Assessing the efficacy of coproduction to better understand the barriers to achieving sustainability in NHS chronic kidney services and create alternate pathways

Abstract

Context Too many people living with chronic kidney disease are opting for and starting on hospital‐based dialysis compared to a home‐based kidney replacement therapy. Dialysis services are becoming financially unsustainable. Objective This study aimed to assess the efficacy of coproductive research in chronic kidney disease service improvement to achieve greater sustainability. Design A 2‐year coproductive service improvement study was conducted with multiple stakeholders with the specific intention of maximizing engagement with the national health kidney services, patients and public. Setting and Participants A national health kidney service (3 health boards, 18 dialysis units), patients and families (n = 50), multidisciplinary teams including doctors, nurses, psychologists, social workers, and so forth (n = 68), kidney charities, independent dialysis service providers and wider social services were part of this study. Findings Coproductive research identified underutilized resources (e.g., patients on home dialysis and social services) and their potential, highlighted unmet social care needs for patients and families and informed service redesign. Education packages were reimagined to support the home dialysis agenda including opportunities for wider service input. The impacts of one size fits all approaches to dialysis on specialist workforce skills were made clearer and also professional, patient and public perceptions of key sustainability policies. Discussion and Conclusions Patient and key stakeholders mapped out new ways to link services to create more sustainable models of kidney health and social care. Maintaining principles of knowledge coproduction could help achieve financial sustainability and move towards more prudent adult chronic kidney disease services. Patient or Public Contribution Involved in developing research questions, study design, management and conduct, interpretation of evidence and dissemination.

The Future of Public Mental Health: Challenges and Opportunities

“…The British National Health Service is increasingly integrating coproduction approaches into its health system-including but not limited to the mental health system-and could serve as a model. [96][97][98][99][100] Finally, social policy changes are critical to improving population mental health moving forward. 75 Specifically, the relationship between oppression and poor mental health points to the imperative to dismantle public policies that perpetuate oppression, such as mandatory minimum sentencing policies and funding of public education via property taxes.…”

The systems engineering approach to quality improvement in the NHS

“…5 More optimistically, however, there is emerging evidence to suggest successful change management following a renewed emphasis on PPIE: McLaughlin et al observed the importance of coproduction in improving chronic kidney disease care pathways in the NHS, while O'Flaherty et al also advocate for stakeholder engagement in evaluating the effectiveness of the NHS Health Check programme. 6,7 The implementation gap A key limitation when applying a systems approach to QI in healthcare has been to transition from a purely theoretical exercise towards real-world applicability. Despite being comprehensive in its scope, the approach is grounded in complexity and poses questions of resources, training and appetite.…”

Understanding the low take-up of home-based dialysis through a shared decision-making lens: a qualitative study

“…22 Barriers to home dialysis have been found to be complex. 23 Patients have reported insufficient knowledge and education as a barrier to selecting home dialysis. 24 Practically, home dialysis requires people to have adequate housing including space for supplies and in the case of home haemodialysis (HHD), an affordable and satisfactory supply of water.…”

“…Elsewhere, we report the outcomes from the coproduction in relation to specific service improvement aspects of the study. 23 In this paper, we include the patient and public involvement (PPI) and wider stakeholder activity related to the empirical research study. We map the PPI in the study against the UK standards for public involvement 38 Open access online file (online supplemental appendix 2).…”