Principles Of Co-production Research Articles

Application of Co-Production in Waste Management Through Waste Banks Program in Batu City

The problem of waste in Batu City can threaten tourism sector in this city. The Waste Management System Program is held by the Environment Agency (DLH) Batu City seems to be unable to access waste problems in the upstream sector, particularly household waste from residential settlements. This lack capacity of the program followed up by DLH by organizing a waste bank program through the establishment of the Community Waste Bank (KBS) Kartini Sejati which coordinated around 60 waste banks in Batu City to be involved in waste management.This study aims to explain the involvement of KBS Kartini Sejati in waste management in co-production and the obstacles faced by it. The concept of co-production refer to an alternative concept in the implementation of public services where implementation focuses on the dominant role of the community, while the government or other parties such as the private sector are only facilitators. This research use qualitative method by utilizing data from observations, interviews and documentation. The results of this study indicate that KBS Kartini Sejati in several of its activities which include training in waste management, waste management, and "Sapu Bersih Sanpah Nyemplung Kali" (Saberpungli) have applied the principles of co-production. It is due to those activities have implemented six co-production principles, namely the development of community capacity, mutually beneficial relationships between actors, network development, the government as a facilitator and catalyst, and the community as an important asset in implementing services. However, in its implementation, the waste bank program still has several obstacles such as the limitations of the budgetary resources, the decreasing level of public awareness to be active in waste banks, and the lack of innovation in waste managementKeywords: Co-production; waste management, waste bank

Application of Co-Production in Waste Management Through Waste Banks Program in Batu City

The problem of waste in Batu City can threaten tourism sector in this city. The Waste Management System Program is held by the Environment Agency (DLH) Batu City seems to be unable to access waste problems in the upstream sector, particularly household waste from residential settlements. This lack capacity of the program followed up by DLH by organizing a waste bank program through the establishment of the Community Waste Bank (KBS) Kartini Sejati which coordinated around 60 waste banks in Batu City to be involved in waste management.This study aims to explain the involvement of KBS Kartini Sejati in waste management in co-production and the obstacles faced by it. The concept of co-production refer to an alternative concept in the implementation of public services where implementation focuses on the dominant role of the community, while the government or other parties such as the private sector are only facilitators. This research use qualitative method by utilizing data from observations, interviews and documentation. The results of this study indicate that KBS Kartini Sejati in several of its activities which include training in waste management, waste management, and "Sapu Bersih Sanpah Nyemplung Kali" (Saberpungli) have applied the principles of co-production. It is due to those activities have implemented six co-production principles, namely the development of community capacity, mutually beneficial relationships between actors, network development, the government as a facilitator and catalyst, and the community as an important asset in implementing services. However, in its implementation, the waste bank program still has several obstacles such as the limitations of the budgetary resources, the decreasing level of public awareness to be active in waste banks, and the lack of innovation in waste managementKeywords: Co-production; waste management, waste bank

Application of Co-Production in Waste Management Through Waste Banks Program in Batu City

The problem of waste in Batu City can threaten tourism sector in this city. The Waste Management System Program is held by the Environment Agency (DLH) Batu City seems to be unable to access waste problems in the upstream sector, particularly household waste from residential settlements. This lack capacity of the program followed up by DLH by organizing a waste bank program through the establishment of the Community Waste Bank (KBS) Kartini Sejati which coordinated around 60 waste banks in Batu City to be involved in waste management.This study aims to explain the involvement of KBS Kartini Sejati in waste management in co-production and the obstacles faced by it. The concept of co-production refer to an alternative concept in the implementation of public services where implementation focuses on the dominant role of the community, while the government or other parties such as the private sector are only facilitators. This research use qualitative method by utilizing data from observations, interviews and documentation. The results of this study indicate that KBS Kartini Sejati in several of its activities which include training in waste management, waste management, and "Sapu Bersih Sanpah Nyemplung Kali" (Saberpungli) have applied the principles of co-production. It is due to those activities have implemented six co-production principles, namely the development of community capacity, mutually beneficial relationships between actors, network development, the government as a facilitator and catalyst, and the community as an important asset in implementing services. However, in its implementation, the waste bank program still has several obstacles such as the limitations of the budgetary resources, the decreasing level of public awareness to be active in waste banks, and the lack of innovation in waste managementKeywords: Co-production; waste management, waste bank

