Table 2.
Co-production initiatives, timeline and methods
| Co-production initiatives | Timeline | Description and stated or inferred method |
|---|---|---|
| Esther | 1997 to ongoing | A person-centered approach that started from the guiding question: What is best for Esther? Focusing on the needs of the elderly population with complex and multifaceted needs. Development of personas and storytelling aiming at facilitating person-centered care together with quality improvement methods and tools. The work relates to a variety of different co-production/co-design methods that have been developed over time |
| The child dialogue | 2001 to ongoing | Development of an integrated health system for child health with the needs of the child and family in focus. QI principles and complex adaptive system theory guided the efforts. A wide range of stakeholders, schools, public health, health care, oral health, social care and many more are engaged. Patients, family members or citizens have guided directions and sometimes led activities. A similar approach has later been developed for the elder population in Senior Dialogue. Relates to co-design methods |
| Pharmaceuticals project | 2004, 2007, 2011 | Invitation of users to participate in dialogues on pharmaceutical use in three different programs. The idea was that involvement of end users can improve process and documentation of action plans in improving drug handling. Relates to co-evaluation |
| Passion for life | 2005 to ongoing | A program aiming to create conditions for a healthy life of high quality for the older people using QI tools and a group/network approach with facilitators. The concept also was developed for a younger population named ‘more to life’ (2008). Relates to co-design and collaborative QI methodology |
| The Ryhov hospital self-dialysis unit | 2005 to ongoing | A concept development that started from a single patient’s initiative, with patients and health-care professionals collaboratively developing self-dialysis whereby patients learn to master all aspects of their hemodialysis. Relates to co-design, person-centered care and co-production of health-care services |
| Patient safety program | 2006–2012 | Storytelling was used and developed in relation to how patients can co-produce safety in health care. This was applied in both leadership meetings, mesosystem-level development programs and microsystem-level everyday work. Method of storytelling and person-centered care |
| Learning cafés | 2007 to ongoing | A meeting place based on a health pedagogy model where patients and their loved ones learn about their disease from their own perspective, questions and situation (a shift from diagnosis-oriented schools starting from the professionals’ perspectives). Developed with inspiration of health pedagogy model by Landtblom, Vifladt and Hopen [13]. Relates to co-design |
| PEERs (people with lived experience of a mental illness) | 2010 to ongoing | A network of persons with patient experience in psychiatric care with skills to participate in education and development efforts in different ways. Started with co-production work designing training in recovery-oriented approaches in psychiatry. All peers have some training in recovery orientation and peer education. Relates to co-design |
| Colon cancer—improvement work | 2010–2012 | A demonstration improvement collaborative, supported by RJC, to pursue promises on person-centered care involving health-care professionals, patients and their families, researchers, payers (leaders), planners and educators spanning multiple organizational boundaries across RJC and two adjacent regions QI methods including patient representation in the team relate to co-production in QI initiatives |
| Together part I | 2010 | A collaborative QI improvement approach aiming at actively include patients ‘and relatives’ experiences and knowledge in health-care QI work and patient safety. The aim also was to develop methods and learnings on coproduction to facilitate reaching the overall aim, which was, by December 2010, patient/user participation will be a natural part in the County Council’s development work. Relates to co-production in QI initiatives |
| Together part II | 2011 | An improvement work in the psychiatric care with an improvement group consisting of patient and professional representatives working together through a quality improvement process with QI facilitators. Co-design approach in QI initiatives |
| Patient supporters | 2012 to ongoing | A person with own patient experience identified the need of and facilitated the development of the patient supporter role in RJC. A patient supporter is a staff member with the role of supporting other patients. It can regard information about a process, treatment or operation from a patient perspective. They have a broad experience of many patients’ different experiences (in addition to their own). Staff can also benefit from patient supporters asking for their knowledge and perspectives. Relates to persons with patient experience as staff resources |
| Breakthrough collaboratives on heart failure and quality of care | 2013–2014 2015 |
A national breakthrough collaborative with patient participation in the team. RJL teams participated with patients. In addition, improvement advisors from RJC also participated and facilitated the national initiative overall. RJC participated in two collaboratives. A co-design and collaboration approach in QI initiatives |
| Dialogue meetings with patient organizations and RJC politicians | 2015 to ongoing | Development of regular and structured dialogues between politicians and patient organization A facilitated macrosystem-level dialogue initiative creating shared meeting places |
| Together for best possible health and equal care | 2016 to ongoing | A systems approach to move most health care closer to the inhabitants. An overall approach with initially 23 subprojects. Persons with patient experiences are involved in the strategic meeting places. A variety of co-production tools and methods are developed and used. Personas from different population segments were developed on a strategic level to illustrate the needs from different perspectives. Relates to various co-production methods |
| The Living Library | 2016 to ongoing | The development unit’s response to increased demands for patient representatives to participate in QI initiatives from around the RJC, prompted the creation of a ‘Living Library’ of persons with patient experience. The Living Library consists of persons with own patient experience. They are trained to provide patient perspectives in improvement efforts, give lectures, support other patients, participate in educations, contribute with storytelling and driving development projects. Qulturum, RJC’s development and innovation center, coordinates the Living Library |
| The House of Hearts— meeting place for persons and loved ones living with cancer | 2016 to ongoing | A meeting place for persons living with cancer and/or their family and friends. Designed and developed by a former cancer patient with support from RJC initially; later further developed with additional external funding. This is an example of persons with patient experience driving own initiatives |
| PEER—supporters in psychiatric care | 2018- ongoing | An addition to the PEER network described earlier, a new role with extended education and professionalization was developed. The peer supporter is part of the staff group at a clinic and participates in the ongoing work, mainly working with PEER patient support and participates in the everyday development work in the organization. In RJL, the peer supporter is a person with own patient experience who has a specific education in recovery- oriented approach in psychiatric care. Relates to co-design and further development of persons with patient experience as staff |
| Patient contract | 2018 to ongoing | Patient contract started as a national initiative that RJC adopted as a central component in developing health-care co-production. The patient contract concept has four parts: (1) shared agreement between patient and professional(s), (2) shared understanding of the suitable time for a next contact, (3) a jointly agreed comprehensive, coordinated care plan and (4) care continuity through a named person to contact. The RJC approach to patient contracts is co-designed by persons with patient experience, improvement advisors and health-care professionals |
| International collaboration and communities of practice | 2018 to ongoing | International benchmarking and development of co-production knowledge with two cases in a learning network. Patient contract (2018–2019) and a clinical case regarding value creation for and with persons with multiple sclerosis (2019). Patient participation in different ways involving different methods. Interactive research programs are connected to both initiatives. Relates to several approaches: co-design, collaborative QI, storytelling and personas |
| Integration of co-production in leadership and professional training | 2018 to ongoing | Evolution of how to convey understanding of co-production and its value more systematically in professional and leadership development programs in RJC. Continuous small-scale testing, with expert support from Professor Paul Batalden, at the Dartmouth Institute and Jönköping Academy, includes exploring the lived realities of patients and professionals. Relates to patients as ‘learning partners’ in exploring co-production of health-care services |
| Short-term self-managed hospitalization | 2018 to ongoing | Ongoing person-centered care program in mental health with short-term self-managed hospitalization, in RJC for persons with self-harming behavior. The self-managed hospitalization gives increased autonomy and an opportunity to retain personal responsibility for health and control over interventions. Relates to person-centered care and co-production of health-care services |