Reflections after the Public Value Agreement webinar
The webinar, organized on July 14th as part of the Public Value Alliance, focused on the role that the public value-based public management concept and method can play in reforming the healthcare system and public governance more broadly. This topic is of paramount importance given the challenges we face as a country and society.
Public value as a axis of change in the health system
Robert Mołdach, PhD, presented a starting point. He pointed out that the discussion on health reform is taking place in conditions of weakened community and social capital. He drew on the reflections of Robert Putnam, who demonstrated how the breakdown of social bonds leads to the fragmentation of communities and, consequently, the ineffectiveness of public institutions, and on Mark H. Moore’s concept of public value. The latter, developed in response to the challenges of contemporary administration, is based on the assumption that the role of public leadership is not merely to implement policies but to create sustainable public value.
Moore’s strategic triangle model, encompassing the creation of public value, building legitimacy, and implementing capacity, was presented. It was emphasized that although this approach originated in the American context, its essence—linking the meaning of actions with their real feasibility and social mandate—remains universal. This remains particularly relevant in times of challenges and conflicts.
From concept to practice – tools and approaches
Later in the meeting, Emilia Kowalczyk demonstrated how the strategic triangle can be used as a tool for planning and implementing changes in the healthcare system. Gabriela Moczeniat, PhD, EMBA, discussed the concept of public value accounting as a method for assessing actions in the context of social utility, and Agnieszka Dubiel introduced the concept of the public value chain – from political intention to actual outcomes experienced by citizens.
It was pointed out that viewing public value through the lens of public value allows us to transcend institutional and particularistic logic. It enables a more coherent approach to planning and evaluating reforms – regardless of who currently holds the decision-making role.
How is the public value approach different?
One of the questions concerned what the public value approach brings to the table compared to existing public management methods used in Poland. Emilia Kowalczyk emphasized that the difference lies not only in the tools, but also in the starting point: it’s not about improving the effectiveness of institutions for their own sake, but about giving meaning to public actions by referencing socially recognized values. It is by aligning these values that work on public policies should begin. Agnieszka Dubiel added that this requires a change in current practice and an understanding by public leaders of the public value chain based on real needs, social justice, and fairness.
It was emphasized that public value is neither a tool for optimization nor an economic category. It is a framework that allows us to understand who the system serves, what creates its legitimacy, and what resources are needed to maintain and develop this value.
Voices from Practice: Accountability, Coherence, and Constraints
In an open discussion, superbly moderated by Tomasz Rowiński, PhD, EMBA, Agnieszka Dubiel spoke directly about staff burnout and internal tensions – and how change begins not with another regulation, but with a culture of collaboration. Magdalena Łasińska-Kowara highlighted the lack of distributed responsibility in the healthcare system and the need to think in terms of teams and collective outcomes. Gabriela Moczeniat, PhD, EMBA, emphasized the role of technical and information limitations that hinder the realization of the concept of public value, such as distributed IT systems and lack of interoperability. Łukasz Bruski cited the example of the decision of the deaf parents of a deaf child who opposed the implantation of a hearing-restoring implant for their child, fearing it would exclude the child from their community. He demonstrated that understanding public value requires sensitivity, dialogue, and consideration of individual identities and relationships, not just data and procedures. Dariusz Dziełak brought this discussion to a close by pointing out that a conversation about values must begin before political deadlines and campaigns emerge. This is a task not only for politicians but also for professional, academic, and civic communities.
Leadership Research and the Need to Talk About the Meaning of Reform
In the final section, one participant mentioned her research on the attitudes of leaders in primary care. Robert Mołdach, PhD, suggested that such research should also be extended to political decision-makers – for example, members of the Council of Ministers or the Chancellery of the Prime Minister – to understand their beliefs regarding public value and their willingness to think long-term about reform. The question, however, is whether they would be willing to undergo such research and share its results with the public?
Conclusions and perspectives
The meeting confirmed that the concept of public value can be a starting point for a more sustainable, meaningful, and socially acceptable approach to changes in the healthcare system. Not as an alternative to efficiency, but as its complement – organizing goals, defining meaning, and helping to build a common language in a fragmented system. It also creates conditions for the objective selection of state priorities and ensures effective implementation.
The next meeting of the Agreement for Public Value is planned for the Economic Forum in Karpacz, as part of the Fishbowl session, to which you are cordially invited.
p.s. Special thanks to Iga Lipska MD PhD MPH for inspiring this unique discussion format.