The process of change in introducing coproduction - the case of ESTHER Network in Singapore

Background: Organisational change is often driven by strategy, structure, and leadership. Yet beneath these visible mechanisms lie the cultural and relational foundations that shape how change is understood and sustained (1). This workshop explores these foundations through the introduction of coproduction (2,3) with patients and caregivers—specifically the ESTHER Network model—within Singapore’s public healthcare system. Originating in Sweden, ESTHER Network represents a shift toward collaboration and shared responsibility between managers, professionals, and service users (4), offering a lens to examine how co-production is interpreted and practised in a hierarchical, efficiency-oriented context. The workshop aligns with ICIC’s pillar of integrated care—people as partners in health and care.

 

Target Audience: This workshop is relevant for health and social care leaders, managers, practitioners (doctors, nurses, allied health professionals), and patient or caregiver partners engaged in complex care transformation across acute and community settings, within population health and person-centred care.

 

Workshop Aim and Approach

Using an insider action research approach (5), the workshop examines how managers, practitioners, and service users make sense of and negotiate co-production in their daily work. Patients and caregivers, as people with lived experience of health and social care services, contributed insights revealing that practitioners often equate coproduction with better communication for treatment adherence rather than genuine partnership. While formal mechanisms such as committees and training build early readiness, past experiences highlight emotional and relational barriers that constrain authentic collaboration. Findings—drawn from interviews, focus groups, observations, document analysis, and surveys—illustrate how change unfolds at both structural and relational levels.

Participants will engage in interactive sessions tracing the evolution of quality improvement (QI) from QI 1.0 to QI 3.0, shifting from linear, technical solutions to approaches that emphasise coproduced care grounded in trust, relationships, and shared value (6). Integrating improvement science and social science, small-group discussions will explore the socio-cultural foundations—such as language and shared meaning—that shape how patient and caregiver involvement is understood and enacted.

 

Outcomes: and Takeaways

Viewing change as a social process, the workshop presents a Reflexive Model for Adaptive Working—outlining five interrelated dimensions that foster dialogue, learning, and collaboration. The model offers a practical framework for organisations seeking to navigate complex care transformation and cultivate genuine, rather than tokenistic, coproduction with patients and caregivers.

 

References

1.Czarniawska B. A theory of organizing. 2nd ed. Cheltenham: Edward Elgar Publishing; 2014.

2.Batalden M, Batalden P, Margolis P, Seid M, Armstrong G, Opipari-Arrigan L, et al. Coproduction of healthcare service. BMJ Qual Saf. 2016;25(7):509–17.

3.Bovaird T. Beyond engagement and participation: User and community coproduction of public services. Public Adm Rev. 2007;67(5):846–60.

4.Gray BH, Winblad U, Sarnak DO. Sweden’s Esther model: Improving care for elderly patients with complex needs. New York: The Commonwealth Fund; 2016.

5.Coghlan D, Brannick T. Doing action research in your own organization. 4th ed. London: SAGE Publications; 2014.

6.Batalden P, Foster T. From assurance to coproduction: A century of improving the quality of health-care service. Int J Qual Health Care. 2021;33(Suppl 2):ii10–4.