There is little evidence of co-production and improvement methodologies being used together. Therefore we spoke to several people who have applied this approach to understand to learn from their practice.
This recording features Catriona Ness and Jackie Doe who were involved in the Perth and Kinross Healthy Communities Collaborative. They discuss how the programme used co-production in combination with improvement methodology.
Lisa Curtice, Programme Director for People Powered Health and Wellbeing Programme at the Health and Social Care Alliance Scotland (the ALLIANCE) speaks about the work of the programme and gives her thoughts on the compatibility of co-production and improvement methodology.
Fiona Garven, Director of the Scottish Community Development Centre, which incorporates the Community Health Exchange (CHEX), and the Scottish Co-Production Network, gives her take on co-production and improvement methodology and the compatibility of the approaches.
Shaun Maher, Improvement Advisor at Health Improvement Scotland offers his views on co-production and improvement methodology and how he has combined the approaches in practice.
Susan Hannah, Head of Improvement Programme – Raising Attainment For All, tells us how co-production has been combined with improvement methodology in education settings.
Kerry Musselbrook, Project Lead for KiP also shares her thoughts about combining co-production and improvement methodology based on her experiences through the project.
We began by wondering if improvement methodology was the ‘best fit’ for this project in the context of person-centred care and co-production?
It seemed that the focus of improvement methodology in health service has been on the point of care eg when a patient and health professional meet/interact and on ‘quick wins’ that the practitioner can deliver ‘tomorrow’ (or next day or day after). It fits within dialogues about ‘leadership at ever level’ – so what you can do (not what you can’t) and practitioners, wherever they are in the system, identifying improvements ad taking the initiative on this.
In this scenario, tests of change are easy/easier for practitioners to trial with one person, and repeat the next and next again day with different patients say. You can do 5 tests in a week! Most emphasis (as highlighted at the National Learning events) has been on changes to the behaviour of practitioners – something as simple as introducing yourself by name, sitting alongside or asking key questions about what matters to someone as part of a reliable procedure.
The other thing that’s been emphasised is patient experience feedback and/or big data/real-time feedback with systems to support this to drive improvement and change forward. But again, this seems to be about measuring something at a point in time, a snapshot.
Applying this to more collective responses/ peer-supported action to providing person-centred care such as setting up carers groups or peer support groups needs a slightly different approach. An appreciation of the following through our experiences of Keeping it Personal might help:
- Intervals (or opportunities for tests of change with feedback as part of a learning loop) are further apart than tests that are tried out with one or two people and then repeated the next day with a few more. The dementia and carers cafes set up by the carers meet once a month.
- The cafes involve a group of people over time. This includes the core group who led in setting up and delivering the cafes in the first place, and new people joining. The group is a bit different at each meeting. As far as ‘tests of change’ go, we might consider we will need to consider some of the same challenges faced in longitudinal research such as continuity of response over time/attrition.
- Also, the cafes involved people ‘doing it for themselves.’ As such, the people at the cafes are both the evaluators and subjects in this (as well as new members who join).
- Perhaps, most significantly for me, is that we are following the ‘same’ peoples’ experiences though – rather than taking a snapshot of an individual’s experience of a service at ‘a snapshot in time’. It is also more holistic, recognising the importance of peoples’ home lives and communities as part of our definition and understanding of person-centred care – as well as being something that you can be involved in providing yourself as a patient/service user or carer. If we are taking a more holistic approach we also need to recognise that peoples’ health and wellbeing can change – because of or quite independent of our improvement or initiative.
- Improvement methodology to my mind, doesn’t exclude more qualitative approaches to gathering data on what impact it has had on peoples’ lives in terms of their health and wellbeing – so this does not seem to be a reason for saying it isn’t appropriate in this respect. Why can’t group members co-produce these indicators, based on the notion that ‘what matters to them’ is likely to be important to any new members joining the group?
These reflections are really about how the improvement model works with our ambitions and philosophy of working in Keeping it Personal. Other co-production projects, may well bring other perspectives?