Teamwork can be easier said than done. Co-production is 'teamwork with kapow'

By Kath Sutherland, FRSA,  Equalities Consultant, START Ability Services. 

Why is being part of a team such a big deal?

We’re often told that teamwork is the key to success in many areas of life, be that in terms of a thriving business, playing as a football team at the top of the Premier League, or having a successful and happy marriage or partnership.    

The reason for this is that working together as a team is the only way that complimentary, but alternative viewpoints can be brought together to find solutions to the challenges that are faced.  This is especially the case when the barriers towards success are particularly difficult to overcome.  After all, no one person can know about every single aspect of a particular situation or challenging set of circumstances.

Sounds like hard work to me..

You’re right.  Effective and efficient teamwork presents significant problems and can be difficult to get used to at first. The reason for this is that it requires all team members to work together and commit to a common goal.  

This is easier said than done, as in order to do this, team members will need to either have, or acquire, skills in effective communication, mutual respect and the ability to resolve conflicts.  In this way, good teamwork cannot only increase performance, but it can also support teams to develop a stronger shared understanding of how to meet the goal.

Co-production is teamwork with an extra...  

Co-production is a highly effective form of teamwork that also requires these attributes.  So, in order to bring about innovative thinking to resolve difficulties that arise, co-production needs good communication skills, including the ability to really listen to someone else’s viewpoints. 

Additionally, traditional notions of ‘power’ held by different individuals need to be abolished, in favour of a belief that everyone has something valuable to contribute. 

Furthermore, everyone is given equal opportunity to contribute, as any barriers to access that they might face are addressed and removed.  In this way, all viewpoints can be considered in order to reach the most holistic and appropriate resolution and ‘the common goal’. 

So, is co-production worth the effort?

Co-production can be hard to master, but it results in enormous benefits.  For example, as it involves the team in all aspects of planning, designing, delivering and reviewing services, where team members are rewarded for their contributions, they gain a feeling of increased wellbeing.  

As such, morale and productivity, as well as ingenuity, is significantly increased.  This feeling of wellbeing results in higher quality services that are much more likely to be fit for purpose.  And if people actually want and value the service, you are much more likely to be successful. 


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Beyond the usual suspects. Co-production and Casablanca

By Pete Fleischmann, SCIE head of co-production 

"Round up the usual suspects". So said Captain Renault, the policeman, played by Claude Rains in the closing moments of Casablanca.

Often professionals I meet through SCIE’s co-production training and consultancy work seem to disagree with Captain Renault.  They want to move beyond the usual suspects.  On the surface this sounds very sensible. They want to involve a broad range of people who use services and carers who are representative of the community. And they want to avoid the small group of people who seem to turn up to everything.

You are too articulate and you know too much

But maybe something else is going on. People who use services and carers are often held to a higher standard of representativeness than professionals. If a GP joins a working group, they are not asked how representative they are of all local GPs. Usually people are pleased that a GP has taken the time to contribute their perspective and expertise.  

Pete Fleischmann

But people who use services and carers may face questions about their representativeness. And in some cases this could be seen as a way of undermining their contributions. They might be questioned about how typical they are of local people and about their ability to consult widely. The sub text to these challenges are might be, ‘You’re not like the people who use my service, you’re too articulate and you know how the system works. The implication being that user groups should not be represented by good speakers or by people who understand the system.

Instead of being acknowledged as a spokesperson for local users and carers they become one of the usual suspects. Is this constant need to move beyond the usual suspects a genuine wish to include a diverse range of people or is it so that the clearly articulated but uncomfortable views of local citizen leaders can then be undermined and dismissed as un-representative?  

Round up the usual suspects

In my view the ideal mix of people to involve in co-production work is a balance between local user and carer leaders plus a wider group of people who are not ‘usual suspects’.  One of SCIE’s co-production principles is Diversity. This means that it is vital not to exclude anyone on the basis of race, gender or sexuality. 

