There is a lot of talk about coproduction in the academic and health and social care world at the moment but there are various ideas and concepts of what it actually it. Some peope believe it has been around for a long time under different names such as involvement, engagement and empowerment, while others may think is it a new and exciting way of working with people who use public health and social care services. I believe that Arnstein’s Ladder of Participation is still as relevant today as it was in the 1960s when it was developed around co production in social housing. If we are to work in a participatory way as advocated by Arnstein then we must also be able to demonstrate it in a narrative of practice.
Of course we know that even though we can dig way back into history for some of the practices we now use in our everyday lives we also know that we have learnt nothing from history according to the philosopher Hegel “We learn from history that we do not learn from history.”
If we are to work more towards a practice of working with people instead of doing things to them, then we must also create a narrative of evidence around that practice so that we can demonstrate – Evidence Based Practice or EBP.
In order to compassionately develop services that are coproduced in a way that people feel empowered and involved we need to think about what that will look like in practice. Creating a narrative is a good way to do this because it is something that can be done together and is evidence based, although the evidence may come from various sources e.g. the patient experience or journey, the student journey or real life practice.
Using my research on compassionate care over the last decade where I have explored what involvement looked for service users in mental health care (Ghisoni 2016 – see reference list on this blog site) I developed a model of compassionate care that could be adapted to any scenario or service, even social housing, to demonstrate how compassionate care or services or even leadership, can be co produced. This is outlined in the model below with examples.
UNIVERSALITY – ( See Me) this is where all parties come together to identify their own individual needs and co produce some shared goals that they can work on. Some things might already be set in stone and cannot be changed e.g. Laws, Standards and Protocols but they can be used as a baseline or framework to begin co production. The narrative that is created here is in the shared goals that all parties agree upon for example, we want houses with gardens or healthcare that is person centred. If we try to fit people into laws and standards then is it manipulation not empowerment.
DIVERSITY – ( Hear Me) It is also a good idea to work out very early in co production where our differences lie, these may be professional differences or personal ones. All differences must be respected and valued because if they are not this will lead to problems later on and the narrative will be skewed, meaning it will not be a fair representation of everyone involved. E.g Services are set up but not accessible or education is provided but only in one format. If we do not listen to the diverse needs of people then it is tokenism. (See Lloyd & Carson 2012 in reference list for how to develop these critical conversations).
RECOVERY – (Help Me ) This is where the real work gets done and is dependant upon the other two stages being done properly and fairly. This is the product so to speak where outcomes are identified, reviewed and achieved. If our aim is to empower people to feel more in control of their housing, their health or their education we must make sure we have produced something that recognises all of their involvement. Otherwise what is the point of involvement in the first place if we cannot demonstrate working in true partnership to improve services. If we are to learn from history then we must develop the evidence based narratives that prove it.
