# What is Co-Production? - Related to #mental_health #Mental_Illness #recovery [[Recovery MOC]] [[Psychiatry]] #psychiatry Co-production in mental health refers to the collaborative approach of involving individuals with lived experience of mental health conditions, their families, and mental health professionals in the design, delivery, and evaluation of mental health services and interventions. It recognizes that those with personal experience of mental health challenges possess valuable insights and expertise that can contribute to the development of more effective and person-centered services. By actively engaging individuals in decision-making processes, co-production aims to empower them, reduce stigma, and improve the overall quality and relevance of mental health care. ==Links - [[Recommended Reading on Co-production]] # What is the difference between Co-production and the usual Design Thinking processes where we conduct focus group interviews with end-users? ==There are some distinct differences between the two, especially in terms of philosophy, power dynamics, and the extent of user involvement.== The underlying philosophy and intention behind co-production are what set it apart from other user-centered design approaches like design thinking. Co-production is not just a method or a set of tools; it's a mindset and a commitment to partnership and power-sharing. Here are some of the philosophical underpinnings of co-production: 1. **Equality and Respect**: There is a fundamental belief that all participants are experts in their own right. Patients or end-users are valued not just for their feedback, but for their lived experiences, knowledge, and expertise. 2. **Empowerment**: Co-production aims to empower users by involving them directly in the creation and decision-making processes, giving them a sense of ownership and control over the services they use. 3. **Collaboration**: The process is inherently collaborative, with an emphasis on building relationships and working together in an open and transparent way. 4. **Democratization**: Co-production seeks to democratize the design process, breaking down traditional hierarchies between professionals and service users. 5. **Sustainability**: By involving users in the design and delivery of services, co-production aims to create more sustainable and effective solutions that are better aligned with user needs. 6. **Transformation**: Co-production has the potential to transform not just services but also the individuals involved, fostering a sense of community, mutual support, and shared purpose. In practice, this means that in a co-production project in mental health care, patients are involved from the very beginning, helping to define the scope of the project, generating ideas, designing prototypes, implementing solutions, and evaluating outcomes. Their input is not limited to predefined stages but is integral throughout the project lifecycle. The intention is to create services that are not just for patients but by patients, ensuring that the end result is truly reflective of their needs, desires, and preferences. This can lead to more personalized, effective, and high-quality mental health care services that are better able to meet the complex needs of those they serve. # Difference between Design Thinking and Co-Production: # **Design Thinking** Design thinking is a problem-solving approach that involves understanding user needs, re-framing problems in human-centric ways, generating ideas, prototyping, and testing. It typically consists of the following stages: 1. **Empathize**: Understand the needs, thoughts, emotions, and motivations of the users. 2. **Define**: Define the core problems identified after compiling information from the empathy stage. 3. **Ideate**: Brainstorm a range of creative solutions to the problem. 4. **Prototype**: Build a representation of one or more of your ideas to show to others. 5. **Test**: Return to your users for feedback. In design thinking, users are often involved as subjects from whom insights and feedback are gathered. They contribute to the understanding of the problem and the solution, but they are not always part of the actual design team or decision-making process. ## Co-Production Co-production, particularly in the context of mental health care, goes beyond user involvement for insights and feedback. It is a partnership where users are active agents in the design, development, and delivery of services. Here are some key aspects: 1. **Equality**: Users are seen as equal partners with professionals in the design process, not just as subjects of research or sources of information. 2. **Shared Power**: There is a deliberate effort to redistribute power, ensuring that user voices are not only heard but have actual influence on the outcomes. 3. **Sustainability**: Co-production aims to build long-term relationships where users continue to play an active role in the ongoing development and evaluation of services. 4. **Resource Integration**: Users contribute their own resources (time, expertise, experience) in a way that is integrated into the service delivery, not just the design phase. 