Partners in Care Programme

Co-design in health and care services

Websession 1

Dr Lynne Maher Director for Innovation Ko Awatea Associate Professor of Nursing The University of Auckland

Welcome to …….

Taranaki, Hutt

Valley and Capital

and Coast DHB

Teams

Web sessions – tips on etiquette and

interaction

• Interacting- an important part of everyone's learning is that you contribute with your progress and ask lots of questions. • Speaking- ‘raise your hand’- you will find an icon that you can

click on which alerts us.

• Or type into the ‘chat box’, we will monitor this throughout the call

• If you are sharing the call with others in the room can someone please type everyone's name into the chat box or send a list to us so that we know who is on the call.

Web sessions – tips on etiquette and

interaction

• Background noise- we can hear you!

If you are able to please mute your phone until you want to speak to the group

Agenda for todays web session

• Project start up- clarity of the area

you are planning to work in. Consideration of scope and time

• Engage- have you started?

• Check in- any concerns/ questions ?

• Next activities

Combined Web session and second

workshop dates

• Wednesday 9th November 12-1pm

• Wednesday 7th December 10-11am

Second workshop

Wednesday 25th January 2017 Taranaki Teams

Wednesday 8th February 2017 Hutt Valley & Capital & Coast Teams

• Wednesday 22nd February 12-1pm

• Wednesday 15th March 12-1pm

• Wednesday 5th April 12-1pm

• Wednesday 3rd May12-1pm

• Wednesday 31st May 12-1pm

Second Workshop

Will have a focus on:

• Reviewing progress, challenges, successes and

learning from each team.

• Planning actions for the remainder of the programme

including;

• Planning and running one or more co-design sessions

• Prioritising and selecting ideas

• Implementing and measuring success using the Model

for Improvement -plan, do, study act cycles.

Workbooks and case studies

Workbooks- Templates are provided and follow the

stages of the co-design methodology.

First submission 2nd March 2017

Second submission 25th May 2017

Case studies – a template is provided and it also

follows the stages of the co-design methodology

Visit the HQSC web pages

• https://www.hqsc.govt.nz/our-programmes/partners-in-

care/work-streams/co-design-partners-in-care/

• Scroll down for lots of resources and case studies from

previous programmes

Co-design approach

Co-design approach includes the following stages:

• Project start up: scope, plan, aim

• Engage: patients, families and staff

• Capture: patient, family and staff experiences using a range of methods

• Understand: emotions and “touch points” along the journey of care

• Improve: work together to identify and prioritise what to improve

• Measure: check to see if experience is improving

Stop before you start…..

“When developing new products, processes or even businesses most

companies are not sufficiently rigorous in defining the problems they are attempting to

solve”

Spradlin (2012) Harvard Business Review

If I had an hour to save the world, I would spend 59 minutes defining the problem and one minute finding solutions. Albert Einstein

Bobby Umar @raehanbobby

Project set up- tips for project teams

• A core part of a co-design approach is to really understand the experiences of people who are receiving and delivering services and then working with them to identify their ideas for improving that service/product.

• This means that teams should not start with a project that already has a clear solution. For example – “we aim to create an education system for patients a to reduce the number of people who ‘do not attend’ outpatient clinics”.

• Teams can identify the ‘challenge’ and ‘aim’ they have for example; the do not attend rate is increasing and we aim to reduce it by x% by y month. Do recognise in this statement I have not suggested ‘how’. We don’t know that until we have captured and understood experiences.

• Co design means patients, families and staff working in partnership. It does not mean that staff develop something then show it to patients for their approval- this reflects a ‘tick box’ mentality

Use multiple data sources

Co-design enables you to define the problem or challenge clearly from multiple perspectives including……..

Organisation- How?

Staff and other stakeholders- Who?

Consumers/families – Who?

Co-design approach

Co-design approach includes the following stages:

• Project start up: scope, plan, aim

• Engage: patients, families and staff • Capture: patient, family and staff experiences using a

range of methods

• Understand: emotions and “touch points” along the journey of care

• Improve: work together to identify and prioritise what to improve

• Measure: check to see if experience is improving

How do we typically design services

with patients?

