It is crucial that organisations and managers understand that it takes time for projects to become established and to build the relationships needed to embed an enduring culture of co-design. Teams also need to appreciate that EBCD is essentially exploratory in nature: goals emerge as part of the process and it is not possible to clearly describe the anticipated outcomes at the outset.
It is natural for staff to find change unsettling. Successful project leaders overcome this by taking time at the outset to clarify the vision, aims and change strategy, connecting the project to existing structures and systems and building consensus and understanding around goals and methods.
Project leaders need to build alliances at both organisational level and within departments, including with people who might be seen as ‘informal leaders’ and opinion formers, as well as people who are regarded as leaders because of their hierarchical position. The co-design process connects people with their motivation for working with patients and, in time, people who use the method move from being allies and supporters to being strong advocates and champions for it.
The speed of this process depends on the strength of these relationships at the outset.
When clinics overrun it is frustrating for patients and staff. The staff working in this clinic have wanted to improve flow to reduce late running clinics for sometime. The EBCD project work is helping to accelerate progress. The clinic has very little space and sees a 30% increase in patient numbers each year, but there is optimism and confidence that improvements are possible when staff and patients work on solutions together. Strong project management and staff engagement characterise this team’s approach.
Members of the stakeholder group were selected to include staff at every level, including some who had not been involved in anything like this before. It was no surprise to find that receptionists and care assistants could describe what it was like to work in the clinic and had brilliant ideas about what could be changed to make improvements. Seeing their ideas implemented convinced staff that they had the power to make a difference.
Some of the stakeholder group had training in the use of the EBCD tools and helped those team members who hadn’t. The lead manager had used the method before and was able to build understanding about the principles and benefits of working this way. Although the stakeholder group could not meet face to face as often as they would have liked, the lead manager and others ensured that all the staff were kept updated. This combination of leadership and involvement is a recipe for success even though the service is busy and the improvement work is being done as part of the day job.
Patients were recruited for interviews and for the patient feedback and joint staff/patient event with a conversation in clinic with a member of staff they already knew and a follow-up phone call with more explanation.
The POCF training emphasises the importance of identifying and engaging with key stakeholders from the outset, understanding their interest in the co-design work and designing engagement and communication strategies accordingly. It also emphasises the importance of strong project management, establishing governance structures for projects, a clear plan, timeline and milestones.