5. **Organizational Change**: Co-production often requires changes in organizational culture and practices to accommodate equal partnership with users. # **Key Differences** - **Role of Users**: In design thinking, users provide the context and validate the solutions. In co-production, they are co-designers and decision-makers throughout the process. - **Scope of Involvement**: Design thinking can involve users to varying degrees, while co-production requires consistent and deep involvement of users at every stage. - **Outcome Ownership**: In design thinking, the outcome ownership might still reside with the organization or designers. In co-production, the ownership is shared with the users. - **Power Dynamics**: Co-production emphasizes power sharing and flattening hierarchies, which is not a primary concern of traditional design thinking processes. In essence, while design thinking can be user-centered, co-production is user-driven. Co-production in mental health care is not just about creating a product or service that meets user needs; it's about transforming the service delivery model to one that is collaboratively developed and managed with the users. It's a more radical approach that seeks to empower users and integrate their lived experience into the very fabric of service design and delivery. --- **Experienced-Based Co-Design (EBCD)** Experience-based Co-design (EBCD) is an approach that involves patients and staff working together to co-design health services and improve the quality of care. It is a form of co-production that specifically focuses on using the experiences of users and providers to shape the design process. **Understanding Co-production in Mental Health Care** 1. **Gather Experiences**: Start by collecting detailed narratives from patients and staff about their experiences with the mental health care system. This can be done through interviews, observations, and group discussions. 2. **Identify Touchpoints**: Analyze the collected narratives to identify key 'touchpoints' – moments that significantly impact the patient's experience. These could be positive or negative and are opportunities for improvement. 3. **Bring People Together**: Organize co-design groups that include both service users and providers. These groups should reflect a range of experiences and perspectives. 4. **Develop Improvement Priorities**: Use the identified touchpoints to determine areas for improvement. Prioritize these based on their impact on the patient experience and the feasibility of implementing changes. 5. **Co-design Solutions**: Work collaboratively in the co-design groups to develop solutions to the identified problems. This should be a creative process that encourages innovative thinking. 6. **Prototype and Test**: Develop prototypes of the solutions and test them in the real-world setting. This iterative process allows for feedback and refinement. 7. **Implement and Evaluate**: Once solutions are refined, implement them more broadly. Evaluate the impact of these changes on patient care and experience, and adjust as necessary. --- # What training/preparation can we get to prepare the team for co-production? ### **Understanding Co-production** 1. **Co-production Principles**: Training should begin with a thorough grounding in the principles of co-production, including equality, diversity, accessibility, and reciprocity. 2. **Value of Lived Experience**: Training on the value of lived experience in mental health care, understanding how personal experiences can inform and improve service design and delivery. 3. **Cultural Competence**: Ensuring that all team members are sensitive to and respectful of cultural differences and the ways these may impact experiences of mental health and care services. # **Practical Skills for Co-production** 1. **Facilitation Skills**: Training team members in facilitation skills to ensure that meetings and workshops are productive, inclusive, and collaborative. 2. **Communication Skills**: Effective communication is key, so training should cover active listening, clear and respectful dialogue, and strategies for ensuring all voices are heard. 3. **Conflict Resolution**: Equip team members with the skills to manage and resolve conflicts constructively, which is essential in a collaborative environment. 4. **Project Management**: Training in project management, including how to use collaborative tools and software, can help keep the co-production process organized and on track. ## **Specific Methodologies** 1. **Design Thinking**: While distinct from co-production, training in design thinking can complement co-production by providing a structured approach to innovation and problem-solving. 2. **Service Design**: Training in service design methodologies can help team members understand how to design services that are user-centered and meet the needs of those with lived experience. 3. **Participatory Research Methods**: Training in participatory research methods can be beneficial for involving service users in the research process that informs service design. ### **Reflective Practice** 1. **Reflective Practice Workshops**: Encouraging team members to reflect on their work, learn from experiences, and adapt their approach is crucial for continuous improvement. 2. **Supervision and Mentoring**: Providing supervision and mentoring can help team members apply co-production principles in their day-to-day work. ### **Tailored Training** 1. **Role-Specific Training**: Depending on their roles, different team members may require specific training. For example, data scientists might need to understand how to incorporate user feedback into product development cycles, while case managers might focus on person-centered planning. 