Balancing power in co-production: introducing a reflection model

The role and position of users in health and welfare has recently changed to become more active in co-production of care. When more co-production is preferred, challenges related to power need to be considered. In this paper, power is seen as the possibility to influence. The paper focuses on power in co-produced improvement work by introducing a reflection model based on Franzen's power triangle, further developed from improvement coaches' perceptions. First, empirical data from interviews with improvement coaches were analyzed and then the theoretical model was created. Twelve coaches were included in the interviews, all of them with experience of co-production and improvement work within a region in southeast Sweden. By combining the empirical results with the power triangle, a reflection model concerning power dimensions was developed. The results showed the necessity of reflection regarding several power-related factors. Resources were found to be important and depending on contextual settings. Attitudes and perceptions among personnel and users were also vital. To accomplish co-production, the power dimension must be considered, and the power triangle acknowledges different power dimensions and how they affect each other. The model has a systematic character and allows adjustments to the power dimensions within any other context. It can inspire and be used by improvers working with co-production to promote deeper professional and organizational reflection and thereby contribute to new insights on how to balance power in co-producing health and welfare services.

Automated summary

This paper explores the changing role of users in health and welfare as becoming more active in co-production of care, and the importance of considering power dynamics in these processes. Empirical data and a theoretical model were used to develop a reflection model on power dimensions, highlighting the significance of resources, attitudes, and perceptions in co-production efforts. The power triangle model offers insights for improvers working with co-production to promote professional and organizational reflection, contributing to a more balanced approach in co-producing health and welfare services.