Realising value through patient/public-healthcare professional co-creation for service improvement

Abstract

This thesis explores how the public and healthcare professionals work together (co-create) to improve services. It investigates how this co-creation happens in practice and what enables these groups to shift towards more collaborative working. Alongside this, it examines whether there is any point in co-creation. Specifically, does it improve healthcare? This research explores healthcare improvement initiatives mainly across the UK, with some examples from the USA, Sub-Saharan Africa and Eastern Europe. Data was collected retrospectively and prospectively from six organisational case studies and from the experiences of seven individuals. This research was framed by participatory and ethnographic approaches resulting in 55 semi-structured interviews, 160 hours of observations, documents, and secondary data sources. Existing research has highlighted a gap between advocated public-healthcare professional (PHCP) co-creation and what happens in practice. For some, co-creation is an intrinsic way of improving healthcare, while for others this is a new way of working. Alongside this, there is an ongoing debate about the need to assess the impact of PHCP working. A marketing theory highlights co-creation as a process where individuals interact with each other and the systems in which they are situated. This study applies this theory and provides the first known exploration of PHCP co-creation as an interactional process in healthcare improvement. This research describes co-creation in practice highlighting how the public and HCPs interact with each other and the wider systems. It explores the factors that facilitate co-creation, and demonstrates what can be achieved when the public and HCP work together. This thesis shows PHCP working can realise value for individuals, organisations and society, and that the complex, dynamic nature of co-creation impacts how the process can be managed. The research demonstrates conditions that can be engineered to improve how people work together. Co-creation can be facilitated by the individuals involved and through the structures and processes that are used or created. This can shift the public and HCPs towards more effective co-creation for service change.