— Discussion and Analysis

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.

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.