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Created in partnership with Warwick Business School

Defining Public Value and related terms
The notion of public service is well understood in the UK (it needed to be more clearly explained for US audiences by Mark Moore). The term public can be either an adjective or a noun but either way it emphasises people as citizens, society as a whole system, and transparency opposed to privacy.

For those in health, identifying your public(s) is akin to stakeholder analysis (see our 'Further reading and additional resources' section).


adjective 1 of, concerning, or available to the people as a whole. 2 of or involved in the affairs of the community, especially in government or entertainment. 3 done, perceived, or existing in open view. 4 of or provided by the state rather than an independent, commercial company.

noun 1 (the public) treated as sing. or pl. ordinary people in general; the community...

Compact Oxford Dictionary.
Accessed 25th August 2009
ValueThe Cabinet Office report on public value argues that what the public values is only meaningful when linked to questions of what it is willing to give up in exchange for any benefit – establishing public value therefore includes trade-offs. (Kelly et al 2002)Attributing value to something implies that you are willing to give something up in order to obtain the most valued result. Sometimes this can be related to money: for example, if you value higher specifications on a car, you will part with more cash to obtain them. Value can also be related to non-monetary benefits and trade offs - privacy or time. For example, do you value the potential benefit of medical staff being able to treat you according to your medical history wherever you are in the country sufficiently to ‘give up’ your personal data to a national database?

Some authors have proposed that value needs to be more clearly specified For example: value-added for users, value-added for wider groups, social value-added, political value-added and environmental value-added. (Bovaird, 2008)In a similar vein, Benington (forthcoming, 2010) identifies several dimensions of value-added to the public realm, including ‘economic’ ‘social and cultural’ ‘political’ and ‘ecological’ value.

It is likely that in practice, the definition of value – or types of value – may differ depending upon your context, challenge and environment. More important than the precise definition is a process of deliberation in which healthcare staff and organisations engage the public in careful detailed debate about what they most value and what adds most value to the public sphere.
Trade-offA situation in which you balance two opposing situations or qualities.

A situation in which you accept something bad in order to have something good.

Cambridge Dictionaries online Accessed 25th August 2009
In healthcare, resources are finite and choices often need to be made between two or more potentially beneficial options. These often require trade-offs, in which the benefits and costs of each option are considered carefully and are weighed up against each other.

The choice between the options will never be perfect and will often involve sacrificing some desired benefits in order to achieve something else judged to be of higher value. For example, the UK population is currently debating how much liberty and freedom it is willing to sacrifice in order to achieve greater security from terrorist threat.

When using the public value concept, trade-offs and the reality of constrained resources needs to be consistently kept to the forefront of thoughts and questions.
In a Public Value approach, much hinges on deliberation and engagement with the public, so that perspectives and choices are subjected to dialogue, evidence, expertise, and persuasion before reaching decision. However, the refining of preferences must be balanced against the imperative of being responsive to the public’s values. If this is not carefully done, it may be construed to be manipulation.

Deliberation is an approach to decision-making that allows participants to consider relevant information, discuss the issues and options and develop their thinking together before coming to a view..Engagement diagram accessed 25th August 2009 from