Achieving Research Impact Through Co-creation in Community-Based Health Services: Literature Review and Case Study

Trisha Greenhalgh, Claire Jackson, Sara Shaw, Tina Janamian, Trisha Greenhalgh, Claire Jackson, Sara Shaw, Tina Janamian

Abstract

Policy points: Co-creation-collaborative knowledge generation by academics working alongside other stakeholders-is an increasingly popular approach to aligning research and service development. It has potential for "moving beyond the ivory towers" to deliver significant societal impact via dynamic, locally adaptive community-academic partnerships. Principles of successful co-creation include a systems perspective, a creative approach to research focused on improving human experience, and careful attention to governance and process. If these principles are not followed, co-creation efforts may fail.

Context: Co-creation-collaborative knowledge generation by academics working alongside other stakeholders-reflects a "Mode 2" relationship (knowledge production rather than knowledge translation) between universities and society. Co-creation is widely believed to increase research impact.

Methods: We undertook a narrative review of different models of co-creation relevant to community-based health services. We contrasted their diverse disciplinary roots and highlighted their common philosophical assumptions, principles of success, and explanations for failures. We applied these to an empirical case study of a community-based research-service partnership led by the Centre of Research Excellence in Quality and Safety in Integrated Primary-Secondary Care at the University of Queensland, Australia.

Findings: Co-creation emerged independently in several fields, including business studies ("value co-creation"), design science ("experience-based co-design"), computer science ("technology co-design"), and community development ("participatory research"). These diverse models share some common features, which were also evident in the case study. Key success principles included (1) a systems perspective (assuming emergence, local adaptation, and nonlinearity); (2) the framing of research as a creative enterprise with human experience at its core; and (3) an emphasis on process (the framing of the program, the nature of relationships, and governance and facilitation arrangements, especially the style of leadership and how conflict is managed). In both the literature review and the case study, co-creation "failures" could often be tracked back to abandoning (or never adopting) these principles. All co-creation models made strong claims for significant and sustainable societal impacts as a result of the adaptive and developmental research process; these were illustrated in the case study.

Conclusions: Co-creation models have high potential for societal impact but depend critically on key success principles. To capture the nonlinear chains of causation in the co-creation pathway, impact metrics must reflect the dynamic nature and complex interdependencies of health research systems and address processes as well as outcomes.

Keywords: co-creation; health research systems; knowledge production.

© 2016 Milbank Memorial Fund.

Figures

Figure 1
Figure 1
Value Co‐creationa aAdapted from Figures 1, 2, 3 in Ramaswamy and Ozcan.37 (p29)
Figure 2
Figure 2
Cacari‐Stone and Colleagues’ Model of Impacts From Community‐Based Participatory Researcha aReproduced from Figure 1 in Cacari‐Stone and colleagues.35 (p1616)
Figure 3
Figure 3
Realist Model of Impact in a Multi‐stakeholder Research Collaboration, Based on a National Evaluation of UK CLAHRCsa +ve = positive, ‐ve = negative. aReproduced under terms of UK noncommercial government license from Rycroft‐Malone and colleagues.66

