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Coproduction of healthcare service
Open accessAbstract
Efforts to ensure effective participation of patients in healthcare are called by many names—patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always ‘coproduced’. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.
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“When developing interventions, involving diverse stakeholders (e.g., patients, healthcare staff and their managers, researchers, and policy makers) has been recommended to enhance accuracy, fit, and sense of ownership within the specific setting [15, 16].”
From Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study. (2026) · cites this paper as [15]
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“Alongside tailoring to patient preferences, the process also acknowledges the input and expertise of front-line healthcare staff.(18) Involving patients in service improvement has been suggested to help improve the quality of services delivered and helps redress inequities in service accessibility.”
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Vallée, A., & Arutkin, M. (2024) · Public health reviews · doi:10.3389/phrs.2024.1606371 · Cited by 31
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“Patient-centeredness and patient and family engagement have been recognized by multiple organizations, including the Institute of Medicine, Centers for Medicare and Medicaid Services, and National eHealth Collaborative, as key to improving health care.(1,2) Patients’ capacity to engage in their care is shaped by multi…”
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Schenk, E. C., Bryant, R. A., Son, C. R. V., & Odom‐Maryon, T. (2018) · Journal of Nursing Care Quality · doi:10.1097/ncq.0000000000000333 · Cited by 24
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Protocol of a Pilot Study of Technology-Enabled Coproduction in Pediatric Chronic Illness Care
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“In addition, patients and clinicians need support to truly coproduce care, allowing them to collaborate to produce information (eg, clinical data, patient-reported outcomes [PROs]), knowledge (insights), and know-how (expertise) to improve health care and health outcomes [1,3-5].”
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“Co-production has been stressed as a main important factor to understand, reach and engage users that are going to use the digital solution in practice [45, 54, 55].”
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“Involving people in healthcare has also been shown to improve satisfaction and quality [21].”
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“of power and responsibility, that should be shared [2].”
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“The concept of coproduction of health care (Batalden et al., 2015) involving both health care professionals and patients or family members encapsulates a fundamental tenant of family-focused care: it is especially critical when dealing with children and adolescents given their dependency on their…”
Preliminary effects and acceptability of a co-produced physical activity referral intervention
Buckley, B. J. R., Thijssen, D. H. J., Murphy, R., Graves, L., Whyte, G. P., Gillison, F., Crone, D., Wilson, P. M., Hindley, D., & Watson, P. M. (2019) · Health Education Journal · doi:10.1177/0017896919853322 · Cited by 22
A Pathway to Precision Medicine for Aboriginal Australians: A Study Protocol
Cheng, Y.-Y., Nunn, J., Skinner, J. C., Rambaldini, B., Boughtwood, T. F., Calma, T., Brown, A. D. H., Meldrum, C. J., Dinger, M. E., Byrne, J. A., et al. (2021) · Methods and Protocols · doi:10.3390/mps4020042 · Cited by 20
Corbett, R., Goodlet, G., MacLaren, B., Jolliffe, A., Joseph, A., Lu, C., da Silva, C. C. F., Soni, B., Wicks, M., Brown, E. A., et al. (2020) · Peritoneal Dialysis International · doi:10.1177/0896860820918822 · Cited by 20
“Co-production, “the voluntary or involuntary involvement of public service users in any of the design, management, delivery and/or evaluation of public services,”(5) is increasingly recognized as important in not only research(6) but also in health care.(7) Models of patient-led panels in developing guidelines have be…”
Racine, N., Chow, C., Hamwi, L., Bucsea, O., Cheng, C., Du, H., Fabrizi, L., Jasim, S., Johannsson, L., Jones, L., et al. (2024) · JMIR AI · doi:10.2196/51535 · Cited by 19
Competency-based medical education: The spark to ignite healthcare’s escape fire
Schumacher, D. J., Kinnear, B., Carraccio, C. L., Holmboe, E. S., Busari, J. O., van der Vleuten, C. P. M., & Lingard, L. (2023) · Medical Teacher · doi:10.1080/0142159x.2023.2232097 · Cited by 19
“In medical education, the wildfire is the dysfunctional structure of clinical learning and care that often fails to focus on what patients need – safe, effective, patient-centered, timely, efficient, and equitable care (Baker 2001; Health Affairs 2013; Batalden et al. 2016).”
