{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T19:34:26Z","timestamp":1792956866414,"version":"4.5.0"},"reference-count":67,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Primary care in Switzerland faces a set of interrelated systemic challenges that exemplify a wicked problem. Addressing such complexity requires participatory approaches that integrate diverse perspectives and generate context\u2010sensitive solutions. The project Health2040 engaged stakeholders in a co\u2010creation process to co\u2010design a future model of ambulatory primary care for Switzerland and an accompanying action plan to support its implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The project employed a structured co\u2010creation process, beginning with context exploration, evidence synthesis, and stakeholder consultations. Following the preparation phase, two co\u2010design workshops with more than 50 stakeholders, including patients, healthcare professionals, government authorities, social care representatives, insurers, and researchers. The workshops combined customised participatory methods such as patient personas, visioning, system mapping through building blocks, fishbowl discussions, and the X\u2010Curve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The process produced two main outputs: (1) the \u2018Health Network for All\u2019 model, a vision for patient\u2010centred, network\u2010based, and digitally supported primary care, and (2) the Action Plan, which identifies three central action areas, profession\u2010specific activities, and implementation strategies. Thirty\u2010one individuals endorsed the plan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The project illustrates how co\u2010creation can be used to address wicked problems in health systems by linking visionary model\u2010building with actionable strategies. The outputs provide a framework that may inform ongoing efforts to shape the future of Swiss primary care. Beyond the Swiss context, the study illustrates how internationally established primary care principles can be operationalized through co\u2010creation in a local context and highlights methodological design principles that may inform similar processes in other settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>Patients and members of the public contributed at different stages of the project. Stakeholder feedback informed workshop design and materials, and representatives from all relevant groups participated in developing and refining the project outputs and supporting dissemination activities. Patient representatives shared lived experiences, contributed to patient\u2010specific model development, and participated in group discussions during the workshops.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70927","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:59:11Z","timestamp":1792655951000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Co\u2010Creation for Health System Innovation: Developing a Model and an Action Plan for Future Primary Care in Switzerland"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0563-0496","authenticated-orcid":false,"given":"Anna","family":"Romanova","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences and Medicine University of Lucerne Lucerne Switzerland"},{"name":"Swiss Learning Health System University of Lucerne, Faculty of Health Sciences and Medicine Lucerne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9311-022X","authenticated-orcid":false,"given":"Andreas","family":"Balthasar","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Medicine University of Lucerne Lucerne Switzerland"},{"name":"Swiss Learning Health System University of Lucerne, Faculty of Health Sciences and Medicine Lucerne Switzerland"},{"name":"Interface Politikstudien Forschung Beratung AG Lucerne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0032-5836","authenticated-orcid":false,"given":"Manuela","family":"Oetterli","sequence":"additional","affiliation":[{"name":"Interface Politikstudien Forschung Beratung AG Lucerne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9316-3512","authenticated-orcid":false,"given":"Sarah","family":"Mantwill","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Medicine University of Lucerne Lucerne Switzerland"},{"name":"Swiss Learning Health System University of Lucerne, Faculty of Health Sciences and Medicine Lucerne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.4324\/9781315102597-2"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01405730"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/13504509.2020.1859415"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/14494035.2018.1488797"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/postmj\/qgaf058"},{"key":"e_1_2_12_7_1","volume-title":"Governance for Health in the 21st Century\"[Internet]","author":"Kickbusch I.","year":"2012"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.4324\/9781003256717-5"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/23297018.2021.1910987"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.5334\/ijic.ICIC24038"},{"key":"e_1_2_12_11_1","volume-title":"\u201cMedizinische Grundversorgung und Fachkr\u00e4ftemangel. Faktenblatt\u201d [Internet]","author":"Bundesamt f\u00fcr Gesundheit (BAG)","year":"2024"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jep.13891"},{"key":"e_1_2_12_13_1","unstructured":"L.Burla M.Widmer andC.Zeltner \"Zuk\u00fcnftiger Bestand und Bedarf an Fach\u00e4rztinnen und \u2010\u00e4rzten in der Schweiz. Teil 1: Total der Fachgebiete Hausarztmedizin P\u00e4diatrie Psychiatrie und Psychotherapie sowie Orthop\u00e4die. Schlussbericht des Obsan und des Gremiums \u00abKoordination der \u00e4rztlichen Weiterbildung\u00bb im Auftrag des Dialogs Nationale Gesundheitspolitik (Obsan Bericht 04\/2022)\" [Internet]. Neuch\u00e2tel: Schweizerisches Gesundheitsobservatorium (Obsan) (2022) https:\/\/www.obsan.admin.ch\/de\/publikationen\/2022-zukuenftiger-bestand-und-bedarf-fachaerztinnen-und-aerzten-der-schweiz."