Exploring hospital staffs’ experiences of participatory service improvement methods

Healthwatch Essex has released a new report that explores hospital staffs’ views and experiences of co-production in a Foundation Trust.

NHS Foundation Trusts (FTs) are increasingly using participatory methods to encourage collaborative partnerships between patients, carers, families, and members of the public to help design service improvements. Participatory methods are founded on the notion that individuals with lived experience of a service are often the best people to work with when making decisions about how to improve them. Co-production is one example of a participatory method which foregrounds patients’ lived experience and actively involves them in decision-making processes. Whilst existing research often emphasises how important it is for patients to get involved in participatory approaches, less attention is directed to hospital staffs’ perspectives on co-production and how they can be encouraged to take part.

Healthwatch Essex’s new report – Supporting Partnerships – addresses this gap by capturing hospital staffs’ perspectives and experiences of participatory service improvement approaches like co-production, across a FT. It draws on in-depth qualitative interviews to explore hospital staffs’ understandings of co-production, the barriers that may restrict their involvement, and their views on how staff can be better supported to get involved in service improvement projects. We also observed a variety of professional meetings to see how staff were included in the design of co-production projects in real time. Our report highlights several key themes that inform hospital staffs’ perceptions and experiences of co-production.

During our interviews, staff shared that co-production had become increasingly prevalent across their FT in recent years. They acknowledged a shift in the mindset and knowledge of co-production amongst staff, with a greater emphasis placed on the value of working with patients to improve services. When asked to define co-production, our participants shared that they understood what co-production meant. However, they all defined the term in different ways. Some staff emphasised that collaboration between service users and service providers was a vital aspect of co-production. Others suggested that co-production projects needed to have a tangible outcome to be successful.

Another key theme to emerge from our study highlighted that hospital staff work on different timelines. Participants who held strategic positions contrasted the priorities of frontline staff with those working in transformational roles. They suggested that frontline staff are obliged to tackle immediate priorities, whilst the work of staff in transformation roles is more future-oriented. Strategic staff therefore felt this influenced frontline staffs’ willingness to be involved in service improvement projects. They assumed that frontline staff, including matrons and nurses, were too busy in their daily roles to take part in co-production. Staff working in service improvement roles, on the other hand, had the time to invest in co-production and saw the future benefits of doing so.

All our participants emphasised the need for further learning within their FT regarding co-production. They reflected on the importance of learning from mistakes, and cascading this learning between teams, across divisions and linking with other centres to support staff to get involved in co-production. Participants also provided valuable reflections on how co-production could be better understood within the Trust. They suggested several ways in which staff could be supported by their managers to develop successful co-production projects. Some staff suggested formalised approaches, such as developing a co-production template or a bite size training course that staff could attend. Others explained that co-production training should not be one-size-fits-all, but tailored to staffs’ specific roles:

Having training put on specific to roles is always really useful because I think when things are really generic, people kind of go, ‘oh that doesn’t affect me. That’s not part of my role’.

Our report contains several recommendations for how FTs can better support hospital staff to engage in co-production. These recommendations include clearly informing staff about the benefits of getting involved in co-production and encouraging managers and senior staff to provide additional support to ensure that all staff feel as though they have a voice in decision-making. They also highlight the need for healthcare professionals to recognise and respect the expertise patients gain by accessing services, and what they can therefore bring to service improvement projects.

Healthwatch Essex’s Research Manager Dr Kate Mahoney said:

‘This report makes a significant contribution to our understanding of hospital staffs’ views and experiences taking part in co-production. Whilst health and care services routinely promote the value of co-production, less time is taken to ensure that staff understand what the process entails and why it is valuable to engage with patients, service users and the public when developing improvements. By interviewing staff in strategic roles and conducting meeting observations, we have demonstrated how organisational hierarchies, and perceptions of colleagues in different divisions, inform how staff are brought into co-production projects and how their involvement could be improved. We hope that our recommendations provide a blueprint for the successful inclusion of staff from a range of roles and divisions in co-production projects across FTs in Essex and beyond’.

This project was led by Research Officer Bethany Pittuck and kindly supported by our Research Ambassadors Sangeeta Sooriah, Jayne Taylor, and Rae Spencer.

You can find our report here. For more information about this research project, please contact Bethany Pittuck at [email protected].