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  • 1.
    Batalden, Maren
    et al.
    Department of Medicine, Cambridge Health Alliance, Cambridge, MA, United States.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth, Lebanon, NH, United States.
    Margolis, Peter
    Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
    Seid, Michael
    Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
    Armstrong, Gail
    College of Nursing, University of Colorado, Aurora, CO, United States.
    Opipari-Arrigan, Lisa
    Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
    Hartung, Hans
    Department of Pulmonary Medicine, University Hospital Crosshouse, Kilmarnock, East Ayrshire, United Kingdom.
    Coproduction of healthcare service2016In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 25, no 7, p. 509-517Article in journal (Refereed)
    Abstract [en]

    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.

    Download full text (pdf)
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  • 2.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Dartmouth Institute for Health Policy and Clinical Practice, Geisel Medical School, Dartmouth College, Lebanon, NH, United States.
    Getting more health from healthcare: Quality improvement must acknowledge patient coproduction - An essay by Paul Batalden2018In: BMJ. British Medical Journal, ISSN 0959-8146, E-ISSN 0959-535X, Vol. 362, article id k3617Article in journal (Other academic)
    Abstract [en]

    Modelling healthcare as either a product or a service neglects essential aspects of coproduction between doctors and patients. Paul Batalden shares his learning from 10 years of studying change.

  • 3.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    Intermission: A coproduction fika [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    In the Swedish practice of “fika” workers gather for coffee and a small sandwich in mid-morning. They then talk about their work. In this episode, we use the idea of “fika” to reflect on what we’ve learned about coproduction so far and where we’re headed next: how science informs the practices where “disease or condition”, “illness”, and “service” come together. Knowledge of all three components is basic to the coproduction of a healthcare service. Integrating them is a form of knowledge and skill in itself.

  • 4.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Geisel Medical School at Dartmouth.
    Introduction: Paul on coproduction [podcast]2021Other (Other (popular science, discussion, etc.))
    Abstract [en]

    Distilling many years of experience examining the different applications of the coproduction of healthcare service in diverse settings, Paul Batalden describes a way of understanding its key components. He shares some of the knowledge, skills and habits that contribute to coproducing a healthcare service along with the implications and benefits of new framing to improve health care overall.

  • 5.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Geisel Medical School at Dartmouth.
    Arvidsson, Charlotte
    Family physician and medical educator for Region Jönköping, Sweden.
    Chao, Serena
    Chief of Geriatrics Division,Cambridge Health Alliance (CHA), Director of CHA’s House Calls Program, Co-Chair of CHA’s Post-Acute Committee and Instructor of Medicine,Harvard Medical School.
    Episode 2: The person will see you now [podcast]2021Other (Other (popular science, discussion, etc.))
    Abstract [en]

    Lotta Arvidsson worked with a learning partner to gain insight into the lived reality of someone struggling with congestive heart failure. She was subsequently able to apply some of those approaches to her practice as a primary care physician.

    Serena Chao found a way to visualize the setting in which her patient’s family was making decisions that relied heavily on the emergency care system. This enabled Serena to identify and implement changes in her geriatric practice to lessen the family’s reliance on emergency care.

    Paul focuses his takeaways on how to build on the knowledge that Lotta and Serena gained.

  • 6.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    Batalden, Sonja
    Nurse-Midwife & Director of Perinatal Care, Minnesota Community Care (MCC), St. Paul, Minnesota, USA.
    Banigo, Diane
    Social Architect and Nurse-Midwife Health Consultant.
    Episode 5: Stop talking! Equity begins by listening [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    Sonja and Diane knew that as an organization they could do better with their services for African-American women during pregnancy. The two nurse leaders, who’d also served as nurse midwives, began a program of active listening to improve their understanding of pregnant womens’ stories, observations, questions, frustrations...and so much more. As Sonja and Diane built “DIVA Moms” they worked to connect what they heard with what they and their colleagues did. Together, they built a different way.

    Sonja and Diane tell Paul how they co-created DIVA Moms.

  • 7.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    Brennan, John
    MD, General Practitioner, Ballyhale Health Centre, Co. Kilkenny, Ireland.
    Episode 10: My work depends on the setting ... [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    John tells us how his work environments influence the content of his work. In his experiences with two settings, he illustrates concretely how this happens and what difference it makes to him as a physician-person.