2. **Training for People with Lived Experience**: Specialized training might be needed for people with lived experience to feel fully equipped to participate in co-production, covering topics like governance, research methods, and public speaking. ### **Ongoing Learning** 1. **Continuous Learning**: Co-production is an evolving field, and ongoing learning opportunities should be provided to keep up with new developments and best practices. 2. **Learning from Other Sectors**: Sometimes valuable insights can be gained by looking at how co-production is implemented in other sectors, such as social care or community development. ### **Finding Training Resources** - **Professional Organizations**: Look for training programs offered by professional organizations in mental health, service design, and patient advocacy. - **Academic Institutions**: Universities and research institutions may offer courses or workshops on co-production and related fields. - **Online Courses**: Platforms like Coursera, edX, or FutureLearn may have relevant courses on co-production, collaborative working, or service design. - **Consultants and Specialists**: Consider hiring consultants or specialists who can provide tailored training and workshops based on the specific needs of your team. _Consider that different people with lived experience have different perspectives on illness and recovery, which will conflict with clinicians. Does one Peer speak on behalf of all patients?_ --- # Ladder of Co-Production The "ladder of co-production" is a concept that builds on Arnstein's Ladder of Citizen Participation from 1969, which was originally developed to describe the levels of power citizens hold in planning processes. In the context of co-production, especially in health and social care, a similar ladder is often used to illustrate the varying degrees of involvement and collaboration between service providers and service users. While the specific terms and steps can vary, here's a general outline of the ladder of co-production, adapted to the context of health care services: ### **1. Doing To** At the bottom of the ladder, professionals make decisions and take actions without consulting service users. Care is delivered in a paternalistic manner, where the professional is the expert, and the service user is expected to comply with the care prescribed. ### **2. Doing For** Professionals still lead the process, but there is some consideration for the needs and wants of the service users. There may be some communication about what will be done, but the decision-making power remains with the professionals. ### **3. Doing With** This is the first rung on the ladder where genuine co-production begins. Professionals and service users work together to plan and deliver care. There is a partnership approach, with both parties contributing to the decision-making process. ### **4. Supporting** Professionals take on a supportive role, enabling service users to lead the planning and delivery of their own care. The professional's role is to facilitate access to resources and provide expertise when needed. ### **5. Enabling** Service users are given the tools, power, and responsibility to design and implement their own services, with professionals available to assist but not to lead. This can include peer-led services or user-led organizations. ### **6. Partnering** Service users and professionals are equal partners in the design, delivery, and evaluation of services. This level of the ladder represents a full realization of co-production, with shared power and responsibility. ### **7. User-Led** At the top of the ladder, service users have complete control over the services. They may design, deliver, and evaluate services independently of professionals, or professionals may only be involved as employees or consultants at the discretion of the service users. --- # Can i still create a product/service without co-production? What will be the Pro and Cons? Yes, it is entirely possible to create a product or service without co-production. In fact, many products and services are developed without the direct involvement of users in the design and decision-making process. However, there are both advantages and disadvantages to this approach. ### **Pros of Creating Without Co-production:** 1. **Speed**: Without the need to consult with users at every stage, the development process can be faster. 2. **Control**: The development team has full control over the design and implementation process, which can simplify decision-making. 3. **Cost**: Co-production can be resource-intensive. Skipping this can reduce the immediate costs associated with user engagement activities. 4. **Expertise**: Decisions are made by experts who presumably have a deep understanding of the subject matter, which can lead to high-quality technical outcomes. 5. **Predictability**: The process may be more predictable and easier to manage when it's confined to a smaller, more consistent group of decision-makers. ### **Cons of Creating Without Co-production:** 1. **User Fit**: There is a risk that the final product or service may not meet the actual needs and preferences of the end-users, leading to lower satisfaction and adoption rates. 2. **Innovation**: By not involving users, you might miss out on innovative ideas that could make the product or service more effective or appealing. 3. **Adoption and Buy-in**: Users may be less likely to feel a sense of ownership or buy-in, which can affect the uptake and sustainability of the service. 4. **Relevance**: Without user input, there's a higher chance of the product or service becoming quickly outdated as it may not adapt to changing user needs. 