Co-production: a single-page guide, Catherine Wilton, Director Coalition for Collaborative Care
Over the last few months, our co-production group have been working with others to produce a simple guide to help organisations embed co-production into their day-to-day working. The ‘Co-production Model’ describes the values and steps needed to ensure the voices of people with lived experience are included in decision-making, from commissioning to co-design and co-delivery.
As one of our three Cs, co-production is an essential part of achieving a better deal for people with long-term conditions. Co-production involves sharing power and recognising that people with `lived experience’ have a hugely important contribution to make in decisions about every aspect of healthcare and in creating the conditions for better health and wellbeing in communities.
The model is available now for everyone to access and we look forward to hearing your stories about how it is helping you to embed co-production into the work you do. Further materials and resources will soon be available, so watch this space. Click here to download and print the model.
Why We Need It, Fiona Carey, C4CC Co-chair
Co-production – the best, if most elusive, version of ‘people involvement’ – is gaining ground as an idea. So it’s great news that C4CC has produced this Co-production Model. Even better, is that it’s on a single A4 page and that it is a model, too, of simplicity, sense and plain English. In a meagre 300-or-so words* it:
- explains what co-production is,
- describes five ‘values and behaviours’ that need to be present in an organisation to make co-production possible,
- offers seven steps to implementation.
It has already been received with huge enthusiasm in several places where it’s been presented, which seems to reflect the reality of where we are with co-production. That is, that the argument ‘for’ has largely been won, but that people aren’t sure how to do it, or where to start.
The rightness of doing co-production
In fact, there is a growing acknowledgement that co-production is simply the right thing to do, both for people who use services and for their families. But it also makes operational sense. This is true for lots of reasons, but here are the three biggies (and some slogans!).
First, it’s better for patients to be actively involved in their care. People with long-term conditions are probably best-placed to know what services they want and need, and can contribute massively to their proper design and planning.
Slogan alert #1: Plan with us, not for us.
Second, you get better outcomes. Individually, patients will understand more, ‘comply’ more, and be healthier. Where systems and processes are designed with users, you’ll get to the right solution quicker, and with fewer iterations. Then once in place, the systems and services will work better, faster, and with fewer revisions.
Slogan alert #2: We know things you don’t know; we see things you don’t see.
Slogan alert #3: As ‘expert advisory groups’ go, if people who use services didn’t exist, you’d have to invent us.
Third, it’s better for health care professionals. Usually a bit scared and sceptical at first, the experience of the C4CC Co-production group, and hundreds of other ‘users’ working with professionals around the country, is that once professionals have co-produced properly, they are bitten by the bug, and become serious advocates of the methodology. Pathways work better, systems work, and job satisfaction goes up.
Slogan alert #4: Co-production helps us to prioritise and that’s better for us all.
How to do it and where to start
The interest shown in discussions about co-production, and early reactions to the Co-production Model, suggest that there is a huge number of professionals out there who really want to work using co-production, but aren’t sure how to go about it. (Although the oft-cited difficulty in ‘finding patients’, frankly seems a bit weird to me…)
Co-production is the easiest thing in the world to do badly, and really hard to get right. But the basic principles aren’t difficult, and the Co-production Model suggests a methodology that is simple and straightforward.
It’s a great place to start. And it’ll be followed soon with some case studies that will help further to address some of the practicalities.
The chances are you won’t get it right the first time, but don’t let that stop you!
Slogan alert #4: Don’t wait until the plan is perfect. Make a start, and fix it as you go along.
* Beaten into a cocked hat by the Gettysburg address, one of the finest examples of concise writing ever produced, at just 272 words. We did try.
How we created it, Shahana Ramsden, Senior Co-production Lead, C4CC
Before the first co-production model meeting I was influenced by two concepts extracted from different authors. The first was Susan Cain’s book, “Quiet; The power of introverts in a world that can´t stop talking” and the second was Time to Think: Listening to Ignite the Human Mind by Nancy Kline. Both authors remind us of the importance of creating an open and safe space in meetings so that every perspective is heard and valued.
