This Friday, Healthwatch Essex are celebrating #Red4Research 2024, an annual awareness day that champions the positive impact of research in the health, care, and voluntary sectors. In recognition of #Red4Research, we will be publishing a series of blog posts that showcase our most recent research project – Supporting Partnerships.
This post is the first of three blog posts where Research Officer Beth provides an overview of her project exploring hospital staffs’ experiences of participatory methods, such as co-production, within a Foundation Trust (FT). This first blog outlines her study and findings.
Participatory methods are being increasingly used in NHS FTs to enhance the inclusion of patient and public voices when designing and improving services. Co-production is one example of a participatory method which foregrounds patients’ lived experience and actively involves them in decision-making processes. In literature, emphasis is often placed on patients’ involvement in co-production. Less attention is directed to hospital staffs’ perspectives. We wanted to address this gap, exploring what hospital staff understood about service improvement approaches and how FTs can encourage greater staff involvement in co-production.
The study adopted a qualitative approach and we used two methodologies to collect our data. This included 6 semi-structured one-to-one interviews with staff members across a variety of divisions and bands. We also observed 8 meetings, comprised of staff from a range of clinical and transformation roles. The interview transcripts and field notes collected from our observations were then analysed using the principles of thematic analysis. Our findings generated 8 themes, which are briefly outlined below.
Understanding Co-production
Most staff members demonstrated an understanding of co-production and provided a range of definitions of the term. They recognised that the term itself had been increasingly used over the past few years but felt that the activities which underpin co-production were already practiced within the FT. Staff also distinguished between two types of co-production, informal and formal. Further insight into these two types will be available in my second blog, ‘Informal and Formal Co-production’.
The Value of Patient Input
All interviewees asserted that including patients in discussions and collaborative activities around service design and improvement was a vital aspect of co-production. Staff recognised that attitudes towards patient inclusion had improved over the past few years. Nonetheless, several staff members described instances where patients continued to be overlooked or included too late in the service improvement process.
Duality of Emotions
Our participants highlighted both positive and negative emotions surrounding their involvement in different aspects of the co-production process. Some staff emphasised their enjoyment working with patients to improve services. Staff who did not work as closely with patients reflected on the challenges and frustrations they faced when working with staff and trying to encourage them to get involved in co-production projects.
Hierarchy and Culture
Several participants reflected on their positioning within the FT’s organisational structure and how this impacted on their involvement in co-production initiatives. Staff explained that healthcare organisations tend to operate as top-down structures, whereby information is fed down through the system like a chain. They shared how this make-up meant that junior members of staff were less likely to challenge their more senior colleagues and subsequently had little influence in decision-making processes.
Communication
Our participants felt that communication was a vital part of the effective collaboration needed for co-production. Our observations of the patient experience meetings highlighted that communication between staff and patients was a repeated concern across the Trust. Staff highlighted instances where communication ‘fell short of what they would expect’ and raised several strategies which could help to improve their communication.
Working on Different Temporalities
Our research also identified that staff in FTs work on different temporalities. The staff members that we interviewed suggested that frontline staff operated, primarily, with a focus on their day-to-day priorities. They contrasted this with staff in senior management positions, who they felt worked in a more future oriented way. Participants felt that the divide in priorities influenced staffs’ willingness to get involved in co-production.
Factors Influencing the Outcome of Co-production
There were several factors highlighted by our interviewees that they felt both encouraged and inhibited their involvement in co-production. The main barriers included clinical and operational pressures, time, resistance to co-production and staffs’ understanding of what a co-production project entails. Staff also indicated how legislative changes can influence how they develop a co-production project, and what the outcome of the project may be.
Future Learning
In our final theme, participants reflected on instances where they had made mistakes or could have performed better when engaging in activities integral to co-production. Staff discussed the importance of learning from their mistakes and cascading this learning across the Trust. Participants also suggested holding reflection sessions at the end of each project to encourage staff to think about what went well and what they could do to improve.
This blog was the first of three posts where I am providing an overview of my project, in recognition of #Red4Research 2024. This blog outlined the varied themes drawn from my research. These themes help to generate a holistic understanding of staffs’ views and understandings of co-production and the barriers and facilitators that influence staffs’ involvement in co-production projects. In my upcoming posts, I am going to discuss the distinction between informal and formal co-production. In my final blog, I will provide a set of recommendations for FTs and organisations that work with patients to create change, on how they can encourage their staff to engage in service improvement projects.
Beth Pittuck, Research Officer
