Co-production and co-design practices are increasingly being promoted to develop user-centred public services. Analysing these practices with literature on power, participation and realist social theory this article explores the power dynamics, mechanisms and impacts within co-production and co-design processes. Two case studies were evaluated using qualitative longitudinal methods: an experience-based co-design project within hospital-based breast cancer services was followed from initiation to completion, alongside a local government innovation team that used co-production and co-design techniques to enable person-centred policies and services. The two cases illustrate how co-production and co-design techniques involve facilitating, managing and co-ordinating a complex set of psychological, social, cultural and institutional interactions. Whilst existing power relations can be challenged in different ways, constant critical reflective practice and dialogue is essential to facilitate more equal relational processes within these techniques, and to institute changes at individual, local community and organisational levels.
- collective reflexivity
- user involvement