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This book examines the key principles and models associated with service operations, co-production and co-design. Two popular quality improvement models within healthcare are reviewed. Lean thinking has typically been the prominent approach when improving the design of healthcare systems and is often selected by healthcare professionals to standardize and improve the delivery of care. Although the first principle of Lean is to understand value little attention is often paid to this opportunity to engage with service users. The model for improvement is a well-recognised and practiced model to guide improvement in healthcare. Again, how co-production or co-design principles within the model has not been previously explored. In this text case studies are used to explore how co-production and co-design approaches can be used to improve healthcare. We draw on two care pathways and published case studies. This is the second Improving Healthcare Operations text. The first explored the application of lean, agile and agility in the design of care pathways. This text explores the benefits and challenges of integrating co-production and co-design principles when improving service operations.