Healthy Living: does “the messenger” make a difference? Evidence from an experiment of co-production with teenagers in Tuscany (original) (raw)
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Co-production in Healthcare: Moving Patient Engagement Towards a Managerial Approach
Co-production in the Public Sector, 2016
In the European debate on public policies, co-production is suggested as an innovative way to organise and manage services and to develop 'a smart, sustainable and inclusive Europe by 2020' (European Commission 2010). The healthcare system is one of the most elective co-production domains in the public sector (Department of Health 2006; Voorberg et al. 2014). The application of co-production is believed decisive for the achievement of necessary healthcare service improvement and system sustainability (Dunston et al. 2009). At present, healthcare managers at different organization levels must cope with increasing and changing demands, while resources to provide them are decreasing. The population is becoming older, with multi-faceted needs and high expectations, and the rates of chronic diseases are growing. This puts the onus on western healthcare systems to contain costs without detracting from the high quality of care. Rising hospitalization costs are pushing healthcare administrators to reduce the length of hospital stays and the readmission rate, making it necessary to build relational models in which the patient feels part of the healthcare team and willing and able to continue self-care after discharge. This is especially the case for chronically ill patients where the relationship is longer term and involves repeated interactions with and between the professional staff (Verschuere et al. 2012).
Co-production in healthcare: rhetoric and practice
International Review of Administrative Sciences, 2015
Co-production in healthcare is receiving increasing attention; however, insight into the process of co-production is scarce. This article explores why hospitals involve patients and staff in co-production activities and hospitals’ experiences with co-production in practice. A qualitative study with semi-structured interviews ( N = 27), observations (70 hours) and document analysis was conducted in five Dutch hospitals, which involved patients and staff in order to improve services. The results show that hospitals have different motives to involve patients and staff and have adapted existing methods to involve patients. Interestingly, areas of improvement proposed by patients were often already known. However, the process of co-production did contribute to quality improvement in other ways. The process of co-production stimulated hospitals’ thinking about how to realize quality improvements. Quality improvements were facilitated by this process as seeing patients and hearing their ...
Healthcare services and the co-production challenge : insights for engaging unwilling patterns
2014
The need to reconcile effectiveness with shrinking budgets is pushing contemporary health services to develop co-production practices. But the patient is often an unwilling client and patient engagement with both their therapy and the relative organizational system remains largely unexplored. The article analyzes an Italian hospital\u2019s co-production initiative and uses the results to reflect on what key factors impact the efficacy and the efficiency of healthcare co-production. The empirical evidence indicates that a) the socio-organizational conditions of both the patients and the relevant actors must be taken into account to achieve the truly meaningful engagement of the patient, as opposed to merely symbolic acceptance in co-production practices, as opposed to just their symbolic acceptance; b) no divide exists between organizational production and client co-production, rather, it is a relationship of interdependence that in turn raises critical issues; and c) to take a signi...
Co-Production and Health System Reform - From Re-Imagining To Re-Making
Australian Journal of Public Administration, 2009
There is growing interest in the application of citizen participation within all areas of public sector service development, where it is increasingly promoted as a significant strand of postneoliberal policy concerned with re-imagining citizenship and more participatory forms of citizen/consumer engagement. The application of such a perspective within health services, via co-production, has both beneficial, but also problematic implications for the organisation of such services, for professional practice and education. Given the disappointing results in increasing consumer involvement in health services via 'choice' and 'voice' participation strategies, the question of how the more challenging approach of co-production will fare needs to be addressed. The article discusses the possibilities and challenges of system-wide co-production for health. It identifies the discourse and practice contours of co-production, differentiating co-production from other health consumer-led approaches. Finally, it identifies issues critically related to the successful implementation of co-production where additional theorisation and research are required.
