This principle is in many ways at the heart of the Tavistock principles. It recognises that all those who work in health care depend on each other, on patients, and on those outside health carefor example, politicians, researchers, and social workers. Pulling out the principle in the middle of a bitter dispute in a hospital might prove extremely useful.

Jo Ivey Boufford, dean of the Robert F Wagner School of Public Service at New York University, argued that "cooperation" was too weak a word. She wanted recognition that patients are "coproducers" of health and supported the notion of "nothing about me without me"in other words, practitioners would not make decision about patients without their direct involvement, and health authorities would not make policy decisions without public (and professional) involvement.

Improvement
This principle means that it isn't good enough to do well. We must aspire to do better, recognising the escalating rate of new knowledge, the rapid advances in technology, that patients want to be partners, and that our healthcare systems are too complex, giving too much room for error and waste.

Being serious about improvement (rather than simply paying lip service) means learning the skills of improvement, being willing to accept and even encourage change, and recognising that improvement is never ending. Most health professionals have not mastered the improvement skills, and many resist change.