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Improving networked care

Support for those implementing co-design

It is important to consider how well the co-design methodology fits with the cultural norms in an organisation. EBCD works best when staff feel empowered to lead and make changes. The best project leaders are proactive and do not wait to be given permission.

Practical support for teams who are building their confidence really helps, as do patience and encouragement.  Having support to help with some tasks can really help, as long as it doesn’t weaken local staff engagement.

Experience of, and confidence with, the method really helps teams to make rapid progress. Identifying a project champion who is comfortable with the method at the outset helps get things started. People’s initial reluctance usually stems from apprehension when they haven’t been involved in anything like this before. POCF trainers are used to seeing this but once the training gets underway, there is a realisation that the approach is an appreciative one, in which all progress to greater patient engagement is to be applauded, and confidence grows rapidly.

What is apparent from people who implement the co-design approach, is that it is easier to apply than people anticipate. Practical support to help start a project and the inclusion of more confident practitioners early on can have a huge impact on progress. Although the process cannot rely on a single ’heroic leader’ if it is to be sustained across an organisation, an enthusiastic, confident champion is a valuable starting point.

Permission and determination to take the time to apply the method are critically important. This requires strong clinical and non-clinical leadership and a recognition that co-design is an inherent part of clinicians’ and managers’ everyday jobs.

Finally, support for the implementation of co-design needs to be tailored to the needs of the organisation.  There is a need to carefully balance practical support for the teams implementing co-design, while on the other hand not de-skilling or disempowering those whose role it is to take ownership to make the changes and improvements.

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case studies iconCase study: Reducing the wait

The prospect of 120 booked outpatients, many having to wait a long time in the department, was the regular situation facing staff on a Monday morning.  By December 2017 new nurse-led clinics for patients with a stable eye condition had been introduced enabling some patients to be seen, tested and discharged in around an hour. Under the new system their results are reviewed by a consultant within three days and a message is sent to the patient to confirm the outcome and any further appointment. It has also been arranged that some patients needing long-term review can now be seen at clinics run on a Saturday, further reducing the numbers at Monday clinics. 

Local medical consultant leadership has been very important. A new consultant works alongside an experienced colleague to help instigate and implement new ideas. Similarly, local leadership from department managers has been key to getting started with EBCD.

Experiences will continue to change at this site as patients, doctors, nurses, clerical staff and patients are interviewed about what it is like to deliver and receive the service.

Waiting in clinic is the top concern for patients and uppermost in the minds of staff too. Interviews and observation are helping staff to explore what long waits feel like and to provide the foundation for involving patients and staff in designing improvements.

Some staff had training about the tools used in EBCD, while others heard about the process during interviews and because of the ‘buzz’ of discussion in the department. The team have identified patients who frequently come to the Monday clinic to invite them to become involved, aiming for 10 patients to work with staff on service improvement projects.

Staff are excited that new ideas are being implemented and want to showcase the pathway changes they have made. They want patients to know they are making improvements. They don’t want to miss the opportunity to get feedback from patients about their experience in clinic and gauge how successful the changes have been. They also want to find out what else can be done in time to improve the experience for staff and patients.

case studies iconCase study: The Point of Care Foundation

The Sweeney Programme

Patient experience and staff experience go hand in hand. That is why we focus on making sure that when it comes to healthcare, everyone’s needs are met, to provide compassionate care and a fulfilling work life. We believe that staff can provide the best care by stepping back and seeing the care they give through the patient’s eyes.

The Sweeney Programme enables staff to do just that. Through the programme, we deliver training in quality improvement tools and techniques, including Experience Based Co-Design (EBCD) and Patient and Family Centred Care (PFCC). We help staff see their routines and practices in a new light, to produce sustained improvement and cultural change. We run it as a collaborative, bringing a number of teams together for learning events so they learn from each other. The programme usually consists of two or three learning events over six to nine months with implementation support (coaching and mentoring) in between.

As of early 2018, 750 healthcare staff have taken part in Sweeney training and returned to their organisations with the skills, motivation and inspiration to create sustainable changes to improve the quality of care.  The Sweeney Programme builds staff confidence and skills, to drive sustainable, bottom-up change in their services using insights into patients’ experience of care, producing tangible changes for patients and carers, staff and organisations.

Read the impact report here.