Background
Nowadays co-production is discussed as a driver to transform public services: “public services work better when designed and delivered in partnership with citizens in order to harness their interest, energies, expertise and ambitions” (OECD, 2011, p. 17). This article is an inquiry into the application of design-led approaches for co-production in the case of mental healthcare services; here co-production is associated with the concept of Recovery which is a recent orientation of therapeutic practices moving from focusing on the treatment of the disease (clinical recovery) to the promotion of wellbeing (personal recovery) that implies a growing engagement of service users.
Aim
The inquiry is based on an action research project in collaboration with Unità Operativa di Psichiatria 23 (UOP23) of the Spedali Civili di Brescia (Italy), aiming to apply service and collaborative design approaches to further ongoing Recovery oriented experimental practices and values across the organisation. The relevance of co-design for co-production in healthcare is associated with its inherent notions of “equality, equal contribution, and mutual respect”, that are “proving difficult to establish in health care contexts where traditional roles of provider and recipient of care are clearly demarcated” (Donetto et al. 2015). Given the current challenges, the project collaboration wanted to explore and reflect on the practical implications and conditions that affect the development of co-production as a situated process, affecting the organization as a whole.
Methodology
The action-research process led by a designer-in-residency, has been involving a heterogeneous group of researchers (design and management engineering) and actors with different roles in the planning, research and co-design activities, including patients, family members, doctors, caregivers and local actors for a total of 59 people. The project was planned in two cycles of 10 weeks to be conducted within two very diverse contexts. The first cycle was conducted in the Community Mental Health Centre, the Day Centre and the Rehabilitative Residential Unit of UOP23 in Brescia, while the second cycle in the Inpatient Unit and the Community Mental Health Centre of UOP23 in the Montichiari hospital.
Results
The process shed light on specific needs when working toward a recovery-oriented organisation, that we clustered and associated to design roles and practices:
- initiate and envision: the very diverse but interrelated services presented different understanding and acceptance of the values and feasibility of co-production which required initiating a dialogue within and across service units, while enhancing their ability to envision;
- empower and engage: organisations and users were not all at the same position in terms of readiness to change and engagement, which meant that co-design sessions became an arena for engaging and giving the tools to participate in the change process;
- adjust and evolve: during a Recovery journey users change their healthcare needs and capabilities to participate, which requires designing services able to adjust and evolve as a way to accompany this process;
- bridge and orient: the complexity of the recovery journey demands that co-production happens across and in-between services, users and the territory, developing bridges and supporting orientation.
Design-led approaches to value creation in public administration
