Landmark suite of tools puts co-production at the centre of quality improvement

Last year we told you about Shine a Light, a monthly series aimed at bringing together people using services, their families and unpaid carers, and those providing services to share good practice in improving NHS services together. 

We heard voices from across the country and gained a wealth of insight about how co-production – which involves engaging directly with those who have lived experience of services – can be a game changer for quality improvement.

This work has been deeply rewarding for me as a nurse. One of the most valuable insights I can share about co-production is its ability to reconnect you with your original motivation for joining your profession.

It brings you close to those who use your organisation’s services and grounds your thinking in their lived reality. The act of listening to and understanding what really matters to people using services, unpaid carers and families is a great place to begin any quality improvement journey.

At a time when we are all working so hard to help the NHS recover from the impact of COVID-19, this is not only a practical tool for quality improvement. For me, co-production has become a way to regenerate that deeper sense of connection and joy in work, which is a powerful motivator for change.

We define co-production as a way of working that involves those who use health and care services, carers and communities, in equal partnership. It engages groups of people at the earliest stages of service design, development and evaluation. 

Co-production acknowledges that people with lived experience of a particular condition are often best placed to advise on what support and services will make a positive difference to their lives.

Done well, co-production helps to ground discussions in reality, and to maintain a person-centred perspective.

Pre-pandemic we began some work where we visited organisations a little further along the co-producing quality improvement journey to learn from them what others need to pay attention to. I have been working with colleagues from We Coproduce and NHS England’s Improvement and Experience of Care teams to use the learning from this work to produce a suite of materials.

Our driving purpose is to make co-production the way we approach quality improvement. Co-production is also identified as one of the key enablers for NHS Impact, the NHS approach to improvement and in the National Quality Board Shared Commitment to improving experiences of care.

These new materials include:

• an introduction to co-production
• a supporting literature review
• a resources guide
• a QI Venn diagram
• QI Postcards for starting engaging conversations
• five films and animations featuring Don Berwick and others.

From our learning of what we observed on the site visits, our interpretation of what we heard, and the evidence from the literature review we identified six themes:

In our journey, we have identified these to be important  areas to focus on and have conversations about when we want to co-produce quality improvements together. Within each theme, we have developed a set of practical tools to facilitate co-production in a guided, strategic way.

For example, under the Power Sharing theme, there can be resistance and we have shared ways to help each of us lean into being comfortable with the uncomfortable.

This is a new way of approaching quality improvement and it is reasonable to expect that some professionals may be uneasy about inviting those who use health care services to engage with systems and organisations as equal partners.

Our co-production resources encourage professionals and leaders to expect to hear a range of experiences and be curious and open minded to these views.

Those who have experience of care can offer systems and organisations a primary source of high quality evidence-based data and have great improvement ideas.

This is good for people using services and it’s also good for those providing care. In all my years of experience co-producing improvements, this approach has consistently resulted in improved experiences for everyone.

If you are working in a system or organisation where you want to introduce quality improvement of services, you might be wondering how to get started.

It’s often a good idea to start small. A great way to begin is to meet with those using your services to find out their experience and what matters to them. Look at what reports and information you already have. Listen to colleagues and find out what matters to them. Then, together as lived and learnt experience partners, co-produce your improvement.

At all times, be curious and open to feedback, remembering that you are one team, with the same goal of improving experiences of care together.