Coproduction, an approach to service delivery that emphasizes the collaboration between service providers and users, has been present in the social sector and service industries since the 1970s. More recently, it has been adapted for application in health care, which is where I heard about it first. The students, faculty and staff in my program discuss coproduction in the context of patient-centered care, shared decision-making and transforming care delivery so that it meets the needs, goals and interests of the people it serves. It’s an approach that makes sense in a wide range of contexts and has been explored across disciplines: restorative justice, governance, environmental management and urban planning, among others. With historical roots in the civil rights movement, coproduction gives a voice in the development of a service to the people it intends to serve. This not only has implications for inclusion and justice, but also goes a long way toward ensuring engagement, cooperation and community relevance.
A conversation with my colleagues today about the promise and challenge of coproduction in health care made me wonder whether a model of coproduction exists in higher education. A cursory scan of the literature reveals coproduction connections to collaborative research, community-based experiential learning and university-business partnerships that provide internship opportunities to students. While these examples begin to get at education as a service and educators as service providers, they seem to overlook the promise of students as partners in the coproduction of their own education. Some key points from the health care literature suggest the viability (and transformational potential) of such a model for education:
- Collaborative coproduction requires users to be experts in their own circumstances and capable of making decisions.
- Professionals must move from being fixers to facilitators.
- Coproduction requires a relocation of power towards service users.
- Coproduction necessitates new relationships with front-line professionals who need training to be empowered to take on these new role.
- Patient centredness describes the relationship between clinicians and patients as a meeting of two experts, each with their respective knowledge and skills.
From “What is Co-Production,” The Health Foundation, 2010.
Replace “professionals” with faculty and “users” with students above, and you get a pretty good description of what instructional designers and other faculty developers are envisioning and working toward in higher education today.
As with any any attempt to change cultural expectations, coproduction is not without its challenges. In health care, my colleagues tell me, a major barrier is getting beyond the entrenched hierarchy that exists between clinician and patient. Another is how to empower and motivate patients as their own advocates. An implicit third, perhaps, is our deeply held beliefs about expertise: what knowledge has value, and from whom. Again, the parallels in education are apparent.
I have seen one model in my experience on the receiving end of health care services that I think holds great promise to address some of the challenges described above. My provider, Dartmouth Health Connect, a faction of Iora Health, employs health coaches who provide education, advocacy and observation during clinical visits. According to the Iora model, health coaches are hired not for their clinical expertise, but for their abilities in relationship-building and communication. They are aptly described as the connection or the bridge between a patient and their care team, providing an extra set of ears and eyes, translating medical jargon into plain English, and helping to smooth the path of the patient experience. When we widen the circle of coproduction to include not just a clinician and patient, but someone to care explicitly about the experience, we get better results–both for health and for the people involved.
Sound familiar, learning experience designers? In education as in medicine, the experts sometimes lack the requisite skills to create effective, person-centered experiences that meet the needs, interests and goals of their users.
Might instructional designers, like health coaches, help alleviate the hierarchy that exists naturally between faculty and student? Might faculty developers have insights about student motivation that could equip faculty to engage students as advocates in their own learning? Might learning experience designers provide both faculty and students with a wider perspective on what knowledge has value, and from whom?
Maybe it’s a theoretical model without further merit beyond a few interesting parallels, but it seems to me a comparison worth considering.