Dr Lynne Maher is the Innovation and Improvement Clinical Director at Ko Awatea. She is a recognised international leader in healthcare improvement and innovation, with an extensive career ranging from critical care nursing to operational and board posts at local and national level. Dr Maher has published guidance on innovation, co-design, culture change and sustainability of improvement, and has worked with a wide range of healthcare organisations and charities to provide advice in these fields.
Co-design is a process that enables those who deliver services and those who receive services to create improvements together. Each person or group is considered to have equally important views. For example, in healthcare staff have extensive knowledge to offer on the clinical or technical aspects of care and consumers have extensive knowledge about how it feels to experience the process as it is delivered to them. Many consumers also have significant expertise in their own health conditions, especially those with long-term conditions. Both parties are able to contribute ideas from their perspectives, which leads to better understanding of the current process and increased ability to create the most effective improvements for the future.
This article shares six tips for healthcare teams to maximise the benefits of co-design and ensure it runs smoothly.
- See co-design as part of a wider process. The first part of the process is the identification of a challenge or opportunity for improvement. The second part is to engage consumers, whānau and staff, and the third part is to capture their experiences of the care journey and any ideas they have that could improve it. The fourth part is to create new understanding of the care journey and the emotions associated with it by learning from the experiences captured. The fifth part of the process is for consumers, whānau and staff to work together to plan and implement ideas for improvement based on their deeper understanding of the care journey. The final part is to review what difference improvements have made to peoples experiences of receiving and delivering care and any other key measures that were collected within the baseline.
- In addition to engaging with people to understand their experience it is also important to engage with consumers to work as core members of the project team or work group. It is preferable to attract at least two people as consumers and whānau often feel isolated and vulnerable if they are a ‘lone voice’ amongst many staff members. Remember that consumers may need to withdraw at any time because of their health condition or other personal circumstances, which is another reason to attract more than one person to be part of the team.
- Take the time to engage with a range of people including those who may struggle to access the service of focus. Also explain to people why you need their involvement and what the involvement entails. People whose main role is not working in healthcare often need help to understand why you are looking at a care pathway or service and how they might contribute from their unique perspective either at the project or work group or in sharing their lived experience.
- Think carefully about where to hold meetings and or discuss experiences. Community halls, churches and local venues are often less intimidating than the clinical environment and better enable consumers and whānau to contribute. Remember to plan meetings and discussions in advance so that everyone, especially consumers and whānau, can organise other things in their lives to be able to contribute.
- Always ask people if they would like to know the outcome of the work. Even if they have only been involved for a short period of time, a thank you card, e mail or phone call with an update on the improvement is welcomed.
- Cherish the emotions. While you will collect a wide range of data to understand the baseline and measure the improvement, do not lose the rich emotional data which comes through the stories and quotes gathered from consumers, whānau and staff. It is these that often depict the emotional journey of the care pathway and really connect with us all – they are priceless.
There is a range of helpful toolkits available online including:
EBCD: Experience-based co-design toolkit [Point of Care Foundation, UK]
“The toolkit includes short videos from staff and patients involved in experience-based co-design (EBCD) projects to help bring to life the successes and intense rewards of running this type of improvement project.” - https://www.pointofcarefoundation.org.uk/resource/experience-based-co-design-ebcd-toolkit/
Health Service Co-Design Toolkit [Waitemata DHB, NZ]
This guide is for any operational, clinical or quality staff who want to involve patients in improving healthcare services and contains a range of useful tools.
The Australian Healthcare and Hospitals Association has developed an Experience Based Co-Design Toolkit as a reference to equip those working in the health sector with the tools and approaches to bring consumers and health workers together in an authentic and equal partnership to co-design care to deliver an improved experience. https://ahha.asn.au/experience-based-co-design-toolkit
Case Studies from co-design projects within New Zealand
The Health Quality and Safety Commission have a number of case studies from the National Partners in Care programme. These can be viewed on line via the following link: https://www.hqsc.govt.nz/our-programmes/partners-in-care/work-programmes/co-design/
Dr Lynne Maher
Innovation and Improvement Clinical Director
Ko Awatea, Counties Manukau Health