And it’s vital to be proactive about reaching out to seldom heard or marginalised groups and invite them to get involved. Often the usual suspects are very knowledgeable about their community and they may have a good track record of involving seldom heard groups.  So planning some co-production? Then take Captain Renault’s advice and get started by rounding up the usual suspects and start building a beautiful friendship. 

Setting the standard for co-production in #coproweek

By Alison Lowe, Chief Executive, Touchstone (Mental health and wellbeing provider) 

We strive to model all that is great about co-production.  
In 2016, we delivered Leeds’ first ever co-production conference which included contributions from all sectors and - of course – experts-by-experience. We also wrote a blog about the conference for SCIE. 

And on 6th July 2017, we at Touchstone will be holding our second conference in Leeds. This will coincide with SCIE’s Co-production Week and will be jointly run by our partners: Leeds Involving People, Together We Can (Experts by Experience), Leeds West CCG, Leeds and York Mental Health Trust, West Yorkshire Finding Independence and others.

Kitemark 

This time, rather than just auditing what we do well and learning from others, the aspiration is to begin building a quality standard – or kitemark – for co-production, not just for Leeds, but hopefully the whole of the UK.

In 2015/16, Together We Can members were involved in constructing, writing and evaluating a set of mental health “I Statements” against their own experiences. The six “I Statements” were then agreed by the Leeds Mental Health Framework Programme Board. This will be the overarching principles that will inform the delivery of all commissioned mental health services by the clinical commissioning group; and future service improvement and redesign projects. 

“More than a mental health diagnosis” 

The statements set out the values and competencies that will be expected from the commissioned care and support provided:

1. I am more than a mental health diagnosis. Treat me like an individual human being
2. I may rely on family and friends to stay well. Give them support, information and respect
3. I want to be heard and included, regardless of my identity. Offer me accessible and culturally competent support
4. I may be facing more than just a mental health challenge (e.g. Substances including alcohol or a physical condition). Respond to these creatively and without judgement
5. I will know the name of the person responsible for my support. Show me that you are a human being too
6. I have a story to tell. Share information effectively, with my permission, so I don’t have to repeat myself.

These statements will form the basis of our conference discussions on 6th July and will hopefully become the architecture of our future co-production standard.  In time, our vision is that experts-by-experience will be trained to assess organisations and services against the co-produced standards of practice. They will also be paid by them to improve compliance with the expected standard.  We hope that eventually, no organisations working in mental health will be commissioned unless it has, at least level One in co-production, rising to level three for the best performing organisations.  

We know this is a big ask and an even bigger vision.  We think Leeds is up for it and on 6th July, we will find out – please come along too if you fancy an adventure. 

Contact us here >>>

Co-production and mental health: the ‘ideal ward round’ in acute settings

By James Shutt, advocacy service manager and advocate

Times are changing

A question that's bothered me for a long time: could a co-produced project between patients, carers and willing professionals – a real group of ‘outsiders’ – make a tangible difference to the experience of being on an acute mental health ward? Well, I realised it was bothering quite a few other people too.

The “Ideal ward round” project set out to do just this

It brought people with current and recent experience of mental health services, including carers, together with professionals working in and managing those services. We took from the start the meaning of co-production as: "The voluntary efforts of individuals or groups to enhance the quality and/or quantity of services they receive. (Parks et al, 1981*). 

In this spirit, we got all these people together in a room with tea, decades of combined experience, a blank piece of paper and three unwritten rules: 

1. Everyone’s opinion holds the same weight
2. Wherever we go in terms of methodology or outcomes, we decide together 
3. Whatever this turns out to be, it has to make a real difference, especially for patients.

How did this all start? An idea and a conversation, then another conversation. Where did it go? Over two and half years, it included a literature review (ward rounds in mental health settings generally get a bad press!) - plus development of questionnaires for patients, ex-patients, carers and staff, data analysis, findings, focus groups, presentations, recommendations, buy-in from Trust senior managers and now pilots on real life wards and evaluations with a Russell Group University. 

