The latest talk of the town is about breaking with the traditional role of the patient as a passive recipient of care, a vision of value creation centered on the provider. This status quo is being increasingly questioned, and practical methods and empirical studies on the involvement of the patient are making progress.
Co-creation is a manifestation of collective intelligence
Collective intelligence is a pillar of Co-creation
It’s not easy to look around and be objective, because each one of us has their own bias . But we should agree on certain trends: shortening of product and service life cycle, quick transition to knowledge based jobs, easy do it yourself, or emergence of social accountability and oikosnomy, to cite some of them. This kind of trends are pushing to a new mental framework, and participation is one of its key elements. More efficiency in participation and collaboration drives to collective intelligence development, a pillar of this new mental framework. Here comes co-creation and participatory design.
The joint creation of value with customers
In 2004 Prahalad and Ramaswamy remarked that customers would no longer be satisfied with making yes or no decisions on what a company offers, and defined co-creation as “the joint creation of value by the company and the customer; allowing the customer to co-construct the service experience to suit their context” So, “The meaning of value and the process of value creation are rapidly shifting from a product and ﬁrm-centric view to personalised consumer experiences. Informed, networked, empowered and active consumers are increasingly co-creating value with the ﬁrm”.
Among other things is worth to say that designers are no longer in the business of product and service design, with their brilliance and magic, they are in the business of customer co-creation.
Co-creation begins with participatory design
First step in co-creating value is designing with the involvement of stakeholders: partners, customers, citizens or end users. All of them become more and more actively involved. Stakeholders can participate during the initial exploration and problem definition both to help define the problem and to focus ideas for solution, and during development, they help evaluate proposed solutions.
The first advantage of participatory design is that the result will meet the needs and will work appropriately including usability. But what is great is that once people have learned the way of participation, things are going to be different forever. Moreover, research suggests that designers are more innovative when working within a participatory design environment than creating on their own.
Co-creation has many forms
There are many theories and new models influenced by “co-creation” and customer collaboration: crowdsourcing, crowdfunding, open innovation, wikinomics, Living Labs, Design based learning, Knowledge sharing, collective innovation and many others. A noteworthy idea is that participation models and strategies are the result of cross learning, paired with being aware of which practices get success anywhere.
In successful urban environments, rigorous participation in the design and creation of space is becoming the essential ingredient. Companies from very different areas claim that their competitiveness is based on their capacity to approach customers in co-creation strategies. Even in some cases, customers are in fact invited to feel part of the company. Citizens are gradually embracing a new concept of democracy, asking for participation in collective decision making.
Co-creation has many difficulties
Management staff must accept losing or sharing control
For those who have the authority and the control of the organisation and processes is very difficult to share it with others, abandon the culture of predominance and accept egalitarian idea sharing.
Users and consumers must be prepared and motivated
For many people, it’s difficult to believe in their creativity and behave accordingly, taking initiative in the co-designing experience. Moreover, not all customers are alike in their capacity to bring knowledge.
Organisations must move towards new paradigms.
Technology and quality are becoming commodities and companies are forced to look outside the product-service and be aware that the user’s service-experience is the key concern. Among other aspects new issues about ownership of design arose.
Society must get over consumerism
Participatory thinking is antithetical to consumerism, in which personal happiness has been connected to consuming material goods. It will take time to shift toward a consumptive/creative/sustainable balance.
A myriad of styles
First approaches to co-creations considered only Lead users, people who have already explored innovative ways to get things done and are willing to share their approaches with others. However, is not yet clear whether these elite groups of people represent the majority. The increasing education of people and the facilities provided by technology are surpassing the concept of lead users.
Defining processes of co-creation and participatory design
There are a diversity of tools and techniques that can be applied to the processes and procedures of participatory design. Moreover, the process of co-creation is built gradually, and involves learning by doing until the method fits ok.
In general, the method should consider:
– The statement of the problems with open questions and ideas
– Technology platforms and resources for the activities
– Stakeholders selection criteria and relationship strategy
– Interaction strategies and techniques of debate and consensus
– Mapping out current interactions among stakeholders
– Management and clarification of value for all the stakeholders
To build the space of co-creation some variables should be adjusted:
– Degree of internal – external environment.
– Degree of openness – closeness.
– Combination of online and offline activities.
– Degree of freedom – restrictions in topics.
– Time and rhythm of the process: temporary – continuous.
Health: The participatory lab of the future
The measure of value in healthcare is difficult because stakeholders have often conflicting goals in terms of: access to services, profitability, quality, cost, safety, convenience, patient-centeredness, and satisfaction. So, achieving value for patients involves a complex consensus to define the reasonable outcomes per each patient, that may be different from one to another. Moreover value co-creation in health care requires “embedding the approach across the whole health care system – from the microsystem level to the mesosystem and the entire macrosystem”.
My thesis is that a participatory lab involving patients is the only way of defining the value frameworks of diseases, that in turn will allow measuring the personalized outcomes of each individual health process. Let me expose why.
Co-creation is more than working together
Co-creation forces a change from traditional visions to a new mental framework
Creation of Values
Delivering a deﬁned experience to targeted patient set
Constantly enhancing experiences for all stakeholders
Establishment of Goals
At the outset, not signiﬁcantly changing them.
Considering initial goal as a starting point and let full strategies emerge over time
Focus of interest
The ﬁrm wants to maximise its share of the value in relation to other stakeholders.
Stakeholder centred to maximise the ecosystem.
Through realising economies of scale.
Through engagement of stakeholders and new experiences that increase productivity, creativity, and lower costs and risks.
