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A sense of collective free-thinking with tangible goals makes co-creation an enlightening experience. Yet despite the freedom and organic flow of the methodology, there remain barriers to deploying co-creation in the real-world context. The aim was to understand the barriers and solutions to co-creation, reflect on applying co-creation in practice and co-create an applicable framework for co-creation.

These reflections and conceptual developments were completed using a Participatory Action Research Approach through the co-creation of the Erasmus+ funded Co-creating Welfare course.

Results presented are centric to the experiences in the United Kingdom but led to application at an international level. Problem formulation led to solutions devised about who should co-create, what co-creation aims to achieve, how to receive management buy-in, co-creating beyond the local face to face context and evaluation.

The Three Co’s Framework is proposed using the outline of: Co-Define, Co-Design and Co-Refine. Those who take part in co-creation processes are recommended to be called co-creators, with less focus on “empowerment” and more about facilitating people to harness the power they already have. Utilising online and hybrid delivery methods can be more inclusive, especially in response to the COVID-19 pandemic. The use of co-creation needs to be evaluated more moving forwards, as well as the output co-created.

Research has established the prevalence and relevance of moral injury in healthcare workers, though less attention has been paid to the different classes of potentially morally injurious events (PMIEs) experienced by this population and their impact. This exploratory study sought to examine the frequency of self- and other-generated PMIE classes and their associations with demographic characteristics and well-being outcomes among mental healthcare staff.

Secondary analysis of data drawn from two cross-sectional surveys of 267 frontline and leadership staff from mental healthcare settings in the UK was conducted. Responses on the Moral Injury Events Scale and the Short Professional Quality of Life Scale were extracted for analysis.

Betrayal by others was most frequently endorsed (61.8%), whilst self-transgressions were least frequently reported (25.5%). After controlling for the number of PMIE classes experienced, betrayal significantly predicted secondary traumatic stress (p = 0.01) and burnout (p = 0.04). Additionally, other transgressions significantly predicted secondary traumatic stress (p = 0.008). The predictive effects of self-transgressions on burnout, secondary traumatic stress and compassion satisfaction were all nonsignificant after controlling for the number of PMIE classes experienced.

Findings highlight differences in the frequency and impact of self and other PMIEs experienced by healthcare professionals. Reducing cumulative exposure to differential PMIE classes appears to be of critical importance to improving occupational well-being in this group.

To our knowledge, this study is the first to explore the associations between PMIE classes and occupational well-being in a mental healthcare population, inclusive of frontline and leadership staff.