},{"key":"e_1_2_12_14_1","article-title":"Berufsaustritte Und Bestand Von Gesundheitspersonal in der Schweiz. Eine Analyse Auf Basis Der Strukturerhebungen 2016\u20132018 (Obsan Bericht 01\/2021)","author":"Lobsiger M.","year":"2021","journal-title":"Neuch\u00e2tel: Schweizerisches Gesundheitsobservatorium (Obsan)"},{"key":"e_1_2_12_15_1","unstructured":"S. K.Brandt S.Essig andA.Balthasar\"Zuk\u00fcnftige ambulante Grundversorgung: Einstellungen und Pr\u00e4ferenzen von Medizinal\u2010 und Gesundheitsfachpersonen ausgew\u00e4hlter Berufsgruppen (Obsan Bericht 06\/2023)\" [Internet]. Neuch\u00e2tel: Schweizerisches Gesundheitsobervatorium (Obsan) (2023) https:\/\/www.obsan.admin.ch\/de\/publikationen\/2023-zukuenftige-ambulante-grundversorgung-einstellungen-und-praeferenzen-von."},{"key":"e_1_2_12_16_1","unstructured":"Bundesamt f\u00fcr Statistik (BFS). \"Arztpraxen und medizinische Grundversorgung in der Schweiz 2018\u20102021\". [Internet] (2023) https:\/\/www.bfs.admin.ch\/asset\/de\/28285298."},{"key":"e_1_2_12_17_1","unstructured":"OECD\/WHO. OECD Reviews of Health Systems: Switzerland 2006 [Internet]. Paris: OECD Publishing; 2006 Oct. (OECD Reviews of Health Systems) https:\/\/www.oecd.org\/en\/publications\/oecd-reviews-of-health-systems-switzerland-2006_9789264025837-en.html."},{"key":"e_1_2_12_18_1","unstructured":"Bundesamt f\u00fcr Gesundheit (BAG) [Internet]. 2025. Agenda Grundversorgung https:\/\/www.bag.admin.ch\/de\/agenda-grundversorgung."},{"key":"e_1_2_12_19_1","volume-title":"Bericht der Arbeitsgruppe \u201eNeue Versorgungsmodelle f\u00fcr die medizinische Grundversorgung\u201c von GDK und BAG\"[Internet]","author":"Die Konferenz der kantonalen Gesundheitsdirektorinnen und \u2010direktoren (GDK) und Bundesamt f\u00fcr Gesundheit (BAG","year":"2012"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/daaa063"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2025.105783"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-016-0119-2"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.17061\/phrp3222211"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/1467-8500.12310"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13731-021-00176-2"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11030363"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-024-01126-6"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2023.116413"},{"key":"e_1_2_12_29_1","unstructured":"Bundesamt f\u00fcr Gesundheit (BAG).Forum Medizinische Grundversorgung [Internet] https:\/\/www.bag.admin.ch\/de\/forum-medizinische-grundversorgung."},{"key":"e_1_2_12_30_1","unstructured":"Universit\u00e4t Z\u00fcrich.Citizens\u2019 Assembly 2025 [Internet].2023 https:\/\/www.pnyx25.uzh.ch\/en.html."},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.70447"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40900-021-00252-7"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2025.105922"},{"key":"e_1_2_12_34_1","unstructured":"P.K\u00e4ppeli N.Messerli A.Romanova S.Essig andA.Balthasar\u00abHealth2040\u00bb: Innovative Angebote ambulanter Grundversorgung in der Schweiz \u2212 Bestandesaufnahme und Perspektive. Evidence Brief [Internet]. Luzern; 2024 https:\/\/www.health2040.ch\/vision-action-plan\/innovative-practices."},{"key":"e_1_2_12_35_1","unstructured":"C.Kaufmann Z.F\u00f6hn andA.BalthasarZuk\u00fcnftige ambulante Grundversorgung: Einstellungen und Pr\u00e4ferenzen der Bev\u00f6lkerung (Obsan Bericht 04\/2021) [Internet]. Neuch\u00e2tel; 2021 Sep. https:\/\/www.obsan.admin.ch\/de\/publikationen\/2021-zukuenftige-ambulante-grundversorgung-einstellungen-und-praeferenzen-der."},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcsop.2023.100253"},{"key":"e_1_2_12_37_1","unstructured":"T.Cartier N.Senn J.Cornuz andY.BourgueilSwitzerland. In: Building Primary Care in a Changing Europe: Case Studies [Internet] [Internet]. European Observatory on Health Systems and Policies; 2015 [cited 2023 Nov 6] https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459012\/."},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-019-0393-4"},{"key":"e_1_2_12_39_1","unstructured":"G.Nellessen\u2010MartensandW.HoffmannVersorgungsforschung \u2013 eine Disziplin im Aufschwung. GGW \u2010 Gesundheit + Gesellschaft Wissenschaft [Internet]. 2017 https:\/\/www.wido.de\/fileadmin\/Dateien\/Dokumente\/Publikationen_Produkte\/GGW\/wido_ggw_0117_nellessen_hoffmann.pdf."