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This paper describes a quality improvement project to improve oversight of quality at national board level using statistical process control (SPC) methods, complimented by a qualitative experience of patients and frontline staff. It demonstrates the application of the “Picture-Understanding-Action” approach and shares the lessons learnt.

Using co-design and applying the “Picture-Understanding-Action” approach, the project team supported the directors of the Irish health system to identify and test a qualitative and quantitative picture of the quality of care across the health system. A “Quality Profile” consisting of quantitative indicators, analysed using SPC methods was used to provide an overview of the “critical few” indicators across health and social care. Patient and front-line staff experiences added depth and context to the data. These methods were tested and evolved over the course of six meetings, leading to quality of care being prioritised and interrogated at board level.

This project resulted in the integration of quality as a substantive and prioritised agenda item. Using best practice SPC methods with associated training produced better understanding of performance of the system. In addition, bringing patient and staff experiences of quality to the forefront “people-ised” the data.

The application of the “Picture-Understanding-Action” approach facilitated the development of a co-designed quality agenda item. This is a novel process that shifted the focus from “providing” information to co-designing fit-for-purpose information at board level.

Globally, urban planners and decision makers are pursuing place-based initiatives to develop and enhance urban infrastructure to optimise city performance, competitiveness and sustainability credentials. New discourses associated with big data, Building Information Modelling, SMART cities, green and biophilic thinking inform research, policy and practice agendas to varying extents. However, these discourses remain relatively isolated as much city planning is still pursued within traditional sectoral silos hindering integration. This research explores new conceptual ground at the Smart – Natural City interface within a safe interdisciplinary opportunity space. Using the city of Birmingham UK as a case study, a methodology was developed championing co-design, integration and social learning to develop a conceptual framework to navigate the challenges and opportunities at the Smart-Natural city interface. An innovation workshop and supplementary interviews drew upon the insights and experiences of 25 experts leading to the identification of five key spaces for the conceptualisation and delivery at the Smart-Natural city interface. At the core is the space for connectivity; surrounded by spaces for visioning, place-making, citizen-led participatorylearning and monitoring.The framework provides a starting point for improved discussions, understandings and negotiations to cover all components of this particular interface. Our results show the importance of using all spaces within shared narratives; moving towards ‘silver-green’ and living infrastructure and developing data in response to identified priorities. Whilst the need for vision has dominated traditional urban planning discourses we have identified the need for improved connectivity as a prerequisite. The use of all 5 characteristics collectively takes forward the literature on socio-ecological-technological relationships and heralds significant potential to inform and improve city governance frameworks, including the benefits of a transferable deliberative and co-design method that generates ownership with a real stake in the outcomes.