Coproducing value within the clinical encounter

Problem: Current medical care often uses a reductionistic biomechanic viewpoint. Although such a viewpoint may be of value in highly specialized care in patients with one disease, such an approach may not be optimal in chronic, elderly patients with signs of vulnaribility. Vulnerability has its core expressions in functional disturbances, co- and multimorbidity, polyfarmacy, low health literacy and social deprivation.These types of patients are regarded as ‘complex’ because there is no simple technical quick fit to deal with the multiple interacting problems.How should these patients be encountered?The solution(s): Integrated care that is attuned to the wishes, needs and possibilities of patients (and their informal care providers) may be a solution. Within that model of integrated care ‘patient-oriented’ consultation types, based on a revised holistic BioPsychoSocial (BPS) design and the principle of coproduction may prevent unwanted care and influences triple aim outomes with more positive experiences and resulting in better health at lower costs.Methodology: From the start of this programme patients were involved in all activities. We opted for an integrated mixed methods approach surpassing tribal domains. From a literature search on patient oriented care, several focus groups (with patients, care providers, managers and payers), rapid reviews of themes that ocurred, an administered survey on patient-oriented care, qualitative experiments (interviews and observations) and research experts discussions a value driven and person centered consultation model was constructed.Results: On the bases of the review, the survey, the coproduction and the Social Quality Model, the experiences of care providers (especially GP’s) and patients an adapted and evolving consultation intervention was designed.The consultation themes that emerged were:1- an active listening attitude2- determining mutual value, goals and possibilities resulting in shared decision making regarding diagnostics, treatment and follow-up4- reminder (by recorded teach back) of mutual goals agreed upon5- positive health aspects. To implement the patient oriented consultation model, communication training with video reflection feedback is used. Patients are informed of the five patient-oriented steps and can take one or more cards (offered to them in the waiting room) that depicts the themes to handover to the GP and saying: ‘this is that I would like you to pay special attention to’.Limiting conditions are time, lack of an empathic and activating attitude of the care provider and insufficient fit with the patient needs and possibilities (especially in case of health illiteracy).From the number and type of cards handed over, we will estimate patient preferences with consultation types.Experiences with the positive health applications suggest a reduction in referals and better experiences of care providers and patients.Discussion: We did not opt for a classical intervention tested in an experimental design, but for a gradually developing pre-post learning codesigned bundle with variable approaches according to patient preferences in GP practices. Although experienced valuable, the integrated approach met many barriers (especially time constrains).

I023 An overview of co-production and knowledge mobilization principles

I023 An overview of co-production and knowledge mobilization principles

Improving Intellectual Access for Blind and Partially Sighted Visitors to Temporary Exhibitions: An Inclusive Design Solution

This article explores the collaborative design, curation and assessment of a temporary exhibition that aimed to bring intellectual access to blind and partially sighted visitors. The multi-sensory desk concept is the core component of the inclusive design, and is the focus of this paper. Older people (65-74 years) are increasingly likely to experience sight loss and they are the fastest growing visitor group to UK museums and galleries. Presently there are approximately two million people in the UK registered blind or partially sighted, which will double by 2050. Accessible design guidance was reviewed and a working document of relevant guidelines developed. Most guidance is aimed at developing permanent exhibitions. This research was directed by co-production principles using a multi-methods approach. Ethnographic fieldwork was conducted with observations and note taking, along with open-ended interviews, co-creation workshops, visitor written feedback, and co-assessment sessions. The research participants were blind and sight loss visitors, curatorial staff, exhibition designers, SENSE and RNIB representatives. The resulting exhibition has achieved a positive experience and emotional impact for the blind and partially sighted visitors, through the opportunity for independent movement and thought, and subsequent learning and knowledge exchange. Over 15,500 people visited the exhibition in three months.

