Abstract
The role and position of users in health and welfare has recently changed to become more active in co-production of care. When more co-production is preferred, challenges related to power need to be considered. In this paper, power is seen as the possibility to influence. The paper focuses on power in co-produced improvement work by introducing a reflection model based on Franzén’s power triangle, further developed from improvement coaches’ perceptions. First, empirical data from interviews with improvement coaches were analyzed and then the theoretical model was created. Twelve coaches were included in the interviews, all of them with experience of co-production and improvement work within a region in southeast Sweden. By combining the empirical results with the power triangle, a reflection model concerning power dimensions was developed. The results showed the necessity of reflection regarding several power-related factors. Resources were found to be important and depending on contextual settings. Attitudes and perceptions among personnel and users were also vital. To accomplish co-production, the power dimension must be considered, and the power triangle acknowledges different power dimensions and how they affect each other. The model has a systematic character and allows adjustments to the power dimensions within any other context. It can inspire and be used by improvers working with co-production to promote deeper professional and organizational reflection and thereby contribute to new insights on how to balance power in co-producing health and welfare services.
Highlights
IntroductionThe role and position of users in health and social care have changed significantly
In recent years, the role and position of users in health and social care have changed significantly
This paper introduces a reflection model, making power relationships visual during co-produced improvement work led by improvement coaches in complex care situations
Summary
The role and position of users in health and social care have changed significantly. Instead of being passive recipients of care, users are active co-producers of health and welfare services (Bovaird, 2007; Karlsson and Börjesson, 2011; Norman, 2015; The National Board of Health and Welfare, 2011). The idea behind this is that co-production will lead to effective change and create value (Boyle and Harris, 2009). The underlying power imbalance needs to be addressed and challenged to create an equal and reciprocal relationship between professionals and users (Thor et al, 2004; UCL Public Engagement Blog, 2020; Vindrola-Padros et al, 2019). This paper introduces a reflection model, making power relationships visual during co-produced improvement work led by improvement coaches in complex care situations
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