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This paper aims to identify reverse flows and exchanges that support public service provision. Reverse flow literature has focused on manufacturing based supply chains using the lens of exchange (recovery, reuse, repair and recycle) to gain performance improvement in product flows. Limited research is available to support an understanding of customer-derived reverse exchange (RE) service processes. The authors contribute to the service literature through the development of RE antecedents and derive new and revised definitions with the supporting constructs of RE service processes.

This paper synthesises literature creating a framework of antecedents for RE. Antecedents reflect differences of service flow (level of service inseparability and ‘acting upon’). These antecedents are empirically tested within an illustrative pre-existing UK healthcare case study against the synthesised antecedents and existing RE definitions. Two teams of researchers reviewed the data generated from public service supply chain processes. Definitions of RE were either revised or derived from the empirical data by each team.

The service concept of ‘acting upon’ for inseparable public service supply chain flows provides a basis for examining the existence of reverse flows and exchanges. Revised and new classifications to the RE model are proposed to stimulate contextual performance improvement and innovation in public service provision. Psychological utility is an additional feature to economic, environmental and social utility in public service RE. RE offers practitioners and academics a strategic operational competence to achieve improvement and innovation in public services and further advance this concept.

Extending the literature beyond the manufacturing derived RE concept to develop an understanding of the customer’s role in preserving and co-creating value in RE and flows in public service. New RE antecedents for public services, including the potential of psychological utility, are presented.

This article aims to explore quality improvement (QI) at individual, group and organisational level. It also aims to identify restraining forces using formative evaluation and discuss implications for current UK policy, particularly quality, innovation, productivity and prevention.

Learning events combined with work‐based projects, focusing on individual and group responses are evaluated. A total of 11 multi‐disciplinary groups drawn from NHS England healthcare Trusts (self‐governing operational groups) were sampled. These Trusts have different geographic locations and participants were drawn from primary, secondary and commissioning arms. Mixed methods: questionnaires, observations and reflective accounts were used.

The paper finds that solution versus problem identification causes confusion and influences success. Time for problem solving to achieve QI was absent. Feedback and learning structures are often not in place or inflexible. Limited focus on patient‐centred services may be related to past assumptions regarding organisational design, hence assumptions and models need to be understood and challenged.

The authors revise the Plan, Do, Study, Act (PDSA) model by adding an explicit problem identification step and hence avoiding solution‐focused habits; demonstrating the need for more formative evaluations to inform managers and policy makers about healthcare QI processes.

Although UK‐centric, the quality agenda is a USA and European theme, findings may help those embarking on this journey or those struggling with QI.