It feels like we’ve come quite far… I feel like I’ve forgotten something… 

Oh yes, and lots and lots of meetings were held in between. And lots of conversations. Some tangential, some experiential, some abstract, but all relevant! And then lots of voting.

And this is the crunch I suppose from our experience 

Co-Production requires voluntary effort, quite a bit of voluntary effort from everyone, which in turn requires little more in essence than patience, trust and a sense of purpose. People have come and gone (and often come back) during the lifetime of the project but all of them claim the same credit. They have come from every pay grade and from a lifetime’s lived experience through to a first-time episode and admission. It has felt at different times frustrating, exhilarating, insurmountable and unstoppable. We continue now with the purpose we started with, and perhaps more importantly, the same rules.

‘The Ideal Ward Round’ started as a project in 2014, with the first meeting set up by James Shutt Jonathan Wright, Involvement Centre Manager for Nottinghamshire Healthcare NHS Foundation Trust. The Ideal Ward Round is due to be piloted by Nottinghamshire Healthcare NHS Foundation Trust in Summer 2017.

*Parks, R. B., Baker, P. C., Kiser, L., Oakerson, R., Ostrom, E., Ostrom, V., Percy, S. L., Vandivort, M. B., Whitaker, G. P. and Wilson, R. (1981), CONSUMERS AS COPRODUCERS OF PUBLIC SERVICES: SOME ECONOMIC AND INSTITUTIONAL CONSIDERATIONS. Policy Studies Journal, 9: 1001–1011. doi:10.1111/j.1541-0072.1981.tb01208.x

All things being equal: co-production and the careful use of language

By Michael Turner, SCIE co-production support manager 

This blog originally appeared on the Department of Health website

One of the great things about writing easy-read documents is that you really have to stop and think about each and every word and exactly what means. For any words that may be difficult to understand or not used very often, and for outright jargon, you have to stop and think and then put them into easy-to-read words.

Equality is one of those words. It’s also one of the four key principles for co-production in SCIE'
guide, Co-production in social care: what it is and how to do it.  And when it came to writing the easy read version of the guide summary, it was an interesting word to think about. (If you want to access one, please email us).

Equality’s not a particularly long word 

...and the meaning is fairly clear at face value. Everyone is equal and that everyone should be treated the same.

But it’s not that simple. Everyone isn't the same. Treating everyone as the same would mean not doing all the important things that you need to do in co-production (and in other things) to make sure you have diversity in your work.

The key thing is not that everyone is the same

...It is that nobody is more important than anyone else. Andrew Cozens - an independent social care and health policy and improvement specialist - makes the point in the Have we got co-production news for you?  film that  supports the guide saying equality means. He says: “Your perspective is equally valued whoever you are in the process; nobody is more important than anybody else.”

The principle of equality is a key foundation for co-production. It is what makes co-production different from previous approaches to working with people who use services and carers, such as participation and involvement.

The principle of equality also means everyone has assets

Knowledge, experience and skills are brought to the co-production effort. Making the most of these assets and working with everyone as equals, is the key to success in co-production.

Achieving this means doing things like developing structures to communicate with everyone who should be part of the co-production process, making sure that everything is accessible and making sure that everyone gets something positive from taking part in co-production. Crucially, equality can only be achieved with a shift in power to people who use services and carers; people are only equal if they have the same amount of power.

SCIE's guide takes readers through the changes that organisations and projects need to make, through a jigsaw model of change management covering culture, structure, practice and review. So that they don't just know what the words mean on the page, but what they mean in action.

What is a Patient Champion?

A conversation between Leanne Winfield, Patient Champion and Pamela Fisher, Principal Lecturer, Health Promotion & Public Health, Leeds Beckett University.

Pamela: Tell me about being a Patient Champion.

