It is Co-production Week and the theme is sharing power, something that is central to the very definition of co-produced research. According to the National Institute of Health Research,“Co-production is about working in equal partnership with people using services, carers, families and citizens. Co-production offers the chance to transform social care and health provision to a model that that offers people real choice and control”.
I was first introduced to co-production as a distinct approach for collaboration a few years ago and have not looked back since. It is an approach that we often use at McPin as it is values based and it makes sense – why wouldn’t you involve different types of expertise to improve your work? It also has the potential to dismantle unhelpful hierarchies of established practice, something that is key if you are trying to do something new, interesting and innovative.
This isn’t easy, however, especially in research. Hierarchical power structures are everywhere. Take two examples – universities and gold standard evidence.
- Universities are built around power structures that include a promotion ladder for academics to professorship and head of the department roles linked heavily to demonstrating ‘research excellence’. People who make it to the top often exude a sense of power. Academics can also be found working in charities or industry but they may be less visible and less valued without the kudos that comes with working at a university on a permanent contract.
- Gold standard evidence refers to approaches – usually randomised controlled trials (RCTs) - that are deemed the ‘best’ way of evaluating scientific data. They are the top of the hierarchy of study design. This means that RCTs are privileged over other study designs, such as qualitative approaches that are often used in mental health research.
These and other hierarchical structures make doing co-produced research really very difficult. Even with excellent guidance, the practice of building relationships, sharing power and valuing all types of knowledge (whether that’s from different types of expertise or different study designs) can be extremely challenging. With all the good will in the world, power structures and professional status can get in the way. I think the hardest part is sharing power and reducing personal influence over the process. This is true for everyone but particularly those with a research status such as “professor” or “doctor” – PhD or medical.
Compromise and careful planning
In my experience, co-production in research is a learning journey for all involved. It requires everyone to give of themselves personally and professionally, often in a different way to usual. I enjoy that but not everyone does, so understanding different preferences is part of the process of building relationships and trust across the entire team. Compromise is needed, as is lots of effort and careful planning. Projects must set up mechanisms to enable shared decision making – so the “project lead” doesn’t decide everything! There should also be ways for members of a team to be mentored or trained in new research methods or approaches, be they established academics or people new to research.
The upshot of co-production is that it is not one thing - it has to be different in every context. We must consider the people involved, the topic being researched, the setting for the study, timescale, budget and ... so much more. This is a strength as it’s not a fixed framework but something to co-create with others in the team.
I learn from the people I work with on every study how to co-produce research. Here are a few practical things I’ve found can help reduce power disparities:
- Rotate the roles during meetings – change who chairs each time
- Change how a room is set up to make sure people sit in different places – you don’t want all the academics in one cluster, mental health service users and carers in another, practitioners again grouped separately
- Use more group work and have fewer presentations, as this will enable people who don’t like speaking in front of a big audience to give their opinions more easily
- Have clear roles for everyone and equalise them as far as possible in terms of how much paid time people have to work on the project and what outputs are expected from everyone
- Provide opportunities for members to develop new skills and share their own expertise. Include a budget for training.
- Try and keep group membership stable with a balance of backgrounds, for example, a group with 3 practitioners, 3 people with experience of mental health issues and 3 researchers (while acknowledging people can have multiple expertise).
It’s great to see Co-production Week focusing on the topic of power. I look forward to learning from lots of other examples because although coproducing research it is not easy, it is vital.
If you are interested in reading more about co-production in research, take a look at page 36 of our summary report of Side by Side, the evaluation of a community-based peer support project.
For reasons why RCTs are problematic in mental health research, please see Alison Faulkner’s Talking Point paper on the subject.