References

    1. Glasziou P, Altman DG, Bossuyt P, et al. Reducing waste from incomplete or unusable reports of biomedical research. Lancet. 2014;383(9913):267‐276.
    1. George AL. The two cultures of academia and policy‐making: bridging the gap. Political Psychology. 1994;15(1):143‐172.
    1. Raftery J, Hanney S, Greenhalgh T, Glover M, Young A. Models and applications for measuring the impact of health research: update of a systematic review for the Health Technology Assessment Programme. Health Technol Assess. 2015.
    1. Greenhalgh T. Research Impact in the Community Based Health Sciences: What Would Good Look Like? [MBA dissertation]. London, United Kingdom: UCL Institute of Education; 2015.
    1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003;362(9391):1225‐1230.
    1. Eccles MP, Armstrong D, Baker R, et al. An implementation research agenda. Implement Sci. 2009;4(1):18.
    1. Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ. 1998;317(7156):465‐468.
    1. Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13‐24.
    1. McCormack L, Sheridan S, Lewis M, et al. Communication and Dissemination Strategies to Facilitate the Use of Health‐Related Evidence. Evidence Report/Technology Assessment No. 213. Rockville, MD: Agency for Healthcare Research and Quality; 2013.
    1. Oliver K, Innvar S, Lorenc T, Woodman J, Thomas J. A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res. 2014;14:2.
    1. Long JC, Cunningham FC, Braithwaite J. Bridges, brokers and boundary spanners in collaborative networks: a systematic review. BMC Health Serv Res. 2013;13(1):158.
    1. Brown C. The “policy‐preferences model”: a new perspective on how researchers can facilitate the take‐up of evidence by educational policy makers. Evidence & Policy. 2012;8(4):455‐472.
    1. Meagher L, Lyall C, Nutley S. Flows of knowledge, expertise and influence: a method for assessing policy and practice impacts from social science research. Research Evaluation. 2008;17(3):163‐173.
    1. Ferlie E, Crilly T, Jashapara A, Peckham A. Knowledge mobilisation in healthcare: a critical review of health sector and generic management literature. Soc Sci Med. 2012;74(8):1297‐1304.
    1. Dopson S, Fitzgerald L. Knowledge to Action? Evidence‐Based Health Care in Context. New York, NY: Oxford University Press; 2005.
    1. Davies H, Nutley S, Walter I. Why ‘knowledge transfer’ is misconceived for applied social research. J Health Serv Res Policy. 2008;13(3):188‐190.
    1. Nicolini D, Powell J, Conville P, Martinez‐Solano L. Managing knowledge in the healthcare sector. A review. IJMR. 2008;10(3):245‐263.
    1. Ellis KS. Knowledge Translation and the Governance of Health Research in Canada: A Critical Discourse Analysis [dissertation]. London, Canada: University of Western Ontario; 2014.
    1. Gibbons M, Limoges C, Nowotny H, Schwartzman S, Scott P, Trow M. The New Production of Knowledge: The Dynamics of Science and Research in Contemporary Societies. London, United Kingdom: Sage; 1994.
    1. Nowotny H, Scott P, Gibbons M. Mode 2 revisited: the new production of knowledge. Minerva. 2003;41(3):179‐194.
    1. Nowotny H, Scott P, Gibbons M. Re‐thinking Science: Knowledge and the Public in an Age of Uncertainty. Cambridge, United Kingdom: Polity Press; 2001.
    1. Van de Ven AH, Johnson PE. Knowledge for theory and practice. Acad Manage Rev. 2006;31(4):802‐821.
    1. Kincheloe JL. Describing the bricolage: conceptualizing a new rigor in qualitative research. QI. 2001;7(6):679‐692.
    1. Hessels LK, Van Lente H. Re‐thinking new knowledge production: a literature review and a research agenda. RP. 2008;37(4):740‐760.
    1. Ziman J. Is science losing its objectivity? Nature. 1996;382(6594):751‐754.
    1. Hanney S, Kuruvilla S, Soper B, Mays N. Who needs what from a national health research system: lessons from reforms to the English Department of Health's R&D system. Health Res Policy Syst. 2010;8:11.
    1. Jameson JK, Clayton PH, Jaeger AJ. Community‐engaged scholarship through mutually transformative partnerships In: Harter LM, Hamel‐Lambert J, Millesen J, eds. Participatory Partnerships for Social Action and Research. Dubuque, IA: Kendall Hunt Publishing; 2010:259‐277.
    1. Carayon P. Human factors of complex sociotechnical systems. Appl Ergon. 2006;37(4):525‐535.
    1. Patton MQ. Utilization‐Focused Evaluation. London, United Kingdom: Sage; 2008.
    1. Ramaswamy V, Gouillart F. Building the co‐creative enterprise. HBR. 2010;88(10):100‐109.