Clinical Adoption of mHealth Technology to Support Pediatric Cystic Fibrosis Care in Sweden: Qualitative Case Study

BackgroundMobile health (mHealth) technologies have potential to improve self-management and care co-ordination of pediatric chronic diseases requiring complex care, such as cystic fibrosis (CF). Barriers to implementation include the lack of support and infrastructure to use mHealth in the clinical microsystem. Coproducing mHealth technology with patients, clinicians, and designers may increase the likelihood of successful integration into the clinical setting.ObjectiveThis study explored the development, adoption, and integration of a new, co-produced mHealth platform (Genia) for the management of pediatric CF in Sweden.MethodsA retrospective, qualitative case study approach was used. The case was defined as the process of introducing and using Genia at the Pediatric Cystic Fibrosis Center at Skåne University Hospital in Lund, Sweden. Data sources included interviews, presentations, meeting notes, and other archival documents created between 2014 and 2017. To be included, data sources must have described or reflected upon the Genia adoption process. Iterative content analysis of data source materials was conducted by 2 qualitatively trained researchers to derive themes characterizing the mHealth clinical adoption process.ResultsIn total, 4 core themes characterized successful clinical integration of Genia in Lund: cultural readiness to use mHealth; use of weekly huddles to foster momentum and rapid iteration; engagement in incremental “Genia Talk” to motivate patient adoption; and co-design approach toward pediatric chronic care.ConclusionsPrinciples of quality improvement, relational co-ordination, user-centered design, and coproduction can facilitate the integration of mHealth technology into clinical care systems for pediatric CF care.

Coproducing healthcare service improvement for people with common mental health disorders including psychotic experiences: a study protocol of a multiperspective qualitative study

IntroductionSome people, who have common mental health disorders such as depression and anxiety, also have some psychotic experiences. These individuals may experience a treatment gap: their symptoms neither reach the...

Education for Integration

The Public Bodies Joint Working Scotland Act 2014 and the World Health Organisation’s document Strengthening a Component HealthWorkforce for the Provision of Coordinated / Integrated Health Services Langins and Borgermans, 2015, position the integration of health and social care services as the principal means of transforming the delivery of services. In relation to staff, the Scottish Government’s 2017 National Health and Social Care workforce plan, acknowledge that the planning for the future workforce within NHS Scotland will require a broad range of professionals who will recognise inter-dependence, the importance of ‘whole of workforce’ and that a distributed model of professional leadership will support the provision of more sustainable services. From an international perspective, the World Health Organization’s 2015 Strengthening a Component Workforce for the Provision of Coordinated / Integrated Health Provision Langins and Borgermans, 2015 highlights that, “all health professionals in all countries to be educated to mobilize knowledge and to engage in critical reasoning and ethical conduct so they are competent to participate in patient and population-centred health systems as members of locally responsive and globally connected teams” Frenk et al 2010. This highlights that delivering integrated care across the globe requires that the workforce are appropriately educated. At the University of West of Scotland UWS we have responded to this need by developing undergraduate and post graduate programmes in integrating health and social care. These have been developed to address the educational needs of a cross-sectoral health and social care workforce in cultural transformation focusing on educating for enablement and empowerment through co-production and an asset based approach. The programmes we deliver at UWS are the BA Hons Integrated Health and Social Care programmes, which have been successfully running since 2011 and the recently validated MSc in Leading People-centred Integrated Care at the University of the West of Scotland. These programmes are reflective of 3 stages of education as identified by Frenk et al 2010, informative education, formative education and transformative education. The undergraduate programme is focused on informative education and the post graduate on transformative education, the ethos behind both are to enable and empower the students to deliver, develop and lead integrated services to promote and enhance quality, effective and efficient people-centred services. A key feature of the programmes are through the multi-professional and multi-sectoral nature of shared co-productive learning to Integrated Care education students can explore the complexities and challenges of delivering and leading system integration. This is advocated as a way of breaking down professional boundaries and in developing a more cohesive approach to professional practice. The principle of co-production is evident throughout both the ongoing developments in the undergraduate programme and in the development of the Masters programme. Both programme teams have been commended for the co-productive approach taken, which has included Subject specialists in Integrated Care, students and programme staff. Delivering and developing programmes relating to integration cannot be done in isolation and must up hold the very principles of integration it is aiming to achieve.

