Tuesday, September 11, 2012

CoProduction and OrgIntelligence in Healthcare

At @TheKingsFund today for a workshop on implementing healthcare reforms, with particular focus on the introduction of Health and Well-Being Boards. In this blogpost, I want to pick up the topic of Co-Production, which may appear at three logical levels:
  1. Healthcare delivery (orchestration and service delivery)
  2. Healthcare planning (commissioning and service design)
  3. Strategic healthcare development (experimentation, innovation and learning)

There are various versions of Co-Production in the literature, in Healthcare and in other domains, but there are several related themes.
  • Services rely as much upon the unacknowledged knowledge, assets and efforts of service ‘users’ as the expertise of professional providers (Elinor Ostrom, via Wikipedia)
  • Collaborative co-production requires users to be experts in their own circumstances and
    capable of making decisions, while professionals must move from being fixers to facilitators. (Health Foundation)
  • Sharing experiences, mutual aid, mutual problem-solving, shared ownership (Guardian)
  • Combining professional and lay perpectives (Owens)

Coproduction provides a very interesting example of what I call organizational intelligence, involving a connected set of information gathering, feedback and learning loops. Paying attention to these collective intelligence loops helps us see how effective patient participation and coproduction should contribute to the quality and productivity of healthcare delivery, healthcare planning and healthcare strategy.

@BenP1972 tweeted that this sounded like a job for @patientopinion ... "must b other existing models where feedback and user experience transformed service offering". Meanwhile @PatientVoicesUK quoted Donald Schön (1988) "Storytelling is the mode of description best suited to transformation in new situations of action."

Storytelling and sensemaking are vital elements of organizational intelligence. Professionals are trained to see the world according to a fairly prescribed set of narratives. These narratives give them considerable expertise and power, but they may also constrain thinking. For example, so-called "evidence-based medicine" may be dominated by professionally approved modes of evidence (double blind or triple blind studies) and it may be hard to accommodate the patient experience in this process. Interaction between different professional disciplines, together with the interjection of the (lay) patient voice, potentially brings in a much richer diversity of narratives.

But this diversity in turn calls for greater organizational intelligence - the collective ability to create a meaningful synthesis. What are the (organizational, political, cultural) conditions for successfully and flexibly integrating patient thinking with professional thinking?


Becky Malby, Involving service users in design: Four steps to co-production (Guardian, Aug 2012)

John Owens, Conflict in medical co-production: The challenge of combining professional and lay perspectives (Centre for Public Policy Research)

Alba Realpe and Louise M Wallace, What is co-production? (Health Foundation, 2010)

Wikipedia: Coproduction (public services) 

Richard Veryard, Organizational Intelligence Primer (LeanPub, 2012) 

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