Co-production and learning in older people s community health and social care services

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1 Co-production and learning in older people s community health and social care services Katharine Aulton, Doctoral Researcher, University of Edinburgh Business School 18 th June 2015

2 2 Research question One strand findings from research for PhD thesis.. What types of learning arise in co-produced community health and social care services for older people?. What are the mechanisms for harnessing and supporting learning? Concepts: co-production (public management), co-creation (services management) Focus: learning and knowledge from co-production at an individual level in everyday service interactions Scottish public bodies - integrated working arrangements: community health services (National Health Service) social care services (Local Authorities)

3 Why this research question? Theoretical relevance Public management literature - renewed interest in co-production Individual co-production in statutory sector under researched area Unique focus on learning in everyday service interactions Empirical relevance Unique level of interest in co-production in Scotland policy & practice Policy: Christie Commission; Outcomes: Talking Points; Personalisation; Reshaping Care for Older People Practical relevance Financial constraints, demographics, need for more effective service models Can a wide range of service users with different needs levels input into the design of effective services?

4 4 Co-production Public Management field Co-production acknowledges inputs, role and contribution of service users to service delivery, working in combination with service providers (e.g. Pestoff 2012, Alford 1998) Different to Public Administration and New Public Management approaches which assume management control of resources Barriers to co-production in public bodies: e.g. funding and performance (Bovaird & Loffler 2012, inefficiencies (Thomas 2012), challenge to professional roles (Dunstan et al 2008)

5 5 Co-production & co-creation Services Management field Differences to co-production concept in public management field (Osborne et al): all customers are co-producers (Ordnanini & Pasini 08) co-production linked to: open innovation (Chesbrough 06, von Hippel 94) co-creation (Prahalad & Ramaswamy 04) Elg et al (2012), differentiate between: co-creation for use - service user inputs into design of own care arrangements co-creation for others the customer provides ideas, shares knowledge to improve the service process for the benefit of other customers

6 6 Research design Qualitative research design 3 elements: policy analysis; national stakeholder interviews; cases Health & social care case studies at 2 locations in Scotland including: meso level: health, social care, voluntary & independent sectors micro level: 4 service level health and social care cases Methods: Interviews older people; observations of user/staff interactions; Interviews senior, middle, junior managers, professionals, staff; Observations of meetings; and Documentary analysis

7 7 Service level - micro cases Location 1 Location 1 Location 2 Location 2 Low level Services Medium level Services Low level Services Medium level Services community health social care 1.1 Physiotherapy Preventative Service 1.2 Community Link Service (voluntary sector) 1.3 Specialist Community Nursing Service 1.4 Social Work Assessment & Care Planning Service 2.1 Occupational Therapy Preventative Service 2.2 Community Link Service (voluntary sector) 2.3 Community Nursing Service 2.4 Reablement Service

8 8 Overview of initial findings 2 types of learning: learning how to co-produce learning from co-production

9 9 1. Learning how to co-produce Shift to a new style of working, active co-production 5/6 cases co-productive role (expertise and contribution of both parties) is explicit and recognised by users and employees, and harnessed in service delivery Some similarities & some differences to co-production in the design and implementation of core services Brandsen & Honingh (2015) and co-generation Osborne (2015) Perceived by employees and managers as distinctly different way of working, Not implemented at scale, several years to fully refine & embed Social care: aiming for widespread implementation, local interpretation of national policy Health: pockets of active co-production, locally initiated; focus on long term conditions

10 10 1. Learning how to co-produce: levels Individual level - employees/professionals 5/6 cases comprehensive training on recognising and encouraging service users to play active role in service delivery challenge to expert professional role Individual level - service users/patients Degrees of engagement fluctuate between consumer/pure (Osborne et al 2013, 2015) and active co-production Social care cases core services, active co-production depends upon willingness and ability of user Health cases enhanced optional services patients commit to active role Service and team level process changes, iterative

11 11 2. Learning from co-production Learning from inside everyday service delivery interactions used to improve services, contribute to redesign.. cocreation for others (Elg et al 2012) Learning used at 3 levels: local team/service; services elsewhere in organisation; services in wider network Learning captured via employee or via service user: Mix of traditional and new mechanisms Older people with medium level needs less likely to take part in activities outside service settings Learning from inside service interactions is one piece of jigsaw

12 12 Initial analysis Active co-production at 2 locations, designed in, scale differences in health and social care, all taking time to embed To consider inter-relationship 2 types of learning: how & from Older people medium level needs less likely to take part in activities outside of service settings. Mechanisms for learning inside interactions currently limited and could be further explored.how to improve balance between learning inside and outside interactions? Is active co-production relevant in other settings without long term relationships?

13 13 Other research: thesis How does learning from the co-production of services inform the design of community health and social care service systems for older people in Scotland? Concepts: co-production (public management), co-creation (services management), service systems (services management)