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The potential for including patients in implementation processes has received limited attention in the literature. The purpose of this paper is to explore the different roles adopted by 63 patients that emerged during and after four participatory quality improvement interventions, and the nature of their impact upon implementation processes and outcomes.

A cross-case ethnographic comparison of Experience-based Co-design in two clinical pathways in two UK NHS Trusts.

Two key themes emerge from the data. First, the authors found a range of different roles adopted by patients within and across the four projects; some were happy to share their experiences, others also helped to identify improvement priorities alongside staff whilst others were also involved in developing potential solutions with the staff who had cared for them. A few participants also helped implement those solutions and became “experts by experience” through engaging in the whole co-design process. Second, in terms of the impact of patient engagement with the co-design process whilst the changes championed by patients and carers were often small scale, as co-designers patients provided innovative ideas and solutions. Through their involvement and contributions they also acted as catalysts for broader change in the attitudes of staff by providing a motivation for wider organisational and attitudinal changes.

The research was conducted in two clinical pathways in two NHS trusts. However, the findings complement and add to the growing body of knowledge on experience based co-design.

Patient engagement is likely to require support and facilitation to ensure that patients can play a meaningful role as partners and co-designers in service improvement and implementation. Different roles suited particular individuals, with participants stepping in and out of the co-design process at various stages as suited their needs, capacities and (albeit sometimes perceptions re) skills. In this context, facilitation needs to be sensitive to individual needs and flexible to support involvement.

Patients and carers can play active roles in service improvement, particularly where the approach facilitate active engagement as co-designers.

Analysis of the role patients and carers in implementation and improvement.

The aim of this study is to explore and discuss key challenges associated with having stakeholders take part in co-designing a health care intervention to increase mobility in older medical patients admitted to two medical departments at two hospitals in Denmark.

The study used a qualitative design to investigate the challenges of co-designing an intervention in five workshops involving health professionals, patients and relatives. “Challenges” are understood as “situations of being faced with something that needs great mental or physical effort in order to be done successfully and therefore tests a person's ability” (Cambridge Dictionary). Thematic content analysis was conducted with a background in the analytical question: “What key challenges arise in the material in relation to the co-design process?”.

Two key challenges were identified: engagement and facilitation. These consisted of five sub-themes: recruiting patients and relatives, involving physicians, adjusting to a new researcher role, utilizing contextual knowledge and handling ethical dilemmas.

The population of patients and relatives participating in the workshops was small, which likely affected the co-design process.

Researchers who want to use co-design must be prepared for the extra time required and the need for skills concerning engagement, communication, facilitation, negotiation and resolution of conflict. Time is also required for ethical discussions and considerations concerning different types of knowledge creation.

Engaging stakeholders in co-design processes is increasingly encouraged. This study documents the key challenges in such processes and reports practical implications.

The purpose of this paper is to identify and improve patient care processes by collaborating patients, relatives and healthcare professionals.

To identify and improve patient care processes by collaborating patients, relatives and healthcare professionals.

Healthcare problems captured from collaboration between patients and healthcare professionals fall into simple, complicated and complex problems. Healthcare staff and patient experiences with patient processes differ, and a collaborative approach is needed to capture all areas needing improvement.

The conclusions are drawn from a project with few participants in a context that probably influenced the results. In contrast, other studies in the same area confirm the results.

The study outcomes have direct implications for healthcare professionals who can learn from patients involved in quality improvements such as this experience-based co-design (EBCD) project.

The paper contributes to limited studies on EBCD involving patients in healthcare quality improvements.

The purpose of this paper is to illuminate strengths and limitations in quality improvement work, when involving patients.

The experience-based co-design (EBCD) method was used when improving care for patients undergoing otosclerosis surgery. Individual interviews and focus groups were interpreted using qualitative content analysis.

Strengths mentioned by patients were that their participation made a difference. The first steps were found effective in giving an in-depth view of patients’ experiences and the staff got an increased understanding about specific patient needs. However, weaknesses were found in the latter phases, those of improving and follow-up, health care staff had difficulties to keep their focus on patients’ experiences and invite patients to be involved. Patients’ participation decreased, and there was a lack of tools to support the process.

The content in this paper is mainly based on one case. However, the findings are in congruence with earlier research and add further knowledge to the research area.

The findings can be used in healthcare when involving patients in improvement work.

There is no earlier study which involves patients with otosclerosis when using EBCD. Furthermore, this paper illuminates that there is a need to increase collaboration with patients. The latter phases often seem to be handled by health care professionals without involving patients; this paper suggest a development using dedicated quality tools.

The purpose of this paper is to investigate patient perspectives on attending pulmonary rehabilitation (PR). This qualitative case study identifies the benefits and challenges to attending PR and presents areas of improvements as recommended by patients.

A qualitative case study of a UK case study based on a PR programme based on undertaking focus groups (n=3) and interviews (n=15) with current and former patients.

The findings report patient perspectives of the challenges and benefits of attending a PR programme along with recommendations on how the service could be improved.

The authors focussed solely on a UK PR programme, so the findings might not be applicable to other countries if PR is organised and provided in a unique way or setting.

This paper provides valuable insights to patient perspectives offrom patients attending PR programmes, which are useful to those running and designing these services.

The findings identify the benefits and challenges for patients attending PR programmes and suggest areas where improvements can be made.

The purpose of this paper is to describe a study which aims to provide an alternative approach to clinical governance. This involves patients in redesigning services based on their actual experiences of health services. This will be of interest to front line health care staff and public and patient involvement leads.

The paper illustrates Experience Based Design (EBD) as a structured, formal methodology with clearly defined roles, actions and timescales. A case study approach is used to describe the implementation of this model in a District General Hospital.

