Confronting barriers to co-creation in aged care settings

Purpose Co-creation is increasingly recognised as an approach to improving aged care services, yet its implementation continues to encounter substantial barriers. Drawing on Social Exchange Theory (SET), this study aims to investigate barriers that hinder co-creation in aged care settings and their impact on co-creation development. Design/methodology/approach Using a qualitative case study approach, data were collected from managers, employees, and clients across two Australian aged care organisations through interviews, focus groups, and observation and participation. Thematic analysis identified two interconnected sets of barriers to co-creation development, namely overt barriers (i.e. consisting resource limitations and structural inadequacy) and covert barriers (i.e. client insecurity, staff burnout, and relational distrust). Findings The study illuminates both the individual impact and the dynamic interplay between overt and covert barriers, thereby deepening the understanding of co-creation processes within aged care organisations. While overt barriers restrict the availability of resources, covert barriers undermine the relational foundation of exchange. By delineating how structural deficiencies and psychological dynamics disrupt reciprocal engagement, this study advances understanding of the barriers to co-creation development. Practical implications For practitioners in the aged care sector, the findings highlight the importance of integrated interventions that address relational and structural aspects simultaneously and maximise services to clients by attending to overt resource needs and covert relational dynamics to develop more interdependent and reciprocal relationships and more successful co-creation outcomes. Originality/value This study enriches Social Exchange Theory by proposing a dual-barrier framework with triadic exchange dynamics, offering a dynamic and empirically grounded explanation of how structural and psychological barriers jointly undermine co-creation in aged care.