Applying Elinor Ostrom's Design Principles to Guide Co-Design in Health(care) Improvement: A Case Study with Citizens Returning to the Community from Jail in Los Angeles County

Glenn Robert; Oli Williams; Bertil Lindenfalk; Peter Mendel; Lois M Davis; Susan Turner; Cedric Farmer; Cheryl Branch

doi:10.5334/ijic.5569

Applying Elinor Ostrom's Design Principles to Guide Co-Design in Health(care) Improvement: A Case Study with Citizens Returning to the Community from Jail in Los Angeles County

Int J Integr Care. 2021 Feb 12;21(1):7. doi: 10.5334/ijic.5569.

Authors

Glenn Robert^{1

2}, Oli Williams¹, Bertil Lindenfalk², Peter Mendel³, Lois M Davis³, Susan Turner⁴, Cedric Farmer⁵, Cheryl Branch⁵

Affiliations

¹ Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK.
² The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Sweden.
³ RAND Corporation, United States.
⁴ University of North Carolina, Chapel Hill, United States.
⁵ Los Angeles Metropolitan Churches, United States.

Abstract

Introduction: Increased interest in collaborative and inclusive approaches to healthcare improvement makes revisiting Elinor Ostrom's 'design principles' for enabling collective management of common pool resources (CPR) in polycentric systems a timely endeavour.

Theory and method: Ostrom proposed a generalisable set of eight core design principles for the efficacy of groups. To consider the utility of Ostrom's principles for the planning, delivery, and evaluation of future health(care) improvement we retrospectively apply them to a recent co-design project.

Results: Three distinct aspects of co-design were identified through consideration of the principles. These related to: (1) understanding and mapping the system (2) upholding democratic values and (3) regulating participation. Within these aspects four of Ostrom's eight principles were inherently observed. Consideration of the remaining four principles could have enhanced the systemic impact of the co-design process.

Discussion: Reconceptualising co-design through the lens of CPR offers new insights into the successful system-wide application of such approaches for the purpose of health(care) improvement.

Conclusion: The eight design principles - and the relationships between them - form a heuristic that can support the planning, delivery, and evaluation of future healthcare improvement projects adopting co-design. They may help to address questions of how to scale up and embed such approaches as self-sustaining in wider systems.

Keywords: case study; co-design; common pool resources: co-production; healthcare improvement; quality improvement.

Grants and funding

GR, OW and BL are affiliated to the Samskapa research programme on coproduction led by Jönköping University. This is funded by Forte, the Swedish Research Council for Health, Working Life and Welfare under grant agreement no. 2018–01431. GR and BL receive funding from this grant. OW is supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies Institute. We gratefully acknowledge the 54 returning citizens and 23 service providers who participated in the CO-SHARE study. Support for this study was provided by the Robert Wood Johnson Foundation (Grant No. 74212) as part of an effort to learn from programs, policies, and practices around the globe that could improve health and well-being in the United States. The views expressed here do not necessarily reflect the views of the foundation.