a series of organisational and service improvements that were selected from circa 1,500 ideas, although far from all of those instantly/directly dealt with value co-creation with citizens.

Additionally, the senior management did implement several major reorganisations. One of those was abandoning multi-layered hierarchy, and delegating more power and responsibilities to first-line managers in implementing the reform intentions. First-line managers and their personnel were seen as the ultimate change actors in the strategic steering towards co-creative culture. These managers were to set the operational goals for their service units (guided by the DIALOGEN overarching goals of meaningful, coherent and innovative services) and contribute in selecting their assessment criteria. Such management logics required that ideas for testing service improvements stemmed from the initiatives of first-line managers and their personnel. This way, senior management engaged circa 200 first-line managers not only in implementing but also in co-governing and co-managing the cultural shift towards co-creation.

To illustrate, in our studied PA services the senior management has approved of initiating a service improvement that evolved from dialogues among mid-managers for the PA service unit and the first-line managers. The pilot was focusing on health promotion as a service value to be co-created with users. The senior management has further chosen to support the entrepreneurial mid-manager acting as change leader in initiating a sense-making with the 17 first-line managers about what changes could be necessary, why and how they could be achieved. This was a journey to be primarily undertaken jointly by the 17 managers who, in turn, had to further explore it with their personnel.

As part of this strategy the senior management allocated resources to pedagogical development to support first-line managers and service personnel in the entire Disability Services Department. These pedagogical professionals could, for example, assist with dialogical approach when planning or implementing services in citizens’ homes; for more overarching service improvements they helped to organise focus group interviews or participatory chain dialogues with groups of citizens and professionals and assisted the communication of feedback between these groups until an agreement is reached.

In the Jönköping pilot, senior management allocated resources for manager meetings and hired an experienced dialogue facilitator, a researcher with a solid professional background in social service management and organisational development. The researcher proved to be a valuable support, within given resource and organisational limitations. She applied action research principles to help structure and advance the learning dialogues among first-line managers towards their chosen improvements whose need was clearly voiced among service users. Additional pedagogical resources were used to explore the voices and lived stories of the service users, mostly in small focus groups, following sound ethical principles. A key driving principle in reforming services was a ‘salutogenic’ perspective (Antonovsky, 1996), according to which any service improvements were to be guided by an assessment of their coherence, that is, if change is seen as understandable, meaningful and possible to implement. The action researcher applied similar principles that she expected first-line managers to apply in their dialogues with personnel – the deep listening, disturbing the established narrative, and providing new evidence and perspectives while at the same time recognising their capabilities and resources. It was cultivating a more open and supportive culture with positive examples from their own reality and the support they received from exploring selected literature with the facilitator in study circles that had mainly helped to initiate and sustain a healthful transformation in their narrative. The dialogues and group work with desired changes offered new insights about available organisational resources and strategies to deploy those, including broader competence development tools.

While the senior management actively engaged in sense-giving (Gioia and Chittipeddi, 1991) by laying out the overarching goals, strategies of the reform and co-creative principles, they also adopted a learning approach. They had opened up to the fact that initiating piloting changes faced some resistance among implementing first-line managers and personnel. Examples from studied housing or PA indicate that at the early pilot stage far from all first-line managers were comfortable with leading their personnel through the landscape of change. As a group they felt stuck in a disabling narrative about their identities and roles in supporting co-creation on a daily basis, their powerlessness or hindrances presented by inadequate administrative routines, resources, and failures in attracting and retaining qualified personnel. In the case of our pilot, by way of consulting with employed action researchers the senior management came to understand change among front-line workers and managers as largely dependent on their joint sense-making processes (Alvesson and Sveningsson, 2015), where some facilitation from engaged researchers has been appreciated.

A major challenge for first-line managers was seeing themselves as capable change leaders while often being new to the job, working with service changes and being accountable to each other primarily in small fragmented teams, managing sense-making with constantly rotating personnel groups and with limited possibilities to support them from a distance in users’ homes. The regular dialogues over a year resulted in drawing and committing to joint change vision, exposing their perceptions, fears and vulnerabilities to each other in a larger assistance services group and, gradually, by sense-making together, rediscovering their strengths and abilities, new ways to support each other. The joint sense-making with support from action research and drawing upon open deliberation and joined study circles has contributed in shifting towards a more empowering narrative (Narbutaité Aflaki and Lindh, 2021). These are all examples of co-designing, co-managing and co-implementing micro- or service-level changes.

