of healthcare services Professor Glenn Robert, Chair of Healthcare - PowerPoint PPT Presentation

Patients and staff as co-designers of healthcare services Professor Glenn Robert, Chair of Healthcare Quality & Innovation Florence Nightingale Faculty of Nursing & Midwifery twitter: @gbrgsy

Structure • What does co-design mean? • What is Design theory? • What is it like to co-design? • What are impacts/outcomes?

What does co-design mean?

Different ways of involving patients Patient blogs Staff and patients Consulting and and web-based working together to Complaints Information Surveys advising stories redesign services Experience-based Co-design (EBCD) Adapted from Bate P, Robert G (2006). ‘Experience -based design: from redesigning the system around the patient to co-designing services with the patient’. Quality and Safety in Health Care vol 15 (5), pp 307 – 10

Hear the voices of the people served The more patients and families become empowered, shaping their care, the better that care becomes, and the lower the costs. Clinicians, and those who train them, should learn how to ask less, “What is the matter with you?” and more, “What matters to you?” “Coproduction,” “co - design,” and “person -centered care” are among the new watchwords, and professionals, and those who train them, should master those ideas and embrace the transfer of control over people’s lives to the people. Berwick D. (2016) ‘Era 3 for Medicine and Health Care’, JAMA 315(13): 1329 -1330

What is Co-Design? • co-design is a well-established approach to creative practice • enables a wide range of people to make a creative contribution in the formulation and solution of a problem • builds and deepens equal collaboration between citizens affected by, or attempting to, resolve a particular challenge; users, as 'experts' of their own experience, become central to the design process • enables people to engage with each other as well as providing ways to communicate, be creative, share insights and test out new ideas • wide range of tools/techniques support co-design process: user personas, storyboards, user journeys, prototyping and scenario generation techniques Source: John Chisholm. ‘What is Co - Design?’ http://designforeurope.eu/what-co-design (accessed March 2016)

Co-design & healthcare quality improvement • value in integrating human-centred tools and values of co-design into quality improvement approaches in healthcare organisations • a co-design approach (Experience-based Co-design) as applied to quality improvement ‘work’ in healthcare services Bate SP and Robert G. (2007) Bringing user experience to health care improvement: the concepts, methods and practices of experience-based design . Oxford; Radcliffe Publishing

EBCD: A participatory ry action research approach th that combines: a use ser-centred orientation (E (EB) and a collaborative change process (C (CD)

The Experience-based Co-design process patients at the heart of the quality improvement effort - but not forgetting staff a focus on designing experiences, not just systems or processes where staff and patients participate alongside one another to co-design services Robert G, Cornwell J, Locock L, Purushotham A, Sturmey G and Gager M. (2015) ‘Patients and staff as co - designers of health care services’, British Medical Journal , 350:g7714

The Experience-based Co-design pr proce ocess ss

Online toolkit: www.kingsfund.org.uk/projects/ebcd

What is Design theory?

Design theory • Draws its inspiration from a subfield of the design sciences such as architecture and software engineering • Distinctive features are: • direct user and provider participation in a face-to-face collaborative venture to co-design services • a focus on designing experiences as opposed to systems or processes (thereby requiring ethnographic methods such as narrative-based approaches and in-depth observation)

Design theory The What makes a good service: designing experiences Performance Engineering Aesthetics of Experience Is it safe Is it What does and functional? it feel like? reliable? Physical Human environment environment Safer Lean Patients Co-design Initiative Berkun, 2004 adapted by Bate. Source: Bate P, Robert G (2006). ‘Experience -based design: from redesigning the system around the patient to co- designing services with the patient.’ Quality and Safety in Health Care vol 15 (5), pp 307 – 10

What is it like to co-design?

Staff views ‘It was one of the most meaningful things I’ve ever done in my entire career I think. That sounds really trite, but I really do mean it, it was wonderful. I am glad I had the opportunity even though I felt like an emotional ragdoll by the end of it. It was a great experience. If we could do more of it I think it would really help. It’s the level of engagement that we should do, but we just don’t invest the time, and the energy, and the money. We wait for complaints ...’ (Interview#05) ‘I think the most important things were that staff really appreciated the time to think about the experience. It became apparent that they perhaps didn’t have or make time to reflect on what they do in their daily workings, so I think they actually found it quite cathartic and therapeutic … the staff really appreciated that their point of view was being listened to because up until that point the political drive had always been patient experience and now all of a sudden we were interested in staff experience’. (Facilitator, interview) Robert G. (2016) ‘Developing person -centred services: the contribution of Experience-based Co-design to high quality nursing car e’. In: S Tee (ed.) Person-centred approaches in healthcare: a handbook for nurses and midwives . Buckingham: Open University press

Humanising healthcare Forms of humanization Forms of dehumanization objectivication insiderness passivity agency homogenization uniqueness isolation togetherness loss of meaning sense-making loss of personal journey personal journey dislocation sense of place reductionist body embodiement Adapted from Todres L, Galvin T and Holloway I. (2009) ‘The humanisation of health care: a value framework for qualitative research. Int J of Qualitative Studies on Health and Wellbeing , 4: 68-77

What are impacts/outcomes?

The primary strength of EBCD over and above other service development methodologies was its ability to bring about improvements in both the operational efficiency and the inter- personal dynamics of care at the same time. EBCD teaches project staff new skills; it enables frontline staff to appreciate better the impact of health care practices and environments on patients and carers; it engages consumers in ‘deliberative’ processes that were qualitatively different from conventional consultation and feedback. Iedema R, Merrick E, Piper D et al (2010). ‘Co - designing as a discursive practice in emergency health services: the architecture of deliberation’ . The Journal of Applied Behavioural Science , vol 46 (1), 73 – 91.

Where has co-design reached in healthcare quality improvement? (1) • includes: participatory design, creative design, co-production, co-design, experienced-based co-design (EBCD) & ‘accelerated’ EBCD (AEBCD) • identification of specific changes to services or to patients’ well -being that resulted from the projects was limited in the majority of the studies • reported ‘outcomes’ of the projects can be categorised in four main ways:  patient and staff involvement in the co-production or co-design processes  generating ideas and suggestions for changes to processes, practices and clinical environments impacting on patients experiences of a service, (and often indirectly on staffs ’)  tangible change in services and their subsequent impact on patient experiences  better understanding challenges involved in conducting co-production or co-design projects and how to address these in research led or hospital staff led quality improvement initiatives Clarke D, Jones F, Harris R and Robert G. (manuscript in preparation). ‘What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings? A rapid evidence synthesis’

Where has co-design reached in healthcare quality improvement? (2) • lower levels of involvement in latter co-design stages; patients feel that staff should implement QI solutions? • further (creative) work needed to overcome tendency towards administrative & bureaucratic processes • for example, multiple sclerosis outpatients using future groups, analogies & physical props • interpersonal burden for patients, carers and staff in speaking across socio-cultural & organizational boundaries • emotional work: requires ongoing support to ensure patients play a meaningful role as co-designers in QI • facilitation role is critical

Embedding design(ers) in healthcare organisations