5. **Ethical Considerations**: Especially in sensitive areas like mental health care, not involving users can raise ethical concerns about imposing solutions that affect their lives without their input. ### **When Co-production May Not Be Necessary:** - **Highly Technical Products**: For products that are highly technical with little user interface, such as backend systems, co-production might not add significant value. - **Well-Established Solutions**: If you're creating a product that is well-established and has a long history of user feedback integrated into its design, additional co-production might not be necessary. - **Limited Scope**: For small-scale projects with a limited scope and a very clear brief, co-production might be an excessive investment. ### **When Co-production Is Highly Beneficial:** - **Complex Problems**: When the problem is complex and multifaceted, co-production can bring diverse perspectives that lead to more robust solutions. - **Services with Direct User Interaction**: For services that users will interact with directly, especially in health and social care, co-production can ensure that these services are user-friendly and meet real needs. - **Innovation-Driven Projects**: If the goal is to innovate, co-production can be a source of creative ideas and ensure that innovations are grounded in real-world needs. In summary, while you can create a product or service without co-production, doing so may impact the relevance, acceptance, and effectiveness of the outcome. The decision to involve users should be weighed against the goals, context, and resources available for the project. Co-production is not an all-or-nothing approach; it can be adapted to different levels of user involvement based on the specific circumstances of the project. --- # Are they different ways to involve patients, to understand their needs without going to the co-production? Yes, there are several ways to involve patients and understand their needs without engaging in full co-production. These methods can provide valuable insights into patient experiences and preferences, and they can be adapted to fit various stages of the product or service development process. Here are some common approaches: ### **1. Surveys and Questionnaires** - **Pros**: Can reach a large number of patients quickly and are relatively easy to analyze. - **Cons**: May not capture the depth and nuance of patient experiences. ### **2. Interviews** - **Pros**: Offer deep insights into individual experiences and allow for exploration of complex issues. - **Cons**: Time-consuming and may not be representative if the sample size is small. ### **3. Focus Groups** - **Pros**: Provide a range of perspectives and can stimulate discussion and idea generation. - **Cons**: Dominant personalities can skew the group, and it may not be as in-depth as one-on-one interviews. ### **4. Patient Journeys and Mapping** - **Pros**: Help to understand the patient experience from the patient’s perspective and identify key touchpoints. - **Cons**: Requires careful planning to ensure that the journey map is comprehensive. ### **5. Observation and Shadowing** - **Pros**: Offers real-time insights into patient behavior and interactions with services. - **Cons**: Can be resource-intensive and may not capture the rationale behind behaviors. ### **6. Patient Diaries or Logs** - **Pros**: Provide longitudinal data on patient experiences over time. - **Cons**: Relies on patient commitment and may suffer from selective reporting. ### **7. Usability Testing** - **Pros**: Gives direct feedback on specific aspects of a product or service. - **Cons**: Focuses on interaction with the product rather than the broader patient experience. ### **8. Advisory Panels or Committees** - **Pros**: Can provide ongoing feedback and guidance from a patient perspective. - **Cons**: May not always represent the broader patient population. ### **9. Complaints and Feedback Mechanisms** - **Pros**: Direct insight into what patients feel needs improvement. - **Cons**: Typically highlights negative experiences and may not provide a balanced view. ### **10. Social Listening** - **Pros**: Gathers unsolicited feedback from social media and forums, which can be candid and informative. - **Cons**: May not be representative and can be difficult to analyze systematically. ### **11. Patient Advocacy Groups** - **Pros**: Can articulate collective patient concerns and priorities. - **Cons**: May not capture individual nuances and unique experiences. ### **12. Experience-Based Design** - **Pros**: Focuses on emotional experiences of patients to inform service design. - **Cons**: Less direct in terms of co-designing with patients but uses their input as a key informant. ### **13. Ethnographic Research** - **Pros**: Provides a holistic view of patient experiences in their real-life context. - **Cons**: Can be very time-consuming and requires specialized skills to conduct and analyze. Each of these methods has its strengths and limitations, and they can often be used in combination to provide a more comprehensive understanding of patient needs. The choice of method will depend on factors such as the project's goals, resources, timeline, and the level of detail required. While these approaches do not constitute co-production in its entirety, they are important components of a patient-centered design process. They can inform the development of products and services in a way that aligns with patient needs and expectations, even if patients are not involved in every decision-making step. --- # Why is Co-production