Today I saw co-production in action. Commissioners want to achieve a different experience for patients. They worked with a patient champion group to develop the tender. Together they defined the outcomes and experience that they wanted to see delivered. I was at the introductory meeting with four other organisations who want to bid for this work. We were invited into a room with 6 round tables, and at each table were two patient champtions. The morning was designed for us to listen to patients, and we heard five different patient experiences, told in peoples own words. There is so much that needs to change, and it was a moving and powerful experience. Then we had an opportunity to ask patients questions. Naturally, patients are part of the decision-making panel too.
This was impressive, and an excellent demonstration of what co-production looks like, however they called it co-design. Does the language really matter?
Why don’t people just call it ‘working together’? was a comment after we posted our first blog on co-production. I can understand this sentiment. In the blog we shared three different definitions of co-production and there are many more.
There are a range of terms that describe people working together – for example engagement, participation, involvement, consultation and co-production. However they are not the same. They carry different nuances of power, and how decisions get made. The ‘ladder of participation’ helps separate those that are tokenistic from real examples of sharing power. Developed by Sherry R Arnstein (1969), the ladder of citizen participation has 8 rungs. At the bottom of the ladder, the lowest rungs are manipulation, then therapy, informing and then consultation, placation, partnership, and delegated power with the top rung being citizen control.
She doesn’t use the term co-production, and in 1969 it didn’t exist. Can we create a shared understanding (beyond what the Oxford English Dictionary would give us) for the different words we use to describe working together?
Here is my simplified version to get started:
Informing: We let you know about the decisions we are making.
Consulting: We make our decision and ask for your feedback.
Involving: We take your views into account as we decide.
Co-production We decide together.
The phrases, ‘working together’ and ‘partnership’ could look like ‘involving’ here. I is important that we know what people really mean when they say ‘involving people’ and understand that it is not co-production (or co-design).
Does language matter here? I think it does. We need to move from definitions of co-production to being able to simply explain a new ladder, a range of ways that people are involved in decision-making. To be able to show what good looks like, we need to first know what we mean.