3 stirling co production and critical realism
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CO-PRODUCTION: A CRITICAL REALIST
PERSPECTIVE ON CONNECTING
OLDER PERSONS WITH SERVICES
AND CHOICE
DR CHRISTINE STIRLING
UNIVERSITY OF TASMANIA
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OVERVIEW
Co-Production
Critical Realist Concept
The More Things Change…
Benefits of Partnership and Choice
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CO-PRODUCTION
Services produced in a reciprocal relationship between professionals, service users, families and neighbours.
Service users are resources
Services need to interact with neighbourhood level support
Family, neighbourhood, community and civil society are the ‘core economy’ – social capital
Services need to promote idea of equal partnership
Focus on effectiveness not efficiency
(Boyle and Harris 2010)
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CO-PRODUCTION BENEFITS
‘Co-production changes all this. It makes the system more efficient,
more effective and more responsive to community needs. More
importantly, it makes social care altogether more humane, more
trustworthy, more valued – and altogether more transforming for
those who use it.’
Phil Hope – then Minister of State for Care Services UK 2009
‘Co-production shifts the balance of power, responsibility and
resources from professionals more to individuals, by involving
people in the delivery of their own services.’ (Boyle and Harris
2009).
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PEOPLE GETTING
CARE THEY DON’T
WANT AND OTHERS
NOT GETTING CARE
THEY NEED.
“FELT NEED” PROVIDING
A BETTER INDICATOR
FOR DEMENTIA SUPPORT
SERVICES NEED THAN
EXPERT ASSESSMENT?
THIS
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“Well there’s been five actual assessments and three interviews… over the last four months…then there was the day care lady came and assessed her and that was fruitless” Carer of Person With Dementia
A simple one-item measure of carers’ felt need for more services was significantly related to carer stress as measured on the GHQ-30.
65% of carers would like more help from services than they were currently receiving (felt need). The statement- ‘I need more help from services than I am given’ was positively related to carers’ GHQ-30 (Spearmans rho = 0.625, p = 0.01).
Qualitative data showed that there are many potential stressors for carers, other than those related to the care-giving role.
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AGENCY - VISION, SHARED IDEAS, AND SKILLS
Change is the result
of the Interplay
between
Agency and Context
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CRITICAL REALIST PERSPECTIVE - ICT
A G E N C Y
Vision
Skills
Power – as a group
New field – no existing
power elites
Consumers – voted
with purchasing
power
C O N T E X T
Silicon Valley a hub of innovation
Life circumstances – education and freedom
Venture capital
Unknown potential – no plan
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CRITICAL REALIST PERSPECTIVE – THE +VE FOR
CHANGE IN HEALTH
A G E N C Y
ICT technologies
helping link
consumers – voice,
new power elite
Purchasing Power for a
large group
C O N T E X T
System breaking
Baby boomers are ageing
Social media, connectivity
Vast potential from healthy older workforce
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RISKS TO CHANGE
A G E N C Y
Existing groups try to
hang onto power
Many consumers lack
the skills to access
and engage
C O N T E X T
Unwieldy, busy,
entrenched health
system makes
change difficult
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SERVICE REDESIGN
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STRATEGIES TO DEVELOP AND MAINTAIN EQUAL
RELATIONSHIPS
Develop Agency for Consumers – able to communicate as a collective, new vision, able to be heard.
Listen - Continue to capture the experiences and voices of consumers and use this to inform new programs. Redefine experts.
Systems and Tools that facilitate agency and partnerships
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BUILD CONSUMER SKILLS TO NAVIGATE AND
USE THE SYSTEM
P R O B L E M
S O L U T I O N
A complex fractured
system
How to make choices?
ICT
Focus on skills
Targeted information
Decision making assistance
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REMOVE BARRIERS FOR ACCESS TO SERVICES-
THE NURSE-LED MEMORY CLINIC
P R O B L E M
Consumers able to self-refer
Free nurse-led cognitive assessments and diagnosis
Follow-up visit to facilitate appropriate referrals to community supports such as Alzheimer’s Australia, HACC
S O L U T I O N - A G E N C Y
Difficult to get a diagnosis
Difficult to get information
Referral onto other services inconsistent
‘I'd say, "Mum's memory isn't too good"; try and not make her look silly in front of them, but, she'd say, "Oh, it's better than yours", and they'd just laugh with her and that would be the end of that. You know, you couldn't get anyone to take it very seriously.’
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SERVICES NOT FITTING NEED
P R O B L E M
Power, voice, representation
Australia – Consumer
Directed Care Packages
Patients Know Best
website,
www.patientsknowbest.co
m
Local Involvement
Networks
S O L U T I O N
• Assessment Not Capturing
Need
• Rigid boundaries around
service provision –
“He’s had four [carers]
and this gentleman will be the fifth
today. So he gets very confused
about who is coming and I have to
explain each week.”
• Experts within narrow silos.
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There is a lot of work to be done to change culture
so that we have more equal relationships with
a sharing of power.
In Conclusion
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Boyle, D., & Harris, M. (2009). The Challenge of Co-Production: how equal partnerships between
professionals and the public are crucial to improving public services. London: NESTA.
Lloyd and Stirling (in Print Sep 2011). Ambiguous Gain: uncertain benefits of service use for
dementia carers. Sociology of Health and Illness
Stirling, C., Andrews, S., Croft, T., Vickers, J., Turner, P., & Robinson, A. (2010). Measuring dementia
carers' unmet need for services - an exploratory mixed method study. BMC Health Services
Research, 10(122), EJ.
REFERENCES