Principles and Praxis Co-Design in Healthcare Marie Ennis-O’Connor
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Principles and Praxis
Co-Design in Healthcare
Marie Ennis-O’Connor
WHAT, WHO, WHY, WHEN, HOW
WHAT IS CO-DESIGN?
3 WAYS TO DO
HEALTH CARE IMPROVEMENT
• Don’t listen very much to users and do
the designing for them
• Listen to users then go off and do the
designing for them
• Listen to users and then go off with
them to do the designing together
Paul Bate, 2007
TO For With
Co-design challenges power paradigm
Lived experience is equal to other forms of
knowledge, evidence and expertise
“Co-production is a relationship where professionals and citizens share power to
plan and deliver support together, recognising that both partners have vital
contributions to make in order to improve quality of life for people and communities.”
Source: nef/NESTA (National Endowment for Science, Technology and the Arts UK)
Co-production Critical Friends
Co Design
Edgar Cahn in his book No More Throw-Away People relates the parable of the
Blobs and Squares to explain
co-production.
THE PARABLE OF THE BLOBS AND SQUARES
WHAT, WHO, WHY, WHEN, HOW
WHO SHOULD BE INVOLVED?
STAKEHOLDERS
patients
service users
carers
front line staff
communities
health professionals
researchers
industry
policy makers
WHAT, WHO, WHY, WHEN, HOW
WHY CO-DESIGN CARE?
#1 Democratic
people have the right to
participate in the design of things that impact them
#2 PRAGMATIC
we can achieve more
by working together than we can apart
#3 USER EXPERTISE
drawing on user experience and expertise
will accomplish a better outcome
#4 INNOVATION
seeing things from different points of view leads to new perspectives and greater innovation
#5 DIVERSITY
more diverse and accessible care for all
#6 TRUST AND
TRANSPARENCY
improves interactions and understanding
#7 COLLECTIVE OWNERSHIP
develops a sense of joint ownership
WHAT, WHO, WHY, WHEN, HOW
WHEN TO CO-DESIGN
use co-design when…
• Starting a new service improvement project.
• Developing a new process, product or service.
• Exploring a specific service issue, e.g. reducing waiting times.
• Wanting to understand services from the patient perspective.
• Implementing changes.
WHAT, WHO, WHY, WHEN, HOW
THE CO-DESIGN PROCESS
FOUR CO-DESIGN PRINCIPLES
1. Prioritise the patient experience
2. Trust the process
3. The ‘means’ is as important as the ‘ends’
4. Acknowledge the patients’ contributions throughout the process
#1 Prioritise the patient experience
What would this look like?
#2 Trust the process
What would this look like?
#3 The ‘means’ is as important as the ‘ends’
What would this look like?
The social outcomes
of co-design work
are just as important
as the co-design outputs
OUTPUTS
#4 Acknowledge contributions
What would this look like?
some ideas…
• Assistance to attend meetings (travel expenses, accommodation, etc)
• Personal thank you cards after workshops or other events
• Celebratory events when improvements have been made
• Written recognition in publications, reports and website
CO-DESIGN PROCESS
Engage
Plan
Explore
Develop
Decide
Change
STEP 1 ENGAGE
who needs to be involved?
engage them early in the process
ensure engagement is meaningful
what are
the ethical considerations?
PRINCIPLES OF GOOD PRACTICE
1. The improvement initiative should be designed and undertaken in a way that ensures its integrity and quality
2. All people who are involved, must be informed fully about the purpose, methods and intended possible uses of any information they provide
3. All participants must formally consent to the use of any information they provide, including attribution of quotations, film extracts, etc
4. All people involved participate on a strictly voluntary basis, free from any coercion and able to withdraw at any time without need for explanation
5. All people involved must not be knowingly exposed to harm or distress
6. Privacy and confidentially must be respected as requested
(Ethical Considerations for Experience Based Design: 2007)
www.institute.nhs.uk
what are
the barriers
to
meaningful
engagement?
some thoughts
• Lack of time
• Accessibility
• Entrenched thinking
• Reluctance to cede power
• Tokenism
• Balance of power
• Trust
STEP 2 PLAN
establish the goals of your
improvement work and how you might go about achieving them
ensure you have adequate funding and
organisational commitment in place to see the process through
map assets
ASSET MAPPING
• The resources, including the skills, knowledge and networks which people and communities have to offer
• Transforming the perception of people from passive recipients to equal partners
STEP 3 EXPLORE
learn about patient experiences
how are they treated?
how would they like to be treated?
what outcomes do they want?
how will you
do this?
some ideas
experience based survey
co-design workshop
patient journey mapping
Focus on designing
experiences rather than
systems or processes!
drill down into the emotions
how will you turn it around?
STEP 4 DEVELOP
turn your ideas into specific improvements
what are the desired outcomes of this work
for patients and their communities?
STEP 5 DECIDE
brainstorm as many specific goals and ideas as
you wish, then narrow these down to two or
three key goals and ideas
DECISION MATRIX
idea
strengths
uniqueness
weakness
fixes
transform
STEP 6 CHANGE
turn your IDEAS
into ACTION
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