Co-producing safer care Practical tools and frameworks — how to design for co-production in real-world settings

Background and overview

Healthcare improvement does not depend only on technical expertise or compliance with standards. Implementation science shows that new practices succeed only when both technical and adaptive challenges are addressed. This means creating systems that are reliable while also engaging the people who use and deliver them. Co-production represents this shift: moving from provider-centered approaches to user-defined solutions where patients, families, and communities help shape how care is designed and experienced.

Research across sub-Saharan Africa consistently shows that health programs are most effective when they draw on local knowledge and foster community ownership. Co-production in practice requires more than consultation; it demands shared decision-making, clarity of roles, and investment of time in building trust. It also requires providers and institutions to commit to sharing power; an area where many initiatives falter because of entrenched hierarchies, lack of contextual adaptation, or absence of sustainability planning. The FACES HIV program in western Kenya offers a compelling case study: by engaging families, building local capacity, and integrating services, it transformed outcomes and created sustainable, family-centered care. Such examples back evidence that when communities help define what quality means, healthcare becomes more equitable, reliable, and resilient.

At the heart of co-production lies kindness. Kindness is more than politeness or courtesy; it is the practice of empathy, compassion, and thoughtfulness toward patients, colleagues, and oneself. Small acts like reassuring a worried patient, organizing food for those who cannot afford it, or ensuring transport for treatment carry enormous weight. These everyday gestures demonstrate that high-quality care is not simply about protocols but about presence, connection, and recognition of shared humanity.

Acts of kindness within healthcare vividly illustrate the human side of co-production. Stories of patients receiving reassurance from a provider, families showing gratitude with a simple gesture, or staff members going beyond their formal roles reveal how small but meaningful actions strengthen relationships. These “everyday kindnesses” demonstrate that safe and effective care is not just about clinical procedures but also about presence, empathy, and recognition of shared humanity.

Reflection is a critical discipline that sustains this process. By pausing to consider what happened, why it matters, and what should change, healthcare workers transform tacit experiences into conscious learning. Reflection helps reduce medical errors, strengthens decision-making, and deepens the recognition that kindness is not a one-off gesture but a continuous thread across the continuum of care. Structured models such as the Gibbs cycle or Rolfe’s framework provide tools for this practice, but even a few minutes of journaling, voice notes, or quiet thought each day can be transformative.

Key themes

• Kindness is more than politeness

  It is about empathy, compassion, thoughtfulness, and selflessness, directed not only toward patients and colleagues but also toward oneself. Healthcare workers often excuse the struggles of others while denying themselves the same grace, making self-kindness a critical foundation for sustaining compassionate care.

• Small actions matter

  Everyday acts of kindness, such as offering reassurance, helping a patient find their way, or simply listening, can significantly reduce stress and improve patient outcomes. In contrast, neglect or indifference, such as ignoring patients or failing to explain delays, creates frustration and erodes trust.

• Going beyond the call of duty

  Providing emergency care in difficult circumstances, contributing funds to cover treatment or transport for patients in need, or ensuring vulnerable patients receive food to support adherence to medication all speak to how healthcare workers can go beyond the call of duty to show kindness. These acts highlight how compassion extends beyond professional obligations to solidarity and shared humanity.

• Relationships and meaning

  By fostering connection, kindness helps build relationships and meaning. Feeling seen, valued, and supported nurtures belonging and resilience for both patients and providers. Healthcare becomes not just a site of treatment but also a space of shared humanity where healing and fulfillment can take root. Kindness generates a ripple effect, encouraging others to pass it forward and creating a culture of shared care.

• Co-production is an expression of kindness

  It requires stepping into another person’s shoes, sharing power, and designing services around people’s lived realities. Evidence from the FACES (Family AIDS Care and Education Services) HIV program in western Kenya demonstrated how collaboration, community engagement, and capacity building created sustainable, integrated, family-centered services. When communities are empowered to shape care, health systems become stronger and more responsive.

