The role of co-production in Learning Health Systems

Abstract

Background Co-production of health is defined as ‘the interdependent work of users and professionals who are creating, designing, producing, delivering, assessing, and evaluating the relationships and actions that contribute to the health of individuals and populations’. It can assume many forms and include multiple stakeholders in pursuit of continuous improvement, as in Learning Health Systems (LHSs). There is increasing interest in how the LHS concept allows integration of different knowledge domains to support and achieve better health. Even if definitions of LHSs include engaging users and their family as active participants in aspects of enabling better health for individuals and populations, LHS descriptions emphasize technological solutions, such as the use of information systems. Fewer LHS texts address how interpersonal interactions contribute to the design and improvement of healthcare services. Objective We examined the literature on LHS to clarify the role and contributions of co-production in LHS conceptualizations and applications. Method First, we undertook a scoping review of LHS conceptualizations. Second, we compared those conceptualizations to the characteristics of LHSs first described by the US Institute of Medicine. Third, we examined the LHS conceptualizations to assess how they bring four types of value co-creation in public services into play: co-production, co-design, co-construction and co-innovation. These were used to describe core ideas, as principles, to guide development. Result Among 17 identified LHS conceptualizations, 3 qualified as most comprehensive regarding fidelity to LHS characteristics and their use in multiple settings: (i) the Cincinnati Collaborative LHS Model, (ii) the Dartmouth Coproduction LHS Model and (iii) the Michigan Learning Cycle Model. These conceptualizations exhibit all four types of value co-creation, provide examples of how LHSs can harness co-production and are used to identify principles that can enhance value co-creation: (i) use a shared aim, (ii) navigate towards improved outcomes, (iii) tailor feedback with and for users, (iv) distribute leadership, (v) facilitate interactions, (vi) co-design services and (vii) support self-organization. Conclusions The LHS conceptualizations have common features and harness co-production to generate value for individual patients as well as for health systems. They facilitate learning and improvement by integrating supportive technologies into the sociotechnical systems that make up healthcare. Further research on LHS applications in real-world complex settings is needed to unpack how LHSs are grown through coproduction and other types of value co-creation.

Stroke Learning Health Systems: A Topical Narrative Review With Case Examples

“…Learning is fundamental to the LHS model. 59 As facilities, systems, and countries develop and implement stroke LHSs as outlined in Figure 2, they should explicitly consider how to optimize ongoing learning and adaption. That is from (1) evidence generation and synthesis (including mechanisms to share evidence and guidelines as they emerge); (2) engagement with stakeholders (including patients, front-line clinicians, and hospital or health system administrators);…”

Consensus on how to optimise patient/family engagement in hospital planning and improvement: a Delphi survey

“… 11 Co-production refers to users and professionals who are creating, designing, producing, delivering, assessing and evaluating the relationships and actions that contribute to the health of individuals and populations, which is fundamental to learning health systems. 23 True co-production requires meaningful engagement or sharing of power between patients and health professionals, yet research suggests that engagement is often token due a variety of barriers. 21 24 25 Therefore, ongoing research is needed to confirm the uptake of these recommendations, including their influence on policy at the health system or hospital level, and on various impacts in hospitals with both new and established PE.…”

“…High PE capacity hospitals were characterised by PE activity organisation wide and use of largely collaborative rather than consultative PE approaches, referring to co-production 11. Co-production refers to users and professionals who are creating, designing, producing, delivering, assessing and evaluating the relationships and actions that contribute to the health of individuals and populations, which is fundamental to learning health systems 23. True co-production requires meaningful engagement or sharing of power between patients and health professionals, yet research suggests that engagement is often token due a variety of barriers 21 24 25.…”

The Role of Independent Value Creation, Value, and Trust on Banking Marketing Performance: Moderating Role of Gender

“…However, IVC is value creation carried out by not dealing with providers but with transaction media. It is similar to engaging as an active participant in Learning Health Systems (Gremyr et al, 2021), consumer engagement in AI technology (Wen et al, 2022), and co-creation in banking self-service technology (Galdolage & Rasanjalee, 2022). In banking, this activity is conducted by customers through self-service technology, namely ATM, mobile banking, and internet banking.…”