Outlining the role of experiential expertise in professional work in health care service co-production

Abstract

Patient and public involvement is widely thought to be important in the improvement of health care delivery and in health equity. There has been exponential growth in the employment of experts by experience in the health and social care sectors in the UK, and recently this trend has spread to the Nordic countries. Purpose: The article examines the role of experiential knowledge in service co-production in order to develop opiate substitution treatment services (OST) for high-risk opioid users. Method: The data analysed includes 18 two-hour meeting sessions conducted during the development project. Drawing on social representations theory and the concept of social identity, we explore how experts by experiences’ and registered nurses’ understandings of OST contain discourses about the identity of the participants and the effects these may have on developing or hindering inclusive and bottom-up forms of patient and public involvement. Results: The meeting sessions that potentially offer room for creativity and problem-solving fail to provide any new propositions for fixing the system. Experts by experience present themselves as experts of substance abuse problems whose experiential knowledge adds value to the professional knowledge of nurses in the rehabilitation of drug addicts. The health care professionals in turn primarily identify themselves as regulators who protect the correctness of their actions and show little interest in considering experiential knowledge on opioid addiction. Conclusion: The participation of patients has been one of the prominent reforms implemented in health care. The goal of client-centered thinking is often emphasized; however, the implementation is not simple due to the strongly institutionalized knowledge and related working patterns and practices in health care. Promoting the participation of patients and expertise by experience is of primary importance and cannot be ignored in practices and relations in health care services.