    1. Hardyman W, Daunt KL, Kitchener M. Value co‐creation through patient engagement in health care: a micro‐level approach and research agenda. Public Management Review. 2015;17(1):90‐107.
    1. Bate P, Robert G. Bringing User Experience to Healthcare Improvement: The Concepts, Methods and Practices of Experience‐Based Design. Abingdon, United Kingdon: Radcliffe Publishing; 2007.
    1. Procter R, Greenhalgh T, Wherton J, Sugarhood P, Rouncefield M, Hinder S. The day‐to‐day co‐production of ageing in place. CSCW. 2014;23(3):245‐267.
    1. Wherton J, Sugarhood P, Procter R, Hinder S, Greenhalgh T. Co‐production in practice: how people with assisted living needs can help design and evolve technologies and services. Implement Sci. 2015;10(1):75.
    1. Cacari‐Stone L, Wallerstein N, Garcia AP, Minkler M. The promise of community‐based participatory research for health equity: a conceptual model for bridging evidence with policy. Am J Public Health. 2014:e1‐e9.
    1. Jagosh J, Macaulay AC, Pluye P, et al. Uncovering the benefits of participatory research: implications of a realist review for health research and practice. Milbank Q. 2012;90(2):311‐346.
    1. Ramaswamy V, Ozcan K. The Co‐creation Paradigm. Redwood City, CA: Stanford University Press; 2014.
    1. Iedema R, Merrick E, Piper D, et al. Codesigning as a discursive practice in emergency health services: the architecture of deliberation. J Appl Behav Sci. 2010;46(1):73‐91.
    1. King's Fund. Experience‐Based Co‐design Toolkit. London, United Kingdom: King's Fund; 2013. . Accessed March 12, 2016.
    1. Donetto S, Tsianakas V, Robert G. Using Experience‐Based Co‐design (EBCD) to Improve the Quality of Healthcare: Mapping Where We Are Now and Establishing Future Directions. London, United Kingdom: King's College London; 2014.
    1. Coulter A, Locock L, Ziebland S, Calabrese J. Collecting data on patient experience is not enough: they must be used to improve care. BMJ. 2014;348.
    1. Cherns A. Principles of sociotechnical design revisted. Human Relations. 1987;40(3):153‐161.
    1. Symon G, Long K, Ellis J. The coordination of work activities: cooperation and conflict in a hospital context. CSCW. 1996;5:1‐31.
    1. Dostilio LD. Democratically engaged community‐university partnerships: reciprocal determinants of democratically oriented roles and processes. J High Educ Outreach Engagem. 2014;18(5):235‐244.
    1. Jackson C, Askew D. Is there a polyclinic alternative acceptable to general practice? The “beacon” practice model. Br J Gen Pract. 2008;58(555):733.
    1. Larkin M, Boden ZV, Newton E. On the brink of genuinely collaborative care: experience‐based co‐design in mental health. Qual Health Res. 2015;25(11):1463‐1476.
    1. Pearce V, Baraitser P, Smith G, Greenhalgh T. Experience‐based co‐design In: Greenhalgh T, Humphrey C, Woodard F, eds. User Involvement in Health Care. Hoboken, NJ: BMJ Books; 2010:28‐51.
    1. Clemensen J, Larsen SB, Kyng M, Kirkevold M. Participatory design in health sciences: using cooperative experimental methods in developing health services and computer technology. Qual Health Res. 2007;17(1):122‐130.
    1. Clemensen J, Larsen SB, Kirkevold M, Ejskjaer N. Treatment of diabetic foot ulcers in the home: video consultations as an alternative to outpatient hospital care. Int J Telemed Appl. 2008:132890. doi:.
    1. Vassilakopoulou P, Grisot M, Aanestad M. Co‐creation of patient‐oriented services: design of electronic booking for Norwegian healthcare In: Oinas‐Kukkonen H, Iivari N, Kuutti K, Öörni A, Rajanen M, eds. Nordic Contributions in IS Research. Vol. 223 Switzerland: Springer International Publishing; 2015:193‐207.
    1. Potvin L, Cargo M, McComber AM, Delormier T, Macaulay AC. Implementing participatory intervention and research in communities: lessons from the Kahnawake Schools Diabetes Prevention Project in Canada. Soc Sci Med. 2003;56(6):1295‐1305.
    1. Nield A, Quarrell S, Myers S. Community based early intervention for the prevention of type 2 diabetes: a case report of the Kahnawake Schools Diabetes Prevention Project. J Diabetes Metab. 2013;4(277):2.
    1. Findley S, Irigoyen M, Sanchez M, et al. Community empowerment to reduce childhood immunization disparities in New York City. Ethn Dis. 2004;14(3 Suppl 1):S134‐141.
    1. Findley SE, Irigoyen M, Sanchez M, et al. Effectiveness of a community coalition for improving child vaccination rates in New York City. Am J Public Health. 2008;98(11):1959.
