Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration.

Gillian Mulvale,Glenn Robert,Alicia Powell,Victoria J Palmer,Melissa Girling,Michael Larkin,Ashleigh Miatello,Sandra Moll,Chelsea Gable

doi:10.1111/hex.12864

Abstract

BackgroundCodesign has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective codesign.ObjectiveTo explore citizens’ involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements.DesignA modified case study approach. Pattern matching was used to compare reported challenges with a priori theoretical propositions.Setting and participantsA two‐day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations.Intervention studiedEight case studies working with vulnerable and disadvantaged populations in three countries.ResultsWe identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. In response, a focus on relationships and flexibility is essential. We encourage codesign projects to enact a set of principles or heuristics rather than following pre‐specified steps. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations.Discussion and conclusionsCodesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when working with services for vulnerable populations. The need for flexibility and responsiveness to service user needs may challenge expectations about timelines and outcomes. User‐centred evaluations of codesigned public services are needed.

Highlights

Advocates suggest that empowering service users and providers to work together can be transformative in creating value in health and other public services, and that service users and communities should play a larger role in shaping decisions and delivery outcomes
Extra attention to transparency during recruitment can ensure participants clearly understand what is expected, and on-going communication from practitioners can promote trust and model the open attitude and willingness to learn that is needed for effective codesign
Lessons from the eight cases examined at our international symposium suggest that challenges in engagement and power differentials require particular attention when codesigning health and other public services for vulnerable populations

Summary

Introduction

Governments around the world face increasing economic and political pressure to move towards “coproduction” of public services in health care. The coproduction concept first appeared in the public administration, civil rights and social care literatures in the United States in the 1970s5 and sought to enhance the importance of citizen participation, initially in municipal services such as policing. The concept rests on an understanding that service users have assets that can help to improve those services rather than being passive recipients of services designed and delivered by someone else.1,6 there is no universal definition, coproduction has been defined as the “... involvement of public service users in the design, management, delivery and/or evaluation of public services”.7 A variety of seemingly interrelated terms drawn from different disciplines (eg, cocreation and codesign) have been used which align with principles found in the citizen engagement literature. Advocates suggest that empowering service users and providers to work together can be transformative in creating value in health and other public services, and that service users and communities should play a larger role in shaping decisions and delivery outcomes. Early work on coproduction sought to acknowledge and enhance the value created by citizens through their engagement with public services.. Work on coproduction sought to acknowledge and enhance the value created by citizens through their engagement with public services.. Objective: To explore citizens’ involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements. Setting and participants: A two-day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations. Results: We identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations. Discussion and conclusions: Codesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when

Objectives

Discussion

Conclusion