Co-creation has been implemented as an effective approach that integrates resources and interactions between stakeholders, such as patients and health professionals with the aim to deliver valuable healthcare services [1]. Such processes have shown to positively affect patients experience by involving them as active participant in the cure process and improving the overall service, that is perceived as more qualitative and valuable [2] and to expand patients’ health literacy regarding their illness [3]. From the healthcare professionals’ perspective, co-creation can spur the development of new skills and knowledge [4] and lower hospitalization costs for healthcare organizations through positive outcomes resulting from the collaboration between doctors, patients and caregivers and the use of technologies, particularly in chronic illnesses [5]. Alongside, digital technologies are experiencing incremental application in the implementation of healthcare services, showing great potential in supporting the transition from cure to prevention, patient centered focus, more efficient, safer, and cheaper healthcare management and delivery [6]. Digital technologies can become a mean to co-create value for patients, revolutionizing the way healthcare institutions deliver services and citizens engage in public sector management, however, little academic attention has been destined to the intersection between these two occurrences. Therefore, the objective of the present research is to explore this gap in the literature; the relevance of this study lays in the opportunity to identify how digital approaches and technological tools can help deliver valuable services for and along with citizens, better understand stakeholders’ needs, preference and experiences using technologies and consequently allow healthcare organizations to appropriately answer patients’ healthcare necessities. The combination between these themes could have great impact on society’s wellness, in line with Sustainable Development Goals (SDG), as new services created through digital technologies could broaden access to healthcare and reduce inequalities. Moreover, the required initial investment in technologies for healthcare organizations could subsequently translate into a financially sustainable way to continue delivering services for future generations and create value for stakeholders through their involvement. A comprehensive analysis of literature represents the necessary starting point in that direction, collecting and organizing scientific knowledge that could then be used to shape a value-based healthcare offer. Indeed, digitalization of public services calls for strategical re-thinking and re-shaping in the way healthcare organizations operate, starting from their management practices, economic investments, training and development of digital skills required by medical and administrative professionals to enable digital healthcare service provision, to the way citizens interact and take part in said process [7].

The research methodology that has been adopted is a Structured Literature Review (SLR); as it follows strict rules and quantitative methods such as reliability and validity testing, it supports the researcher’s findings by investigating a broad field, like the one of value co-creation in healthcare, focusing on an emerging but mostly unexplored theme within it, as digitalization. In addition to the development of insights, this methodology stimulates to constructively criticize what has been produced in the literature on said topic and identify future directions for the research [8].

By applying a specifically developed analytical framework, literature selected through PRISMA methodology [9] from the Scopus, Clarivate Web of Science and PubMed databases was explored regarding the digitalization focus on value co-creation of healthcare services. Types of healthcare systems and nature of healthcare organizations was considered, focusing on public ones, as well as medical field where co-creation activities and digital processes have been applied to. Different perspective were included: patients, caregivers and healthcare professionals experience and level of engagement in co-creation of healthcare services using digital technologies, factors enabling or hindering the application of technologies in co-creating valuable healthcare services, the way new technologies can be employed and used as tools to favor co-production in healthcare Moreover, how co-creation processes can happen through digital technologies and how the PLS logic and co-creation can be used as perspective, theoretical framework and method to realize digital healthcare services were explored.

The main findings suggest how digital technologies find favorable application in co-creating valuable healthcare services. They support patients and caregivers’ engagement is the whole service process and therefore the outcomes in the healthcare offer are deemed as qualitative and satisfactory. In particular, great value potential has emerged from co-creation in online healthcare platform and courses and using digital innovations, such as Artificial Intelligence (AI) and blockchain technologies. This study contributes to theoretical knowledge building in both digitalization and value co-creation research in the healthcare field, with the distinctive feature of studying the underexplored intersection between these themes.

References

1. McColl-Kennedy, J.R., Vargo, S.L., Dagger, T.S., Sweeney, J.C., Kasteren, Y.V. (2012). Health care custumer value co-creation practice styles. Journal of Service Research, 15(4), 370-389.

2. Kim, J. (2019). Custumers’ value co-creation with healthcare service network partners. Journal of Service Theory and Practice, 29(3), 309-328.

3. Munoz, S.A. (2013). Co-producing care services in rural areas. Journal of Integrated Care, 21(5), 276-287.

4. Thorne, K., Andersson-Gare, B., Hult, H., Abrandt-Dahlgren, M. (2017). Co-producing interprofessional round work: designing spaces for patient partnership. Quality Management in Health Care, 26(2), 70-82.

5. Spanò, R., Di Paola, N., Bova, M., Barbarino, A. (2018). Value co-creation in healthcare: evidence from innovative therapeutic alternatives for hereditary angioedema. BMC Health Service Research, 18(1), 571.

6. McKee, M., van Schalkwyk, M.C.I., Stuckler, D. (2019). The second information revolution: digitalization brings opportunities and concerns for public health. European Journal of Public Health, 29(3), 3-6.

7. Odone, A., Buttigieg, S., Ricciardi, W., Azzopardi-Muscat, N., Staines, A. (2019). Public health digitalization in Europe. EUPHA vision, action and role in digital public health. European Journal of Public Health, 29(3), 28-35

8. Massaro, M., Dumay, J., Guthrie, J. (2016). On the shoulders of giants: undertaking a structured literature review in accounting. Accounting, Auditing & Accountability Journal, 29(5), 767-801.

9. Page, M.J., McKenzie, J. E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., Brennan, S.E., Chou, R., Glanville, J., Grimshaw, J.M., Hrobjartsson, A., Lalu, M.M, Li, T., Loder, E.W., Mayo-Wilson, E., McDonald, S., McGuinness, L.A., Stewart, L.A., Thomas, J., Tricco, A.C., Welch, V.A., Whiting, P., Moher, D. (2021). The PRISMA statement: un updated guideline for reporting systematic reviews. British Medical Journal, 372(71).

