Public healthcare as a destroyer of value – a customer perspective

Abstract

Purpose – This study explores how customer value is destroyed in Lean-managed public healthcare by applying the concepts of value destruction and value co-destruction. Design/methodology/approach – The study draws on a qualitative analysis of customer feedback (n = 507) collected in 2024 from general practitioner and nurse consultations and oral healthcare services, including telephone interactions related to these services, within a Finnish wellbeing services county operating under Lean management principles. The dataset was limited to responses with a Net Promoter Score of 0, accompanied by open-ended comments detailing reasons for perceived value loss. An abductive content analysis was conducted, guided by existing theories of value destruction and co-destruction. Findings – Customer value was destroyed or co-destroyed due to restricted access to care, dysfunctional service processes and inadequate service encounters. Some mechanisms reflected systemic failures that excluded customers from interaction altogether, while others emerged during deteriorated service encounters. These issues resulted in confusion, compromised self-care, emotional harm and a breakdown of trust. Originality/value – This study contributes to service research by operationalising the concepts of value destruction and value co-destruction using empirical data from a Lean-managed public healthcare organisation. It challenges the assumptions of public service logic, which positions value co-creation as a normative ideal, by demonstrating that co-creation may become structurally impossible when essential conditions such as service accessibility, continuity of care and professional communication are absent.