  • 8.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    Johnson, Julie
    Department of Surgery and the Center for Health Services Outcomes Research, Northwestern University, Evanston, Illinois, USA.
    Bryant, Chandlee
    Career Advisor to Undergraduates, Dartmouth College, Hanover, New Hampshire, USA.
    Episode 3: Let's get real: the way things are [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    When healthcare “professionals'' listen to the steps people must take to get healthcare services, and what those experiences are actually like, understanding begins. As these stories unfold there’s opportunity for gaining even greater insight into the surprises and the feelings associated with the “patient” journey.

    This is what happened for Julie and Chandlee as each took in what patients had to navigate to get necessary care and support. It was eye opening to say the least, and helped everyone see that the current state of much of healthcare service, this “as is” system, is where the worlds of the “patient-person” and the “professional-person” meet. And, often unhappily. But, this first step is crucial for determining what needs changing. Paul extrapolates from Julie’s and Chandlee’s stories to describe the tools and methods that are helpful to regularly discovering and documenting the current state of the system.

  • 9.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Geisel Medical School at Dartmouth.
    Jones, Fiona
    Rehabilitation Research, St George’s University, London, UK; Kingston University, Kingston upon Thames, UK; Founder and CEO, Bridges Self-Management Limited, London, UK.
    Episode 4: Allow me to empower you: the wisdom of self-care [podcast]2021Other (Other (popular science, discussion, etc.))
    Abstract [en]

    What started as an intervention has become a way of being for Fiona Jones and her colleagues. Fiona started with her clinical training as a physical therapist, which meant doing things “to” patient-persons. When she moved from hospital settings to home settings, she began to appreciate the variety of PT practices people had come up with on their own. She began to wonder, “what if we combined forces?”

    Fiona shares her insights with Paul into the language and practices that help people navigate the continuum of support for self-care.

  • 10.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    Kirkland, Kathryn
    MD, Dorothy and John J. Byrne, Jr. Distinguished Professor and Chief of Palliative Medicine, Geisel School of Medicine and Dartmouth-Hitchcock Health.
    Episode 9: Stories clarify [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    Kathy’s story starts with the lived reality and prognosis for a patient-person in a coma on a ventilator machine. She invited everyone involved to describe the situation. Their narratives revealed that family members and the neurologist had very different understandings of the word “okay.” Kathy connected these insights with scientific data to enable the interested parties to come to a common understanding and decide next steps. Kathy draws on this experience when she teaches others the value of narrative medicine. Among other things, it’s a way to clarify what’s at stake and to correct misunderstandings, especially when critical medical decisions must be made.

  • 11.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    Kyle, April
    President and CEO for Southcentral Foundation's Nuka System of Care, Anchorage, AK, USA.
    Episode 12: Coproduction and macrosystems of healthcare [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    April and Doug bring their long familiarity to describe the transformative change when the indigenous community became the “customer-owners,” as they now call the members of the Native American community. They explore the way commonly occurring meetings happen and some of the implications for their work as executive-persons in the setting. April describes what it’s like getting a professional-person’s help for a problem. Doug describes some of the data that is used to measure the changes that have occurred since the change.

  • 12.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH, USA.
    Lachman, Peter
    Department of Quality Improvement, Royal College of Physicians of Ireland, Dublin, Ireland.
    von Plessen, Christian
    Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland; Direction Générale de la Santé, Lausanne, Switzerland.
    Johnson, Julie K.
    Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
    García-Elorrio, Ezequiel
    Instituto de Efectividad Clínica y Sanitaria, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
    Coproduction of healthcare services: from concept to implementation2023In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 35, no 4, article id mzad083Article in journal (Other academic)
  • 13.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    Lind, Cristin
    Project Manager, European Patients’ Academy on Therapeutic Innovation (EUPATI) Sweden, Swedish Disability Rights Federation and Facilitator-in-Preparation, Center for Courage and Renewal.
    Episode 7: The web I tend [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    Living with a long term condition that begins at birth involves so many unplanned needs. It invites a diverse set of resources to help. Putting them all together to support the flourishing of a person involves building and integrating new knowledge. If a condition is present from birth, everything changes as the child grows and develops. Cristin’s experience helping her son, Gabriel, invites us to understand the journey.

  • 14.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    Lucas, Bill
    Professor of Learning and Director of the Centre for Real World Learning, Winchester University, UK.
    Episode 11: From principles to practices [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    After describing a situation where learning and the “learner” seem “blocked”, Bill explores the creative ways teachers address situations like this. Together, Bill and Paul discuss the multiple issues that arise when learning new/different knowledge, skills and dispositions (habits) and using them in daily work. Their conversation explores traps that commonly occur and an overview of ways to start.

