Exploring the impact of tensions on value co-creation: practitioner perspectives from a private healthcare setting

Purpose Service-dominant logic proposes that value is co-created through a process of resource integration. However, this assumes that actors (care providers and patients) possess, and are willing and able to apply, resources. The purpose of this study is to investigate the impact of tensions on resource integration and outcomes in a private healthcare setting. Design/methodology/approach Adopting a theoretical framework combining value co-creation and paradox theory, this article draws on semi-structured interviews with 22 practitioners in independent, for-profit, optometry. Findings We identify three levels of tension – micro (organisational tensions), meso (practitioner–patient interactional tensions) and macro (system tensions). We identify six tensions and show their potential negative effect on patient and/or practitioner resource application and outcomes. Finally, we reveal practitioner responses to tensions, including strategies that allow them to accommodate both poles of a tension or to combine poles and produce a synergistic result. Research limitations/implications Research was limited to a single, private healthcare sector. Given that co-creation and competing demands are ubiquitous, further research could investigate the nature of tensions, their impact and practitioner coping mechanisms, in other contexts, both private and public. Practical implications Tensions should not be ignored because they cause frustration, anxiety and sub-optimum care. Management teams need to engage with paradoxes and design coping strategies. Originality/value Studies combining co-creation and paradox theory are scarce. This article contributes to the literature by revealing how competing demands influence provider and patient resource integration and, consequently, outcomes.