BackgroundCollaborating internationally on physician leadership development: why now?
Chan, M., Meschino, D. D. C., Dath, D., Busari, J. O., Bohnen, J. D., Samson, L. M., Matlow, A., & Mendiola, M. S. (2016) · Leadership in health services · doi:10.1108/lhs-12-2015-0050 · Cited by 19
Carr, E., Patel, J. N., Ortiz, M., Miller, J., Teare, S., Barber, C. E. H., & Marshall, D. A. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4196-9 · Cited by 19
Hatlie, M. J., Nahum, A., Leonard, R., Jones, L., Nahum, V., Krevat, S. A., Mayer, D. B., & Smith, K. M. (2020) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2019.12.001 · Cited by 19
Using co-production to increase activity in acute stroke units: the CREATE mixed-methods study
Jones, F., Gombert, K., Honey, S., CLOUD, G. C., Harris, R. G., Macdonald, A. S., McKevitt, C., Robert, G., & Clarke, D. J. (2020) · Health Services and Delivery Research · doi:10.3310/hsdr08350 · Cited by 23
A multi-stakeholder approach to the co-production of the research agenda for medicines optimisation
Fellenor, J., Britten, N., Courtenay, M., Payne, R., Valderas, J. M., Denholm, R., Duncan, P., McCahon, D., Tatnell, L., Fitzgerald, R., et al. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06056-5 · Cited by 22
“It emphasises the contribution that all stakeholders can make as initiators or recipients of the service delivery process [11, 12] and is based on egalitarian relationships between experts and lay people, using a process of open exchange and participation [13].”
BackgroundPersson, S., Andersson, A., Kvarnefors, A., Thor, J., & Gäre, B. A. (2021) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzab060 · Cited by 19
“There is no definitive nomenclature; several terms and concepts associated with co-production include patient participation, patient collaboration, patient involvement, partnership, patient empowerment, personcentered care, co-creation and co-design [4, 6, 7].”
Claessens, F., Castro, E. M., Jans, A., Jacobs, L., Seys, D., Wilder, A. V., Brouwers, J., der Auwera, C. V., Ridder, D. D., & Vanhaecht, K. (2022) · Patient Education and Counseling · doi:10.1016/j.pec.2022.07.007 · Cited by 19
Chapman, K., Dixon, A., Cocks, K., Ehrlich, C., & Kendall, E. A. (2022) · Australian Occupational Therapy Journal · doi:10.1111/1440-1630.12847 · Cited by 19
“Best practice citizen engagement methods include co-design (Robert et al., 2015; Steen et al., 2011), co-production (Batalden et al., 2016; Whitaker, 1908), and co-creation (Frow et al., 2016; Hardyman et al., 2015; Voorberg et al., 2015) and are often centred on principles for inclusive research…”
MethodSexual and Reproductive Health of Young Women With Cystic Fibrosis: A Concept Mapping Study
Kazmerski, T. M., Prushinskaya, O., Hill, K., Nelson, E. B., Leonard, J., Mogren, K., Pitts, S., Roboff, J., Uluer, A., Emans, S. J., et al. (2018) · Academic Pediatrics · doi:10.1016/j.acap.2018.08.011 · Cited by 19
Kayser, L., Nøhr, C., Bertelsen, P., Botin, L., Villumsen, S., Showell, C., & Turner, P. A. (2018) · Informatics · doi:10.3390/informatics5040041 · Cited by 19
Sutton, E., Brewster, L., & Tarrant, C. (2019) · Health Expectations · doi:10.1111/hex.12874 · Cited by 19
“The burden of responsibility for medical and surgical error, for example, must fall disproportionately on healthcare professionals.(3)”
BackgroundGaufberg, E. H., Olmsted, M. W., & Bell, S. K. (2019) · Journal of Medical Humanities · doi:10.1007/s10912-019-09563-z · Cited by 19
Pediatric-to-adult healthcare transitions: Current challenges and recommended practices
Hobart, C. B., & Phan, H. (2019) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxz165 · Cited by 19
Perry, A., Waterman, M. G., House, A. O., Wright-Hughes, A. M., Greenhalgh, J., Farrin, A. J., Richardson, G. A., Hopton, A., & Wright, N. M. J. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026095 · Cited by 23
“This is a common problem in the design and implementation of complex interventions in organisations other than healthcare.(19) These findings emerged during the implementation phase.”
