Co-production helps ensure that new technology succeedsBMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4833 (Published 25 July 2019) Cite this as: BMJ 2019;366:l4833
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We read with interest the editorial (1) and associated articles regarding co-production of healthcare technology. Positive co-production is important for patients, offering them increased confidence and involvement, while simultaneously providing much needed service improvement.
The effective participation of patients in healthcare is increasingly important. Co-production is defined ‘as a way of working that involves people who use health and care services, carers and communities in equal partnership; and which engages groups of people at the earliest stages of service design, development and evaluation’ (2) . Co-production is just one part of a shift of healthcare culture towards person-centred medicine empowering activated patients to better engage with their own health and wellness (3) .
There are significant challenges to co-production of healthcare services in general and digital solutions in particular because of diversity amongst patients and professionals, potential threats to professional expertise, relative balances of power and responsibility and resistance to system change (4,5 ). Key in true co-production is the commitment to continue long term co-production between patients and staff through iterations of service development and the serious alignment of co-production with ongoing review and governance. Our patient group feel the latter point is key to avoid tokenism which undermines co-production validity.
In Sheffield in 2014 we implemented a new model of musculoskeletal care – Sheffield MSK – which brought together through a single electronic referral process the previously separate services of orthopaedics, rheumatology, chronic pain and therapy. This whole-system approach was commissioned on an outcomes basis shifting the emphasis from payment by appointment or procedure to commissioning a block of care based on the difference it made to people using the service. Co-production was a key tenet in our approach and the model was devised and tendered after 2 large, carefully facilitated ‘marketplace’ events with local stakeholders and underpinned by a robust patient engagement strategy with patient ambassadors as ongoing and equal partners in the program board overseeing Sheffield MSK and a contract model in which some remuneration is dependent on demonstration of this partnership approach.
To collect outcomes we have co-produced, again with wide consultation with patients, a digital platform - MyPathway (mypathway.healthcare Advanced Digital Innovation, Salts Mill, West Yorkshire) which links patients and Sheffield MSK in a unique way underpinned by our comprehensive resource for staff and patients (www.sheffieldachesandpains.com). On their MyPathway app, patients get a personalised timeline of care with specific resources signposted and the opportunity to input their own data to validated outcome scores related to their care. For staff, this outcomes data can be used at an individual patient level to inform care in the clinic and at a system level to improve service quality. Patient co-production has consistently challenged Sheffield MSK to maintain a patient-centred approach. The patient group consulted to provide a definition of ‘supported self-care’ and have held Sheffield MSK, and particularly our digital platforms, to account with respect to this. Examples of the results of this are an arthroplasty decision aid and myth busting back pain sheet now widely used. Recent evaluation confirms this platform has high levels of patient satisfaction.
This example of co-production of a digital platform to improve patient care is wholly built on coproduction of many stakeholders and is a ‘real world’ example of the operationalisation of co-production including ongoing patient involvement in governance.
1. Dobson, J BMJ 2019;366:l4833 doi: 10.1136/bmj.l4833 (Published 25 July 2019)
2. http://coalitionforcollaborativecare.org.uk/coproductionmodel/ accessed 11th August 2019
3. https://www.kingsfund.org.uk/publications/shared-responsibility-health#m... accessed 11th August 2019
4. Batalden M, Batalden P, Margolis P, et al. Coproduction of healthcare service BMJ Qual Saf 2016;25: 509–517.
5. Batalden P Getting more health from healthcare: quality improvement must acknowledge patient coproduction BMJ 2018;362:k3617 doi: 10.1136/bmj.k3617
Competing interests: No competing interests
Adapting to new technology is the secret of success if not survival in modern professional life and living. Despite early inertia on the part of both some doctors and patients, it may not take much time to realise that you are out of 'sync' or even become anxious about being 'redundant'. A smooth transition is the key to many issues that may arise. Elementary understanding, familiarity, dependence, and even 'addiction ' to technology has been observed in usage. Periodic personal visits and interactions interspersed with digital usage makes for the right clinical balance, avoiding the risk of 'robot' practice. Undeniably, technology can help doctors and patients with getting the right perspective on clinical conditions in good time.
Dr Murar E Yeolekar, Mumbai
Competing interests: No competing interests