Equality, Liberty and the Limits of Person-centred Care’s Principle of Co-production

Abstract The idea that healthcare should become more person-centred is extremely influential. By using recent English policy developments as a case study, this article aims to critically analyse an important element of person-centred care, namely, the belief that to treat patients as persons is to think that care should be ‘co-produced’ by formal healthcare providers and patients together with unpaid carers and voluntary organizations. I draw on insights from political philosophy to highlight overlooked tensions between co-production and values like equality and liberty. Regarding equality, I argue that co-production compounds both problems of gender inequality in the distribution of care labour and the challenges associated with securing equal access to care. Turning to liberty, I identify important commonalities between co-production and republicanism in political philosophy, given their shared insistence on common citizens’ civic virtue. Then, I use against co-production some liberal arguments against republicanism, to highlight a problem of over-demandingness. In bringing my argument to a close, however, I wish to caution against hastily rejecting co-production as a policy programme.

"She doesn't want to go to hospital. That's one thing she hates": Collective performativity in avoidable nursing home to hospital transfers.

Older people who live with a combination of conditions experience fluctuations over time, which others may interpret as a need for medical attention. For some nursing home residents, this results in transitions in and out of hospital. Such transfers may be arranged without expectation of improved quality of life, can be associated with significant morbidity and mortality, and may preclude end-of-life preferences. Factors affecting avoidable hospitalization for nursing home residents are not well understood. I aim to explore potential drivers, moving beyond deficit explanations relating to funding, training, and resources. I use a framework of analysis that firstly considers medicalization of frailty, as a state of vulnerability that provides focus for others' action. I then draw on Judith Butler's theory of performativity, to explore nursing homes as sites of identity work for staff, residents and families. I consider ways subjectivities can be effected through reiterative practice that is compelled by normative conventions. Trouble may arise when citational practice of health care staff, and performative acquiescence of residents and families, culminates in an inevitability of hospitalization when navigating grey areas of assumed clinical risk. Principles of coproduction could present a disruptive opening, to rework power asymmetries, and move toward aspirations for residents and their relatives to be at the centre of decisions about care.

Transitional supported housing for mental health consumers enabling personal recovery: Allowing me to be me

ABSTRACTObjective: Safe, secure, affordable housing is recognised as pivotal to supporting mental health recovery. This article aims to evaluate an innovative West Australian transitional supported housing service for mental health consumers. The service offers 12-months accommodation and individually-tailored, recovery-oriented outreach support followed by six months of less intensive support.Method: Informed by the principles of personal recovery and co-production, the research team, consumers and service staff worked together to create a participatory evaluation process. Semi-structured interviews were conducted with consumers (n = 8), family members (n = 3), and staff (n = 5) which focused on the experience and impact of the service. Data were analysed using thematic analysis.Results: Consumers and family members were satisfied with the service, particularly its person-centred and co-produced approach, and the primacy of relationships characterised by power sharing, authenticity and transparency. Having stable accommodation enabled consumers to make positive changes, including engaging in new therapies, developing independence, and pursuing study and work opportunities. When re-interviewed at least three months after leaving the accommodation, consumers reflected that the service had a significant role in facilitating their recovery and were hopeful about their future.Discussion: Housing stability alongside flexible, tailored, recovery-oriented support were central to satisfaction with the service. Challenges in securing stable, affordable housing post-service highlight the broader issue of housing affordability and supply, and highlight the need for more low cost and social housing to promote mental health recovery. As recovery is a unique, individual process, a variety of flexible supported housing options are needed.

How Can Social Media Lead to Co-Production (Co-Delivery) of New Services for the Elderly Population? A Qualitative Study.

BackgroundThe future of health care services in the European Union faces the triple challenges of aging, fiscal restriction, and inclusion. Co-production offers ways to manage informal care resources to help them cater for the growing needs of elderly people. Social media (SM) is seen as a critical enabler for co-production.ObjectiveThe objective of this study was to investigate how SM—private Facebook groups, forums, Twitter, and blogging—acts as an enabler of co-production in health and care by facilitating its four underlying principles: equality, diversity, accessibility, and reciprocity.MethodsWe used normalization process theory as our theoretical framework to design this study. We conducted a qualitative study and collected data through 20 semistructured interviews and observation of the activities of 10 online groups and individuals. We then used thematic analysis and drew on principles of co-production (equality, diversity, accessibility, and reciprocity) as a deductive coding framework to analyze our findings.ResultsOur findings point to distinct patterns of feature use by different people involved in care of elderly people. This diversity makes possible the principles of co-production by offering equality among users, enabling diversity of use, making experiences accessible, and encouraging reciprocity in the sharing of knowledge and mutual support. We also identified that explication of common resources may lead to new forms of competition and conflicts. These conflicts require better management to enhance the coordination of the common pool of resources.ConclusionsSM uses afford new forms of organizing and collective engagement between patients, carers, and professionals, which leads to change in health and care communication and coordination.

