Co-Creating Health

Andy PhillipsDirector of Therapies and Health Science

ABMU Health Board

Why Cocreation ?

• Knowledge and Evidence demonstrates that cocreation of public services leads to increased staff and patient satisfaction, better outcomes, experience and reduced cost.

• The contention is that if public services recognise and develop people’s potential to help themselves, they both show those people more respect and potentially achieve more – for the people themselves and for society more generally.

• In contrast, if public services offer only ‘professional’ fixes for needs or problems, and if people must continue to present needs or problems if they are to continue to be eligible for help, service provision will perpetuate needs and problems and will miss opportunities to harness people’s own potential to improve things

• These notions emphasise the importance of treating service users as unique and whole human beings and of ensuring that public services are oriented to serve the needs of service users rather than the convenience and interests of professionals or service provider organisations.

• Ideas such as partnership, participation or involvement, and the recognition of service users’ own ‘assets’ (not just material resources) can be applied at the levels both of communities or groups and of individuals.

Cocreation Principles

• Recognising people as assets: seeing people as equal partners in the design and delivery of services, not passive recipients of – or worse, burdens on – public services.

• Building on people’s existing capabilities: rather than starting with people’s needs (the traditional deficit model), co-created services start with peoples capabilities and look for opportunities to help make these flourish.

Cocreation Principles• Mutuality and reciprocity: co-creation is

about a mutual and reciprocal partnership, where professionals and people who use services come together in an interdependent relationship recognising that each are invaluable to producing effective services and improving outcomes.

• Peer support networks: engaging peer and personal networks alongside professionals as the best way of transferring knowledge and supporting change.

Cocreation Principles• Blurring distinctions: blurring the distinction

between professionals and service users, and between producers and consumers of services, by reconfiguring the way services are developed and delivered.

• Facilitating rather than delivering: enabling professionals to become facilitators and catalysts of change rather than providers of services.

Core requirements for co-producing public services

1. Relationship centred Interactions

2. Active partnering

3. Continuous quality improvement

4. Information and communication technology

5. Public health perspective

1. Relationship-centred Interactions

• Effective communication

• Assisting changes in behaviours

• Supporting self-management

• Coaching Relationship

• Staff and service users experience an ‘enriched

environment’

Public Service Professionals : From Mentor to Coach

“Mentoring invents a future based on the expertise and the wisdom of another, whereas coaching is about inventing a future from the individual’s own possibilities... Mentors freely give advice and opinions regarding strategies and policies, whereas coaching is about evoking answers from the individual... Mentors convey and instil the standards, norms and values of the profession/organisation.”

Zeus and Skiffington 2002, pg4

Coach / Mentor Ladder

NON DIRECTIVE

Discovery

Informing

DIRECTIVE

Listen

Empathise

Clarify

Ask questions

Share opinions

Inform

Provide guidance

Give advice

Tell

3 Pillars of Coaching Relationship

Growth Model

Coaching Skills

Emotional Intelligence

The GROWTH coaching system is…

G

R

O

W

T

H

Results

Goals What do you need to achieve?

Reality What is happening now?

Options What could you do?

Way Forward What will you do?

Tactics How and when will you do it?

Habits How will you sustain success?

Relationships Building the trust

Celebrating the results

2. Active partnering

• Active Partnering between service users and professionals

• Active Partnering between public services

• Active Partnering with communities

Active partnership

• Service Users and Professionals work in equal partnership

• Shared high quality information

• Shared decision making

• Embed active partnership in professional and service user values and expectations

• Excellent communication between the partners

• Adaptation of partnership to suit context and individuals

3. Quality improvement

• Measuring service delivery, outcomes and experience

• Learning and adapting to change

• Translating evidence into practice

4. Information and communication technology

• Designing and using registries

• Communication between partners

• Shared knowledge and information

• Decision making aids

5. Public health perspective

• Providing population-based service

• Systems thinking

• Working across boundaries

Three experts

• Service users bring expertise about themselves, their own social circumstances, attitudes to life and risk, values and preferences.

• Professionals bring coaching skills, emotional intelligence, knowledge of the effectiveness, probable benefits and potential harms of options.

• ‘The computer’ provides equality of access to records for service user and professionals, information on relationship-centred pathways, outcome measures and evidence based decision aids to help active partners make informed decisions, particularly where there are uncertainties.

3 questions for service users to ask public service professionals

• What are my options ?

• What are the possible benefits and risks ?

• How can we make a decision together that is right for me ?

Co-creating Health – clinical interactionsThe co-creating health framework aims to

facilitate patient self management. It includes

agenda setting, use of decision support tools,

clinical outcome measurement, audit processes and

continuous service improvement

Evaluation of knownInformationPatients need to have a levelof health literacy and be awareof their own condition. Patientand Clinician both understandknown information

Conversation betweenProfessional and patientPatients need to be prepared toParticipate in setting agenda

Further informationMay be needed to fully Describe the patientscondition and preferences

Shared understanding of optionsBased on condition andPreferences, use of decision support tools

Agreement of wayForwardProfessionals and patients workclosely to share decision making

.

Facilitation of agreedaction(s) and choice(s)Patients and clinicians are clear about the next steps and agree plan

Evaluation of OutcomesPatients and professionals

reviewclinical and experience outcomes

Sha

re the evid

ence a

nd

celebra

te success

Develop sustainable patient and clinician peer-support networks