The Co-Production of Health: Translating Community-Led Innovations in Healthcare
Authors:   , Fagan Kylie 
Published: September 2024

Co-production is increasingly popular within public sector services, especially across health and social care settings. Within the context of Scotland, co-production forms a mainstay of the current policy environment. Learning is being taken from a range of successful local and international models for use within the Scottish health care sector. Amongst the international models is the Nuka System of Care, a well-renowned co-produced model of care from South Central Alaska. Based on a series of pilot programmes in five regions across Scotland, this research utilises the Nuka System of Care as a lens through which to explore the translation of co-produced models between contexts. To achieve this goal, a qualitative research approach was adopted. Initially observing the Nuka System of Care in its Alaskan context helped shape and legitimise this research within Scotland. Qualitative research methods enabled an exploration of which elements of the Nuka model had been prioritised in the translation to the Scottish context. The views of Scottish stakeholders involved within the five pilot regions were also elicited and explored. Semi-structured interviews formed the core method of data collection within this stage of research. To better understand this translation, this study developed a typology exploring how this model was adapted into Scottish primary care. Across the five regions of Scotland, clear differences in translation emerged. A focus on translating the structural aspects of the Nuka model contrasted with an approach that gave priority to the underpinning ethos and philosophy driving the model. Where there was a crossover between these two clear approaches, tensions emerged. This study reveals a tendency to 'cherry-pick' elements for adaptation, with minimal translation of collective co-production – especially in the phase of co-design. The balance between fidelity to the original model and adaptation is a key dilemma facing the translation of co-produced models. Different phases of co-production, such as co-commissioning, co-design, and co-delivery, were shown to impact transferability differently. The research not only contributes to the understanding of this specific health care model but also addresses a critical gap in the broader co-production literature. It identifies a paradox inherent in collective co-production, where fidelity to the original model conflicts with translating the underpinning process of collective co-production in the new context. This paradox poses significant implications for the transferability of co-produced models, especially given the increasing emphasis on co-production in public sector policy. This thesis is interdisciplinary and draws on frameworks of co-production and translation theory to explore and elucidate the translation of the Nuka System of Care to Scotland. Combining these approaches enabled a unique perspective on the patterns of translation - exploring how the locus of co-production impacts transferability. In doing so, this work contributes to both empirical and theoretical understandings of translating co-produced models. Through detailed examination, this study offers nuanced insights into the potential transferability of co-produced models, contributing new knowledge and emphasising the need to navigate this inherent challenge in disseminating learning from one community to another.