Achieving the Sustainable Development Goals (SDGs) by 2030 requires a paradigm shift in the way governments respond to growing development challenges. The role of government in the digital age and its interactions with society and the business sector needs to be reconsidered. Digital government refers to the overall digital policies and structures of government that are designed to respond to the needs and concerns of its citizens. The goal of digital government is to better meet the needs of citizens by improving the management and organization of government services through the use of available tools. Digital government actions offer the opportunity to accelerate the achievement of the SDGs while ensuring that no one is left behind. In this context, digital transformation is crucial because it enables governments to leverage data and technology to create more efficient, transparent, and responsive services. Through the implementation of digital platforms, governments can enhance public service delivery, making it more accessible and user-friendly. For instance, digital government solutions can streamline bureaucratic processes, reduce corruption, and increase transparency, thus fostering trust between the government and its citizens. Additionally, digital tools can facilitate better data collection and analysis, enabling evidence-based policy-making and targeted interventions. Moreover, digital transformation can support sustainable economic growth by promoting digital inclusion and bridging the digital divide. By providing digital skills training and expanding access to digital infrastructure, governments can empower marginalized communities and foster greater social and economic participation. This inclusivity is essential for ensuring that the benefits of digital transformation are equitably distributed, thereby supporting the overarching goal of leaving no one behind.

Thus, the primary goal of this paper is to conduct a thorough and in-depth analysis of digital government transformation research conducted over the past twenty years and its relationship to the SDGs, capturing economic aspects of sustainable development. The specific objectives are to examine descriptive indicators, to identify the most relevant countries, journals, and authors, and to analyse research evolution over time. In the bibliometric analysis, the Scopus database will be considered, as it contains all necessary information regarding publications about the selected SDG targets and digital government transformation. Therefore, several established and innovative bibliometric approaches are applied (e.g., descriptive overview, scientific production, network analysis), and several software tools are utilized (e.g., Python, Biblioshiny, VOSviewer). The findings demonstrate the progress of research in this area during the last two decades, particularly in the years following the COVID-19 pandemic. Digital government transformation is viewed as an important instrument for achieving selected SDGs by implementing the concepts of inclusiveness, accountability, and effectiveness across all sectors, including public institutions, the corporate sector, and civil society.

The purpose of this paper is to examine collaborative public sector innovation (PSI) (Cinar et al., 2022; Hartley et al., 2013; Sørensen and Torfing, 2017) as a supporting mechanism for public sector accrual accounting reforms. Several theoretical studies (e.g., Lüder, 1992; Godfrey et al., 2001; Preston et al., 1992) emphasize the important roles of different actors and their interactions during the development of management accounting systems. Other, more recent studies explore the changing boundaries of the public sector, shifting from public administration as oriented by New Public Management (NPM) to public governance – a concept describing the interrelationships of multiple, diverse organizations engaged in the development of public policies and the provision of public services (Broadbent and Guthrie, 2008; Grossi and Steccolini, 2014; Klijn, 2012; Steccolini, 2019). These developments, combined with technological and digital advancements, influence all aspects of public sector accounting, which lies at the intersection of the different types of public governance: network governance (focusing on the creation of inter-organizational networks), collaborative governance (focusing on citizen involvement and participation), and digital governance (focusing on digital solutions and technologies that change the way that the public sector works) (Grossi and Argento, 2022).

The transition from cash to accrual accounting constitutes an innovation in the public sector (Caperchione et al., 2019), not only because of the significant changes it entails in terms of accounting and financial practices but also due to the investments required in information technology (IT) systems and digital transformations to make the transition feasible. Building up reliable management information systems for accounting and auditing is key to the development of a robust accrual accounting system (Bekiaris and Markogiannopoulou, 2023). Overall, digital technology can improve the quality of democracy in terms of transparency, accountability, and responsiveness (Council of Europe, 2021).

Governments purchase new software, modernize their systems, and redesign their interfaces to increase operational efficiency and reduce costs (PwC, 2020). In many cases, public-sector accounting reforms involve multiple stakeholders, such as different government organizations and ministries, international organizations, big accounting firms, enterprise resource planning systems providers, universities, and other educational organizations (Argento et al., 2018; Bekiaris and Markogiannopoulou, 2023; Christensen et al., 2019). Furthermore, the reform processes are usually long, demanding oversight and coordination of the different stakeholders.

We conduct a cross-country study exploring collaborative PSI in the context of public sector accounting reforms of four central governments: Cyprus, Greece, Italy, and Malta. The rationale behind this selection is that all four countries are currently engaged in significant reforms in their public financial management systems, transitioning to accrual accounting and investing in modern IT systems. Furthermore, they all have low accounting and IT maturities (thus, similar starting points), which are expected to improve by 2025 (PwC, 2020). Following Cinar et al. (2022), we examine the reforms across the four innovation stages of initiation, design, implementation, and diffusion, aiming to identify i) the roles and contributions of the different actors of collaboration at each stage, ii) the nature of collaboration and the governance of collaborative networks, and iii) the most successful constructs of collaboration in terms of the timing of actors’ involvement and the adherence to the agreed timeframe of the reforms.

To our knowledge, ours is the first study exploring collaborative PSI as a supporting mechanism for public-sector accounting reforms. Investigating this aspect of the reform processes for a cross-national setting can provide useful insights into the contextualities of collaborative PSI, the ways and timing of the collaborators’ involvement, and the successful collaborative governance arrangements.