Patient as a source of knowledge and data.
The patient experiences the complete path of a healthcare issue, from symptoms to recovery, going through a diversity of contacts with the healthcare system for examination, treatment and follow-up activities. The amount of unrevealed information and knowledge hidden in patient experience is obviously enormous. The point is how to extract and format this knowledge and take profit from it.
There are major and complementary aspects of patient as a source:
– The patient as a conscious participant in decision making. There is increasing evidence that patients can share ideas and experiences regarding a range of topics, from clinical to organisational.
– The patient as a source of data. The technology allows to capture and analyse big amounts of data at low cost.
– The patient as a volunteer. The combination of the patient experience with the knowledge and abilities of each patient could be a box of surprises.
Health services as a participatory lab
Once launched, the health services participatory lab will be one of the most fruitful co-creation spaces of the future. Why? Because successful co-creation means openness, trust, reciprocity and commitment.
Co-Creation, as the basis for value, builds the health experience of everyone. Participation networks establish nonlinear inter-actions among companies, institutions and patients in an experience driven environment with which everyone has a unique interaction co-creating his or her personalized experience.
To create such a lab is not easy. Although the health sector is intensive in science, it is resilient to certain types of innovation. Technology would make it possible, but the implication of patients in their health is hard to materialise, and innovation practices inside health organisations find some barriers.
– What are the barriers that limit the participation of users?
– In which way the use of the data will allow the patients to have a greater implication in their health?
– How will patients learn to participate in design?
– Is the hierarchy model in health a constrain to multidisciplinary work?
– How will the responsibility of decisions evolve?
There are so many questions. In most of the cases, the amount of knowledge a doctor or a nurse have compared with the patient it’s enormous. But relevance of health will increase and become, more and more, a transcendent issue. Self-understanding of health will become a centre of interest and health knowledge will circulate more quickly and easily.
Strategies to manage participation in health services co-creation
Many of the participation strategies and techniques developed for creativity, quality management or design thinking may be adapted to be used with patients.
Achieving patient focus must start with listening. Methods such as surveys, focus groups, interviews or diaries may help listening and involve patients in service development. However, it’s common that patients don’t feel listened to.
Technology will be necessary as a facilitator, but co-creation can’t be solved just with platforms and devices.
The Patient as a Resource in a responsive health environment
Patients are currently considered active partners, capable of carrying out tasks for themselves. Drivers for this are, from one hand the need to lower costs, but for the other, the fact that health outcomes improve with patient involvement, for instance in adherence to treatment and to beneficial habits.
Patients must acquire a certain degree of expertise on their own health and, try to understand their disease as well as their doctors and nurses, and thus can be involved in the decision making of their own care.
Patients are different one from another, and therefore styles of co-creation must be taken into account:
– Adaptive Realist get over the shock and move on with the changed circumstances adapting their life to the new circumstances as they go along.
– Team Manager believes in a team approach and in addition to medical professionals, he or she has a circle of support people and is very open in communicating with them.
– Partners need good communication and an effective working relationship with their doctors to feel informed and respected.
– Spiritualists have strong religious beliefs tied almost to fate or destiny and external locus of control.
– Isolate Controllers keeps themselves away from close family members and chose to work with only certain medical staff. They like to be alone and not to share their feelings and problems with others.
– Passive Compliant first and foremost follows orders, accepting what the doctors tell them without questioning anything.
Adaptive Realist individuals tend to demonstrate high quality of life, while in contrast the lowest quality of life was evidenced by Passive Compliants and Isolate Controllers.
 The other day I was talking with a friend about the world in general. We kept two positions far away. She wanted to see the world with the gray glasses, emphasizing how many things went wrong, while I, with my yellow glasses, emphasized the tendencies to gradual improvements in all fields. Later, thinking, I told myself that both of us would have been able to share a kind of dark yellow glasses.
 Prahalad, C. K., & Ramaswamy, V. (2004). The future of competition: Co-creating unique value with customers. Harvard Business Press.
 According to Sam Lucente, working in design and innovation at Hewlett-Packard.
 Howe, J. (2006). The rise of crowdsourcing. Wired magazine, 14(6).
 Mollick, E. (2014). The dynamics of crowdfunding: An exploratory study. Journal of business venturing, 29(1).
 Chesbrough, H., Vanhaverbeke, W., & West, J. (Eds.). (2006). Open innovation: Researching a new paradigm. Oxford University Press on Demand.
 Tapscott, D., & Williams, A. D. (2008). Wikinomics: How mass collaboration changes everything. Penguin.
 Barron, B. & Darling-Hammond, L. (2008). Powerful learning. Edutopia.
 Sanders, E. B. N., & Stappers, P. J. (2008). Co-creation and the new landscapes of design. Co-design, 4(1).
 We can’t forget that meanwhile, in other parts of the world, basic human needs, such as clean water, are not solved.
 Von Hippel, E. (2005). Democratizing innovation. MIT press.
 Porter, M. E. (2010). What is value in health care? New England Journal of Medicine, 363(26).
 Janamian, T., Crossland, L., & Wells, L. (2016). On the road to value co-creation in health care: the role of consumers in defining the destination, planning the journey and sharing the drive. The Medical Journal of Australia, 204(7), 12.
 A.R.J. (Rob) Halkes. Principal consultant at Health Business Consult
 McColl-Kennedy, J. R., Vargo, S. L., Dagger, T., & Sweeney, J. C. (2009, June). Customers as resource integrators: Styles of customer co-creation. In Naples Forum on Services. V. 24.