A guide to help hospitals implement Kōrero mai – an escalation process for patient, family and whānau concerns about deterioration while in hospital

Contents of this page:

Background to co-design

Processes supporting patient, family and whānau concerns about deterioration while in hospital are a critical part of successful recognition and response systems.

Ideally, these escalation processes are developed locally using co-design.

Many service-improvement projects engage with consumers, but co-design focuses on involving consumers and their family and whānau (consumers*) at different levels. As core members of the project team, they share their ‘lived experience’ of escalation processes.

Capturing consumer and staff experiences and ideas for improvement, and working together to test and put these in place, is part of co-design.

The co-design process, and working through a Kōrero mai project, helps hospitals understand what a patient, family and whānau escalation process is like for consumers and providers in their area.

Co-design projects are best supported by an experienced facilitator. However, the Health Quality & Safety Commission (the Commission) acknowledges this is not always possible.

We have developed the Kōrero mai implementation guide to support hospitals** to put Kōrero mai into action. Its aim is to generate ideas based on services that have already implemented Kōrero mai. Further information on Kōrero mai and co-design is available through the Commission’s website.

Guide structure

The guide’s structure follows the stages of co-designing a Kōrero mai project. These stages generally follow on from each other but may sometimes overlap. For example, Kōrero mai project teams may be engaging with stakeholders while also capturing and understanding data.

Stages of a Kōrero mai project:

  1. Project start-up
  2. Engage stakeholders
  3. Capture: consumer experiences using different methods
  4. Understand: emotions and touchpoints along the journey of care
  5. Improve: work together to identify and prioritise what to improve
  6. Measure: check to see if experience is improving
  7. Review.

This guide describes the approaches Kōrero mai project teams have used and what they have found. Links are given to examples of techniques and tools used.

Other co-design resources

Health service co-design a guide developed by Auckland DHB.

Experience based co-design a guide developed by the Australian Healthcare and Hospitals Association and the Consumers Health Forum of Australia that brings together resources from the United Kingdom and New Zealand and includes Australian case studies.

* We use ‘patient, family and whānau’ when talking about escalation of concern, and ‘consumer’ more generally.

** In the guide, when we talk about hospitals, we mean any health and disability inpatient service provider within a district health board area (DHB), not just the publicly funded providers or those contractors to a DHB.


The guide uses the work and presentations of Dr Lynne Maher of Ko Awatea, case studies prepared by earlier adopters of Kōrero mai, and evaluations of Kōrero mai by Synergia Ltd.

Last updated 14/12/2021