International Journal for Quality in Health Care, 2021
Background: Pursuing the vision 'for a good life in an attractive region,' the Region Jönköping County (RJC) in Sweden oversees public health and health-care services for its 360 000 residents. For more than three decades, RJC has applied 'quality as strategy,' which has included increasing involvement of patients, family and friends and citizens. This practice has evolved, coinciding with the growing recognition of co-production as a fundamental feature in health-care services. This study views co-production as an umbrella term including different methods, initiatives and organizational levels. When learning about co-production in health-care services, it can be helpful to approach it as a dynamic and reflective process. Objective: This study aims to describe the examples of key developmental steps toward coproduction as a system property and to highlight 'lessons learned' from a Swedish health system's journey. Method: This qualitative descriptive study draws on interviews with key stakeholders and on documents, such as local policy documents, project reports, meeting protocols and presentations. Co-production initiatives were defined as strategies, projects, quality improvement (QI) programs or other efforts, which included persons with patient experience and/or their next of kin (PPE). We used directed manifest content analysis to identify initiatives, timelines and methods and inductive conventional content analysis to capture lessons learned over time. Results: The directed content analyses identified 22 co-production initiatives from 1997 until today. Methods and approaches to facilitate co-production included development of personas, storytelling, person-centered care approaches, various co-design methods, QI interventions, harnessing of PPEs in different staff roles, and PPE-driven improvement and networks. The lessons learned included the following aspects of co-production: relations and structure; micro-, mesoand macro-level approaches; attitudes and roles; drivers for development; diversity; facilitating change; new perspectives on current work; consequences; uncertainties; theories and outcomes; and regulations and frames. Conclusions: Co-production evolved as an increasingly significant aspect of services in the RJC health system. The initiatives examined in this study provide a broad overview and understanding
Information and Knowledge Processes in Health Care Value Co-Creation and Co-Destruction
SAGE Open
The purpose of this article is to explore how information and knowledge processes (IKPs) influence co-creation and co-destruction of value in a health service system. A qualitative, single embedded case-approach is taken to develop theory through a systematic combining of theoretical framework, empirical fieldwork, and case analysis. Six theoretical propositions are set to describe the linkage between IKPs and value co-creation (and co-destruction). The article contributes to health marketing and transformative service research by linking organizational activities to the motivation and empowerment of patients and their families, by highlighting the importance of the role of knowledge integration in value co-creation, by introducing a shift toward systems thinking, by conceptualizing value as manifested as health behavior change, and by underlining that health care processes may have a negative (value co-destructing) influence on the well-being of actors.
The role of co-production in Learning Health Systems
International Journal for Quality in Health Care
Background Co-production of health is defined as ‘the interdependent work of users and professionals who are creating, designing, producing, delivering, assessing, and evaluating the relationships and actions that contribute to the health of individuals and populations’. It can assume many forms and include multiple stakeholders in pursuit of continuous improvement, as in Learning Health Systems (LHSs). There is increasing interest in how the LHS concept allows integration of different knowledge domains to support and achieve better health. Even if definitions of LHSs include engaging users and their family as active participants in aspects of enabling better health for individuals and populations, LHS descriptions emphasize technological solutions, such as the use of information systems. Fewer LHS texts address how interpersonal interactions contribute to the design and improvement of healthcare services. Objective We examined the literature on LHS to clarify the role and contribut...
Towards a value co-creation based healthcare system
Purpose -Healthcare system embraces legal, ethical and socio-economic instances, involving several actors with different priorities, resources and influences. Characterized by a high technological level and, together, a discomfort echoed by a growing distrust of patients it no longer considers man as a whole, but as a set of independent components "to be fixed" as they fail Aware of these issues, aim of this work is to investigate how the interaction is fostered in order to enable the value co-creation process. Design/Methodology/approach -The contribute is based on the principles of Service-Dominant Logic, reinterpreted using the lens of Viable Systems Approach in order to identify, through the Information Variety Model, the peculiarities of the operator individual identity and, consequently, the aspects that act supporting value co-creation. This methodological lens, overcoming the limitations of the reductionist view of phenomena, allows to shift from considering 'the parts' to considering 'the whole'. Findings -The paper highlights the relevance of values alignment and shared objectives for the convergence of the Healthcare System towards a logic of value co-creation. The patient is first-person involved in a sanitary process that starts from the individual. In this way the comparison between the multiple perspectives involved does not end in a fruitless conflict of interests, evolving towards approaches in which the combination of different individual information varieties allows to solve historical problems of Health sector (bureaucracy, individual responsibility, use of resources ...). Research implications -The need to identify effective approaches to value co-creation in Healthcare System is highlighted through the re-reading of surveys and secondary data helpful to understand the underlying dynamics of public-private interaction. The work is thus oriented to identify, using the Information Variety Model, the intervention levers through which making value co-creation possible. Practical implications -The work defines the first step of a research project, whose goal is to establish guidelines that facilitate the process of interaction between different actors through the understanding of individual identities. Originality/value -The value of the work lies in the definition of an observation perspective that is not limited to structural components; it shows that interactions among viable systems, oriented to value co-creation, can be realized in a systemic view, by reading and understanding individual and context instances.
Coproduction of healthcare service
Efforts to ensure effective participation of patients in healthcare are called by many names —patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always ‘coproduced’. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle’s implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services. goods, services are always ‘coproduced’. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle’s implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.