User-Centered Approach to Service Quality and Outcome:Rationales, Accomplishments and Challenges

This paper addresses the rationales, accomplishments, and limitations of the User-Centered Approach (UCA) to service provision, proposed and practiced as a solution to the problems of poor quality and insufficient outcome of services observed in impact evaluations. After discussing conceptual and analytical approaches to the question, a conceptual articulation of the nature of services and classification of services based on degrees of discretion and transaction-intensity is provided, followed by observations on two types of failures in service delivery. Next, a discussion on the effectiveness of the UCA models (co-production and self-management), on the definition and articulation of two key concepts (agency and motivation), and on the typologies of user-provider relations and of user agency in service transaction and utilization is presented. Some of the important proposals and experiences of UCA are summarized in the form of general propositions on co-production in public services, people-centered primary care, and chronic illness care, and in the form of case studies of two salient programs in social work. As the central argument of the paper, the activation and development of user agency for effective partnership in co-production and for self-management is emphasized. This is achieved by making reference to a general conceptual examination of “empowerment,” and to important cases of intervention for agency activation and development, with a view to drawing generalizable implications. A brief discussion on the rationale, accomplishments and limitations of UCA concludes the paper.