Page 17 - WCEN Dr Rochelle Burgess evaluation report\ Baloon

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Defining Coproduction
Despite its heritage in the well-established field of patient participation, coproduction remains a relatively
new and largely under-researched field of study (Batalden et al., 2015). Much of the current appeal of
coproduction is linked to a desire for multi-disciplinary approaches to treatment and care that prioritises
patient engagement, (NHS, 2014). However, its increasing popularity in current discourse is linked to
its ability to provide a direct response to many of the economic and resource challenges facing
overburdened health sectors (Bovaird, Va Ryzin, Loeffler & Parrado, 2015).
A recent review of coproduction identified 64 peer-reviewed articles on the topic, many of which were
theoretical in nature (Palumbo, 2016). Durose and colleagues (2014) note a weakness of the current
evidence supporting coproduction, linked primarily to the concept’s definitional breadth, a position
supported by Bovaird and colleagues (2015) who also highlight the amorphous nature of the concept
in both theory and practice. For example, while the seminal work of Brudney and England (1983) identify
three broad levels of coproduction at the levels of individuals, groups and collectives, Palumbo (2016)
maintains that within the confines of health care, only the individual level of coproduction has been
prioritised. Loeffler and colleagues (2013) extend this individual patient engagement perspective across
four levels of involvement in service improvement: co-commissioning, co-design, co-delivery and
co-assessment. However, even within these broadened areas, a narrow focus on individualistic
engagement remains with an emphasis on relationships between providers and users within a process
of enhancing value of health services for citizens. This is demonstrated by a recent study considering
coproduction and the self-management of COPD, which included discussions of co-design, co-delivery
and co-assessment. These were anchored to the notion of developing expert patients and carers through
training in biomedical perspectives of care (Cramm & Nieboer, 2016).
Research by Bovaird and colleagues (2015) suggests that intersections of individual and collective
processes are common within each type of coproduction. This position informs a definition of
coproduction as a series of inputs and benefits that are either collective or individual in nature. Individual
inputs include contributions made by individual volunteers or users, versus collective inputs, which
include contributions made by groups of individuals or collectives. Individual benefits would include the
results gained from participation in coproduced patient-client or self-management groups, which may
lead to improved health. Collective benefits can also be linked to the wider society. In this iteration,
coproduction involves engagement by groups who may not suffer from a condition themselves, but
participate in improving services for others in the general population. While the authors acknowledge
that not all forms of coproduction fit into their proposed matrix, their position enables a more complex
view of the potential forms of engagement that can occur between professionals and citizens who seek
to make better use of the other’s resources in order to improve service outcomes (Bovaird et al., 2015).
Bovaird’s model (2012; 2015), acknowledges inputs from individuals, communities, and statutory sectors
in order to achieve coproduction at various levels of service design. Figure 1 highlights that within their
proposed model; these groups ultimately remain individual entities, who produce inputs at both collective
and individual levels with a shared target of improving services. This model is well acknowledged within
grey literature reporting on coproduction in the UK and has been applied in numerous settings (New
Economic Foundation, 2013).
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