By Alice Hopkinson, Principal Consultant, PPL
Alice Hopkinson wrote an opinion piece based on her experience of coproduction to transform health systems in North West London. It appeared on The MJ's website on 23rd April. Thanks go to the features editor, Jonathan Werran, for his kind permission to reproduce the article here.
A link to the original piece in The MJ can be found here:http://themj.co.uk/Why-patient-engagement-isnt-enough/200424
Why patient engagement isn’t enough
There’s no doubt that patient engagement can be a real driver for change. But all too often the perception of the process is one of tokenism. Of course, much depends on the way that it is conducted and the purpose for which it is undertaken. Yet, even when carried out with the best intentions, patient engagement in itself can’t drive the radical transformational change we need. For this, a new tactic is required.
Co-production has a vital role to play in today’s healthcare system
What’s important for the NHS is creating a sustainable healthcare system with better, more effective outcomes. To this end, co-production (co-designing and co-delivering services with patients, people who use services, carers, and professionals from managers to frontline staff) is extremely important. It means everyone coming to the table as an equal partner to contribute. It involves working together to find solutions, and rebalancing the power in traditionally hierarchical relationships.
In North West London (NWL), patients, people who use services and carers have played a central role in co-designing the Whole Systems Integrated Care (WSIC) programme – with significant, and at times unexpected, impacts as a result. One of the programme partners from a Foundation Trust reflects on this: “…right from the beginning, lay partners were in the room, and that changed the whole tone… The way we thought, the way we worked together.”
Co-production is a learning experience for everyone involved. It’s hard graft and takes time. Few will emerge from the experience thinking in the same way that they started; it’s a very stimulating process that encourages innovation and new ways of looking at challenges.
Supporting evidence-based, alternative outcomes
Co-production is not just rewarding as an experience; it produces better outcomes. Working with lay partners starkly highlights that traditional performance measures are not always fit for purpose and can incentivise a disjointed system. Asking people what they want from their care system and building impact measurement accordingly supports integration and actively discourages organisations working in siloes.
The act of co-production in itself is an effective change mechanism – building strong relationships to facilitate whole system change can be built through the co-design process. It’s through forging this path that people will feel ownership of change and buy into compromise.
In the words of a Local Authority Chief Executive, leading on WSIC in NWL: “lay partners play a key role, acting as our conscience and growing the ambition, so there is the prospect to do something really different here, founded on collaboration.”
It’s not only professionals who grow and develop through taking part in co-production but lay-partners too. Asking a patient to work with professionals is not just giving them a ‘voice’ with no purpose; it’s asking them to understand the issues from a breadth of perspectives. This should be recognised as a personal development opportunity where patients are supported to contribute effectively as ‘lay partners’. An important outcome of co-production is the building of community capacity and the contribution towards stronger networks supporting resilient individuals.
Making the leap…
Facilitating co-production isn’t always easy. It requires investment and commitment from senior leadership. All partners must not only agree and buy into the principles, but also accept that to put them into practice is to welcome a new way of working.
This applies equally to lay partners themselves. As one NWL lay partner explains, “the learning here is a two way thing. I’ve learnt to be more pragmatic and open to compromise and I’ve definitely learnt from observing other group members.”
It helps to have confident role models and champions who can walk the talk in terms of co-production values (both on the side of professionals and lay partners).
When recruiting lay partners one key barrier that commonly crops up is around the need for in-depth systems knowledge to allow patients to effectively challenge professionals. One-to-one briefings can help with this. Some expectation setting on both sides is required, at least in the initial stages, and periods of self-reflection are very helpful in mutually developing ways forward.
In my experience lay partners tend to work best in pairs to deliver the message in different styles and to provide mutual support.
It’s worth it!
Co-production requires both courage and encouragement: but you can draw this from all the partners involved. Be prepared to feel out of your comfort zone; to unlock assets that you didn’t realise existed; and to develop profound trust in your partners. By moving from patient engagement to co-production we can fundamentally reshape care to reflect patient needs and priorities.