The Prudent Healthcare Blogs - Principle One


The Prudent Healthcare Blogs



  


Principle One


Public and professionals are equal partners through coproduction




Coproduction, like any word which is adopted into policy or management processes, can often feel like a rather hackneyed term and is not universally popular. However, the concept which it describes is extremely important to the delivery of modern healthcare services and for improving the experience and outcomes of the people using those services. Here is a definition of coproduction from the Social Care Institute for Excellence:

‘A way of working whereby citizens and decision makers, or people who use services, family carers and service providers work together to create a decision or service which works for them all.’

For this principle we need to be applied in the context of Prudent Healthcare we must consider to what extent people are (and feel) involved in caring for their health at both a micro and a macro level.

At a micro level, coproduction is referring to shared decision making. This is the process by which healthcare professionals help people to make choices. Doing this really well requires time, taken often over multiple consultations, ideally utilising the differing skill sets of the multidisciplinary team. This should include not only discussions about drugs, radiotherapy or surgical interventions, but also when/if to have a scan or take holidays or any other activity important to that person. All trade-offs in that decision making process should be explored and understood.

It is all too easy to fall into the trap of jumping to conclusions about what our patients’ priorities are, perhaps focusing only on the clinical outcomes as seen through the lens of the clinician.



There are a number of necessary steps in the shared decision making process:

·       A realistic shared view of the situation, taking into account cues from the individual on the amount of information shared and the pace at which this is done, the degree of self-efficacy and health literacy.

·       An appreciation of psychosocial and other contextual factors

·       An exploration of fears, beliefs, expectations, wants, needs and goals

·       Shared goal setting

·       Imparting understanding of treatment options and choices available

·       Acknowledgement of uncertainty

As clinicians we must continuously check our self-awareness as, often with the best of intentions, we tend to default to action when this may not be what the person with us would choose or be in their best interests. This can be difficult as we want the best outcomes for those we care for and we do not like to fail. We are often afraid and we have so little time to meet the holistic needs of the person sitting before us. Therefore good coproduction is most likely to occur when the multidisciplinary team work together seamlessly across the whole system to support the individual all through their treatment and beyond.

As Atul Gawande says in his book ‘Being Mortal’, ‘Life is choices. They are relentless’.



At a macro level, the public must be given the opportunity to make a direct contribution to the design of local services. It is fair to say that we have a long way to go before we achieve this to a high standard in all areas.  In promoting public health and sustaining our healthcare system we should seek to reach a balance between the rights and responsibilities of individuals. This brings into question the experience of public services and fostering a sense of community but there is an onus on service providers to promote equality, diversity, accessibility and reciprocity when embarking on the co-productive process. When these pillars are not in place, the process is tokenistic, of limited value and tends quite rightly to disengage those involved.

When done well, coproduction begins with active listening and the subsequent interaction between the involved groups produces a rich seam of information which can inform a much improved patient experience and better, more innovative and flexible ways of meeting the healthcare needs of the population in question.

If we adopt the approach detailed above in its entirety, we will surely have a better chance of improving patient experience, healthcare outcomes and going some way to create a sustainable health service for the future. Surely then, coproduction is something we must take very seriously indeed.



Dr Sally Lewis

September 2016


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