By Bev J. Holmes
The co-production or co-creation of research is not new – action based research traditions can lay claim to a long history, but are those of us involved in co-production doing enough to understand what it means?
In their work on public involvement, Antoine Boivin and colleagues (2014) note there is such widespread support for the rhetoric of co-production that we may dismiss (I would add not even acknowledge) the tensions that arise when professionals and lay people work together. Co-production in health research is similar. We need to work harder to say what we mean, mean what we say, and learn as we go.
Say what we mean
Co-production is easy enough to say, but what does it actually mean? I don’t often hear it defined, perhaps because it sounds obvious. When pushed, people may describe it as partnership or collaboration.
At a workshop at the 2017 Global Implementation Conference, we defined co-production as collaboration in governance, priority setting, conducting research and/or knowledge translation.
In turn, we defined collaboration according to the International Association of Public Participation’s public participation spectrum (PDF 753KB).
We noted that co-production involves researchers and others with a stake in the project: citizens, patients, health care providers, and/or health care decision- and policy-makers.
The important piece in all of the above is shared decision-making. But operationalizing the ‘co’ in co-production – a prefix implying joint, mutual, in common – is not an easy task. Is co-production the appropriate model for the project at hand? It’s not always: the other elements on the spectrum (informing, consulting, involving, empowering) are as valid, depending on the situation. But they mean different things. The message here is that definitions – or lack thereof – have significant implications for action, discussed next.
Mean what we say
Committing to co-creation – and all it implies with regard to shared decision-making – means acknowledging that co-production is challenging: it requires role clarity, attention to power imbalances, difficult discussions about research rigour versus research relevance, and constant monitoring (Holmes et al., 2016). It also means putting in place the mechanisms to support it.
Boivin and colleagues (2014) note three areas for attention:
- Credibility: Participants need to learn each other’s language and be seen as valued and relevant sources of knowledge for each other.
- Legitimacy: Participants need to be clear on whose behalf they speak (eg., people in the same profession, users of a particular service, patients with the same condition, employees in a specific organization) and be supported to do so.
- Power: All participants must be able to influence decisions.
Practical steps can be taken in all these areas. For example credibility comes from participants’ experience and expertise, but can be built through access to additional information or skill-building. For legitimacy, Boivin and colleagues (2014) point out the difference between statistical representativeness of a group (correspondence between the descriptive characteristics of a sample and those of the population from which they are drawn) and representation. The former is difficult and expensive; the latter, where individuals speak for a wider constituency, is feasible through appropriate connections, for example access to community groups or related data. To achieve a balance of power, facilitation can be critical, helping with seemingly simple strategies like seating plans and titles, as well as ground rules and agenda setting.
Learn as we go
We need to study co-production as a topic, over and above the focus of the research in which it is used. Ideally, those involved in co-productive research will:
- draw on the plentiful, useful but largely dispersed literature that can provide evidence for what works where;
- use an existing framework and model; and,
- commit to the study of their initiative – for example testing the adopted framework – for the benefit of the field. Rather than more lists of barriers and facilitators, we need studies of co-production in action.
Conclusion
Of course, co-produced research will ultimately only be as successful as the broader system enables it to be. Funders and health care and academic organisations also have a role to play (see my blog post with Allan Best; Six actions to mobilise knowledge in complex systems).
What has your experience been with research co-production? Can you point to useful theories, models, frameworks and methods?
References:
Boivin, A., Lehoux, P., Burgers, J. and Grol, R. (2014). What are the key ingredients for effective public involvement in health care improvement and policy decisions? A randomized trial process evaluation. Milbank Quarterly, 92: 319–350. Online (DOI): 10.1111/1468-0009.12060
Holmes, B., Best, A., Davies., H, Hunter., D, Kelly, M., Marshall, M. and Rycroft-Malone, J. (2016). Mobilising knowledge in complex health systems: A call to action. Evidence and Policy, 12, 3. Online (DOI): 10.1332/174426416X14712553750311
This blog post is based on a longer version originally published on the Michael Smith Foundation for Health Research website, but which is no longer available (November 2022).
Biography: Bev Holmes PhD is Interim President and Chief Executive Officer of the Michael Smith Foundation for Health Research, a research funding agency in British Columbia, Canada. She holds adjunct professor appointments at Simon Fraser University and the University of British Columbia. Her research interests include knowledge translation, discourse analysis, health communication, risk communication, and public involvement in health research.
Yes, we will need to begin to see collaboration/co-production as a worthwhile skill and activity to be studied and developed, and we will need to become expert in creating collaborative systems and networks that people can join, engage with and develop. Much as a composer writes a piece of music for others to interpret and perform, the collaborative/co-productive worker of the future will need to be expert in creating collaborative systems within which people can interpret problems in their own unique ways and collaborate to co-produce innovative approaches and solutions.