},{"key":"e_1_2_12_40_1","volume-title":"Co\u2010Creation Toolkit: A Guidance on the Design, Development and Implementation of Effective Co\u2010creation in Industry\u2010Citizen Collaboration Settings [Internet]","author":"Kuhn R.","year":"2021"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1287\/mnsc.2022.02052"},{"key":"e_1_2_12_42_1","first-page":"1539","volume-title":"Inspiration Space: Towards a Theory of Creativity\u2010Supporting Learning Environments","author":"Thoring K.","year":"2017"},{"key":"e_1_2_12_43_1","unstructured":"A.TannerSwiss Academies of Arts and Sciences: Td\u2010Net Toolbox for Co\u2010Producing Knowledge. [Internet]. 2021. Tell your Story by Means of an Object https:\/\/zenodo.org\/records\/4627120#.YHftN2hCTBI."},{"key":"e_1_2_12_44_1","unstructured":"A.BerditchevskaiaandC.BertoncinHow to Make Good Group Decisions [Internet]. Nesta;2021 https:\/\/media.nesta.org.uk\/documents\/Collective-Intelligence-Good-Decision-Making.pdf."},{"key":"e_1_2_12_45_1","doi-asserted-by":"crossref","unstructured":"H.BrouwerandJ.BrouwersThe MSP Tool Guide: Sixty Tools to Facilitate Multi\u2010Stakeholder Partnerships [Internet]. Centre for Development Innovation Wageningen University and Research; 2017 https:\/\/mspguide.org\/the-msp-tool-guide\/.","DOI":"10.3362\/9781780446691.009"},{"key":"e_1_2_12_46_1","unstructured":"Living Guide to Social Innovation Labs. Systems Mapping [Internet] https:\/\/mars-solutions-lab.gitbook.io\/living-guide-to-social-innovation-labs\/seeing\/understanding-the-problem-systems-and-complexity\/systems-mapping."},{"key":"e_1_2_12_47_1","volume-title":"Bringing User Experience to Healthcare Improvement: The Concepts, Methods and Practices of Experience\u2010Based Design","author":"Bate P.","year":"2007"},{"key":"e_1_2_12_48_1","unstructured":"G.Silvestri G.Diercks andC.Matti. X\u2010CURVE booklet. A sensemaking tool to foster collective narratives on system change [Internet].2022 https:\/\/transitionshub.climate-kic.org\/publications\/x-curve-a-sensmaking-tool-to-foster-collective-narratives-on-system-change\/."},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15800"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1177\/0020731416676227"},{"key":"e_1_2_12_51_1","unstructured":"Gesundheitsversorgung der Zukunft \u2013 Was bringt Health 2040 Manuela Oetterli? [Internet]. 2025 https:\/\/www.luzerner-forum.ch\/gesundheitsversorgung-der-zukunft---was-bringt-health-2040 -manuela-oetterli."},{"key":"e_1_2_12_52_1","unstructured":"A.Balthasar M.Oetterli A.Romanova P.K\u00e4ppeli andS.Mantwill\u00abGesundheitsnetz f\u00fcr alle \u2013 pour tous \u2013 per tutti\u00bb: Aktionsplan f\u00fcr eine zukunftsf\u00e4hige ambulante Grundversorgung in der Schweiz. Forschungsprojekt \u00abHealth2040\u00bb der Universit\u00e4t Luzern und Interface Politikstudien Forschung Beratung AG [Internet]. 2024 https:\/\/www.health2040.ch\/vision-action-plan\/results-reports."},{"key":"e_1_2_12_53_1","volume-title":"Agenda Grundversorgung. Fachbericht der Steuergruppe zuhanden des Eidgen\u00f6ssischen Departements des Innern [Internet]","author":"Bundesamt f\u00fcr Gesundheit (BAG)","year":"2025"},{"key":"e_1_2_12_54_1","unstructured":"Stadt Luzern. Stadt Luzern startet Pilotprojekt f\u00fcr integrierte Gesundheitsversorgung [Internet]. 2026 https:\/\/www.stadtluzern.ch\/aktuelles\/newslist\/2980447."},{"key":"e_1_2_12_55_1","unstructured":"Stadt Luzern.Gesundheitswegweiser Luzern [Internet].2026 https:\/\/www.stadtluzern.ch\/projekte\/soziales\/99235."},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-94580-0"},{"key":"e_1_2_12_57_1","volume-title":"Integrated Care Models: An Overview: Working Document [Internet]","author":"WHO","year":"2016"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanprc.2025.100027"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780195125429.001.0001"},{"key":"e_1_2_12_60_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-025-02514-4"},{"key":"e_1_2_12_61_1","doi-asserted-by":"publisher","DOI":"10.1080\/14719037.2020.1786150"},{"key":"e_1_2_12_62_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17072229"},{"key":"e_1_2_12_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2017.05.002"},{"key":"e_1_2_12_64_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-020-0528-9"},{"key":"e_1_2_12_65_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.13054"},{"key":"e_1_2_12_66_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.70381"},{"key":"e_1_2_12_67_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732320979187"},{"key":"e_1_2_12_68_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-025-21544-7"}],"container-title":["Health Expectations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hex.70927","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hex.70927","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hex.70927","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T19:16:20Z","timestamp":1792955780000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hex.70927"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":67,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/hex.70927"],"URL":"https:\/\/doi.org\/10.1111\/hex.70927","archive":["Portico"],"relation":{},"ISSN":["1369-6513","1369-7625"],"issn-type":[{"value":"1369-6513","type":"print"},{"value":"1369-7625","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-02-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70927"}}