necessary? Is it evidence based? Co-production is not necessary for every project or context, but it can offer significant benefits, especially in fields like healthcare, social services, and community development. The necessity and benefits of adopting co-production depend on the goals of the project and the needs of the stakeholders involved. Here are some reasons why co-production can be considered beneficial, along with its evidence base: ### **Reasons for Adopting Co-production** 1. **Improved Outcomes**: Co-production can lead to services and products that are more closely aligned with user needs, which can improve outcomes. For instance, in healthcare, services designed with patient input can result in better health outcomes, higher patient satisfaction, and potentially lower costs due to increased efficiency and reduced need for rework. 2. **Increased Relevance**: Services developed with direct input from users are more likely to be relevant and fit for purpose because they address real-world needs and preferences. 3. **Enhanced Service Uptake**: When users help to design a service, they are more likely to use it and recommend it to others, increasing uptake and adherence. 4. **Innovation**: Co-production can foster innovation by bringing together diverse perspectives, including those of users who may approach problems differently from professionals. 5. **Empowerment**: It empowers users, giving them a voice and a stake in the services they use, which can contribute to greater self-efficacy and engagement. 6. **Building Relationships**: It can build stronger relationships and trust between service providers and users, which is particularly important in sectors like mental health. 7. **Resource Utilization**: Co-production can lead to more efficient use of resources by preventing the development of services that are not needed or wanted by users. ### **Evidence Base** The evidence base for co-production is growing, with research showing positive outcomes in various sectors: - **Healthcare**: Studies in healthcare settings have found that co-production can improve the quality of care, patient satisfaction, and health outcomes. For example, research has shown that patient involvement in care planning can lead to better management of chronic conditions. - **Social Care**: In social care, co-production has been linked to improved service delivery and increased satisfaction among service users. It has also been shown to contribute to community building and social inclusion. - **Public Services**: There is evidence that co-production in public services can lead to more effective and sustainable solutions to community problems. - **Mental Health**: In mental health services, co-production is associated with services that are more responsive to user needs, leading to better recovery outcomes. ### **Challenges and Considerations** While co-production has many potential benefits, it also comes with challenges: - **Resource Intensive**: It can be time-consuming and require more upfront resources than traditional approaches. - **Power Dynamics**: Shifting power dynamics to allow for true co-production can be difficult in hierarchical organizations. - **Representation**: Ensuring that all user groups are adequately represented can be challenging. - **Scaling**: It can be difficult to scale up co-produced solutions while maintaining the level of user involvement. ### **Conclusion** Co-production is not a one-size-fits-all solution, and it is not always necessary or feasible. However, when done well, it can lead to more effective, efficient, and user-centered services. The decision to adopt co-production should be based on a careful consideration of the specific context, goals, and resources of the project, as well as a commitment to the principles of partnership and collaboration. The growing body of evidence supporting the benefits of co-production can guide this decision-making process. --- # The Core Principles of Co-Production ([The Core Principles of Co-Production - NDTi](https://www.ndti.org.uk/projects/the-core-principles-of-co-production)) [Co-production: what it is and how to do it | SCIE](https://www.scie.org.uk/co-production/what-how#introduction) 1. Equality – co-production starts from the idea that no one group or person is more important than any other group or person. So everyone is equal and everyone has assets to bring to the process. 2. Diversity – diversity and inclusion are important values in co-production. This can be challenging but it is important that co-production projects are pro-active about diversity. 3. Accessibility – access needs to be recognised as a fundamental principle of co-production as the process needs to be accessible if everyone is going to take part on an equal basis. Accessibility is about ensuring that everyone has the same opportunity to take part in an activity fully, in the way that suits them best. 4. Reciprocity – ‘reciprocity’ is a key concept in co-production. It has been defined as ensuring that people receive something back for putting something in, and building on people’s desire to feel needed and valued. # Books on Co-Production - [[Co-production in mental health Not just another guide. NDTi]] # How to do it? In order to understand how to implement co-production, we must first understand why we want to use it. To borrow a quote from Victor Frankl, "Those who have a 'why' to live can bear with almost any 'how'." Therefore, we should be guided by our intentions and purpose when deciding to use co-production.