The co-creation discourse and DIALOGEN reform basically reflected the implementation of ‘old’, legally established users’ rights of participation and self-determination. However, an important part of resistance was due to the street-level professionals facing a dilemma with their identities – was co-creation about de-professionalisation or re-professionalisation? In our pilot, after a series of joinet dialogues the first-line managers have come to the conclusion that co-creation does not imply letting the user with impairments decide in all legally approved assistance matters, which to them signalled a ‘let go’ attitude towards the user or de-professionalisation. Instead, allowing user influence in co-creating service value requires a delicate balancing between the professional approach and enacting the user’s right to influence her own autonomy and wellbeing, an approach described as ‘responsible care mentality’. Re-professionalisation was understood as identifying service design or delivery situations with attentiveness to a user’s opinion or choice and encouragement of user participation and influence. Their joined understanding of co-creation could be paraphrased as a collaborative approach allowing to openly question: ‘With whom and how can I figure out how personal assistance [services] can be meaningful and useful in user’s everyday life?’ As a result, acting as change actors, they looked over and simplified the language used in communicating with users, strengthened collaboration on user cases, and introduced more dialogue-based meeting routines, starting with those for first-time service users.

By the end of the pilot, the major concerns of the first-line managers remained sustaining their joint learning dialogues and scaling out such dialogues to their personnel groups, which, given constant personnel rotation, was perceived as a never-ending journey. There was, however, a greater appreciation among managers at all levels that shifting organisational culture and routines on a daily basis requires time, persistence and relevant resources and strategies to support and engage lower managers and care workers in sense-making and providing feedback. Overall, piloting micro-level changes was presumed to be a ground for learning and gradually effecting systemic change. Such half-evolutional, half-steered change, however, was a time-consuming process. When the pilot ended, the cross-unit learning from it was still embryonic, with remaining unclarities in responsibilities and challenges in prioritising between the organisational aims.

Our findings indicate, nevertheless, that the systemic grip of the service management reform in Jönköping municipality has created a momentum towards an organisational culture and professional ethos accommodating greater user influence. The strategic and facilitatory role of senior management and the change leadership at the front line has not been finally shaped, if it ever will be, and the testing and learning is ongoing.

Co-creating an app for the prevention of childhood obesity: evidence from Italy

The Italian pilot in the CoSIE project was about innovative service contributions in preventing and reducing the incidence of childhood obesity in the territory of the Reggio Emilia, a municipality in the Emilia-Romagna region in the north-east of Italy. By the start of the pilot, Reggio Emilia already had an ongoing multilevel and multi-target programme for the prevention and management of childhood obesity known as ‘Bimbi Molto in forma’ (BMInforma). This was aimed at linking health promotion and primary prevention (building an environment where healthy choices are easier) with secondary prevention (counselling and motivational interviews with overweight children) and the treatment of obesity complications (multidisciplinary team interventions for obese children).

The major CoSIE pilot objective was implementing, with the help of researchers from University of Bologna, new co-creation strategies to improve and develop the BMInforma programme and to strengthen the collaboration networks in the various areas of prevention and treatment of childhood obesity. One of these innovative strategies was the co-creation of a digital tool, an app, as a response to the obesity epidemic among children and young people. For more detail about this app (named ‘BeBa’), see Box 4.1.

BeBa was created and later put to test by the pilot partners Lepida (a publicly owned private agency that provides ICT services for the Regional Health Service) and the Reggio Emilia health authority (AUSL), with the support of the University of Bologna. The development of the app engaged numerous stakeholders operating through a series of topic-specific working groups. Contributors included service professionals, the local Institution of Schools and Nursery Schools, the health authority’s sports medicine service, sports associations, and the company running school catering services. The meetings of the working groups were numerous and lasted a year or sometimes longer. The functionalities of the app were designed and developed from the information collected from these groups, clearly indicating collaborative cross-sectoral and cross-organisational co-creation by active players committed to the prevention of childhood obesity in the entire Emilia-Romagna region. Chapter 8 returns to this pilot and examines in depth co-governance across the diverse plurality of actors. Here we focus on the perspective of the main front-line professional group, in this case paediatricians.

There was of course some resistance, especially at the beginning of the Italian pilot, from the paediatricians, to getting involved in co-creation of the app due to the fear of additional workload. Initially, they showed some disappointment towards their senior managers for getting involved with this and many other European Union projects without being asked about their interest or capacities, as well as for lack of monetary incentives especially in terms of compensating for the extra time that they had to spend on the realisation of these projects. Finally, the resistance was also fuelled by perceived insufficient sharing and learning from the results of these projects that were often retained at the central level in the structure. In the pilot, these resistances were gradually overcome thanks to the contributions of two female paediatricians who acted as ‘informal leaders’ due to the high reputation and esteem they held among the professional community. They played the role of catalysts and bridges between the paediatricians and the pilot leaders, facilitating a two-way communication and helping to convince even the more sceptical ones of the value in testing co-creation within the frame of the CoSIE project: “Communicating with people you do not know and with whom you are not used to work is tiring but what you do in this way of working makes the difference” (paediatrician, Italy).