  • 15.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    Marshall, Bruce
    Chief Medical Officer and Executive Vice President, Cystic Fibrosis (CF) Foundation.
    Episode 6: The biology of it all [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    Bruce Marshall describes the journey of developing biologic knowledge of Cystic Fibrosis (CF), an inherited condition. He illustrates the variety of methods that contributed to this development and suggests how CF knowledge impacts the design of coproduced services and the lives of those with Cystic Fibrosis.

  • 16.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
    Ovalle, Anais
    Leadership Preventive Medicine Residency Program, Section of Infectious Disease, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
    Foster, Tina
    The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA;Departments of Obstetrics and Gynecology and Community & Family Medicine, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Hanover and Lebanon, NH, USA.
    Elwyn, Glyn
    The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
    Science-informed practice: an essential epistemologic contributor to health-care coproduction2021In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 33, no Supplement 2, p. ii4-ii5Article in journal (Other academic)
  • 17.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Geisel Medical School at Dartmouth.
    Sabadosa, Kathryn A.
    CF Learning Network; Learning & Leadership Collaborative.
    Leach, David
    Former Executive Director of the Accreditation Council for Graduate Medical Education (ACGME).
    Episode 1: Coproduction is everywhere [podcast]2021Other (Other (popular science, discussion, etc.))
    Abstract [en]

    Paul invites his guests, Kathryn Sabadosa and David Leach, to share a time when healthcare services worked well.

    Kathryn describes the experience of her son, born 20+ years ago with Cystic Fibrosis. She describes the recent changes in the routine care for people with CF and the way together they are changing “good” care for him, and some of the ways that COVID-19 has changed her son’s interactions with professionals.

    David describes his experience deciding to have heart surgery. He focuses on how he sought out the ‘person’ in the professionals he met and worked with.

    After a three-way conversation, Paul offers this episode’s takeaways, focused on the importance of discovering and noticing coproduction in daily healthcare services.

  • 18.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    Sodemann, Morten
    University Professor of Global and Migrant Health, University of Southern Denmark. Senior Consultant, The Migrant Health Clinic, Odense University Hospital.
    Episode 8: Am I allowed to cry here? [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    Creating a safe healthcare space for immigrants who have many issues going on in their lives all at once, invites attention to many factors. Like any good science, it starts with honest inquiry and good tools–clinical tools. Morten describes how these came together to support the co-creation of services at an immigrant clinic in Odense, Denmark.

  • 19.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    Vincent, Charles
    University of Oxford, UK.
    Batalden, Maren
    Chief Quality Officer at Cambridge Health Alliance, Cambridge, MA, USA.
    Episode 13: Safer together [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    The realization that safer healthcare is not a “binary” phenomenon, but a result from a complex set of factors working together in various ways and that healthcare is not limited to what occurs in hospitals led Charles and his colleague to work together to write their important book. Maren and her colleagues at Cambridge Health Alliance near Boston took those ideas and built their efforts. She describes how direct involvement of a patient and his spouse offered a much more helpful understanding of a fall that occurred shortly after this patient-person was admitted to the hospital. Together they illustrate how ideas become new ways of conducting the daily work of making safer healthcare. They open consideration of how automation enters the co-productive workspace and illustrate both its opportunities and its challenges.

  • 20.
    Batalden, Paul B.
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel Medical School at Dartmouth.
    von Plessen, Christian
    Senior advisor for health care quality and safety to the Health Authority of the Canton of Vaud.
    Foster, Tina
    Dartmouth Health and the Geisel School of Medicine at Dartmouth.
    Episode 14: Looking back and ahead [podcast]2022Other (Other (popular science, discussion, etc.))
    Abstract [en]

    Paul, Christian, and Tina weave the foundational content for coproducing healthcare service and a frame for thinking. They reflect on several possible additional themes for subsequent attention. They discuss some of the personal tips that have been helpful in their own thinking & work to further the work of coproducing healthcare service. They hint at the exciting challenges they see moving forward

  • 21.
    Englander, Robert
    et al.
    University of Minnesota Medical School, Minneapolis, Minnesota.
    Holmboe, Eric
    Accreditation Council for Graduate Medical Education, Chicago, Illinois.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
    Caron, Rosemary M.
    Department of Health Management and Policy, College of Health and Human Services, University of New Hampshire, Durham, New Hampshire.
    Durham, Carol F.
    School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
    Foster, Tina
    The Dartmouth Institute, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire.
    Ogrinc, Greg
    Dartmouth Institute at Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
    Ercan-Fang, Nacide
    University of Minnesota Medical School, Minneapolis, Minnesota.
    Batalden, Maren
    Harvard Medical School, Boston, Massachusetts.
    Coproducing health professions education: A prerequisite to coproducing health care services?2020In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 95, no 7, p. 1006-1016Article in journal (Refereed)
    Abstract [en]

