I’ve recently noticed increasing recognition of the need to move from a symbolic approach to a more meaningful dialogue with patients and the public, equally in medical research and service improvement.

This requires a true partnership with service users, their carers, and public representatives. The approach is value-driven and built on the principle that service users are best placed to help design it.

Co-production is a process that can enable true engagement. In co-production, frontline clinicians delivering care need to work with people using the service throughout the entire project, from start to finish, to reach a collective goal and put their shared values into action.

The approach is value-driven and built on the principle that service users are best placed to help design it.

Patients and clinicians face the daily challenges of a complex and sometimes ‘wicked’ system. Although their experiences may appear different, they are complementary and therefore collaboration is vital to design services to deliver the best value and quality of care.

For co-production to work, language matters. We need clinicians and service users to understand and speak the same language: the language of improvement.

The Adolescent & Young Adult (AYA) Rheumatology department at University College London Hospitals (UCLH) has a history of embedding patient and public involvement and engagement (PPIE) into research and service development.

Extending co-production with service users as a formal process for service improvement facilitates the delivery of our ethos of ‘no decision about me without me’ for the young people we serve.

We need clinicians and service users to understand and speak the same language: the language of improvement.

We outline our experience of using health coaching and quality improvement processes as a method of embedding co-production in clinical practice and service improvement.

How did it start and who did we involve?

1.     Embedding health coaching in clinical care

In 2021, a year into the pandemic, the AYA Rheumatology team planned a service improvement strategy. We aimed to engage young people using a co-production model.

We were fortunate enough to successfully compete for two funding awards. We started implementing this project intending to enable young people and clinical staff to sustainably co-produce individual health outcomes and service improvement.

Our baseline data identified significant variations in clinical consultations, with no standardised approach to supporting young people with self-management. A third of clinicians knew about health coaching (HC). NHS England’s Universal Personalised Care model explains health coaching as a technique that aims to “help patients gain the knowledge, skills, tools and confidence to become active participants in their care so that they can reach their self-identified health goals.”

We built our HC core capabilities for the whole AYA rheumatology multidisciplinary team. Four staff members completed European Mentoring and Coaching Council (EMCC) accredited HC training to sustain training in HC.

We started implementing this project intending to enable young people and clinical staff to sustainably co-produce individual health outcomes and service improvement.

A follow-up survey identified that clinicians had started to embed HC into clinical consultation in 30% of our consultations with young people. We developed HC tools in our electronic health records to improve efficiency and standardisation in clinic consultation. We are piloting a dedicated HC clinic for young people with complex needs.

2.     Engaging with young people

I started asking young people if they would be interested in being part of the Quality Improvement (QI) network and shaping the service delivered to them around what matters to them.

I arranged for one-to-one meetings with  young people who expressed an interest, and took them through quality improvement concepts during one-to-one and group sessions.

I also shared materials from the Institute of Healthcare Improvement open school. Three young people used the IHI open school online tutorial on quality improvement and person-centred-care.

3.     Our first face-to-face event

In July 2022, we organised our first face-to-face workshop with service users. With the help of the improvement team at UCLH, we selected activities that matched our engagement aims.

I loved how everyone was allowed to share their opinions and at the end how we all came to a good ending of how to improve the service as well.

The workshop had equal representation of young people to clinical staff.
We used Deming’s Red Bead Experiment to take our participants through system thinking concepts. We facilitated structured coaching conversations and took them through the UCLH Quality improvement (QI) methodology. (Deming, W. E. 1986).

Naz Celic, one of the young people involved, said:

‘I loved the part where we did the talking therapy! I don’t remember what it was called but it really made me realise how much talking to someone and releasing your emotions is important. Also I loved how everyone was allowed to share their opinions and at the end how we all came to a good ending of how to improve the service as well.’

The brainstorming conversations, between young people and clinicians fed into our two key projects:

• Co-producing healthcare consultations
• Setting up a peer-support scheme.

Seeing young people and clinicians coming together to learn from each other, network, and have fun was fantastic. There was a real energy throughout the sessions and it was wonderful to see some lightbulb moments bringing the team together.

At the end of workshop, three young-people expressed an interest in an internship scheme with the AYA service to work with clinicians and deliver these projects. In January 2023, our interns started their QI journey.

One of the interns, Aisha Shah, said of her experience: ‘I feel like I’ve already learnt a lot. Ruth has started to teach me about quality improvement within the NHS which is a topic that I didn’t know much about but find really interesting as it helps in so many ways. I’m excited to lead a QI project “what matters to you”. If anyone is thinking about getting involved, I would high recommend it. You learn so much and it’s been such an enjoyable experience so far.’

As a team, we aimed to embed co-production in the clinician-patient relationship using health coaching conversations and we are extending this approach into co-creating services with users.

Like many other services, we are still learning from our improvement journey. Building relationships with young-people and treating them as equal partners enables us to align the service we provide and its intended impacts, with what matters most to the young person.

You learn so much and it’s been such an enjoyable experience.

We’re very grateful to the Adolescent and Young Adult Team at UCLH and to our young people for their amazing support in the design and delivery of this project.

This piece has been co-authored by:

Aisha Shah, young person, service user and Intern at UCLH
Rhea Burman, young person, service user and Intern at UCLH
Naz Celic, young person, service user and Intern at UCLH
Debajit Sen, Divisional Clinical Director, Medical Specialities, UCLH
Ruth Harvey, Senior QI Facilitator, UCLH
Corinne Fisher, Clinical Lead Adolescent Rheumatology, UCLH
Sophia Mavrommatis, Therapy Lead =, Adolescent Rheumatology, UCLH.

We’d love to hear your thoughts on this project and other examples of game-changing co-production. Comment below or continue the conversation on the Co-production Special Interest Group (SIG).

Learn more

Join our Co-production SIG’s Co-production Mini Series, starting on 24 April, to explore different themes around this topic.

NHS England’s Universal Personalised Care model

Deming’s Red Bead Experiment