This study demonstrates how three theoretical components of good design: functionality, engineering and aesthetics can be used as a framework to improve performance, safety and governance and in addition, actual experience of the service for patients and staff.

The case study approach used has provided a good range of learning and transferable information; however, the results are currently based on a single site.

The use of the EBD approach will ensure that healthcare services truly reflect the needs of patients and carers based on their specific experience. It provides a mechanism whereby patients' views contribute fully to the change process leading to safer, more effective and reliable care. This approach will require the application of the non‐clinical competencies included in the Medical Leadership Competency Framework and specific health and wellbeing dimensions in the Knowledge and Skills Framework.

This paper offers a new model that can be incorporated into service redesign. The model enables greater understanding of clinical governance as described by patients through narrative of their actual experiences.

This study aims to investigate whether the antecedents of co-creation influence braggart word-of-mouth (WoM) in a participative leisure context, theorising the concept of co-created food well-being and highlighting implications for interactive experience co-design.

A sequential mixed-method approach was used to test a theoretical model; 25 in-depth interviews with cooking class participants were conducted, followed by a post-experience survey (n = 575).

Qualitative results suggest braggart WoM is rooted in active consumer participation in co-designing leisure experiences. The structural model confirms that participation in value co-creating activities (i.e. co-design, customer-to-customer (C2C) interaction), alongside perceived support from service providers, increases consumer perceptions of co-creation and stimulates braggart WoM. Degree of co-creation and support from peers mediate some relationships.

Limited by cross-sectional data from one experiential consumption format, the results nevertheless demonstrate the role of active participation in co-design and C2C interactions during value co-creation. This implies that co-created and co-designed leisure experiences can intensify post-consumption behaviours and potentially enhance food well-being.

The results highlight that integrating customer participation into service design, while also developing opportunities for peer support on-site, can stimulate braggart WoM.

Extends burgeoning literature on co-creation and co-design in leisure services. By encouraging active customer participation while providing support and facilitating C2C interactions, service providers can enhance value co-creation, influencing customer experiences and food well-being. Accordingly, the concept of co-created food well-being is introduced.

The purpose of this paper is to reflect on carers’ experiences of being involved in the development of a web-based support programme for carers of people with heart failure (CPwHF), and discuss the challenges related to their involvement in the development process. The focus was on the different phases in the project as well as the methodological challenges and opportunities that occurred in the user group sessions conducted.

This research adopt an explorative design studying a co-design process to develop an information and communication technology based support programme for and with CPwHF. Habermas’ concepts of lifeworld and system are used as a theoretical framework to analyse the co-design process employed in the study.

Reflecting on the co-design approach adopted, the findings highlight the methodological challenges that arise with carer involvement and the possible tensions that occur between researchers’ ambitions to include users in the design process, and the goal of developing a product or service, in the different phases of the design process.

Findings highlight that there is a tension between the system and lifeworld in the co-design process which are not totally compatible. The paper highlights that there is a need to develop flexible and reflexive human-centred design methodologies, able to meet carers’ needs and ideas, and at the same time balance this with proposed research outcomes.

Introducing technology at work presents a special challenge as learning is tightly integrated with workplace practices. Current design-based research (DBR) methods are focused on formal learning context and often questioned for a lack of yielding traceable research insights. This paper aims to propose a method that extends DBR by understanding tools as sociocultural artefacts, co-designing affordances and systematically studying their adoption in practice.

The iterative practice-centred method allows the co-design of cognitive tools in DBR, makes assumptions and design decisions traceable and builds convergent evidence by consistently analysing how affordances are appropriated. This is demonstrated in the context of health-care professionals’ informal learning, and how they make sense of their experiences. The authors report an 18-month DBR case study of using various prototypes and testing the designs with practitioners through various data collection means.

By considering the cognitive level in the analysis of appropriation, the authors came to an understanding of how professionals cope with pressure in the health-care domain (domain insight); a prototype with concrete design decisions (design insight); and an understanding of how memory and sensemaking processes interact when cognitive tools are used to elaborate representations of informal learning needs (theory insight).

The method is validated in one long-term and in-depth case study. While this was necessary to gain an understanding of stakeholder concerns, build trust and apply methods over several iterations, it also potentially limits this.

Besides generating traceable research insights, the proposed DBR method allows to design technology-enhanced learning support for working domains and practices. The method is applicable in other domains and in formal learning.

Patient-centred care and patient involvement are increasingly central concepts in health policy in the UK and elsewhere. However, there is little consensus regarding their definition or how to achieve “patient-centred” care in everyday practice or how to involve patients in service redesign initiatives. The purpose of this paper is to explore these issues from the perspective of key stakeholders within National Health Service (NHS) hospitals in the UK.

Semi-structured interviews, covering a range of topics related to service redesign, were conducted with 77 key stakeholders across three NHS Trusts in the West Midlands. In total, 20 of these stakeholders were re-interviewed 18 months later. Data were managed and analysed using the Framework Method.

While patient-centred care and patient involvement were regularly cited as important to the stakeholders, a gap persisted between values and reported practice. This gap is explained through close examination of the ways in which the concepts were used by stakeholders, and identifying the way in which they were adapted to fit other organisational priorities. The value placed on positive subjective experience changed to concerns about objective measurement of the patients as they move through the system.

Increased awareness and reflection on the conceptual tensions between objective processes and subjective experiences could highlight reasons why patient-centred values fail to translate into improved practice.

The paper describes and explains a previously unarticulated tension in health organisations between values and practice in patient centred care and patient involvement in service redesign.