Dr Lynne Maher presented at the Health Quality & Safety Commission’s Let’s talk forum on 8 March 2018. Lynne is the Director of Innovation at Ko Awatea, Counties Manukau Health, Honorary Associate Professor of Nursing at the University of Auckland, and has led the co-design movement across New Zealand.
She began by asking the audience how many people had ever accessed the health service for themselves or their families – not surprisingly, everybody in the room had. She then asked how many people would describe their experiences as ‘excellent service’? Only about ten people in the room put their hands up. Lynne saw this as an opportunity to learn about integrating the voice of consumers into the design of improved services.
'The response of consumers is a key component of co-design, to create a feedback loop for the design and development of health services,' she said.
'Generally, when consumer voices are integrated into the design of health services, research has shown a number of benefits. For example, patients are more able to take their medications correctly and feel more confident and empowered in their own health care management, which can reduce access to health care services.'
She said that when considering co-design, many mainly focus on working with patients and families. However, co-design is actually about working with everybody who is involved in or impacted by the health care process.
'It is important to understand staff perspective and there is a significant amount of research that demonstrates when staff feel fulfilled and able to work in a positive way, this translates into patients and family/whānau having a more positive experience.'
What is co-design?
Co-design is a process where a challenge or an opportunity is identified. A range of people who have experience and expertise in delivering or receiving services are engaged. The experiences they have are shared and captured with specific attention to how they feel at each step and any ideas they may have for improvement.
We are also capturing consumer experiences that may not have been good. We are gathering ideas for improvement, asking those intricately involved in the care: 'How did it make you feel?' and also what ideas they have to improve the service.
Co-design enables us to:
- explore experiences, which helps us to better understand the root cause of the problem – people feel more engaged with the solution if they understand the problem
- engage and build partnerships between staff and consumers from the start
- better utilise all of the expertise available to us, especially from consumers and staff.
Lynne emphasised the importance of considering appropriate combinations of tools to capture experiences. Surveys provide excellent high-level understanding. This can be enhanced by even a short face-to-face discussion which provides much more depth about the experience.
'This storytelling also be very cathartic – people like to feel listened to – it can be therapeutic for patients to tell their story to get it off their chest and feel heard.'
She said capturing the evocative emotions from interviews with patients was key and could reveal subtexts.
In co-design, we are particularly listening for words that depict emotion: ‘In reception I was scared, but by the time the nurse came to talk to me I felt more comfortable’.
The data we capture helps us to map the care journey from multiple perspectives.
'The maps visually represent the story.
'Co-design is about turning experience into action and this results in improvement. It helps to draw out what is happening.'
She said this is a positive way to enable healing and build confidence and competence in health care services.
'Co-design helps to create a health service that can truly be known as world class.'
The Commission is committed to using co-design; a tool which is integral to its programmes.
You can find out more about co-design here.