Co-production

What’s this all about?

Co- production can sometimes be seen as a complex concept. In our experience, co-production can produce phenomenal results. It takes time and commitment to some fundamental principles to develop and thrive. We have drawn on our extensive experience of developing effective co-production to create this resource.

In order to explain co-production, we’ve developed a new definition which has three essential parts:

• What it is
• What it relies on to work well
• What it does

Each of these is a vital part of the whole definition. We’ll explain each piece in turn and then put them all together at the end.

So, what is co-production?

The first part of our definition is:

Co-production is a way in which organisations work with people, which enables people’s meaningful contribution to agreeing joint priorities for action, influencing decision-making and determining quality indicators.

Co-production is one of the ways in which organisations and people can interact. When organisations want to actively relate to the people who use their services or products, there’s a range of ways in which they can do this. Each of these has different purposes and can work well in different circumstances. 

The different types of participation

In order to explain what co-production is all about, we feel it’s useful to first show where it sits alongside the other types of participation. Co-production can be a slippery concept to grasp and has often been muddled up with other types of participation. For clarity, we have developed the Spectrum of Participation illustrated below. 

Our spectrum illustrates how each type of interaction differs. It’s a spectrum because it moves between doing “TO” people and doing “WITH” people. Each element has its own distinct purpose and value.

In the graphic below we have set out to describe the key questions which help to define the purpose of each type of interaction.

How input varies across the spectrum

The second part of our definition is about what co-production needs to work well:

Co-production relies on an appreciation of different perspectives; the acknowledgement of different amounts of power; the investment of necessary input and the gathering of independent feedback.

In any interaction between people and public health systems, there is a historic power imbalance. People are reliant on the information that the system chooses to share and often are also reliant on the services that the system provides. In order for people to feel safe to work collaboratively with systems, this power imbalance needs to be acknowledged and addressed.

The diagram below shows the relative amounts of input from systems and from people across the spectrum of participation. For example, when an organisation wants to simply inform a population, and there is no expectation of a response, then the only input from the system is provision of information.

As systems move from doing “to” to doing “with” people, the amount of input by the system increases. This is because, in order for people to be able to co-produce meaningfully and effectively, they need:

• An understanding of the challenges the system faces, the resources available, and the scope of what is open to change
• Knowledge of any relevant policy; and opportunities to influence the direction of travel
• Skills to engage constructively and collaboratively with decision-makers
• To know what effect their input has had

The amount and quality of input that people are able to offer is directly related to the amount and quality of input by the system.

How the relationship strengthens across the spectrum

As the amount and quality of input increases, it’s likely that the relationship between people and systems will become stronger.

In the graphic below, you can see that once people begin to be able to share their opinions, and influence decision making, the relationship starts to develop.

In the doing “to” side of the spectrum, the system is acting as expert with no or very limited opportunity for input from people. For example, in consultation, many people are often asked simply for a yes or no answer; there’s no conversation.

As interactions move into the doing “with” side of the spectrum, a more open dialogue develops, and people’s expertise is invited. People move from passive recipients to active participants. Power and decision making begins to be shared.

Effective co-production relies on a strong and trusting relationship, and both partners need to able to see the difference that working together has made. When people and systems value each other’s input and perspectives, then an authentic relationship can grow.

The strongest relationships take time to develop, and rely on honesty, good communication and a willingness to collaborate.

The difference that co-production makes

The third part of our definition is about what co-production produces:

When done well, co-production produces a combination of thinking to achieve change; a mutually beneficial relationship; and a service, policy, process or product which is more fit for purpose.

Co-production aims to balance system or organisational priorities with what matters to people. It’s about agreeing shared priorities and working together towards achieving them. When co-production is effective, what flows from that dynamic interaction works well for both people and systems.

The difference with co-production is that people are actively engaged in creating the agenda, not only responding to it. The first part of the graphic below illustrates how people’s input combines with system input to create a new joint output. Blue and pink becomes purple.

“The whole is greater than the sum of its parts”- Aristotle.

The second part of the graphic shows that when policy and strategy is co-produced on a national level, but is implemented locally without local co-production, people’s influence is diluted. Purple returns to blue. The system can revert to its traditional way of doing things and the implementation of the national policy can lose what matters most to people.

When people’s voices are fully part of local implementation through local co-production, the original policy intent is kept true to purpose. Purple remains purple!

Even with local co-production in place, it’s vital to gather independent feedback from the wider population that the system or organisation is serving. This is to ensure equality and integrity across the whole population.

Our full definition of co-production

Co-production is a way in which organisations work with people, which enables people’s meaningful contribution to:

• Agreeing joint priorities for action
• Influencing decision-making
• Determining quality indicators

It relies on:

• Appreciation of different perspectives, knowledge and experience
• Acknowledgement of different amounts of power and responsibilities
• Investment of necessary input
• Gathering of independent feedback

When done well, it produces:

• A combination of thinking to achieve change – either by innovation or adaptation
• A mutually beneficial relationship which affects the way organisations and people see each other
• A service, policy, process or product which is more fit for purpose from the perspective of both the organisation and the people using it

© peoplehub

We welcome people sharing and making use of our definition and graphics, with acknowledgement of peoplehub’s copyright. Please email us at hello@peoplehub.org.uk if you would like copies of the graphics.

What’s next?

We know that making co-production work well is not an easy task. We think that some of this is because of the confusion about what it is, as well as uncertainty about how to make it work well. This resource aims to clarify what co-production is, and how to recognise it.

We’re working on further resources about how to make it work well, and what some of the first steps might be.