For Whose Benefit? Service User Involvement, Co-Design and Quality Improvement

For Whose Benefit? Service User Involvement, Co-Design and Quality Improvement

For Whose Benefit? Service User Involvement, Co-Design and Quality Improvement

Background: The last decade has seen renewed impetus for the involvement of service users in the design and delivery of healthcare services, recently described as a ‘Zeitgeist’ moment (Palmer et al., 2018; Sheard et al., 2019). At the same time, the spread of quality improvement (QI) methodology continues across healthcare, with QI calling for the combined efforts of multiple stakeholders – that includes patients, families and carers (Batalden, 2018). Seemingly, then, co-production, co-design and QI have much in common, though it could be argued that these have developed in parallel rather than in union (Williams and Caley, 2020). This research forms part of a PhD-level study conducted to explore how concepts of co-production and co-design complemented clinical microsystem QI methods.

Method: This research was conducted in one UK-based Health and Social Care Trust. Semi-structured interviews (n=25) were conducted with ‘key informants’ (individuals positioned in leadership and management roles, front-line healthcare workers and service users) involved in QI. This was primarily to understand how concepts of co-production, co-design and QI were constructed by those involved. Additionally, three clinical microsystem teams (two teams located in a community brain injury service, one team located in a mental health inpatient unit) were followed over a nine-month period (July ’19 – Feb ’20), where microsystem meetings were observed; this was to observe co-design and QI in practice. Data was analysed using an interpretive, hybrid thematic approach.

Result: The results shed light on the presence and equally absence of service users within the microsystems process. In general, the involvement of service users in QI was constructed as being essential, though this was mirrored by the realities of day-to-day practice, making involvement difficult. Over the study period, teams struggled to engage service users in the process of QI, citing tensions around recruitment. In particular, concerns revolved around getting the ‘right’ service user for QI. This was more pronounced within the inpatient team, where the complexity of mental health was cited as being a key issue. At the same time, novel developments within the Trust had begun to develop e.g. ‘home’ microsystem meetings and QI training for service users, indicating some promise.

Summary: This research adds to discussion around the ‘co-production of QI’. Recognising QI as a space where multiple stakeholders with their respective forms of knowledge can converge, results of this study suggest that further attention is needed over these processes, that can help reframe many of the challenges into opportunities. In particular, how can principles of co-production and QI be sustained in contexts that are seen as traditionally ‘challenging’ e.g. mental health. There is also a wider discussion required on how the process of service user recruitment is viewed and managed, and whether this can act as being both inclusionary and exclusionary. Much of this may be seen intertwined with the supporting organisational culture and the respective systems in place. Recent developments may suggest promise in this area; this study calls for further intensity to ensure QI can be truly co-produced.


Presenter/s: Arbaz Kapadi (University of Sheffield, United Kingdom)