Advocating Co-Productive Engagement with Marginalised People: A specific perspective on and by survivors of childhood sexual abuse

Co-production is gaining ground as a key dimension of public policy reform across the globe.This paper argues in favour of social welfare shaped by the principles of co-production and suggests that the promotion of democratic relationships is more likely to enable the agency and recovery of victim-survivors of childhood sexual abuse. The paper, based on an autoethnographical approach, is likely to be of relevance to social care practitioners who work with a range of marginalised people, particularly in liberal states that promote organisational cultures shaped disproportionately by risk. Cultures of risk, it is argued, promote power balances and ‘othering’, arguably an institutional perpetuation of the original abuse. Co-production, on the other hand, has the potential to legitimise expertise by experience, enabling victim-survivors to be reinstated as citizens with associated rights of participation. The paper subsequently draws out some of the benefits of co-production for practitioners whose professional engagement may be stifled. We suggest that co-production potentially points towards practice based on the valuing of expertise by experience and social solidarity.

Changing the culture of social care in Scotland: Has a shift to personalization brought about transformative change?

AbstractIn April 2014, the Social Care (Self‐directed Support) (Scotland) Act 2013 (SDS Act) was implemented in Scotland. This marked a major shift in how social care is delivered and organized for both users and professionals across the country. Whilst it emerged through the personalization agenda—which has dominated international social care systems over recent years—self‐directed support (SDS) represented a significant shift in thinking for service provision in Scotland. In this article, we review the initial stages of policy implementation. Drawing on two Freedom of Information requests from 2015 and 2016 and a series of interviews with local authority practitioners, we argue that, to date, SDS has yet to produce radical transformative change. We explore the reasons behind this through four key themes. First, we highlight the challenges of promoting the principles of co‐production in policy and suggest that, in reality, this has been compromised through SDS implementation. Second, we suggest that SDS has been caught up in a policy overload and ultimately overshadowed by new legislation for health and social care integration. In looking at the impact of this relationship, our third theme questions the role of new partnership working. Lastly, we argue that the timing of SDS in a period of acute austerity in social care has resulted in disabled people being offered limited choice rather than increased opportunities for independent living.

Using Principles of Co-Production to Improve Patient Care and Enhance Value.

Unlike goods, which are concrete and easily quantified, services are intangible processes that are produced and consumed concurrently. Health care is a service that can encourage optimal health outcomes only through meaningful, collaborative partnerships between patients and clinicians. Co-production of health services can be used as a means to rethink how health care is delivered not only in the context of face-to-face encounters in which the benefits of working together are obvious, but also in designing systems that can improve patient care and enhance value.

Polio survivors perceptions of a multi-disciplinary rehabilitation programme

Purpose: Post-polio syndrome refers to a late complication of the poliovirus infection. Management of post-polio syndrome is complex due to the extensive symptomology. European and United Kingdom guidelines have advised the use of rehabilitation programmes to manage post-polio syndrome. There is a paucity of research in relation to the effectiveness of rehabilitation interventions. The objective of this study is to explore polio survivor’s perceptions of an in-patient multi-disciplinary rehabilitation programme.Methods: Semi-structured interviews of community dwelling polio survivors who attended in-patient rehabilitation programme in the United Kingdom. Thematic analysis was used to describe and interpret interview data.Results: Participants’ experiences were influenced by past experiences of polio and their self-concept. Participants generally had a positive experience and valued being with other polio survivors. Positive strategies, such as pacing and reflection changed their mind-sets into their lives after the programme, though they still faced challenges in daily living. Some participants supported others with post-polio syndrome after completing the programme.Conclusions: Our research identified that participants experienced long term positive benefits from attending a rehabilitation programme. Strategies that users found helpful that explored the effectiveness of interventions to manage polio are not cited within a Cochrane review. If we are to recognise the lived experience and service user empowerment within a model of co- production it is essential that patient preferences are evaluated and used as evidence to justify service provision. Further research is required with polio survivors to explore how best rehabilitation programmes can adopt the principles of co-production.Implications for RehabilitationThe patients’ expertise and lived experience must be at the centre of a rehabilitation programme.Strategies such as pacing and reflection are perceived as important strategies to enable self-management of polio and post-polio syndrome despite the limited evidence base to support these interventions.Polio rehabilitation programmes should not be time limited and commissioners and therapists need to ensure that follow up support is provided.When measuring outcomes patient preferences and views must be evaluated.

