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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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Citations
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BackgroundConfigurations of Care Work: Fragile Partnerships in the Co-Production of Long-Term Care Services
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Quality Improvement within Nonprofit Social Service Providers
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Benjamin, E. M., Peterson, A., Schweitzer, L., Calcasola, S., Korn, F., Lodato, P., Bradley, J., & Hemmelgarn, C. (2025) · Frontiers in Health Services · doi:10.3389/frhs.2025.1513670 · Cited by 3
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“In health care, the concept of coproduction refers to collaborative approaches to intervention development where health care professionals and patients work together, drawing on both their expertise to create “new opportunities for innovation and involvement” [32].”
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“Co-production has many applications [6] and is here used as an umbrella term, covering a range of “co”-words, for example co-design and co-creation between patients and healthcare professionals (for a discussion on concepts used, see e.g. [5, 7, 8]).”
MethodA Patient-Driven Mobile Health Innovation in Cystic Fibrosis Care: Comparative Cross-Case Study
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“An example of coproduction and prosumerism (where consumers produce what they consume), patient-driven innovations can be seen as the next logical step in health care evolution [1,2] and could fundamentally challenge the essence of what it means to be a professional health care provider.”
BackgroundBrust, L., Schmidt‐Wolf, I. G. H., & Weigl, M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0307831 · Cited by 3
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“…in its own right or as a means to achieve other clinical and patient reported outcomes [31], b) needing a generic or specific health problem measure [32, 33], and c) the value of patient reported measures over bio-medical or clinical indicators in informing service delivery innovations [34].”
Identifying Flowing Change and Learning Towards Healthy Ageing—An Action Research Study
Persson, J., Svensson, A., Atzori, A. B., Kylén, S. P., & Hägglin, C. (2024) · Journal of Health Management · doi:10.1177/09720634241297449 · Cited by 3
“Figure 1 is inspired by Batalden et al. (2016) and visualises an ecosystem of healthy ageing.”
Gebremeskel, A. T., Udenigwe, O., Etowa, J. B., & Yaya, S. (2025) · PLoS ONE · doi:10.1371/journal.pone.0330159 · Cited by 7
del Río, E. (2025) · Healthcare · doi:10.3390/healthcare13212730 · Cited by 4
“…a transformative future in which the paradigm decisively shifts from the prevalent REPLACE model of mass prosthesis deployment [46] to one that positions patients as empowered, proactive agents in their own care, inaugurating the early dawn of a prosumer-driven preventive era [118,120,128,130].”
InfluentialEmerging personalization elements in health service delivery
Korhonen, O., Mylonopoulou, V., & Giunti, G. (2020) · International Academic Mindtrek Conference (Mindtrek) · doi:10.1145/3377290.3377295 · Cited by 3
“The present paper analyzes and categorizes these elements to provide understanding to the technology-driven field of personalization with a service level perspective [3,5,12].”
BackgroundCase study method to design and evaluate person-centred integrated palliative and end-of-life care
Cruz, G. I., & McGhee, S. M. (2020) · Journal of Integrated Care · doi:10.1108/jica-04-2020-0021 · Cited by 3
Moss, M. E., Grodner, A., Dasanayake, A. P., & Beasley, C. M. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06060-9 · Cited by 3
“In health care service delivery, this framework expands the traditional doctor-patient dyad with an enhanced model that includes community stakeholders and support systems to add value to the process [29, 30].”
BackgroundReimagining Relationship-Based Health Care in a Post-COVID World
Hutchison, K., Sweeney, J., Bechtel, C., & Park, B. (2021) · Journal of Patient Experience · doi:10.1177/2374373521998622 · Cited by 3
“A relationshipbased system would not only measure health, equity, and relationships (bidirectionally) but just as critically, create venues for patients and community members to cocreate quality indicators that represent outcomes important to them, such as trust, sense of connection, and quality of life (12).”
BackgroundSystem transformation in palliative and end of life care: developing a model for excellence
Hewison, A., Hodges, E., Balasubramanian, S., & Swani, T. (2021) · Journal of Health Organization and Management · doi:10.1108/jhom-06-2020-0232 · Cited by 3
Pushing poverty off limits: quality improvement and the architecture of healthcare values
Mitchell, P., Cribb, A., Entwistle, V. A., & Singh, G. (2021) · BMC Medical Ethics · doi:10.1186/s12910-021-00655-x · Cited by 3
“‘co-production’ of success criteria (as well as improvement processes) [40, 41]; a recognition of the importance of ‘soft intelligence’ and not just quantitative measurement in evaluation [42]; and more fundamental calls for the incorporation of pluralistic thinking within QI cultures [28, 43, 44].”
BackgroundKronsell, L., Svedberg, P., Nygren, J., & Larsson, I. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182010948 · Cited by 3
Integrating Youth Voice in Health Plan Quality Improvement
Thorp, K., Van, C. M., Olin, S.-C. S., & Scholle, S. H. (2022) · Academic Pediatrics · doi:10.1016/j.acap.2021.03.006 · Cited by 3
Implementation of a Novel Pediatric Behavioral Health Integration Initiative
Safon, C. B., Estela, M. G., Rosenberg, J., Feinberg, E., Drainoni, M., Morris, A., Durham, M. P., Bair‐Merritt, M. H., & Sheldrick, R. C. (2022) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-022-09803-6 · Cited by 3
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Wong, A. K. C., Wong, F. K. Y., Chow, K. K. S., Kwan, D. K. S., Lau, D. Y. S., & Lau, A. C. K. (2023) · Pilot and Feasibility Studies · doi:10.1186/s40814-023-01412-0 · Cited by 3
“A clear conceptualisation and description of the intervention should be delivered to those delivering the programme to ensure that they are capable of adapting the intervention to their own care settings [18].”
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Recommendations for patient-centered emergency care
Litwin, S. P., Vaillancourt, S., Labelle, F. K., Mondoux, S. E., Berthelot, S., Clarke, L., Hofstetter, C., VandenBerg, S., Lang, E., & Chartier, L. B. (2024) · Canadian Journal of Emergency Medicine · doi:10.1007/s43678-024-00706-3 · Cited by 3
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“18 Coproduction relies on a process and/or technology that leverages an end user’s time and skills for improving the convenience, cost, and efficiency of the end product.”
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“Co-production approaches, whereby public and/or patients and healthcare professionals interacting with organisations outside of the healthcare systems [12] may be necessary for promotion and uptake of physical activity, particularly for people with functional limitations.”
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Using bandwidths to visualize and improve patient pathways
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“This level of involvement links well to the popular co-production of the healthcare agenda (Batalden et al. , 2015).”
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Controlling Versus Supporting in a Sociotechnical System: A Commentary on Falzer (2018)
Xiao, Y., & Gorman, P. (2018) · Journal of Cognitive Engineering and Decision Making · doi:10.1177/1555343418777342 · Cited by 3
“Health care should also be viewed as a service, “coproduced” with patients and their informal caregivers, with the desired outcome and value of health services determined as a result of collaboration between health care professionals and patients (Batalden et al., 2016).”
BackgroundIntegrating the Lived Experience Conditions and Care in the ECHO Model.
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The Application of Salutogenesis in Primary Care
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Participatory Social Work: Research, Practice, Education
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“It refers to that services need to be built on a knowledge framework where those who receive and deliver them are involved [43–45], which also applies to trial research [46].”
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Partnerships to Address Health Needs
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It takes a village: Evolving from learning health system to learning community for health equity
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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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