Applying social innovation theory to examine how community co-designed health services develop: using a case study approach and mixed methods

Farmer, Jane, Carlisle, Karen, Dickson-Swift, Virginia, Teasdale, Simon, Kenny, Amanda, Taylor, Judy, Croker, Felicity, Marini, Karen, and Gussy, Mark (2018) Applying social innovation theory to examine how community co-designed health services develop: using a case study approach and mixed methods. BMC Health Services Research, 18. 68.

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Background: Citizen participation in health service co-production is increasingly enacted. A reason for engaging community members is to co-design services that are locally-appropriate and harness local assets. To date, much literature examines processes of involving participants, with little consideration of innovative services are designed, how innovations emerge, develop and whether they sustain or diffuse. This paper addresses this gap by examining co-designed initiatives through the lens of social innovation - a conceptualisation more attuned to analysing grassroots innovation than common health services research approaches considering top-down, technical innovations. This paper considers whether social innovation is a useful frame for examining co-designed services.

Methods: Eighty-eight volunteer community-based participants from six rural Australian communities were engaged using the same, tested co-design framework for a 12-month design and then 12-month implementation phase, in 24 workshops (2014-16). Mixed, qualitative data were collected and used to formulate five case studies of community co-designed innovations. A social innovation theory, derived from literature, was applied as an analytical frame to examine co-design cases at 3 stages: innovation growth, development and sustainability/diffusion.

Results: Social innovation theory was found relevant in examining and understanding what occurred at each stage of innovation development. Innovations themselves were all adaptations of existing ideas. They emerged due to local participants combining knowledge from local context, own experiences and exemplars. External facilitation brought resources together. The project provided a protective niche in which pilot innovations developed, but they needed support from managers and/or policymakers to be implemented; and to be compatible with existing health system practices. For innovations to move to sustainability/diffusion required political relationships. Challenging existing practice without these was problematical.

Conclusions: Social innovation provides a useful lens to understand the grassroots innovation process implied in community participation in service co-design. It helps to show problems in co-design processes and highlights the need for strong partnerships and advocacy beyond the immediate community for new ideas to thrive. Regional commissioning organisations are intended to diffuse useful, co-designed service innovations. Efforts are required to develop an innovation system to realise the potential of community involvement in co-design.

Item ID: 52625
Item Type: Article (Research - C1)
ISSN: 1472-6963
Copyright Information: © The Author(s). 2018. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated
Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC 1057362
Date Deposited: 21 Feb 2018 07:34
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420319 Primary health care @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3203 Dentistry > 320399 Dentistry not elsewhere classified @ 50%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920402 Dental Health @ 50%
92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920506 Rural Health @ 50%
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