Hungry architecture: spaces of consumption and predation at Göbekli Tepe

ABSTRACTThe subject of this paper is a social ontological approach to the site of Göbekli Tepe in south-east Anatolia. It is argued that modern Cartesian concepts and dichotomous archaeological frameworks are inadequate tools with which to understand and articulate people’s realities, past and present. Consequently, archaeological interpretation is reconfigured on the basis of indigenous theory and recent theoretical developments in anthropology, which provide ways to rethink relations beyond the conceptual confines of the dominant Western ontology. Indeed, the Pre-Pottery Neolithic world appears to be one that was fundamentally relational, predicated on engagements between potentially agential human, non-human and material entities. Through careful attention to the iconography, human and animal remains, and the phenomenal dimensions of the architecture, it becomes apparent that relations at Göbekli Tepe were founded on the socio-cosmic principles of consumption, predation and co-production.

Shaping innovations in long-term care for stroke survivors with multimorbidity through stakeholder engagement.

BackgroundStroke, like many long-term conditions, tends to be managed in isolation of its associated risk factors and multimorbidity. With increasing access to clinical and research data there is the potential to combine data from a variety of sources to inform interventions to improve healthcare. A ‘Learning Health System’ (LHS) is an innovative model of care which transforms integrated data into knowledge to improve healthcare. The objective of this study is to develop a process of engaging stakeholders in the use of clinical and research data to co-produce potential solutions, informed by a LHS, to improve long-term care for stroke survivors with multimorbidity.MethodsWe used a stakeholder engagement study design informed by co-production principles to engage stakeholders, including service users, carers, general practitioners and other health and social care professionals, service managers, commissioners of services, policy makers, third sector representatives and researchers. Over a 10 month period we used a range of methods including stakeholder group meetings, focus groups, nominal group techniques (priority setting and consensus building) and interviews. Qualitative data were recorded, transcribed and analysed thematically.Results37 participants took part in the study. The concept of how data might drive intervention development was difficult to convey and understand. The engagement process led to four priority areas for needs for data and information being identified by stakeholders: 1) improving continuity of care; 2) improving management of mental health consequences; 3) better access to health and social care; and 4) targeting multiple risk factors. These priorities informed preliminary design interventions. The final choice of intervention was agreed by consensus, informed by consideration of the gap in evidence and local service provision, and availability of robust data. This shaped a co-produced decision support tool to improve secondary prevention after stroke for further development.ConclusionsStakeholder engagement to identify data-driven solutions is feasible but requires resources. While a number of potential interventions were identified, the final choice rested not just on stakeholder priorities but also on data availability. Further work is required to evaluate the impact and implementation of data-driven interventions for long-term stroke survivors.

Role-played interviews with service users in preparation for social work practice: exploring students’ and service users’ experience of co-produced workshops

Within a Theory and Practice of Social Work module, prior to embarking on practice placements, social work students practised professional communication skills with people who had used social work services. They undertook role-played interviews with service users about real issues, which had led individuals to seek assistance in the past. Using principles of co-production, the workshop was developed in partnership with members of the University’s social work service users and carers’ group. Care was taken to safeguard service users’ well-being, as well as developing an effective learning opportunity. Drawing on evaluations by students and feedback from service users, this paper discusses the process of planning and delivering the workshops, as well as perceived outcomes for both groups. Findings indicate that students valued the opportunity to engage with service users, gaining key learning about their own practice skills. Service users described a boost to self-esteem through contributing to students’ learning. The workshop provides an example of how service user involvement in social work education has evolved from a primary focus on sharing personal testimonies to active participation in student skill development. It underlines the importance of investment in service user involvement to achieve an appropriate context for such projects to develop.