BackgroundPatient Engagement and Patient Safety: Are We Missing the Patient in the Center?
Abid, M. H., Abid, M. M., Surani, S., & Ratnani, I. (2020) · Cureus · doi:10.7759/cureus.7048 · Cited by 19
Co-production in Healthcare: Moving Patient Engagement Towards a Managerial Approach
Gilardi, S., Guglielmetti, C., Marsilio, M., & Sorrentino, M. (2016) · SpringerBriefs in applied sciences and technology · doi:10.1007/978-3-319-30558-5_6 · Cited by 19
“A relevant condition for improving healthcare services through the co-production approach is to rethink the health professional training/education models, not just the health education of citizens and patients (Dunston et al. 2009; Batalden et al. 2015).”
BackgroundInfluentialHind, D., Parkin, J., Whitworth, V., Rex, S., Young, T. A., Hampson, L. V., Sheehan, J., Maguire, C., Cantrill, H., Scott, E., et al. (2017) · Pilot and Feasibility Studies · doi:10.1186/s40814-017-0132-0 · Cited by 19
Co-Producing Interprofessional Round Work: Designing Spaces for Patient Partnership
Thörne, K. E., Andersson‐Gäre, B., Hult, H., & Dahlgren, M. A. (2017) · Quality Management in Health Care · doi:10.1097/qmh.0000000000000133 · Cited by 19
Rutland, S. B., Bergquist, R. P., Hager, A., Geurs, R., Mims, C., Gutierrez, H. H., & Oates, G. R. (2020) · JMIR Formative Research · doi:10.2196/19413 · Cited by 18
Gheihman, G., Callahan, D. G., Onyango, J., Gooding, H. C., & Hirsh, D. A. (2021) · Medical Teacher · doi:10.1080/0142159x.2021.1935825 · Cited by 18
The Pediatric Inflammatory Bowel Disease Medical Home: A Proposed Model
Michel, H. K., Boyle, B., David, J. G., Donegan, A. M., Drobnic, B., Kren, C., Maltz, R. M., McKillop, H. N., McNicol, M., Oates, M., et al. (2021) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izab238 · Cited by 18
Carlqvist, C., Hagerman, H., Fellesson, M., Ekstedt, M., & Hellström, A. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-07232-3 · Cited by 19
“Although insight within health care regarding the importance of the patient’s role as an active and informed co-producer has increased in recent years [16], patients often lack the means and ability to apply selfcare knowledge.”
BackgroundInfluentialBamidele, O. O., Alexis, O., Ogunsanya, M. E., Greenley, S. L., Worsley, A. J., & Mitchell, E. D. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-021-06716-6 · Cited by 22
Metadata
- Authors
- Batalden, M., Batalden, P., Margolis, P., Seid, M., Armstrong, G., Opipari-Arrigan, L., & Hartung, H.
- Affiliations
- Cambridge Health Alliance (US)
- Dartmouth Institute for Health Policy and Clinical Practice (US)
- Cincinnati Children's Hospital Medical Center (US)
- College of Nursing, University of Colorado, Aurora, Colorado, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University Hospital Crosshouse (GB)
- Corresponding author
- Batalden, Maren
- Venue
- BMJ Quality & Safety
- Publisher
- BMJ
- Published
- 2015-09-16
- Volume
- 25
- Issue
- 7
- Pages
- 509-517
- ISSN
- 1475-3898 (ISSN-L)
- 2044-5415
- 2044-5423
- PMC
- PMC4941163
- OpenAlex
- W2277370197
- Cited by
- 1,078
- References
- 65
- Citations by year
- 2026: 68 · 2025: 84 · 2024: 149 · 2023: 92 · 2022: 130 · 2021: 139 · 2020: 120 · 2019: 91 · 2018: 94 · 2017: 72 · 2016: 38
- FWCI
- 168.93
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Quality & Safety (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Diva portal (Dalarna University Library) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK085719)
- Topics
- Social Sciences › Business, Management and Accounting › Marketing › Service and Product Innovation
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
- Keywords
- patient engagement, patient-centered care, service design, service delivery innovation
- MeSH terms
- Delivery of Health Care, Humans, Patient Participation, Quality Assurance, Health Care, Models, Organizational, Quality Improvement
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