— Discussion and Analysis
Ideas of and issues in co-design and co-production including overcoming barriers.
Summary
Done with care, coproduction research remains the one way to build mental health services that fit real lives. The reward is real too. In doing it, we take the slow road because the quick one doesn’t get us to where we want to be. The people we work with have waited long enough to be heard. The least we owe them is the patience to do it right, and the courage to act on what they tell us.
Abstract
The role and position of users in health and welfare has recently changed to become more active in co-production of care. When more co-production is preferred, challenges related to power need to be considered. In this paper, power is seen as the possibility to influence. The paper focuses on power in co-produced improvement work by introducing a reflection model based on Franzén’s power triangle, further developed from improvement coaches’ perceptions.
First, empirical data from interviews with improvement coaches were analyzed and then the theoretical model was created. Twelve coaches were included in the interviews, all of them with experience of co-production and improvement work within a region in southeast Sweden. By combining the empirical results with the power triangle, a reflection model concerning power dimensions was developed. The results showed the necessity of reflection regarding several power-related factors. Resources were found to be important and depending on contextual settings. Attitudes and perceptions among personnel and users were also vital. To accomplish co-production, the power dimension must be considered, and the power triangle acknowledges different power dimensions and how they affect each other. The model has a systematic character and allows adjustments to the power dimensions within any other context. It can inspire and be used by improvers working with co-production to promote deeper professional and organizational reflection and thereby contribute to new insights on how to balance power in co-producing health and welfare services.
Abstract
Inpatient services are frequently constructed as a topic of concern in research and policy, often in response to service-users’ reports that wards are unsafe, boring, and lacking in amenities. Our research shows that service-users, as well as staff and families, experience inpatient mental health spaces as impermeable, separate and stigmatising, and sometimes uncomfortable, chaotic and unsafe. Experience-based co-design is a participatory action research approach to service development, which has been used extensively in physical healthcare, but is only recently being used to improve mental health services.
This chapter will draw on EBCD projects from two NHS Mental Health Trusts. These projects brought together service-users, staff and families, alongside Trust management and community staff to co-design improvements to the inpatient wards. Sometimes these improvements were as simple as introducing soft furnishings and better signage, sometimes they were more complex interventions in the culture of the wards, however all the improvements, and perhaps more importantly, the improvement process, allowed service-users and families to feel more welcomed and comforted, and helped staff working in difficult circumstances feel more supported.
Abstract
Little is known about how co-creation and co-production is understood, implemented, and sustained within health and social care in Scotland. Given the normative centrality of co-production and co-creation for improving public services, it is timely to investigate the extent to which these approaches are understood, operationalised and sustained as part of the integration of health and social care based on the occupational experiences of those tasked with leading and undertaking integration.
An Audit Scotland (2018) report and the Ministerial Steering Group (MSG) report (2019) (Scottish Government, 2019) both called for quicker progress to be made on integration and strongly encouraged innovative approaches for going so (such as adopting co-productive approaches). In this light, the research also links to the broader theme of public sector governance and reform in Scotland (i.e. how the approaches to public sector reform present barriers or facilitators to the adoption and sustainability of co-production and co-creation) based on the perspectives of those leading integration in health and social care in health and social care areas and within relevant national agencies.
Summary
In this co-presented keynote, two researchers share their personal and professional reflections on the shifting sands of co-production in action. The discussion will centre around contrasting perspectives of the collaborative process, service user and service provider stereotypes within academia, how leaning into uncertainty is an essential component of co-production, and who really is the specialist when both parties consider themselves experts (spoiler alert: it’s both).
To illustrate the reality of co-production, the speakers will draw on the current initiative Piki, a co-produced mental health pilot for 18-25 year olds which is being evaluated by a team at the University of Otago. The speakers are part of this evaluation team and are first-time co-producers who have both at different stages been left perplexed by the process. They thought they couldn’t be more different, but working together on Piki, discovered hidden commonalities amongst the shifting sands. Come find out how and why.