    1. Thorp H, Goldstein B. Engines of Innovation: The Entrepreneurial University in the Twenty‐First Century. Chapel Hill, NC: UNC Press Books; 2010.
    1. Etzkowitz H, Leydesdorff L. The dynamics of innovation: from National Systems and “Mode 2” to a Triple Helix of university‐industry‐government relations. RP. 2000;29(2):109‐123.
    1. Rhoades G, Slaughter S. Academic capitalism in the new economy: challenges and choices. American Academic. 2004;1(1):37‐59.
    1. Bresnen M, Burrell G. Journals à la mode? Twenty years of living alongside Mode 2 and the new production of knowledge. Organization. 2013;20(1):25‐37.
    1. Larsen MT. The implications of academic enterprise for public science: an overview of the empirical evidence. RP. 2011;40(1):6‐19.
    1. Baranick E, Baird A, Vinze A. An economic framework for transitioning to capacity building. Glob Public Health. 2015;10(1):15‐27.
    1. Hanney S, Gonzalez‐Block MA, Buxton MJ, Kogan M. The utilisation of health research in policy‐making: concepts, examples and methods of assessment. Health Res Policy Syst. 2003;1(1):2.
    1. Hinchcliff R, Greenfield D, Braithwaite J. Is it worth engaging in multi‐stakeholder health services research collaborations? Reflections on key benefits, challenges and enabling mechanisms. Int J Qual Health Care. 2014;26(2):124‐128.
    1. King G, Servais M, Forchuk C, et al. Features and impacts of five multidisciplinary community‐university research partnerships. Health Soc Care Community. 2010;18(1):59‐69.
    1. Wehrens R, Bekker M, Bal R. Hybrid management configurations in joint research. STHV. 2014;39(1):6‐41.
    1. Janamian T, Jackson C, Dunbar J. Co‐creating value in research: stakeholders’ perspectives. Med J Aust. 2014;201(3 Suppl):S44‐S46.
    1. Rycroft‐Malone J, Burton C, Wilkinson J, et al. Collective action for knowledge mobilisation: a realist evaluation of the Collaborations for Leadership in Applied Health Research and Care. Health Serv Deliv Res. 2015;3(44).
    1. McGough R, Rubenstein S. Academia. Shaping the new science networks. Health Serv J. 2013;123(6340):32‐33.
    1. Higher Education Funding Council for England. Research Excellence Framework 2014: Overview Report by Main Panel A and Sub‐panels 1 to 6. London, United Kingdom: HEFCE; 2015. . Accessed February 1, 2015.
    1. Frank C, Nason E. Health research: measuring the social, health and economic benefits. CMAJ. 2009;180(5):528‐534.
    1. Bouter LM. Knowledge as a common good: the societal relevance of scientific research. Higher Education Management and Policy. 2010;22(1):119‐132.
    1. Lomas J. Using “linkage and exchange” to move research into policy at a Canadian foundation. Health Aff (Millwood). 2000;19(3):236‐240.
    1. Lomas J. The in‐between world of knowledge brokering. BMJ. 2007;334(7585):129‐132.
    1. Weiss CH. The many meanings of research utilization. Public Administration Review. 1979; 39(5):426‐431.
    1. Penfield T, Baker MJ, Scoble R, Wykes MC. Assessment, evaluations, and definitions of research impact: a review. Research Evaluation. 2013:rvt021.
    1. Hawe P. Lessons from complex interventions to improve health. Annu Rev Public Health. 2015;36:307‐323.
    1. De Savigny D, Adam T. Systems Thinking for Health Systems Strengthening. Geneva, Switzerland: World Health Organization; 2009.
    1. Niederkrotenthaler T, Dorner TE, Maier M. Development of a practical tool to measure the impact of publications on the society based on focus group discussions with scientists. BMC Public Health. 2011;11(1):588.
    1. Mostert SP, Ellenbroek S, Meijer I, van Ark G, Klasen EC. Societal output and use of research performed by health research groups. Health Res Policy Syst. 2010;8(1):30.
    1. Hansen J, Muscat N, Keskimaki L. Measuring and improving the societal impact of health care research. Eurohealth. 2013;19(3):32‐35.
    1. Martin BR. The Research Excellence Framework and the “impact agenda”: are we creating a Frankenstein monster? Research Evaluation. 2011;20(3):247‐254.
    1. Nowotny H. Engaging with the political imaginaries of science: near misses and future targets. Public Underst Sci. 2014;23(1):16‐20.
    1. Brown C. The policy agora: how the epistemological and ideological preferences of policy‐makers affect the development of government policy. Human Welfare. 2012;1(1):57‐70.