    In 2016, Batalden et al proposed a coproduction model for health care services. Starting from the argument that health care services should demonstrate service-dominant rather than goods-dominant logic, they argued that health care outcomes are the result of the intricate interaction of the provider and patient in concert with the system, community, and, ultimately, society. The key notion is that the patient is as much an expert in determining outcomes as the provider, but with different expertise. Patients come to the table with expertise in their lived experiences and the context of their lives.The authors posit that education, like health care services, should follow a service-dominant logic. Like the relationship between patients and providers, the relationship between learner and teacher requires the integrated expertise of each nested in the context of their system, community, and society to optimize outcomes. The authors then argue that health professions learners cannot be educated in a traditional, paternalistic model of education and then expected to practice in a manner that prioritizes coproductive partnerships with colleagues, patients, and families. They stress the necessity of adapting the health care services coproduction model to health professions education. Instead of asking whether the coproduction model is possible in the current system, they argue that the current system is not sustainable and not producing the desired kind of clinicians.A current example from a longitudinal integrated clerkship highlights some possibilities with coproduced education. Finally, the authors offer some practical ways to begin changing from the traditional model. They thus provide a conceptual framework and ideas for practical implementation to move the educational model closer to the coproduction health care services model that many strive for and, through that alignment, to set the stage for improved health outcomes for all.

  • 22.
    Fjeldstad, Øystein D.
    et al.
    International Strategy and Management, BI-Norwegian Business School, Oslo, Norway.
    Johnson, Julie K.
    Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
    Margolis, Peter A.
    Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
    Seid, Michael
    Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
    Höglund, Pär
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
    Networked health care: Rethinking value creation in learning health care systems2020In: Learning Health Systems, E-ISSN 2379-6146, Vol. 4, no 2, article id e10212Article in journal (Refereed)
    Abstract [en]

    Creating better value in health care service today is very challenging. The social pressure to do so is real for every health care system and its leadership. Real benefit has been achieved in manufacturing sector work by the use of "value-chain" thinking, which assumes that the work is a series of linked processes necessary to make a product. For those activities in health care systems that are similar, this model may be very helpful. Attempts to "install" the value chain widely in health care systems have, however, been frustrating. As a result, well-meaning leaders seeking better value have resorted to programs of cost reduction, rather than service redesign. Professionals have not been very happy or willing participants. The work of health care service invites an expanded model of value creation, one that better matches the work. This paper proposes a networked architecture that can mobilize and integrate the resources of health care professionals, interested patients, family, and other community members in the delivery and improvement of health care systems. It also suggests how this value-creation architecture might contribute to research and the development of new knowledge. Two cases illustrate the proposed architecture and its implications for system design and practice, technology development, and roles and responsibilities of all actors involved in health care systems. We believe that this model better fits the need of making and improving health care services. This expanded understanding of how value is created invites attention by senior leaders, by those attempting to facilitate the improvement of current systems, by patients and clinicians involved in the daily work of health care service coproduction, by those charged with the preparation and formation of future professionals, by those who measure and conduct research in health care services, and by those leading policy, payment, and reimbursement systems.

  • 23.
    Foster, T.
    et al.
    Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, 03755, NH, United States.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, 03755, NH, United States.
    New ways of working: Health professional development for effective coproduction2021In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 33, p. ii6-ii7Article in journal (Other academic)
  • 24.
    Godfrey, Marjorie M.
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Melin, Craig N.
    Muething, Stephen E.
    Batalden, Paul B.
    Nelson, Eugene C.
    Clinical microsystems, Part 3.: Transformation of two hospitals using microsystem, mesosystem, and macrosystem strategies.2008In: Joint Commission Journal on Quality and Patient Safety, ISSN 1553-7250, E-ISSN 1938-131X, Vol. 34, no 10, p. 591-603Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Two hospitals-a large, urban academic medical center and a rural, community hospital-have each chosen a similar microsystem-based approach to improvement, customizing the engagement of the micro-, meso-, and macrosystems and the improvement targets on the basis of an understanding of the local context. CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER (CCHMC): Since 2004, strategic changes have been developed to support microsystems and their leaders through (1) ongoing improvement training for all macro-, meso-, and microsystem leaders; (2) financial support for physicians who are serving as co-leaders of clinical microsystems; (3) increased emphasis on aligning academic pursuits with improvement work at the clinical front lines; (4) microsystem leaders' continuous access to unit-level data through the organization's intranet; and (5) encouragement of unit leaders to share outcomes data with families.

