Collaborative system approach can bring improvements, challenges


Co-creation refers to interactive practices that help critical stakeholders—patients, clinicians and administrators, for example—work together to discern mutual values, develop strategies to address shared challenges, promote common goals and motivate desired outcomes.

Popularized in a range of service industries as a means of improving consumer satisfaction, co-creation efforts began by inviting consumer participation in designing, marketing and delivering products and services. In the health care sector, co-creation seeks to maximize health systems’ performance, support efficiency in collaboration among stakeholders and personalize patients’ health care experiences.

This month’s AMA Journal of Ethics® features numerous perspectives on the ethical dimensions of what it means to implement and operationalize this kind of strategic planning in health care, both at the micro level of patient-clinician relationships, and at the macro level among providers, payers, and policymakers.

Take a moment to consider this question: Former patients have been incorporated into a hospital’s strategic planning team for fall prevention, but some clinicians claim the patients’ participation is slowing the process down. How should the clinician in charge of the team respond?

  • Remove the former patients from the team.
  • Keep the former patients on the team but limit their involvement so the process moves ahead more quickly.
  • Explain the value of the former patients’ participation to the other clinician members of the team and ask for their feedback on streamlining the process.
  • Prioritize the former patients’ involvement and hold herself responsible for promoting team efficiency by setting a clear plan for communication.

Give your answer and find responses to this question in the November issue of the AMA Journal of Ethics.

Articles in this month’s issue include:

How Co-Creation Helped Address Hierarchy, Overwhelmed Patients, and Conflicts of Interest in Health Care Quality and Safety.” Co-creation results in collaborations that yield an exchange of values, ideas, and priorities that can individualize care for each patient, argue the authors of this article. Although there are important challenges in co-creative processes—including forging consensus among many different stakeholders, patient overwhelm and conflicts of interest—co-creation has been shown to promote patient engagement, peer learning and improved health outcomes.

Co-Creating an Expansive Health Care Learning System.” Realizing a transformative vision of co-creation—one that invites professionals to genuinely reconsider the purposes, relationships, norms and priorities of health care systems through new forms of collaborative thought and practice—will require radically rethinking existing approaches to health professions education. 

Why Aren’t Our Digital Solutions Working for Everyone? When it comes to digital innovation, health professionals and technology companies rarely have any incentives to focus on underserved populations. This is ethically troublesome since some of the technologies that could provide support to patients in those communities are the same ones that could be leaving these communities behind. 

What Are the Professional, Political, and Ethical Challenges of Co-Creating Health Care Systems? Co-creation has the potential to positively transform health systems, the authors write. Still, it generates a number of political and ethical challenges that should not be overlooked. Those involved in envisioning and implementing co-creation initiatives must pay close attention to significant questions of equity, power and justice and the fundamental challenge of securing a common vision of the aims of health care systems.

The AMA Code of Medical Ethics has several opinions that provide guidance to physicians striving to collaborate with others to create systems that can efficiently serve multiple stakeholders’ interests. Read more.

Listen to the journal’s November podcast, “Bringing ‘Design Thinking’ to Health Care: An Interview with John Meyer, Laura Webb, and Dr. Bon Ku.” Subscribe to the podcast, “Ethics Talk,” in iTunes or one of many other podcast-subscription services.

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

In December, the AMA Journal of Ethics will focus on health care ethics and professionalism in the era of climate change. In January, the journal’s theme is clinicians’ responsiveness to violence. Sign up to receive email alerts when new issues are published.