The Dark Side of Co-Production

Oliver, K., Kothari, A. & Mays, N. The dark side of coproduction: do the costs outweigh the benefits for health research?. Health Res Policy Sys 17, 33 (2019).

This paper was a surprise.

Translation of evidence into practice is central to NSWRHP’s mission and co-production of research, where end users are participants in research creation is considered to increase the likelihood of implementation – that is – the likelihood of change and improvement in clinical practice. 

This view is increasingly supported. The international journal ‘Nature’ recently ran a special on co-production, the editorial making it clear that the era of ‘ivory tower’ scientists was truly over. The British Medical Journal now requires authors of research papers to document if and how they involved patients and the public in setting the research question, the outcome measures, the design and implementation of the study, and the dissemination of its results.

Power sharing is at the heart of co-production. The overall argument made by the authors is that researchers should retain power (cloaked as ‘scientific independence’) and not be forced to share it with end users and policy makers. Attention is drawn to lack of ‘hard’ evidence for the value of co-production or on the best approaches. This is true – our ability to study complex social processes is still developing and more theoretically informed narrative syntheses, able to make sense of rich context, are needed in this area. (However, the evidence they will provide may be robust but will never be ‘hard’ with its quantitative research implications.)

Most attention though in this article is given to costs and challenges. Co-production undoubtedly adds work to early stages of research, as the researchers can’t just ‘get on with it’. Sometimes this may be an excellent return on investment for researchers resulting in more meaningful investigation and sometimes it may benefit policymakers, reducing the costs of later implementation.

Claims are made for co-production leading to burn out and stress and silencing researchers. The sweeping generalisations include creation of false dichotomies:

‘Under business-as-usual rules, researchers spend their time identifying genuine and novel gaps in the knowledge base, which have to be justified at length to colleagues and funders. However, the coproduction process can lead to researchers being asked to answer questions which are dull, not novel (little contribution to the scientific literature), or not generalisable (focused on local issues) – and therefore not easily publishable.’

The emotive language and poorly supported argument are disturbing, including warnings of ‘Damage to interpersonal or organisational relationships, research careers and researcher independence and credibility’. 

In conclusion, not much evidence is provided that co-production is evil! However, the degree of angst displayed in this paper suggests that established researchers are being challenged by expectations of new ways of working.