How can we co-produce effectively with lay partners?
THE CO-PRODUCTION TOUCHSTONE
To be honest, at the start I didn’t really see the point of the lay partners group. I didn’t think we had time. But I have really seen how important it is. They are the ones that really get what we are trying to do. By now, many of the group understand the detail and the complexity better than the professionals.
Manager, North West London Whole Systems Integrated Care programme
It rapidly became clear that the professional members of the module working groups also needed developmental support, particularly around co-production and what it means in practice. The lay partners worked collaboratively to produce a co-production touchstone, designed to serve as a set of behaviours against which actual group behaviour could be tested. Groups attempting to put co-production into practice can adopt and adapt this touchstone to test their own behaviour against it. To do so, it is critical to get buy-in and agreement from all partners at the start towards adhering to these ground rules.
WAYS OF WORKING
The following are key co-production principles that have been agreed by the partners of North West London Whole Systems Integrated Care project.
These are to be used as the basis of forming and shaping all pioneer meetings and workshops and returned to for guidance when we lose our way.
- Regardless of professional position or lived experience – we come to the table as equal partners.
- Lay partners are involved from day one of the process and where possible chair or co-chair meetings.
- We are all ‘assets.’ All contributions are valid and we are all equally heard.
- We use discussion papers in our meetings and working groups and invite open contributions from all members. This removes the top-down imposition of an agenda.
- If we do have an agenda for any meeting, it is co-produced.
- We agree mutual responsibilities and expectations at the start of every new group coming together – where possible roles are equally shared among all members and issues resolved by voting.
- We all have an equal responsibility to contribute our ‘assets’ towards the goals, aims and objectives of the programme and to attend at least 80 percent of meetings.
- We use language that everybody understands and provide a glossary where there is a risk that this might not be the case.
- We are all from one community. We speak collectively of ‘us’ and ‘our’ – not of ‘they’ and ‘them’. We strive to remove paternalism and keep our written communications plain and simple – avoiding jargon.
- We are pioneers. Where necessary we seek to innovate, prototype and problem solve, using blue-sky thinking. We allow ourselves to imagine the ideal solution and not be hampered by the need to adapt what we have or by self-imposed constraints.
- We are brave
- When we find reasons ‘why not’ we always counter these with discussions around reasons why ‘we could’.
- Our thinking is always person-centred – putting the person not the system at the heart of the process. We adhere to the agreed ‘I’ statements with regards to outcomes for people who use services and carers.
- We always ask who has not contributed to our discussions – and consider why
SUPPORT AND TRAINING
- We create a skills bank for our members so that our projects benefit from all the skills and connections in the room. We are proactive in asking people for help to share the skills that they have.
- Support and training is available to everyone who requests it – especially that which helps us empower our communities.
- We evaluate the benefits of working in a co-productive way and share this learning with other communities.
LEARNING AS WE GO
- We all acknowledge that we are on a journey towards a new way of working and that mistakes will be made along the way. By realising that it is the process of getting there that creates value as much as the outcome, we are forgiving and flexible in our attitude and transparent about any lessons learned.
- When we get lost or confused we ask for help and return to our touchstone for direction.
- All completed projects are signed off by lay members to assure fidelity of the process.
- We commit to robust and stretch targets within the outcome measures that are agreed in order to evaluate any scheme.
A particular focus of the lay partners has been on changing the language we use to describe our work.
In practice this means using simple, concise and clear language that everyone can understand. It is not helpful to use jargon that works for one partner when we need language that works for everyone. We need language that is as simple and clear as possible and does not imply any power differences between those people whose job is to commission or provide a service and those who use those services. The language should take the point of view of the individual rather than the system.
Challenging language has been a recurring theme. For me, a key moment was when a manager took up and ran with my challenge that the Board papers had not been patient focused or in user-friendly language. We had a long conversation about how to change this and came up with a highly revised version. It fundamentally changed the way we both looked at each module. But I have to say that I have not seen it sustained or promulgated as widely as we would like!
The lay partners agreed that it was important for Embedding Partnerships to lead by example. We undertook an exercise to rewrite one of the programme’s key communications – an overarching summary of the aims and objectives of each of the programme modules – in person-centred language. One of the tools we used was using active verbs not passive verbs: this is often clearer and shorter. We also tried to use everyday language rather than professional jargon.
From our efforts we learned that undertaking such an exercise is both challenging and time consuming, and takes real commitment from all partners. We have a long way to go to improve the language we all use, but this exercise was a culture changing moment for both the lay partners and professionals involved. Everyone has been involved in trying to make this toolkit use language in a way that makes it easier for joined-up health- and social-care to work more smoothly for individuals, commissioners and providers.