Dr Mark Elliott and his ground breaking work on mass collaboration, as demonstrated by the activities of his company Collabforge: https://collabforge.com/ is a good example of someone who perceives the creation of collaborative vehicles and systems as valuable ends in themselves (most definitely worthy of study!).
Hi Charles – I love the connection you are making with music. I am wondering whether we have somewhat of a clash of cultures here when we are talking about creativity in regards to co-creating/producing health research …research has all sorts of words attached to it that seem the opposite of creative: unbiased, neutral, arms length…I could go on. I can just imagine some of my research colleagues reacting to the idea people interpreting things in their own way! It’s where we have to get to on research into complex societal problems, of course, but I think it will take a while (which is why the study of it will be exciting and important).
Interesting! My hand did hover for several minutes over the phrase ‘within which people can interpret problems in their own unique ways’, but I decided to leave it in as it seemed important somehow. Pondering your comment about the language of research (unbiased, arm’s length, neutral, etc.) In reality, is this an aspiration rather than a reality? There is a view that we change something as soon as we look at it through the lens of our individual perceptions. Significant lessons from research have been missed because people have unbiasedly, neutrally (and at arm’s length) missed what is actually happening because they know what ‘should’ be happening. Just a naïve thought, I readily admit to not being a researcher. Thanks for replying.
Hi again Charles – yes, I think the unbiased aspect of research is aspirational…and easier in some areas than others. For example, being objective in basic/bench science is much easier than being objective in the wonderful but messy world of social relations. I think it is safe to say that all researchers make assumptions by virtue of being human…the key is to be explicit about those assumptions while remaining as objective as possible. I like definitions of science (including social science) that explain it as “the best theory to date,” with an understanding that the theory could change when new evidence comes to light. Co-production and co-creation are going to be challenging when it comes to developing and implementing evidence, because of the different perspectives people bring to the table – but as long as people understand what they’re signing up for, and agree to play by the same ‘rules,’ I believe the solutions will be worth it.
Thanks Bev, I do agree it is important to have some discipline around how we use these terms and what it takes to practice co-production. I like the credibility, legitimacy, power framing you are highlighting. However, I do have a further thought. You seem to imply that co-production and co-creation are interchangeable terms; is that your view? I find it useful to distinguish these terms. I am partly influenced by the use of co-creation by service researchers (Vargo, Lusch, Maglio, Spohrer, Akika. Ostrom, and others). In that literature the focus is on co-creation of value, and is usually distinguished from co-production. The idea is that value is to be found in use or action rather than being found embedded in a product (or, as those authors would say, in ‘goods’). I think we can draw something from this distinction in our work on co-creation in research. If the focus is on the collaborative production of research outputs that are to be seen a bit like ‘goods’ (value embedded), then co-production seems a suitable term. If, on the the other hand, the focus is on the collaborative process of research and its use (value is found ‘in-use’, and therefore value depending on participants bringing their own perspectives and context to the research and its interpretation and use), then co-creation seems a suitable term.
Hi Graeme – thanks so much for this comment, which I found thought-provoking. I wasn’t suggesting that co-production and co-creation are necessarily the same thing, only that people use them as if they are (including me). My plea was to define whatever term one’s using at the beginning of a project so those involved understand (and ideally have input into) the ‘rules of engagement.’ But your comment makes me realize it’s not only the definition that matters (especially if there are established meanings for certain words)…and you have made a great point about the difference between a tangible ‘thing’ and a process. The same point is increasingly made about research itself…is it about things (results) or processes (value and use)? More and more of us see research and its use as more about processes ….which in turn need to be collaborative to succeed. So creation does sound better than production in that case…and words do matter. Thanks for making me think…
Hi Bev – thanks for sharing your learning from doing on co-production. I am finding an active discourse around co-production, but not so many examples drawn for practice.
Hi Annette – I don’t see many examples for practice either – that is, examples from “research on practice” that would in turn further practice, which is what I think we are missing. One example of research-on-practice that I think is a useful example is a process evaluation of a study on public involvement in priority setting by Antoine Boivin and colleagues, whose article I mention in the blog (What are the key ingredients for effective public involvement in health care improvement and policy decisions? A randomized trial process evaluation.). I found it a really good piece with some good insights for co-production practice involving the public. I would love to know from others about any studies of co-production in action (i.e., not a model or framework or theory, but research on co-production in action, with the outcomes of interest being those related to co-production itself).
Hi Kirsten – thanks for your comment. It feels to me as a research funder that “learning as we go’ has been underplayed in co-production and other research endeavours, as it indicates we don’t know everything when we start. Of course we don’t, but many research designs call for thinking things out from the start….not always helpful.,…
I really appreciate your recommendations for learning as we go, especially the push for studies of co-production in action! Thanks for this compelling prompt for better thinking/writing. I plan to use it tonight!