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Co-creation

Engaging in the change: Co-creation

The following guest blog was written by a friend and colleague, Dr. James Wright, who is a recognized Canadian leader in orthopaedic surgery and health care outcomes research. He has also been very involved in leadership activities, both as a part of his professional work and as a student of the discipline of leadership. Jim recently started a new blog on clinical leadership, and I'm delighted to share one of his posts as a part of Dean on Campus. - Richard

You have an ambitious agenda for change. While the specific initiatives are clear, you want to have an overarching approach to increase the potential for successful implementation. What should that approach look like? How do you maximise buy-in from everyone affected by the changes?  

A recurring theme throughout all my posts is the need to engage everyone early and meaningfully in the process of change. People like to be involved in changes that will affect them. Their involvement improves the change and/or the plan to achieve change through feedback. Also, allowing people to contribute to the change process increases their engagement through involvement and the opportunity to participate. I have come to know this approach by the name ‘co-creation’. The concept comes originally from the private sector, where involvement of customers was hoped to improve the quality of a product and its attractiveness to the customer. While most clinical groups don’t function like the private sector, the term has also been adopted by those in Implementation Science, whose aim is to improve the use of best evidence in the care of patients.

There is no set way to co-create, but it surely requires involving the key people (often called stakeholders) in multiple ways and, as indicated above, at the earliest stages. One of the steps to major change initiatives is the requirement for a guiding coalition. The guiding coalition is responsible for managing the change process and to ensure the change actually occurs. Bringing key stakeholders into the guiding coalition seems a good place to start co-creation. Remember that members of task forces and committees need to understand their role is to support the change and not to exclusively advocate for their constituencies.

Understanding who to involve can be partly solved by what has been called ‘stakeholder analysis’. Stakeholders are everyone involved in the change or those potentially affected by it. A stakeholder analysis considers which individuals or groups are influential and interested in the change. Those that are influential and interested should be part of the guiding coalition and approached individually. Those that are interested, but are not that influential should have opportunities to participate and provide input. Those that are influential but aren’t interested should be kept informed. Those that aren’t influential and aren’t interested shouldn’t occupy much concern. In many circumstances, the public or patients also must be part of co-creation.

There are two elements to any change: the change itself and the method employed to achieve that change.  Co-creation can be used to influence both components. For example, the elements of the change itself will need to be modified to suit the particular context. Also, the way the change is achieved is critical to its success, but in my opinion, should be based on inspirational leadership and specifically what is best for patients.

Considering the change itself, the stakeholders need to be consulted on several issues. What is the outcome the change is trying to achieve? Why this change and why now? Does the change need to be modified overall, or according to individual context, to make it successful? Considering the strategy to achieve the change, is there someone or a group responsible for implementing the change? Have the stakeholders bought into the need for change and the strategy to achieve the change? Do the individuals who are expected to change have the necessary knowledge and skills? Have everything been put into place that is likely to make the change successful?

Effective involvement of individuals requires presentation of many opportunities via multiple routes. Advisory groups are an important way to involve stakeholders. However, such groups can only involve a few individuals and may not represent the broad range of views. Social media represents an interesting way to gain feedback from a broader and geographically disparate group. However, social media has its own quirks and runs the risk of advocacy and negativity that sometimes is not easily controlled. Time will tell if this is the best medium to gain the broadest input, but for now represents a prospect worth pursuing.

In conclusion, the concept of co-creation shifts the thinking from a leader or group of leaders who decide what and how to change, to instead a process whereby the change initiative is created together in a meaningful way by everyone affected by the change.

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