The Italian case clearly showcased the challenge of joining several professions and professional and lay knowledge and in a fruitful dialogue. The dialogue succeeded in being sustained for over a year largely thanks to the ability of the leader of the project to motivate the actors and create a welcoming climate for dialogue, where he avoided putting his formal authority above the others, but acted as a peer and, by active and deep listening, allowed other professionals, managers and laymen to step in and make their perspectives visible.

Additionally, any time that there was a disagreement among different positions in the professional community and inside the bureaucracy structure, the research team acted as a buffer, able to absorb the tensions and to reduce the potential of conflict among the actors involved. The researchers contributed with ‘scientific legitimacy’ for the choices made by the steering committee concerning the choice of the service, methodology adopted and the tools employed during the project, given the high reputation rank of the University of Bologna among the health professionals. Moreover, the researchers introduced the European dimension and possibilities to compare the pilot co-creation experiences with those of the other nine project countries, which was particularly appreciated by senior and middle managers. The fact that the facilitated dialogues took place in a neutral arena (‘Luoghi di prevenzione’), Emilia-Romagna Center for the Training of Social and Health Care Workers, made it easier to open up for more power equilibrated dialogues.

Overall, the Italian pilot, similarly to the Swedish one, illustrates professional resistance or at least confusion when facing co-creative norms and roles. Creating platforms for joined and fair deliberation and self-reflection, and engaging trustworthy and change-motivated facilitators seem to be a key mechanism to lower resistance and increase engagement. Such platforms, in turn, require top management and political decision makers who are supportive of experimentation.

Conclusion

We can summarise the key elements that emerged from the project empirical analysis, here exemplified by the Swedish and Italian pilot cases, as facilitatory in improving the propensity of front-line managers and street-level professionals to engage in co-creation processes:

1. 1.Involving middle managers, front-line managers and service professionals from the very early phases in the co-design of the service innovations or improvements.
2. 2.Shifting lower manager roles and responsibilities from pure administrative to leadership tasks, such as by delegating power in setting operational goals, assessment criteria.
3. 3.Establishing a system of incentives in order to motivate public managers and professionals to engage themselves in the co-creation activities by self-selection and building an enabling organisational/administrative environment. For example, allowing flexible working time schedules, creating monetary incentives (allocating additional time and resources); providing the needed technical tools; helping to recruit the right competences; and easing the administrative burden to free more time for development and learning.
4. 4.Finding someone with high reputation or authority and knowledge who is capable to act as a process catalyst and/or facilitator both inside his/her professional community in sense-making about the cultural change, and in a bridging role across professions, service units or organisational boundaries. This is especially imperative in highly professionalised human services (such as healthcare or social services).
5. 5.Supporting street-level professionals in their role as reflective practitioners and key change agents, and lower level managers as change leaders with appropriate pedagogical training on collaborative and co-creative approach, preferably by engaging community stakeholders and concerned citizens.

The CoSIE project results show that street-level professionals may be involved in various co-creation stages beyond co-implementation and maintenance, including initiation, governance and management (see Table 4.2). Indeed, for co-creation logics to be implemented and sustained it is not enough to involve one managerial level, rather, the change has to transpire all the way through organisational hierarchies and across organisational silos and boundaries. Yet, any attempts to govern towards co-creation may fail unless front-line managers and professionals are motivated or feel that they have some freedom and support to explore their identities and shape roles, and that the change is meaningful. It seems that front-line managers and professionals’ motivation, rather than their purely formal roles, provides a good start for building a common ground, while support from senior managers and politicians justifies the efforts and enables the longer-term sustainment. A good way to prepare for the new roles proved to be, in line with earlier arguments, the need to develop a culture of learning (Torfing et al, 2016). This was achieved by designing platforms for dialogue and support to help to continuously reflect, sense-make about changing service aims, principles, roles and their translation into practice.

In conclusion, embedding co-creation as an integral part of the professional and front-line manager approach in an organisational culture or service system that still partly operates under a mixture of TPA and NPM logics needs to be seen as a process in making, or a metaphorical ‘train journey’. The destination of the journey is shifting to adapt to constantly changing political, social and economic dynamics and service demands. Cultural change is challenging, it often faces resistance, involves backward steps, and takes time and consistency. It requires political courage and top-management guidance and support in prioritising values and goals.