People, meaning, impact and cake: A few thoughts on co-production

Hello to all co-production enthusiasts! I am Amy - a quirky by default, late diagnosed, rather complicated and messy autistic! I also have a complex presentation of mental and physical health conditions. I therefore try to harness the experience of these to make any meaningful difference for others as much as I can, advocating for and driving change. Committed to co-production as well as lived experience advisory work, I am involved in a huge variety of projects and different types of involvement. Anything from analysis, training, reviewing and creating ideas to writing articles, poetry, campaigns and research to make people’s lives better. I have worked with a wide range of organisations – from within the NHS, charities, universities clinical research facilities and many more besides. I hope to share some of my humble knowledge and experience in the hope it helps you with your own co-production work.

Learned or lived; Learning or living…

When we seek to learn something, most of us probably look for information from someone who knows. Books, articles, videos, a conversation - whatever the format is, we may look for an expert. Yet does an expert automatically mean an academic, or a person who has lived something? or both?

It is an interesting question, and in some situations, someone with lots of letters after their name might be precisely the person you need. Yet, in the many other spaces, lived knowledge and experience is vital.

There is much merit in the combination of expertise. Mixing it all together matters.

Cake!

Co-production is a little like a recipe for the most delicious cake. If you get an ingredient amount wrong, the balance goes and the result is a mess. Too much baking powder makes something bitter; too little oil can leave something dry and unpalatable. Yet, the co-production cake can be just right when co-production is what it should be. With all the ingredients in harmony – the harmony of all people working together productively, cohesively and fairly. A little bit of alchemy in the co-production space –making something new and cohesive from several separate but equally valuable parts.

Graphics, symbols, representations galore!

Co-production has different representations often shown as a ladder of levels, or perhaps a rainbow. Some places design with interlinked circles, or pieces of a jigsaw puzzle, fitting together neatly. The idea is to convey, in different symbolic ways, the differing levels of what engagement or participation can be. However, not all involvement is created equal and real co-production is not just engagement, or involvement or consultation. It is something in and of itself. So, maybe all these fancy symbols do not really quite capture what the core of co-creation, co-design and co-production is. It is more than the representations, a sum of something, rather than the broken down sections.

That said, something is definitely better than nothing and there in lies an important point. Not every organisation can co-produce in the purest sense of the word. They could however engage or consult – create a survey, roll out a questionnaire, ask for feedback. Something small is a good place to start. It can always grow when circumstances allow. Start somewhere; not nowhere.

Perfectly imperfect

If you can build up to meaningful participation, then that is ideal, but even in that, it really does not have to be perfect. It does however need to come from a place of genuine intent to up hold the values. Organisations with co-production at their heart hold themselves to account over participation. This is the best approach to take. Not the easiest by any stretch, but the best. To actually keep engaging with one’s experts by experience to review, to check, to improve and to grow. Things change and move forward, particularly in the world of healthcare. It constantly faces challenges. There is evolution. Things can only really serve people well if they involve those people. Things do not necessarily go to plan. Organisations will get things wrong, but with meaningful participation, there is space to hear this feedback, to engage with it and put improvements in place, co-designed with the lived experience partnerships and therefore communities who are served.

Shifting cultures

Culture is fundamental – without the right environment, approach and feeling about co-production in your organisation, you won’t be able to do it well. It is a partnership between learned and lived experience. There should not be a hierarchy. People should be valued. That can be recognised through fair remuneration and it should absolutely be, but what matters more is seeing the change. Being part of its implementation. Being a partner in a project from start to finish and seeing results come to fruition. There should be feedback to the lived experience partners. They should know what has happened. Ideally they need to see it and feel it too. Yet, to know that something tangible has occurred which has made an improvement is fundamentally important.

Aiming for equality; Aiming for equity

People in this space should make a concerted effort to reach everyone to engage them. Health inequalities are a huge issue. Widespread disparities exist. It is such a significant challenge to hear those harder to reach voices, but these people can be reached. Communicating to them in a way that meets them where they are, getting to be part of their experience of the world and hearing them. Working with other people with expertise to help you achieve that reach. Respect and safety needs to be conveyed. It is okay for these people to share. It is more than okay. It is hugely necessary.

This is at the heart of something which is meaningful. Equality yet also equity. Inclusion. Embracing and allowing for people with multiple and layered lived experiences (often called intersectionality) and attempting to break down barriers. Considering accessibility in all aspects of involvement. From the language used, the communication forms, the ways people may be able to interact with others. Thinking widely and flexibly to make adjustments for people so they can participate fully. Personalising their involvement wherever possible and appropriate. Thinking about neurotypes, neurodivergent needs and neurodiversity more widely. (See Prisca’s blog for practical ways to make co-production spaces more inclusive for neuro diverse communities These aspects are key ingredients to participation. Key ingredients to your co-pro cake.

Enabling

Facilitation of participation is vital. Carefully executed – helping to remove barriers, creating resources and building confidence. Those involved should have equal voice, but they also need to be supported to participate. There needs to be compassion, care, training if needed, guidance and significantly a commitment to uphold the values of true co-production.

Building safety, building trust…

There are many aspects to consider –governance and structures are important. You need to keep people safe. Those with lived experience and those without. It is all two way. If people are working to harness their lived experience, there will be vulnerabilities. There will likely be traumas. Making spaces safe is essential. How this is done will depend on the circumstances of the particular involvement process, but at the heart is support. Supporting everyone concerned. Whether they be the ‘learned’ or the ‘lived’ contributor to that space. Facilitating a respectful environment for all where everyone has merit, no matter how it is they come to be in the space. Highlighting that clear support and the value a person has is important and enabling their individuality to shine and be encouraged in the space.

It is a partnership with people and communities. Enabling full involvement wherever possible – making those adjustments, but also preparing staff too. It needs to be fair for all and everyone needs to feel comfortable, in as far as is possible with what so often will be difficult challenges and subjects to navigate.

Building trust is hard won, but it can be done. It can easily be lost, so one needs to be so careful not to undermine anyone. People with lived experience need to be heard, valued and their needs catered to where possible. Keep communication lines open and transparent so that trust remains. If people are not heard, you cannot get anywhere, and you may well lose the valuable insight you worked hard to gain.

Grounding in Humanity

Nothing meaningful should exist in a vacuum. Lived experience partners want to help make things better. They are that much needed ‘critical friend’. They need to see their efforts come to something. To have influence and impact is the goal – for everyone concerned. Embedding involvement generally and widely is your ultimate aim, but small is a start. If that is where you are, then just think of where you can go with it. Just think of how much your work can be enriched through true balanced involvement that makes quality improvements and real change over time. If co-production is grounded in all of the above, it is also therefore grounded inhumanity. Grounded in people. If we embrace humanity and helping to make a difference, we will be on the right path.

Photo credit to – Photo credit: SammeeAnderson from Unsplash