    1. Boaz A, Fitzpatrick S, Shaw B. Assessing the impact of research on policy: a literature review. Science and Public Policy. 2009;36(4):255‐270.
    1. Pawson R. The Science of Evaluation: A Realist Manifesto. London, United Kingdom: Sage; 2013.
    1. Jagosh J, Bush PL, Salsberg J, et al. A realist evaluation of community‐based participatory research: partnership synergy, trust building and related ripple effects. BMC Public Health. 2015;15:725.
    1. Lasker RD, Weiss ES, Miller R. Partnership synergy: a practical framework for studying and strengthening the collaborative advantage. Milbank Q. 2001;79(2):179‐205.
    1. Stake RE. The Art of Case Study Research. Thousand Oaks, CA: Sage; 1995.
    1. Lusch RF, Vargo SL, O'Brien M. Competing through service: insights from service‐dominant logic. Journal of Retailing. 2007;83(1):5‐18.
    1. Brook RH. The end of the quality improvement movement: long live improving value. JAMA. 2010;304(16):1831‐1832.
    1. Gray M, El Turabi A. Optimising the value of interventions for populations. BMJ. 2012;345:e6192.
    1. Crossland L, Janamian T, Jackson CL. Key elements of high‐quality practice organisation in primary health care: a systematic review. Med J Aust. 2014;201(3 Suppl):S47‐S51.
    1. Janamian T, Jackson CL, Glasson N, Nicholson C. A systematic review of the challenges to implementation of the patient‐centred medical home: lessons for Australia. Med J Aust. 2014;201(3 Suppl):S69‐S73.
    1. Nicholson C, Jackson C, Marley J. A governance model for integrated primary/secondary care for the health‐reforming first world—results of a systematic review. BMC Health Serv Res. 2013;13(1):528.
    1. Crossland L, Janamian T, Sheehan M, Siskind V, Hepworth J, Jackson CL. Development and pilot study of the Primary Care Practice Improvement Tool (PC‐PIT): an innovative approach. Med J Aust. 2014;201(3 Suppl):S52‐S55.
    1. Janamian T, Crossland LJ, Jackson C, Morcom J. Triggering change in diabetes care delivery in general practice: a qualitative evaluation approach using the clinical microsystem framework. BMC Fam Pract. 2014;15(1):32.
    1. Wilkinson SA, Brodribb WE, Upham S, Janamian T, Nicholson C, Jackson CL. Primary care of women after gestational diabetes mellitus: mapping the evidence‐practice gap. Med J Aust. 2014;201(3 Suppl):S74‐S77.
    1. Askew DA, Jackson CL, Ware RS, Russell A. Protocol and baseline data from The Inala Chronic Disease Management Service evaluation study: a health services intervention study for diabetes care. BMC Health Serv Res. 2010;10(1):134.
    1. Zhang J, Donald M, Baxter KA, et al. Impact of an integrated model of care on potentially preventable hospitalizations for people with type 2 diabetes mellitus. Diabet Med. 2015;32(7):872‐880.
    1. Burridge LH, Foster MM, Donald M, Zhang J, Russell AW, Jackson CL. Making sense of change: patients’ views of diabetes and GP‐led integrated diabetes care. Health Expect. 2015;Jan:1‐13.
    1. Russell A, Baxter K, Askew D, Tsai J, Ware R, Jackson C. Model of care for the management of complex type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial. Diabet Med. 2013;30(9):1112‐1121.
    1. Fitzgerald L, Harvey G. Translational networks in healthcare? Evidence on the design and initiation of organizational networks for knowledge mobilization. Soc Sci Med. 2015;138:192‐200.
    1. Swan J, Bresnen M, Robertson M, Newell S, Dopson S. When policy meets practice: colliding logics and the challenges of “Mode 2” initiatives in the translation of academic knowledge. Organization Studies. 2010;31(9‐10):1311‐1340.
    1. Orr K, Bennett M. Public administration scholarship and the politics of coproducing academic‐practitioner research. PAR. 2012;72(4):487‐495.
    1. Bennet A, Bennet D, Fafard K, et al. Knowledge Mobilization in the Social Sciences and Humanities. Frost, WV: MQI Press; 2007.
    1. Phipps DJ, Jensen KE, Myers JG. Applying social sciences research for public benefit using knowledge mobilization and social media In: Lopez‐Varela A, ed. Theoretical and Methodological Approaches to Social Sciences and Knowledge Management. Rijeka, Croatia: InTech; 2012:179‐208.
    1. Prahalad CK, Ramaswamy V. Co‐creation experiences: the next practice in value creation. J Interactive Mark. 2004;18(3):5‐14.
    1. Schmachtel S. Local partnerships as “rationalized myths”: a critical examination of the micro‐discourse in educational partnership working. Critical Policy Studies. 2015:1‐20.

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