The role of co-production in improvement

Orthostatic hypotension (a drop in blood pressure upon standing from a lying or sitting position) is a major cause of falls, both in the community and for hospital inpatients. At Stockport NHS Foundation Trust we want to improve the incidence of patient falls and reduce unnecessary medication. We’re doing this with support from the Health Foundation’s Shine programme, developing a pathway for patients with orthostatic hypotension. We’re halfway through the project and in this blog I wanted to talk about the role of co-production within the project thus far.

The primary aim of the pathway is to identify those patients who have orthostatic hypotension by testing a pathway document over two ward areas (with a third as a control area) – the document is reviewed weekly and changes adopted formally on a fortnightly basis. It's more or less complete and is now in its final cycle of testing, following agreement from the Trust’s falls collaborative group and the project group.

But back to co-production and its role in this project. As a project manager looking at reducing in-patient falls within a large foundation trust, and organising the development of a tool to be used over the whole health economy, I was determined not to fall into the traps I’ve experienced during other projects. You know the old adage 'if you always do what you’ve always done, you’ll always get what you’ve always had'. Well, this time I wanted something new and so decided to make co-production key to this project. I had read about past Shine award holders using a co-productive approach and it sat well with my personal style.

As NHS professionals we probably think of ourselves as being pretty good at co-production. After all, we attend lots of meetings with other people and churn our way through agendas, making action plans and coming away with task lists. But is thisreally co-production, or are we repeating the same behaviours over and over again? Ask yourself: how many meetings have you recently attended where you can predict who will say what, what the outcomes will be and whose voice you’ll hear most?

From the beginning I wanted to bring individuals from across the whole health economy to work together – student nurses working directly with senior managers, community care staff working with core hospital staff and members of the public working with Governors and the CCG.

To date we have 24 different departments and agencies working at some on this project. Individuals with a clear idea of how they wanted the project to work have had to face challenges from others, often by people of a much lower pay grade, but in our team they have equal value and status regardless of what it says on their ID badge. The range of expertise that has come from our meetings and workshops has been amazing and the clear understanding of our role in the wellbeing of our patients is fantastic.

We’ve broken down some barriers and built some bridges, discovered a new respect for each other that goes beyond everyday professional courtesy. Most importantly, we have got people with different sets of expertise and levels of seniority not just listening, but hearing one another.

If I were to manage another project, yes of course there would be things I would do differently – managing this project can sometimes be like herding kittens! – but I will always choose a co-productive approach where I can, it’s really been worth it.

Iain is the project manager of the Shine project at Stockport NHS Foundation Trust.