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. This blog is the second of Research Officer Beth Pittuck’s three-part blog series which provides an overview of her recent project on participatory methods in Foundation Trusts (FTs). In this blog, Beth discusses the different ways in which staff engage in co-production in health care settings and beyond.
In the initial stages of my project, I spent time looking at the existing literature surrounding participatory methods and service improvement in healthcare. It was evident from my search that the term co-production is often defined in multiple ways and identified through a variety of activities (Masterson et al., 2022). Previous research also demonstrated that healthcare professionals engaged in co-production in different ways.
Jones et al. (2019) found that staff distinguished between two types of co-production, informal and formal engagement with patients.
Informal co-production:
– Staff defined informal engagement as the communication they had with patients at their beside whilst enacting their care. They described how communicating and building relationships with patients in this way meant that they may unintentionally receive feedback which could be used to improve patient care.
Formal co-production:
– Formal engagement on the other hand, involved activities which were developed by the organisation with the aim of embedding patients’ experiences into service improvements. These formal activities included surveys that record patients feedback and/or workshops that foster collaborative discussions between staff and patients to understand how their services can be improved.
This distinction between informal and formal engagement with patients was also described by several of our interviewees. Similarly to the findings outlined by Jones et al. (2019), participants defined informal co-production as their direct engagement with patients on the ward. Conversely, they characterised formal co-production as a series of more structured processes, which included responding to patient complaints or embarking on a service improvement project.
One participant, who works closely with patients in their role, outlined an example of informal co-production, where a conversation with a patient at their bedside led to subsequent improvements in their care:
They were sitting there chatting to them for a little while […] and they say. ‘Oh yeah […] this window is ever so draughty […] screws around the window must be falling out’ […] and you know they got estates in to fix the window.
This participant felt that their informal interactions with patients were more personal and emotionally engaging, as opposed to being part of the ‘bigger stuff’. Participants suggested that the larger, more formalised, projects were often time consuming, and some staff outlined how they were not always able to see the tangible outcomes that resulted from being part of a wider service improvement initiative.
Staff also differentiated between informal and formal interactions with patients in our observations. In the patient experience meetings, informal interactions with patients included complaints being addressed on the ward. Formalised approaches, however, were described by patient complaints being passed through the organisation, resulting in the creation of projects working with these patients to design improvements:
Complaint from patient who had spent 26 hours within the corridor […] Had a complaint meeting and from this began a new initiative- an emergency department focus group, using the family from the complaint meeting to help run it. Family members wanted to be involved in their standards of care, let them have access to talk to staff, to other patients and get some ongoing feedback on care in the department.
Other staff members that we interviewed shared not having previously heard about the term informal co-production. Participants did not acknowledge that their one-on-one interactions with patients could be categorised as a form of co-production and therefore influence the design and development of new services. Subsequently, staff members in FTs, and in organisations where staff regularly interact with service users, may be engaging in co-production without realising it. It’s important that managers identify and outline to staff both the informal and formal opportunities they have to engage with patients and how they can utilise their feedback to improve services.
Beth Pittuck, Research Officer
Reference List:
Masterson, D., et al. (2022) ‘Mapping definitions of co-production and co-design in health and social care: A systematic scoping review providing lessons for the future’. Health Expectations: An International Journal of Public Participation in Healthcare and Health Policy, 25(3), 902–913.
Jones, J., et al. (2019). ‘Reflection in practice: How can patient experience feedback trigger staff reflection in hospital acute care settings?’ Health Expectations, 23(2), 394-404.