Co-production in social care: What it is and how to do it
Practice example: Grŵp Gwalia
About the project
Grŵp Gwalia is a housing association whose services include supported housing for disabled and older people in Wales.
The association took part in a co-productive approach to service and workforce development called Developing Evidence-Enriched Practice (DEEP) with Swansea University in partnership with Joseph Rowntree Foundation (JRF), Health and Care Research in Wales and the Institute for Research and Innovation in Social Services in Scotland (IRISS).
The project involved older people, carers, frontline staff, managers and researchers collectively exploring and addressing the Seven Challenges of the JRF programme A Better Life, and in particular the challenge 'all support must be founded in meaningful and rewarding relationships'.
What has co-production meant to the project?
During the project, participants were able to share and explore research evidence alongside local, contextual evidence from older people, carers, frontline staff and managers regarding the importance of relationships in supporting emotional wellbeing and the delivery of good care and support services.
Participants were able to explore and develop a positive approach to risk management, which supported highly contextualised decision-making regarding lifestyle choice including relationships and activities involving people who use services and staff which were transparent, collectively discussed and agreed and recorded. These ideas were developed further through a revision of the organisation’s Professional Boundaries Policy, which was renamed as its Sharing Lives and Professional Boundaries Policy. Staff, people who use services and carers are now working with this revised policy, to explore and address the implications for practice.
What has helped in implementing a co-production approach?
The project identified five important elements, all of which needed to be addressed in supporting a co-productive approach to using evidence in practice, which were:
- Valuing and empowering all of the people involved in the project – senior managers had to support participants to be creative and able to experiment with ideas. Trusting relationships needed to be developed between everyone involved, so people could be honest and feel safe.
- Valuing and using a range of evidence – it was important to consider ‘what mattered’ to everyone involved. This meant that four main types of evidence needed to be considered – research, the views and experiences of older people and carers, the expertise of frontline staff and organisational concerns including policy.
- Preparing the evidence, so that it was interesting and relevant to everyone – participants were able to understand and use the evidence when it was presented in the form of short summaries, stories, pictures, poetry or even song. Some of the evidence could also be summed up in provocative statements, which got people thinking, for example 'regulation kills kindness'.
- Using well-structured approaches to helping people think and talk together, which enabled them to be better listeners and more open to learning. As a result, they came up with collective ideas and decisions and everyone felt that their contributions were welcomed. Different bits of evidence were weaved-in to discussions as they became relevant over time.
- Tackling local and national obstacles and circumstances, for example, policies that do not fit well with the range of evidence explored.
What difficulties were there in implementing co-production?
The move away from compliance with 'one size fits all' rules and regulations to making decisions based on what works in a specific situation has meant that there needs to be a greater focus on team development and the development of a more reflective organisational culture. Staff need support to explore how they feel about relationships and activities involving staff and service users and the impact on team dynamics. For example, concerns about setting precedents, favouritism or feeling left out.
What are the main strengths in the approach that has been taken?
Integrity, a recognition of common humanity, use of a wide range of evidence, transparency and a collective and appreciative approach to improving wellbeing.
What have been the main outcomes of the project?
What emerged from the project was a recognition that some aspects of the organisation’s Professional Boundaries Policy were at odds with what mattered to people who use services, carers and staff as well as the research literature on emotional wellbeing. A new policy was developed, which was renamed the Sharing Lives and Professional Boundaries Policy, with the intention of making services more friendly and ‘normal’. Further work is currently underway to explore and refine this policy and put it into practice.
How has the project worked to engage all sections of the community?
An essential prerequisite of the project was that older people, carers, frontline staff managers and researchers were all valued as 'experts' and were involved from the outset of the project. They also collectively developed the direction of travel. This was made possible by focusing on what mattered to everyone involved. As one project participant remarked, it 'went with the grain of our humanity'.
What advice would the project give to others?
- Make sure that any co-productive activity is values-driven, with a clear intention of improving well-being and services.
- Involve everyone from the outset and ensure they feel valued and their contribution welcomed.
- Support participants to develop their own ideas and areas for development – don't impose, but rather identify and focus on what matters to them.
- Use carefully structured ways to support the collective exploration and use of evidence regarding the topic being considered.
- Identify and address any structural issues that get in the way of good ideas.
- Celebrate success, even in small things!