    COOLEY DICKINSON HOSPITAL (CDH): CDH has moved from near closure to a survival-turnaround focus, significant engagement in quality and finally, a complete reframing of a quality focus in 2004. Since then, it has deployed the clinical microsystems approach in one pilot care unit (West 2, a medical surgery unit), broadened it to two, then six more, and is now spreading it organizationwide. In "2+2 Charters," interdisciplinary teams address two strategic goals set by senior leadership and two goals set by frontline microsystem leaders and staff

    DISCUSSION: CCHMC and CDH have had a clear focus on developing alignment, capability, and accountability to fuse together the work at all levels of the hospital, unifying the macrosystem with the mesosystem and microsystem. Their improvement experience suggests tips and actions at all levels of the organization that could be adapted with specific context knowledge by others.

  • 25. Godfrey, Marjorie M.
    et al.
    Nelson, Eugene C.
    Wasson, John H.
    Mohr, Julie J.
    Batalden, Paul B.
    Microsystems in health care: Part 3. Planning patient-centered services.2003In: Joint Commission journal on quality and safety, ISSN 1549-3741, Vol. 29, no 4, p. 159-170Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Strategic focus on the clinical microsystems--the small, functional, frontline units that provide most health care to most people--is essential to designing the most efficient, population-based services. The starting place for designing or redesigning of clinical microsystems is to evaluate the four P's: the patient subpopulations that are served by the microsystem, the people who work together in the microsystem, the processes the microsystem uses to provide services, and the patterns that characterize the microsystem's functioning.

    GETTING STARTED: DIAGNOSING AND TREATING A CLINICAL MICROSYSTEM: Methods and tools have been developed for microsystem leaders and staff to use to evaluate the four P's--to assess their microsystem and design tests of change for improvement and innovation.

    PUTTING IT ALL TOGETHER: Based on its assessment--or diagnosis--a microsystem can help itself improve the things that need to be done better. Planning services is designed to decrease unnecessary variation, facilitate informed decision making, promote efficiency by continuously removing waste and rework, create processes and systems that support staff, and design smooth, effective, and safe patient care services that lead to measurably improved patient outcomes.

    CONCLUSION: The design of services leads to critical analysis of the resources needed for the right person to deliver the right care, in the right way, at the right time.

  • 26.
    Gremyr, Andreas
    et al.
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Sahlgrenska Universitetssjukhuset Psykiatri Psykos, Mölndal, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH, USA.
    Elwyn, Glyn
    Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH, USA.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH, USA.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Care Science, Malmö University, Malmö, Sweden.
    The role of co-production in Learning Health Systems2021In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 33, no Supplement 2, p. ii26-ii32Article in journal (Refereed)
    Abstract [en]

    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.

  • 27. Huber, Thomas P.
    et al.
    Godfrey, Marjorie M.
    Nelson, Eugene C.
    Mohr, Julie J.
    Campbell, Christine
    Batalden, Paul B.
    Microsystems in health care: Part 8. Developing people and improving work life2003In: Joint Commission journal on quality and safety, ISSN 1549-3741, Vol. 29, no 10, p. 512-22Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The articles in the Microsystems in Health Care series have focused on the success characteristics of high-performing clinical microsystems. Realization is growing about the importance of attracting, selecting, developing, and engaging staff. By optimizing the work of all staff members and by promoting a culture where everyone matters, the microsystem can attain levels of performance not previously experienced.

    CASE STUDY: At Massachusetts General Hospital Downtown Associates (Boston), a primary care practice, the human resource processes are specified and predictable, from a candidate's initial contact through each staff member's orientation, performance management, and professional development. Early on, the new employee receives materials about the practice, including a practice overview, his or her typical responsibilities, the performance evaluation program, and continuous quality improvement. Ongoing training and education are supported with skill labs, special education nights, and cross-training. The performance evaluation program, used to evaluate the performance of all employees, is completed during the 90-day orientation and training, quarterly for one year, and annually.

