MethodThis approach incorporated the Model for Improvement4 and Experience Based Co-design (EBCD)5 which is a participatory quality improvement approach that uses ethnographic methods such as in-depth interviews and participant-observation to help collect and understand experience.
Six demonstrator sites were established across different care settings.
Each demonstrator site received:
• methodology training at each stage of the EBCD approach (see Figure 1)
• EBCD and improvement coaching (for project leads and local guiding teams), and
• networking and sharing opportunities with other demonstrator sites.
Figure 1 – Experience Based Co-design approach adapted from the Point of Care Foundation4
Outcomes that matter: an experienced based approach to co-designing improvement priorities Authors: Diane Graham, Improvement Advisor ([email protected])Stephen Lithgow, Associate Improvement Advisor ([email protected])
ConclusionsBuilding the capabilities for service users and care teams to co-design improvement priorities is vital to sustainably transforming our health and social care services, focused on what matters to people.
Key learning from supporting the approach:
• coaching and advisory support in co-design methodology and Quality Improvement can increase the ability of organisations and services to deliver outcomes that matter to people.
• focus development of local skills, approaches, processes and tools around the commencement of each stage of EBCD
• flex the approaches used to collect experience data based on context, service user cognition and communication abilities, and
• support navigation of local information governance and consent requirements
The learning will now frame the Scottish approach to supporting co-design using the Experience Based Co-design method.
www.healthcareimprovementscotland.org
References:1. Scottish Government. National Health Service Reform (Scotland) Act. 2004.
Available from: http://www.legislation.gov.uk/asp/2004/7/contents2. Scottish Government. The Patient Rights (Scotland) Act 2011. Available from:
http://www.legislation.gov.uk/asp/2011/5/pdfs/asp_20110005_en.pdf3. Scottish Government. Community Empowerment (Scotland) Act 2015. Available
from: http://www.legislation.gov.uk/asp/2015/6/pdfs/asp_20150006_en.pdf4. The Point of Care Foundation. Experience Based Co-design Toolkit. Available
from: https://www.pointofcarefoundation.org.uk/resource/experience-based-co-design-ebcd-toolkit/
5. Associates in Process Improvement (API), The Model for Improvement. Available from: http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
6. Healthcare Improvement Scotland. Focus on Dementia Impact Report. Specialist Dementia Units Improvement Programme. 2018. Available from: https://ihub.scot/focus-on-dementia/specialist-dementia-units/
IntroductionHealthcare Improvement Scotland (HIS) has worked with health and social care staff to combine co-design and quality improvement approaches that focus on what matters to people.
Recognising a support and coaching need, HIS has worked with local teams to develop an understanding of the challenges and barriers to local facilitation of co-designing improvement.
BackgroundHealth and social care organisations in Scotland have a legislated duty1,2,3 to involve people in designing, developing and delivering the care services they provide.
Developing skills in participatory approaches to involving people in continuously improving their experiences of care is therefore a priority.
1. Improving antenatal educationOverall, 23 women and 15 midwifery staff were involved in sharing their experience of antenatal education; co-designing improvement priorities and prototyping improvement ideas as part of an improvement working group (see Figure 2).
Co-designed improvement priority themes: 1. Improving class information and content2. Social opportunities and networking 3. Facilitation styles of midwife/
interactiveness of sessions4. Engaging men/partners in classes5. Use of social media6. Reducing variation of content delivered
Changes implemented so far:• A new booking form introduced• Women can now book into classes by
email as well as by telephone• New antenatal education evenings
information • Standardisation and inclusion of new class
content, including topics like car safety
2. Improving Specialist Dementia Units6
Forty-three relatives and carers shared experiences of specialist dementia care and 48 members of staff shared their experiences of working in a Specialist Dementia Unit.
Co-designed improvement priority themes: 1. Stress and distress2. Person-centred activity3. Mealtimes4. Environment5. Team resilience and joy in work6. Information for families and carers
Changes implemented so far:• New stress and distress care plan• Physical activity programme and furniture• Carer information board - activity• Mealtimes audit• Values based reflective practice
Baseline median =
45.5
Current median = 19.0
Improvement of 58%
0
10
20
30
40
50
60
70
80
Jun
14
Sep
14
Dec
14
Mar
15
Jun
15
Sep
15
Dec
15
Mar
16
Jun
16
Sep
16
Dec
16
Mar
17
Jun
17
Sep
17
Dec
17
Mar
18
Jun
18
Sep
18
Coun
t
Balmore Incidents of Violence and Aggression
EBCD Co-DesignWorking Groups
Figure 3 – Falls rates Figure 4 – violence aggression ratesFigure 2 – Agreeing together which improvement priorities to start with and prototyping
As a result of the changes made demonstrator sites are seeing a reduction in falls, and violence and aggression (see figures 3 and 4), and staff increased quality improvement skills.
“The best bits were getting together with everyone,
including the midwives – not just having a moan. It was
about making changes. The face-to-face meeting was
great, and finding out that we were all on the same page. It’s
all been pretty enjoyable –feeling that you’re part of a
solution.”
“You feel valued and that you can make an impact.”
“I really enjoyed the larger group and sharing our
experiences.”
“It couldn’t have been better: it’s been
a really positive experience.”
“The best part was finding out that you
can make an impact – and make
it better for all”
ResultsResults from two of the demonstrator areas supported with this approach:
Baseline median = 23.0
Current median = 10.5
Decrease of 54% from baseline
0
5
10
15
20
25
30
35
40
45
Jan
16
Mar
16
May
16
Jul 1
6
Sep
16
Nov
16
Jan
17
Mar
17
May
17
Jul 1
7
Sep
17
Nov
17
Jan
18
Mar
18
May
18
Jul 1
8
Sep
18
Nov
18
Coun
t
Balmore falls
Mobility Risk Ax Falls Alarm
Falls Flowchart New Furniture
Poster No: PC-09