• Partnerships built on equality, honesty and openness

  Genuine co-production requires clear communication and a willingness to share power through joint decision-making. Communities bring unique strengths and lived experiences, whether through contributing resources for patients, organizing support for families, or offering local knowledge that informs sustainable solutions. At the same time, boundaries must be maintained so that roles remain clear and professional responsibilities are not compromised, preserving both safety and trust.

• Kindness is the bridge to quality

  It shapes patient experiences, strengthens trust, and motivates deeper engagement from both providers and patients. When kindness is woven into policies, practices, and daily interactions, it creates the foundation for co-production to flourish and for safe, high-quality care to become a reality.

How healthcare workers can practise reflection

Reflection is about creating space to pause, process experiences, and draw meaning from them. It prevents the cycle of repeating the same actions without learning and opens the door to growth and change. Building reflection into daily practice does not require a large investment of time. Even three minutes at the end of the day; whether writing in a journal, recording a voice note, or typing a short message, can make a significant difference.

The Gibbs cycle

The Gibbs cycle uses six questions to explore actions and feelings in depth:

1. Description. What happened?
2. Feelings. What were your reactions and feelings?
3. Evaluation. What was good or bad about the experience?
4. Analysis. What sense can you make of the situation?
5. Conclusions. What can be concluded from these experiences and the analyses you have undertaken?
6. Personal action plans. What are you going to do differently in this type of situation next time?

Rolfe’s model distills reflection into three simple prompts: what, so what, and now what. These frameworks turn unspoken or subconscious knowledge into conscious insight, which can then inform improvements in practice.

Reflection also strengthens the connection between kindness and quality of care. By reviewing experiences, healthcare workers can identify the role kindness plays across the entire continuum of care. Reflection helps to reduce medical errors, improve decision-making, and reveal gaps that require attention. Through reflection, healthcare providers see how small acts such as calmness, a smile, or listening encourage openness from patients and improve adherence to treatment.

Co-producing safer, kinder care going forward

Advancing healthcare quality is about people. The future of healthcare quality depends on how well systems integrate kindness, co-production, and reflection into everyday practice. These are not soft additions to technical care but essential drivers of safety, trust, and resilience. From small acts of compassion that ease patient stress, to family-centered programs like FACES that transform HIV care, the evidence is clear: care improves when humanity is placed at the center.

This shift is about recognizing that quality cannot be achieved through compliance alone. It requires courage to share power, humility to learn from patients and colleagues, and consistency in reflecting on what worked, what did not, and what must change.

For further reading

• Batalden, P., et al. (2016). Coproduction of healthcare service. BMJ Quality & Safety, 25(7), 509–517.
  qualitysafety.bmj.com/content/25/7/509
• Greenhalgh, T., et al. (2020). Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research, 22(11), e22430.
  jmir.org/2017/11/e367/
• Lehmann, U., & Gilson, L. (2013). Actor interfaces and practices of power in a community health worker programme. Health Policy and Planning, 28(4), 358–366.
  jstor.org/stable/45089983
• Mutale, W., et al. (2013). Improving health information systems for decision making across five sub-Saharan African countries. BMC Health Services Research, 13(S2), S9.
  bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-13-S2-S9
• Diamond-Smith, N., Lin, S., Peca, E., & Walker, D. (2022). A landscaping review of interventions to promote respectful maternal care in Africa. Midwifery, 115, 103488.
  sciencedirect.com/science/article/pii/S026661382200239X
• Robert, G., Donetto, S., Masterson, D., & Kjellström, S. (2020). Applying models of co-production in the context of health and well-being. Health & Social Care in the Community, 28(5), 1385–1397.
  academic.oup.com/intqhc/article/36/3/mzae077/7731045
• Elwyn, G., Nelson, E., Hager, A., & Price, A. (2020). Coproduction: when users define quality. BMJ Quality & Safety, 29(9), 711–716.
  qualitysafety.bmj.com/content/29/9/711