    CONCLUSION: Some health care settings enjoy high morale, high quality, and high productivity, but all too often this is not the case. The case study offers an example of a microsystem that has motivated its staff and created a positive and dynamic workplace.

  • 28.
    Johnson, Julie K.
    et al.
    Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University Feinberg School of Medicine, 633 N. Saint Clair St, 20th floor, Chicago, 60611, IL, United States.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Geisel School of Medicine at Dartmouth, Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, United States.
    Foster, Tina
    Obstetrics and Gynecology and Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
    Arvidsson, Charlotte
    Bra Liv Hälsan 1 Primary Care Centre, Region Jönköping County, Jönköping, Sweden.
    Batalden, Maren
    Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States.
    Forcino, Rachel
    Geisel School of Medicine at Dartmouth, Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, United States.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Futurum—The Academy for Health and Care, Region Jönköping County, Länssjukhuset Ryhov, Jönköping, Sweden.
    A starter's guide to learning and teaching how to coproduce healthcare services2021In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 33, no Supplement 2, p. II55-II62Article in journal (Refereed)
    Abstract [en]

    Background: There has been insufficient attention paid to the role of learning in co-production-both how service users and professional service providers learn to co-produce effectively and how the lessons of co-production are captured at a service level.

    Objective: We aimed to develop and test a curriculum to support healthcare professionals' interest in learning how to co-produce health and healthcare services with patients.

    Methods: We developed a co-production curriculum that was tested iteratively in multiple in-person and virtual teaching sessions and short courses. We conducted a formative evaluation of the co-production curriculum and teaching tools to tailor the curriculum.

    Results: Several theories underpin our approach to learning and teaching how to co-produce healthcare services. The co-production curriculum is grounded in systems theory and shares elements of educational theories, namely, the postmodern curriculum matrix, the actor network theory and situated learning in communities of practice. Learning participants valued the sense of community, the experiential learning environment, and the practical methods to support their exploration of co-production.

    Conclusion: This paper summarizes the educational theories that underpin our efforts to develop and implement the curriculum, reports on a formative assessment conducted with learners, and makes recommendations for creating an environment for learning how health professionals can co-produce health and healthcare with patients.

  • 29.
    Lachman, Peter
    et al.
    Royal College of Physicians Ireland (RCPI), Dublin, Ireland.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States.
    Vanhaecht, Kris
    KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium; Department of Quality, University Hospitals Leuven, Leuven, Belgium.
    A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals to coproduce health2022In: F1000 Research, E-ISSN 2046-1402, Vol. 9, article id 1140Article in journal (Refereed)
    Abstract [en]

    Background: It is twenty years since the US Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging.

    The challenge: With the emergence of "service-oriented" systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement.

    The possible solution: In this paper, we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or "kin-centred care" to emphasise the shared humanity of people involved in the interdependent work. The change of Person Centred Care to Kin Centred Care introduces a broader concept of the person and ensures that Person Centred Care is included in every domain of quality rather than as a separate domain. The concentration on the technological aspects of quality is an example of the problem in the past. This is a more expansive view of what "person-centredness" began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.

  • 30.
    Nelson, Eugene C.
    et al.
    Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Dixon-Woods, Mary
    Institute of Public Health, University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Homa, Karen
    Dartmouth-Hitchcock Health, Lebanon, NH, United States.
    Van Citters, Aricca D.
    Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Morgan, Tamara S.
    Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Eftimovska, Elena
    Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Fisher, Elliott S.
    Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Ovretveit, John
    Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Harrison, Wade
    Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Lind, Cristin
    Quality Register Center Stockholm, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden.
    Lindblad, Staffan
    Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Patient focused registries can improve health, care, and science2016In: BMJ. British Medical Journal, ISSN 0959-8146, E-ISSN 0959-535X, Vol. 354, article id i3319Article in journal (Refereed)
    Abstract [en]

    Large scale collection and analysis of data on patients’ experiences and outcomes have become staples of successful health systems worldwide. The systems go by various names—including registries, quality registries, clinical databases, clinical audits, and quality improvement programmes—but all collect standardised information on patients’ diagnoses, care processes, and outcomes, enabling systematic comparison and analysis across multiple sites. Hundreds of what we will term, for simplicity, “registries,” now exist around the world. The United Kingdom is home to over 50 clinical audit programmes, the United States has over 110 federally qualified registries certified to report quality metrics, and Sweden, perhaps the registry epicentre, has over 100, covering conditions from birth to frail old age.

