Co-production in social care: What it is and how to do it

How to do co-production - Culture

The culture of an organisation is key to determining whether co-production can take root. It needs to be a culture that is open to change and comfortable with well-managed risk.

The culture in existing staff teams has been found to be a key determinant of the effectiveness of introducing peer support workers. [17*]

A change in culture may be necessary if there is to be progress with co-production. There needs to be a move from delivering services to facilitating services [15] and from facilitating and enabling rather than a one-way process of providing care. [41]

A range of cultural issues need to be thought about so that professionals can successfully co-produce with people who use services and carers. These range from ownership of the project throughout the whole organisation to valuing the skills and assets of everyone involved. The culture of the organisation also needs to embrace the key principles of co-production.

Embedding co-production throughout the organisation

Most of the practice examples included in this guide were projects that were part of larger organisations. A commitment to co-production throughout these organisations was critical to success. The support of senior management was especially important.

So co-production needs to be supported through the leadership and management of organisations. [24, 42] For example, strong leadership helps to overcome barriers in a project. [56*]

• Practice examplesOpen

  Birmingham City Council’s Adults and Communities Directorate

  Co-production has become part of the culture of this directorate and working with people as equals is part of its ethos. This was achieved through a vision that is shared by all those who are involved, identified goals and an understanding of what success will look like.

  It took time to develop this ethos through work to raise people’s awareness and understanding of co-production. It also took time to persuade and educate them about the value of the approach. People working in the directorate needed to actively work together to change the culture towards one of co-production.

  My Way

  This project has benefited from the culture of the McIntyre organisation where it is based. Co-production and personalisation are part of the culture of the whole organisation and this has helped the project to build on and embed the experiences from previous work with schools and parents.

  Senior management have responsibility to put co-production into action in the organisation. This means that the approach is valued and avoids an assumption that co-production will just happen. It has given a clear sense of direction and purpose and avoided the danger of just working to rigid targets.

  Look Ahead Care and Support

  This organisation has worked to ensure that co-production runs through the culture of the whole organisation. There is commitment at all levels of the organisation, including senior management and the board.

  Co-production has involved recognising that people who use their services have a great deal to offer. The organisation has moved away from viewing customers as passive recipients of services to people with the potential and power to be major assets to the organisation.

  Introducing and embedding co-production involved taking Look Ahead’s existing approach to customer involvement and personalised services one step further. It represented the next step and an evolution of the ways in which it was already supporting and valuing customer experiences.

  KeyRing

  This had a strong culture built around the idea of mutual benefit following the vision of its founder, Carl Poll. He introduced a co-productive approach before the term co-production became fashionable.

A culture of risk awareness

Issues around risk were not identified in the literature on co-production but they were an important issue in the practice examples. These showed that a culture of co-production means:

• being aware of risk
• taking managed and planned approaches to risks
• being prepared for anything that may go wrong with plans for addressing these, rather than being too averse to risk and missing out on positive outcomes that can only be achieved through actions that involve a level of risk.

The Project Advisory Group noted that while there are risks associated with co-production, they can be managed. At the same time, there are risks around not co-producing as it can be a key part of maintaining services at a time of limited resources. The group discussed safeguarding as a good example of co-productive risk management. Good practice in safeguarding is that everyone should have a role in the protection of people from harm, rather than it being only a professional responsibility. Where this happens, it reflects co-production in action.

• Practice examplesOpen

  All Together Now

  This project found that being averse to risk created barriers to co-production in two important ways. First, there was concern of physical risk as people became more active. Second, there was a concern that staff having or showing feelings towards people and offering reassurance or support by touching or holding them could lead to accusations of abuse and trigger safeguarding procedures.

  It addressed this by developing a Choice and Risk Framework. This set out a system for identifying, assessing and managing risks, and balancing potential benefits of taking a risk against the possible problems it could lead to.

The literature has identified the need for organisations to be more open to risk in other areas too. For example, strategic commissioners need to redefine what risk is so that small- and medium-sized enterprises are not automatically defined as high risk due to their size even when they are profitable and successful. [57]