Co-design will help improve transitions

The Connecting Care Project will see health service providers, consumers, and their families and whānau working together to better understand and improve the experience of transitions between or within providers. Improving the quality of service transitions was identified by the mental health and addiction sector in 2017 as one of the five priority areas requiring a quality improvement focus.

Work began in August, with two workshops held on 21 and 22 August, in Auckland and Wellington. Teams of health and social service providers from district health boards (DHBs), non-government organisations (NGOs) and primary care worked with consumers and their families and whānau to identify and establish pathways for improving transitions.

Three specific service transitions have been identified as a priority under the project and each DHB-led team will target one of the following transitions:

• from DHB specialist services to DHB community teams, or vice-versa
• from DHB specialist services to primary care and/or NGO services, or vice-versa
• from youth to adult services.

“When we talk to consumers they really help us to understand what’s important to them,” Dr Lynne Maher told the workshop.

“First, they want to be treated as a person, not a number. It’s also really important they are given options. Consumers tell us they want to work with staff who actually want to spend time with them.”

Dr Maher, Improvement and Innovation Director for Ko Awatea, Counties Manukau Health, opened the day-long workshop, with a presentation on co-designing solutions.

“When developing new products, processes or even businesses, mostly, we are not sufficiently rigorous in defining the problems we are trying to solve. We need to use multiple data sources to achieve a complete and rigorous baseline dataset. And that dataset must include listening to people’s lived experience.

“Co-design is an important process that engages stakeholders and consumers. It helps us gain insights into their care, their experience and their emotional journey. Co-design is much more than consultation. It’s listening to our consumers and designing the solutions with them.

“There is no level playing field in mental health and addiction services. For Maori across NZ health equity emerges as a critical issue where access is disproportionate and outcomes are at best patchy. Within the co-design system we are establishing a commitment is needed from us all to refocus our strategies and address health inequity.”

Transitions can be complex, and poor transitions can result in negative consequences for the health and wellbeing of consumers, their families and whānau, as well as impacting service providers in many ways. Having commitment from senior leadership is an essential aspect of the change process.

“Co-design works really well, it’s optimal,” Lynne said. “Not just at the level of direct care but also organisational governance. The Health Quality & Safety Commission, and many of the DHB teams involved in this programme, have consumers working with them at the strategic level to ensure we stay true to the principle of partnership and the co-design process.

“Health care providers have a lot of expertise. Consumers also have a lot of expertise not only through their lived experience of health and care processes, but also through their life, work and family. Consumers are now saying ‘I’d like to have more say in this because the things that are important to me, and my perspective on care can add to that of health and care staff.’

“When we work in this way, it’s hard to go back to the old way of working because we see the incredible value consumers bring to understanding challenges from multiple perspectives and designing solutions that are meaningful for consumers, staff, the DHB and the community.”

The six phases of co-design

Setting up

There is usually a challenge or opportunity which sparks improvement work and brings people together. Gathering data as a baseline, is important, as is identifying a team of people (including consumers) and agreeing on a set of principles which will guide the way the team work together through the co-design process.

Engaging people

In addition to the core team, there is a need to engage people who deliver and receive care, as well as other stakeholders who have experience of the system, service or process you are focused on.

Capturing experiences

We need to consider what’s most appropriate for the people whose experiences we want to explore. For example, working with youth often needs a different approach to those who are more mature in age; different cultures require consideration; and those with long-term conditions or a ‘one-off’ care need will respond differently. There is no single ‘right way’. Consider the best way for the people you are engaging with.

In health and care settings there is already a range of survey and feedback mechanisms we can access. These are helpful when combined with more in-depth methods such as one on one conversations and focus groups. Keys to success include:

• make every effort to help people feel safe in sharing their experiences.
• frame questions well and ask about what works well, in addition to what could be improved.

Understand

The capture process yields a lot of valuable information which needs organising, so you can understand what creates a positive and negative experience. Developing a high-level map of the area of focus is helpful and enables you to see what is happening at the different points of the transition. The data can then be themed to highlight the areas of greatest need for improvement, alongside the range of ideas that have also been captured.

Improve

This is where the team can really start on co-design. You will have captured data and ideas; now the team can select the ideas they would like to test, and plan for the testing.

Measure

As testing takes place, the team will measure the impact on the organisational data, experience data and agree on which ideas to fully implement and how to do that.