    These registries have had far reaching effects. They facilitate public reporting, retrospective and prospective research, professional development, and service improvement. They reveal variations in practices, processes, and outcomes, and identify targets for improvement. In the UK, they have been associated with many notable successes, including improvements in management of cardiovascular disease and stroke, cancer, and joint replacement.

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  • 31.
    Ogrinc, Greg
    et al.
    Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
    Davies, Louise
    Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
    Goodman, Daisy
    Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
    Davidoff, Frank
    Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, United States.
    Stevens, David
    Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, United States.
    SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process2016In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 25, no 12, p. 986-992Article in journal (Refereed)
    Abstract [en]

    Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasises the reporting of three key components of systematic efforts to improve the quality, value and safety of healthcare: the use of formal and informal theory in planning, implementing and evaluating improvement work; the context in which the work is done and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognising that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (http://www.squire-statement.org). © Published by the BMJ Publishing Group Limited.

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  • 32.
    Ogrinc, Greg
    et al.
    VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.
    Davies, Louise
    VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.
    Goodman, Daisy
    VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
    Davidoff, Frank
    The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire.
    Stevens, David
    The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire.
    Standards for QUality Improvement Reporting Excellence 2.0: revised publication guidelines from a detailed consensus process2016In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 200, no 2, p. 676-682Article in journal (Refereed)
    Abstract [en]

    Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this article, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of three key components of systematic efforts to improve the quality, value, and safety of health care: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).

    Download full text (pdf)
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  • 33.
    Oliver, Brant J.
    et al.
    The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH, USA; Department of Community and Family Medicine, Dartmouth-Hitchcock Health, D-H Medical Center, One Medical Center Drive, Lebanon, NH, USA; Department of Psychiatry, Geisel School of Medicine at Dartmouth, D-H Medical Center, Lebanon, NH, USA.
    Forcino, Rachel C
    The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH, USA.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH, USA.
    Initial development of a self-assessment approach for coproduction value creation by an international community of practice2021In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 33, no Supplement 2, p. ii48-ii54Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Coproduction offers a new way of conceptualizing healthcare as a service that is co-created by people (health professionals and people seeking health services) rather than a product that is generated by providers or health systems and delivered to patients. This offers new possibilities for those introducing and testing changes, and it enables additional ways of creating value. Fjeldstad and colleagues describe the architecture of several kinds of value creating systems: (i) Chain; (ii) Shop; (iii) Network and (iv) Access. An international Value Creating Business Model Community of practice (VCBM CoP) was formed by the International Coproduction of Health Network and explored these types of systems and developed a self-assessment guide for health systems to use to assess value.

    METHODS: An international community of practice comprising leaders, clinicians, patients and finance specialists representing 12 health systems from four countries (USA, UK, Israel and Sweden) met monthly for 1 year and used a semi-structured process to iteratively refine and adapt Fjeldstad's model for use in healthcare and develop a draft self-assessment guide. The process concluded with initial focus group user experience sessions with six health systems.

    RESULTS: The community of practice successfully completed a 1-year journey of discovery, development and learning, resulting in two products: (1) a full-version self-assessment guide (detailed) and (2) an abbreviated 'short-form' of the guide. Initial focus-group results suggest that there is initial perceived feasibility, acceptability and utility of the guides and that further development and research is reasonable to pursue. Results suggest significant variation and context specificity in the use of the guide, simple and complex knowledge transfer applications in use, and the need for the development of simple and technology supported versions for use in the future.

    CONCLUSION: The VCBM CoP has successfully completed a 1-year collaborative learning cycle, resulting in the development of a self-assessment guide that is now ready for additional investigation using formal research methods. The CO-VALUE study has been designed to build on the work of the CoP and includes qualitative and quantitative assessment phases and a concept mapping study.

  • 34.
    Petersson, Christina
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Dartmouth Institute, Geisel School of Medicine at Dartmouth, USA.
    Fritzell, Peter
    Futurum Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Borst, Sanna
    Department of Radiology at the Region County of Jönköping, Sweden.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Futurum, Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Exploring the meaning of coproduction as described by patients after spinal surgery interventions2019In: Open Nursing Journal, E-ISSN 1874-4346, Vol. 13, p. 85-91Article in journal (Refereed)
    Abstract [en]

    Background:

    In the procedures of surgical pathways it is important to create opportunities for developing active forms of engagement and extending the patients’ health maintenance knowledge, which is essential in nursing. One way is to understand more about the concept of coproduction.

    Objective:

    The purpose was to use experiences from spinal surgery patients’ narratives to explore the conceptual model of healthcare service coproduction.

