What Are the Professional, Political, and Ethical Challenges of Co-Creating Health Care Systems?

Abstract

Co-creation is seen by many as a means of meeting the multiple challenges facing contemporary health care systems by involving institutions, professionals, patients, and stakeholders in new roles, relationships, and collaborative practices. While co-creation has the potential to positively transform health care systems, it generates a number of political and ethical challenges that should not be overlooked. We suggest that those involved in envisioning and implementing cocreation initiatives pay close attention to significant questions of equity, power, and justice and to the fundamental challenge of securing a common vision of the aims of and agendas for health care systems. While such initiatives present significant opportunities for improvement, they need to be viewed in light of their accompanying professional, political, and ethical challenges. IntroductionWorldwide there is a growing awareness of the need to adapt health care systems to meet the challenges of the twenty-first century. The reasons for this need are many but include shifting trends in demographics and illness, epidemiological knowledge of the social determinants of health, the radical possibilities of new technologies, and rapidly increasing health care costs as well as relatively long-standing concerns about the need to respect and support the autonomy of patients [1,2].

Exploration of a Co-Production Approach to Developing a Walking Group with People with Huntington’s Disease

“…A central assumption of co-production is that a common ground is found between participants and this may inherently challenge both the role and perceived hierarchy of power of the healthcare professional [19]. All participants in this study, including the research team, had a common understanding that walking was a beneficial activity, yet people with HD saw the role of the research team, and possibly of the healthcare provider, as being in control and having the ultimate power within the walking group.…”

What do healthcare professionals want from a resource to support person-centred conversations on physical activity? A mixed-methods, user-centric approach to developing educational resources

“…Despite convincing evidence and numerous national guidelines defining the vital role of physical activity across UK healthcare,1–3 11 21 43–45 the translation of knowledge from research to clinical practice remains limited across professional disciplines 14–18 21 46. To address this, we employed codesign principles, which ‘offers the chance for clinicians to reconsider the purposes of medicine and for patients and other stakeholders to have their voices heard and respected’ 47. We listened to a wide range of healthcare professionals and patients to understand clinical practice requirements 27.…”

“…14-18 21 46 To address this, we employed codesign principles, which 'offers the chance for clinicians to reconsider the purposes of medicine and Open access for patients and other stakeholders to have their voices heard and respected'. 47 We listened to a wide range of healthcare professionals and patients to understand clinical practice requirements. 27 We interpreted this in the context of published evidence and recommendations to make a draft solution that we tested and refined through the Delphi study.…”

Interplay of coordination, co-creation and community building: examining interprofessional collaboration in workplace development efforts in health care

“…We emphasize open-ended, emergent objects, collaborative interaction and the proactiveness of actors as features of co-creation (Table 2; Seppänen et al , 2021). Professionals and developers need to pay attention to the extent to which objects are shared: if the assumed existence of a shared object is false, co-creation may fail (Singh, 2017). The notion of relational expertise (Edwards, 2017), which focuses on how IPC is shaped by and co-evolves together with objects (that is, the “what matters” of professionals), exemplifies one mechanism of co-creation.…”

“…The flexible ways of interaction manifested in the examples above are typical in co-creation, during which complex, open-ended or evolving objects are worked on (Spinuzzi, 2015). Co-creation means that professionals, sometimes together with their clients, jointly develop or create new solutions, ideas or practices by advancing and building on insights brought in by other participants (Edwards, 2017; Singh, 2017). Co-creation implies instability by promoting change and novelty.…”