Leanne: I am a ‘Patient Champion’ with my local NHS Clinical Commissioning Group (CCG) in Leeds West. A Patient Champion is a member of the public who works with the NHS to ensure that the needs of patients, and the wider public, are considered by staff throughout the commissioning cycle. My particular roles are as a member the Patient Participation Group at my GP surgery, and as a member of the Equality and Inclusion Group at Leeds and York Partnership NHS Foundation Trust. In these roles I aim to promote the needs of all patients, not just my personal viewpoint.

Pamela: Pamela: We are holding seven one-day seminars are being held over two years in collaboration with the Universities of Huddersfield, Oxford (St. Catherine's College) and York. The seminars are helping to develop new ways of working and researching within mental health. The starting point is that co-production should involve authentic power-sharing, and that this requires a fundamental re-imagining of the relationships between service users, carers and professionals. They are run with the Economic and Social Research Council. Is your work in a Leeds also a good example of co-production?

Leanne: The purpose of a Patient Champion is to bring another perspective to discussions, and ensure that relevant engagement work has taken place. With the CCG I have also been involved in producing and delivering some training for other Patient Champions and staff members on the topic of co-production. This was developed with the ethos of co-production, working with staff members on an equal basis, and the process demonstrated a really good example of co-production. People were valued regardless of whether they were experts-by-learning or experts-by-experience. The training was well received, and we will be running it again later in the year.

Pamela: Our seminars have seen a group of diverse stakeholders, who have contributed different forms of expertise, taking part. The starting point for the seminar series has been that all forms of expertise – service user/survivor, professional and academic - should be viewed as equally valuable. I’d imagine it’s unlikely that you would be able to be so effective as a Patient Champion if you were unable to draw on her own experiences as a ‘user’ of mental health services. 

Also from Dr Pamela Fisher: Blog - reimagining Professionalism in mental health: towards co-production

Making the invisible, visible. Co-production in three areas

By Jane Green, Equality, Diversity and Human Rights + Co-production groups member.

After being forced to give up work – I was a professional autism educationalist - due to Ehlers-Danlos Syndrome (EDS), I was amazed at the length of time it took to get diagnosed and receive help.  This was because EDS can be  mis/underdiagnosed and considered a rare condition.  Two other diagnoses followed, one of which is also rare and one I am very familiar with,  as late-diagnosed female ‘autism’. 

Trustee work 

I have been a carer for my eldest son all his life as he presented with various conditions including autism and dyspraxia.  So I wanted to use some of my experience and skills as a carer and autism specialist and was elected to Trustee for Carers Support West Sussex.  Although not well enough to attend all meetings I was delighted to find out that the support meetings were run with the carers, co-producing where they wanted the support groups to go; with the charity providing the structure to facilitate that.

Relating to my EDS I didn’t know anyone with it and during the time I visited hospitals, meetings doctors and physios and similar, this had not been mentioned to me.  So I joined the Ehlers-Danlos UK Support charity.  Unfortunately they are one of the most underfunded and unknown charities with only a handful of employees.  Social media has helped as we can’t always be well enough to move around.  Due to funding issues and knowing that we as EDS sufferers know what we need - and what support is or isn’t around - the charity asked for some of us in each county in the UK to be a volunteer co-ordinator. 

Where are we now? 

This involves disseminating information, especially the new classifications that came out this year, plus raising awareness and supporting others, as well as fundraising.  So we all work together in any way we can, bearing in mind we are all diverse. We make it accessible to everyone, so immobile people can join us online - and everyone benefits from service users to professionals.  Where are we now?  We are working hard with medical practitioners to make this ‘rare’ condition less rare and more supported. 

Whilst ill, I had no pathway, no information, in fact, disbelief at times, and no overall overseer of my EDS condition. This led to me physically breaking down.  I have brought and am bringing this to the notice of the CCG and NHS.  I am delighted that I have now been invited to work on a rheumatology pathway. This is looking at capacity needs, to be a part of a rheumatology group, so that it can be recognised better. We want to see how things can be more effective, more economical in the long run, and more efficient for all. And hopefully a good example of ‘co-production’ in the health sector.