We acknowledged that people have different learning and thinking styles so during our first meeting we gave everyone space to think about what co-production means to them and how to make it happen in reality. Each person had uninterrupted time to share their ideas so instead of a heated debate where people might forget to listen to other perspectives, we highlighted what everyone in the room agreed on. So by the end of the session we had a checklist of the common themes that the whole room believed in.
These discussions created the foundation of the Co-production Model.
We have been completely committed to modelling collaboration and co-production in the way that we have worked. Within the context of our precision-planned project spreadsheets where we set tight deadlines for delivery, we allowed the engagement to be slightly messy, releasing the energy of all our steering group members to carry the draft co-production model with them wherever they went – discussing the content of the model at meetings and events and gathering feedback about what changes were needed. Using this approach, we triggered multiple conversations about co-production in corridors, trains, coffee shops, patient groups, board meetings, team meetings, national conferences and regional events.
Within a three-month period we collectively had conversations about co-production with hundreds of people, including at notable events such as Fiona Carey’s presentation to the Q event and our popular workshops at the C4CC regional events for New Care Models sites.
During the later stages of development of the model, we were pleased to be led by our Young Health Ambassador, Alexandra Burroughes, supported by Justine Thompson, Macmillan Patient and Public Involvement Lead who facilitated a two-way session to ensure that we used plain English and kept communication clear.
As Christine will explain, now that the model is completed, we have started the process of developing practical tools and materials to show how co-production can work in practice in a range of different organisations.
What we plan to do next and how you can be involved, Christine Morgan, Co-production Group, C4CC
One of the great joys of being able to share the Co-production Model as we worked on it was that we had lots of feedback, as Shahana has described, which we used to amend and adjust the model.
People were getting stuck in and having a go even if it wasn’t perfect from day one and, indeed, why would it be? At the Vanguard events in Leeds and London we heard about different projects where people were working together to improve outcomes in health and care in many different organizations. People were very honest and shared their successes and the ‘not so good’ moments too, which often – and perhaps inevitably – provided the most learning.
Just remember FAIL – First Attempt In Learning (attributed to Dr. A P J Abdul Kalam).
Gathering case studies
To enable more people to hear about these projects, we are gathering case studies to give people some direct information about how this approach works, and to encourage more sharing so that many more people will be encouraged to work in a truly co-productive way.
We want to hear from you so that the case study collection can reflect what co-production can look like in commissioning, primary and community care, hospital trusts, Local Authorities, the Voluntary Sector and any other groups you are working with. Please contact Shahana at Shahana.firstname.lastname@example.org to share your experiences.
Capturing hearts and minds
One thread of feedback that was repeated many times was that senior leaders usually backed co-production, as a theory, but largely saw it as something their excellent communications people did. It is certainly true that a lot of expertise for the ‘how do we do this?’ question can come from communications experts but our model is about more than that.
Co-production and wanting – actually needing – to work with patients, carers and the public is a value and ‘must have’ that should underpin everyone’s way of working in any organisation that commits to it. That means the behaviour of the board, governing body or executive team should model co-production within the organisation and outside it. If that can be achieved then every team, department or group within any organisation, or across systems, will know which parts of their work must be done co-productively, and while they might need some advice on the ‘how’ they will own their specific way of working.
So, calling all leaders – how co-productive are you and your organisation? Is co-production embedded in all that you do? Do you feel confident that the patient and carer voice is heard and informs all that you do in service improvement?
Finally we want to be able to help you. Often a good place to start is to hold a mirror up to see where you are currently: ‘How co-productive or collaborative are you in your work?’ To help you to get the best for your organisation and the people it serves, we are planning on developing a diagnostic tool to help you to carry out a self-assessment. This will help you to see what you do well and where you want to make changes to work more co-productively.
As this work progresses, information will be published on the C4CC website – and of course if you already have a self-assessment or diagnostic tool that works well and are willing to share this, please do get in touch.