    Method:

    A prospective qualitative explorative approach was performed and analyzed in two phases with inductive and deductive content analysis of data retrieved from five focus group interviews of 25 patients with experiences from spinal surgery interventions.

    Result:

    The findings indicate that mutual trust and respect, as well as guidance given in dialogue, are two important domains. An illustration of how to apply the conceptual model of healthcare service coproduction was revealed in the descriptions of the three core concepts co-planning, co-execution and civil discourse.

    Conclusion:

    This study highlights what is needed to reach coproduction in healthcare services concerning patients with spinal disorders. Development of care plans that focuses on co-planning and co-execution is recommended which are structured and customizable for each patient situation to make coproduction to occur.

  • 35.
    Radl-Karimi, Christina
    et al.
    OPEN – Open Patient data Explorative Network, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
    Nielsen, Dorthe Susanne
    Migrant Health Clinic, Odense University Hospital, Odense, Denmark; Center for Global Health, University of Southern Denmark, Odense, Denmark; Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
    Sodemann, Morten
    Migrant Health Clinic, Odense University Hospital, Odense, Denmark; Center for Global Health, University of Southern Denmark, Odense, Denmark.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, USA.
    von Plessen, Christian
    Direction générale de la santé, Lausanne, Switzerland; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.
    "When I feel safe, I dare to open up": immigrant and refugee patients' experiences with coproducing healthcare2022In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 105, no 7, p. 2338-2345Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Interest in the coproduction concept in healthcare is increasing. According to coproduction, services are, unlike goods, always coproduced by a user and a service provider. This study explored how immigrants and refugees perceive the coproduction of their healthcare service in clinical encounters.

    METHODS: We conducted semi-structured interviews with thirteen patients with varied backgrounds and health problems. Participants were purposefully recruited in an interdisciplinary clinic for immigrants and refugees at a Danish University Hospital. Interviews were transcribed, anonymized, and analyzed using meaning condensation.

    RESULTS: Patients emphasized the importance of a safe space where they could be themselves and feel supported. This encouraged them to be open and assume an active role in the coproduction of their health. A stable therapeutic alliance based on kindness and kinship helped them find strength and take responsibility for their own health.

    CONCLUSIONS: This study improves our understanding of how immigrants and refugees experience the coproduction of healthcare services. Further studies, evaluating long-term outcomes of coproduction efforts, are required.

    PRACTICE IMPLICATIONS: Providing a safe space in which health professionals have time to listen and empathically validate immigrant and refugee patients' lived realities, can enable patients to open up and become agents of their own health.

  • 36.
    Sabadosa, Kathryn A.
    et al.
    The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
    The interdependent roles of patients, families and professionals in cystic fibrosis: A system for the coproduction of healthcare and its improvement2014In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 23, no SUPPL1, p. i90-i94Article in journal (Refereed)
    Abstract [en]

    A quality healthcare system is coproduced by patients, families and healthcare professionals working interdependently to cocreate and codeliver care. Cystic fibrosis (CF) patients and families rely on healthcare professionals to provide the best possible care and timely, accurate information. They know that the care at home and in clinical settings needs to be seamless, using shared information and decisions. A parent's journey of better care begins with her son's diagnosis and moves to her involvement to improve the systems and processes of care for others. She reflects on this work and identifies five elements that contributed to the coproduction of improved care: (1) mental and emotional readiness to engage; (2) curiosity and the search for insight; (3) reframe challenges into opportunities for improvement; (4) listen and learn from everyone, bringing home what is relevant; and (5) personal participation. Joined with the reflections of an improvement scientist, they note that chronic care relies on informed, activated patients and prepared, proactive healthcare professionals working together and that it is more than 'patient-centric'. They propose a model for the coimprovement of systems of care.

  • 37.
    Salmiranta, Elin
    et al.
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
    Haywood, Carol
    Institute for Public Health and Medicine, Northwestern University, Evanston, IL, United States.
    Johnson, Julie
    Institute for Public Health and Medicine, Northwestern University, Evanston, IL, United States.
    Building bridges to support self-care2021Conference paper (Other academic)
  • 38.
    Thor, Johan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
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    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
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    Collaborative improvement of cancer services in Southeastern Sweden – striving for better patient and population health, better care, and better professional development2012In: Sustainably Improving Health Care: Creatively linking care outcomes, system performance, and professional development / [ed] P. Batalden & T. Foster, London: Radcliffe Publishing, 2012, p. 175-192Chapter in book (Other academic)
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