For optimal progress, patient engagement must be an organisational priority, with senior leaders taking an active interest in embedding processes like EBCD across the organisation. Co-design work needs a ‘home’ in its host organisations. Related to this is the importance of getting the right people involved and trained in the co-design process. This is critically important to the chances of success.

External factors can be a powerful driving force.  The CQC’s ‘caring and responsive’ requirement, for example, can be evidenced by the use of EBCD and this can be a convincing argument in favour of its adoption.

Sometimes practicalities interfere. One team was in the middle of moving to allow for refurbishment: they saw the timing of the project as unhelpful.