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Co-creating Health & Social Care: Exploring, measuring and enhancing co-production at the national, regional and local levels

Co-creation, co-production and co-design are advocated as effective ways of involving citizens in the design, management, delivery and evaluation of health and social care services. Although numerous case studies describe the nature and level of co-production in individual projects, there remain significant gaps in the evidence base. The originality of our six-year Swedish/UK research program is in moving beyond individual projects and taking a longitudinal, cross-case approach to explore the complexities of delivering and improving health and social care through new forms of relationships.


The overall study aim is to explore, enhance and measure the value of co-production for improving the health and social care of citizens. Our four research objectives are:

  1. To develop, test and establish robust measures of co-production processes and of the outcomes of co-production for participants and wider constituencies at different system levels (measurements)
  2. To study the social processes and organisational forms that enable inclusive and reciprocal co-production across the health and social care sectors (mechanisms)
  3. To explore effective systems and styles of leadership for co-production (management)
  4. To develop an explanatory model and other outputs based on a synthesis of existing evidence, analysis of our case studies and our findings in relation to 1-3 above in order to help enhance future co-production initiatives (model).


Nine confirmed co-production projects form the core of our interactive research program. Seven are underway in Sweden and the others will be undertaken in the UK to allow for knowledge exchange and cross-cultural comparison. Our program has a longitudinal case study design using both qualitative and quantitative methods. Cross-case analysis and a sensemaking process with participants, leaders and researchers will lead to practical lessons for practitioners and will be disseminated to key audiences outside the scientific community. Based on our findings we will develop an explanatory model and other outputs to enhance future co-production initiatives.

Summary of Findings

Years 1-3 of the program set out to explore four significant knowledge gaps relating to co-production in the health and social care sector (what we termed the ‘4Ms’):

  • outcomes (measurement),
  • power relationships and representation (mechanisms),
  • leadership (management), and
  • models.

The ‘measurements’ review suggests 3 primary outcomes: contribution to goal fulfilment, co-production processes, learning and innovation. Different measures exist within each of these perspectives. The studies in years 4–6 will aim to find a framework for a more deliberative choice of measurements to pilot within the case studies.

The ‘management’ review revealed that few studies focus explicitly on leadership and different roles (the largest focus is on senior leaders and facilitators); collective leadership theories are proposed but not used in analysis.

The ‘mechanisms’ review revealed that most applied research did not provide a sufficient description of the interaction between co-producers to explore, analyse or replicate the process. The findings suggest a need for guidance on how co-production and co-design is reported.

The ‘models’ review identified 3 general types of models.

  1. Practice-relevant models providing toolkits, steps and how-to recipes;
  2. frameworks for mapping; and
  3. conceptual/theoretical models for explanation. There is a need to explore and apply some theoretical models in years 4–6 that we think may help develop co-production of health and social care more generally.
Project status: Ongoing
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Principal Investigator



Amount: 2,148,293

Period: January 2019 - November 2024