• Don’t listen very much to our users and we do the

designing

• Listen to our users then go off and do the

designing

• Listen to our users and then go off with them to do

the designing= Co-design

(Professor Paul Bate 2007)

Engaging people…

http://www.hqsc.govt.nz/our-programmes/consumer-engagement/publications-and-resources/publication/2162/

Staff and other stakeholders- Who? Consumers/families – Who?

Engaging consumers at different levels in

projects

• Programme or project governance level

• Project ‘lived experience’ level-

• Today contributing to ‘capture’ phase

• Over time through to the ‘co-design’ phase

Check in- Engaging

How are you doing? Lets have some feedback from at least two teams.

Who has started to engage consumers and staff

• At Project/steering group level?

• At ‘front line’ level?

• Is anyone having challenges?

Communicate

well and often

“The single biggest

problem in communication

is the illusion that it has

taken place.”

George Bernard Shaw, Leadership Skills for Managers

@LynneMaher1

Resistant behaviour is a good

indicator of missing relevance Harald Schirmer

http://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-role-of-hr-driving-social-adoption-and-change-in-the-enterprise

Source of image: driverlayer.com

‘ ‘

When communicating connect with hearts and

minds

“What the leader cares about (and typically bases at

least 80% of his or her message to others on) does

not tap into roughly 80% of the workforce’s primary

motivators for putting extra energy into the change

programme”

Scott Keller and Carolyn Aiken (2009)

The Inconvenient Truth about Change Management

Describe the change from multiple

perspectives

What are the anticipated benefits?

What is in it for consumers, for the organisation and what is in it for staff?

Staff must be able to see that ‘they’ will benefit (WIIFM) if scepticism/anxiety is to be tackled

Communicate in a number of ways

• Use all of the organization’s communication vehicles

• Stories, metaphors, analogies, and examples are all effective means of painting a compelling picture

• “Walk the talk”

• Effectively capture both the minds (What) and hearts ( Why)

Engaging – tips for project teams

• It is important to engage early as one of the reasons to work with consumers and families ( and staff) is to understand their experiences.

• It is helpful to try to engage a small number (2-3) of consumers/family members at project/steering board level. Their role is to help steer the project with staff. These can be people from a consumer council or advisory group and they provide broad support.

• When working ‘at the front line’ teams will need to engage with people who are actually experiencing the service now or have recently ( within the last year) .

• Always try to engage more people than you need. The attrition rate is often high.

Engaging – tips for project teams 2

• A good method of approach is often via a clinician whom patients have had contact with in some way. However teams could just go and talk to people who are in the service today. Important to remember context is critical accessing via churches/charities/community groups may be most appropriate.

• Be prepared with some relevant information and remember ‘framing’ this is important so people feel safe. For example- ‘we want to explore how it feels like to be a patient in ABC service’. ‘We are keen to find out what works really well and what could be improved’.

• Communication, communication, communication

Questions?

Co-design approach

Co-design approach includes the following stages:

• Project start up: scope, plan, aim

• Engage: patients, families and staff

• Capture: patient, family and staff experiences using a range of methods

• Understand: emotions and “touch points” along the journey of care

• Improve: work together to identify and prioritise what to improve

• Measure: check to see if experience is improving

Focus groups

and panels

Patient Stories

Photo booth

Complaints/compliments

Story Board Diary

Public Meetings

Comments cards

Surveys

In depth conversations

The Health Foundation Inspiring Improvement Measuring patient experience

June 2013.

There are many ways of capturing experience

Patient experience questionnaire

Observation Shadowing

Empathy/in their shoes- my view

“We can never fully experience what another does as we cannot possibly feel the same joy, fear, pain, elation or anxiety. But we can expose ourselves to part of their experience so that we can empathise, go on just try.” Lynne Maher 2015

@LynneMaher1

Think carefully when you choose a mechanism for capturing patients experiences

Numbers, numbers…

Breadth

De

pth

Conversation Shadowing Small focus groups Diarys Filming

Surveys Emotion questionnaire Focus groups Observation

Next Activities

Next activities

• Continue with your set up if needed

• Engage at Project/Steering Board Level and at ‘front line’ level. This will require some attention to communications.

• Start to plan for Capture – remember breadth and depth

Time check

• Next Websession-Wednesday 7th December 10-11am

• That is 20 days away if you are working on your project 5

days each week. Or….. four hours away if you are working

on your project one hour a week.

• Consider a time plan where you identify time for each team

member each week and remember to block out holidays.