Through co-production, patients and families work jointly with their clinical team to determine goals and devise means of achieving them.
Through research, St Andrew’s Healthcare has established just how vital this is to the rehabilitation process – and what more can be done to make co-production even more patient-centric
Co-production is not a new term in rehabilitation. But while it is familiar, how widely is it used?
In many settings, while a patient will be involved in some, or even several, aspects of their care and rehab, it is still far from being ‘co produced’ with the patient’s voice – or that of their family – not being heard as it should be.
But for St Andrew’s Healthcare, co-production is something that is keenly felt and understood. By working side-by-side with patients and families, meaningful goals can be set based around personal aspirations, which can lead to better engagement and positive outcomes.
As a provider, which supports with a range of neurological conditions – delivering neuro-rehabilitation to help patients rebuild their lives after brain injury through to bespoke support for those living with Huntington’s disease and dementia – the need for person-centred care, involving the patient and family at every possible opportunity, is a vital part of its care model.
And that commitment is something that is only increasing, with research from lead occupational therapist, Fraser Scatterty whose research into the impact of co-production in brain injury has revealed its crucial importance.
“I think it’s probably priceless to have your voice heard as a patient, and that’s why this matters,” he says.
“Co-production is such an important thing to do, and for your patients to be involved in goal-setting and in being able to read and understand their care plans.
“This can lead to better outcomes and better engagement, which ultimately can only be in the patients’ best interests.”
Co-production in practice
By its very definition, co-production revolves around working jointly to create something, which is vital in the delivery of person-centred care.
But getting to the root of what that should mean has been the mission of Fraser through his MSc dissertation, geared around the work at St Andrew’s and based on the feedback of fellow occupational therapists (OTs) in the neuro team.
“I think, generally, everyone agreed it was related to getting more of the patient’s voice and being more patient goal directed, rather than therapist goal directed,” he tells NR Times.
“Basically, you create your care plans around what’s most important to the patient, getting patient and family advocacy, establishing your treatment programmes, in a more equal partnership rather than it being a traditional medical model.
“From the literature I’ve read around co-production, it looks at the outcomes as well – when people are working towards their own set goals, motivation is more likely to be there. And then we get better engagement and better outcomes.”
The value of being able to set goals is at the heart of co-production, which the patient can then be guided and supported to achieve.
“We’ll ask them ‘What are your goals’? Typically it’s that they want to go home, so it’s about breaking that down into how we are going to do this,” says Fraser.
“What do you need to do? What do we need to do? What can we be working on together?
“We might have a patient who goes to the art studio once a week, but when you break that down and analyse why, it’s because they want to make presents for their family to maintain the links with them and continue to feel involved. So getting to the heart of that makes everything a lot more clear and person-driven.”
Fraser believes language used in care plans also lies at the heart of ensuring a patient can truly be involved in co-production.
“You’ll have a care plan that says ‘Go to the art studio once a week’ but isn’t capturing why. We’re probably using more global language that fits into the FIM+FAM assessment criteria,” he says.
“I think often care plans aren’t really suitable for our patients, they couldn’t really understand them. And it’s really important that we do that, and put our co-production values into achieving this.
“We use the FIM+FAM outcome measure, but that means nothing to our patients. I have never heard a patient say ‘I’m doing level three on cooking, I’d love to be level five’. That just doesn’t happen.
“Co-producing is about getting them to understand and develop a goal around what matters to them. I was working with a lady a couple of weeks ago and she wants to look after her children, she wants to be able to be safe in the kitchen. That’s a very personal goal for her because it’s about looking after her children, it’s not about FIN+FAM level three or four.
“Neither do you want a 17-page care plan a patient can’t understand – you want something that is accessible to them, that they can read and know what we are working with them to achieve. Language is very important in doing that. ”
As well as personal goals, global goals can also be used to positive effect.
“You can have maybe four of five goals, which are very valuable tools – ‘are you happy with your sleeping pattern?’ for example,” says Fraser.
“Patients are never going to come forward with concerns about getting better sleep, but when you raise it and ask about the quality of things, it helps them to recognise that maybe improvement can be made. So they can set a personal goal around that, which we can then work towards.”
However, there are some domains in which clinicians should continue to lead, to protect the best interests of the patients, says Fraser.
“In reality, we sit down, we talk to patients, we get their views – but we always have to balance that against best interests and a duty of care,” he says.
“For example, we maybe have a team goal of somebody having a shower twice a week to maintain their skin integrity and their hygiene. But they might not recognise that as a problem at all.
“Getting them to co-produce a care plan around showering is very difficult – but we will do this as far as possible.”
Co-production made even more person-centred
From Fraser’s research, co-production was identified as being a hugely valuable resource in brain injury rehabilitation at St Andrew’s – but one in which improvements can continue to be made.
With recommendations about the training of staff to secure a better understanding, and the improved accessibility of care plans, the willingness and agility of St Andrew’s to adopt new and improved working practices is seeing changes already being made.
“Ultimately, the whole point of the research is that we want to recognise areas where we could or should be doing things better and to improve our own practice – that’s for the benefit of everyone, and there is always more we can do,” says Fraser.
“I think working in a neuro setting, we work with our patients for long enough and work so closely with them that we do get a really, really good understanding of them and what is important to them.
“I think co-production is something that we do and we have done for a long time, but it maybe isn’t always recorded. The value of doing that is huge for the patient, in transferring that into almost a co-production formula, and that’s something we are already looking at.”
New care plans is something, which is also underway, making them more accessible and relevant than ever before to patients.
“One of the big things that came out of my research was around care plans. I think that’s definitely an area we can get our co-production values in a lot more,” says Fraser.
“It needs to be more ‘This is what I want, this is how I’m going to get it, and this is who’s going to help me’. So very simple.
“And by doing it that way, we can make it more goal-driven for the patient.
“We are all goal-driven people as human beings, and if you’ve got your own goals and agenda, you’re going to work harder for it and be more engaged for longer.”
For staff too, the benefit of further training could in turn support patients and families to achieve their co-production goals.
“I think some training would be a really good idea, where we look at co-production in the care plans, the positive outcomes we achieve, what more we can do,” says Fraser.
“As neuro professionals, we do have a tacit understanding of our patients anyway, and that’s a very important point – but if we documented that more than we currently do, I think that would have a very positive impact.
“I know we’re looking to move forward with that, after what has been a very busy time I think we’re now getting some headspace to look at this and to involve our patients and their families in what we do even more.”
