D11 2 co designing quality improvement

Co-designing quality improvement: from theory to practice 2018 AOHC Health Equity and Action Transformation Conference

Joseph Donia 1, 2 1.

2.

Huddle Innovation, Toronto, Canada Institute of Health Policy, Management & Evaluation, University of Toronto, Canada

Presenter Disclosure Grants / Research Support: none Speakers Bureau / Honoraria: none Consulting Fees: none Patents: none Other: none

LEARNING OBJECTIVES To understand the basic principles of co-design To differentiate co-design from related approaches and methods To understand the role of design in addressing health inequities and experiences of care To identify opportunities for application in local settings To understand factors affecting success

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WHAT IS CO-DESIGN?

A BRIEF HISTORY OF CO-DESIGN Emerged from participatory design in Scandinavia around the 1970s.

Rooted in work with trade unions. New techniques were developed to help workers to influence the design of computer applications.

Co-design Users/Clients

‘Designers’

Stakeholders

Emphasis on egalitarianism and mutual learning.

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THE DESIGN ECOSYSTEM

Image credit: iterations.ie

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The Design Ecosystem

Image credit: Liz Sanders, 2008 7

CO-DESIGN PRINCIPLES Values participants/communities as experts Believes all people are creative Is inclusive and respectful Acknowledges hierarchy and power dynamics Fast and frequent learning by doing

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CO-DESIGN vs ACTION RESEARCH (CB)PAR

Co-design

Values participants as experts

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Emphasizes learning by doing

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Supports community development

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Can be situated within PAR

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Ethnographic roots and methods

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No research ambitions (results oriented)

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EXPERIENCE-BASED CO-DESIGN

Specific form of co-design developed by the UK’s NHS Similar principles, different methods E.g. use of video to assemble and share patient stories Focus specifically on experiences of care

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WHO’S USING CO-DESIGN?

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GETTING STARTED

SOURCES OF INSPIRATION Quality improvement & strategic plans Existing databases / reporting Anecdotal information and staff experiences Patient feedback, stories and lived experiences

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IDEAL CO-DESIGN CONDITIONS Problem not clearly defined or current approach isn’t working Evidence is available, implementation is a challenge Many stakeholders with competing definitions of value You are not on a tight timeline Decisions is not constrained by political decision-making

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ATTRIBUTES OF QUALITY

Appropriately Resourced

Effective

Equitable Safe

Integrated

Accessible

Efficient

Patient Centred Populated Health Focussed

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THE PROCESS

THE DESIGN PROCESS

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THE DESIGN PROCESS

ENGAGE

CO-EXPLORE CO-DEFINE CO-DECIDE

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ANOTHER WAY OF LOOKING AT IT

Credit: UK Design Council , 2015

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DEGREES OF INVOLVEMENT

Co-design can take place at any stage of the design process True empowerment means involving clients/ users in decision-making at every stage

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CO-DESIGN READINESS

Tools Methods Methodologies Mindset Culture

Credit: Liz Sanders

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CO-DESIGN & EQUITY

CO-DESIGN STRENGTHS Makes space for unheard voices Solutions more likely to be culturally relevant Meaningful engagement = increased social capital Inherently more ethical, though not always referred to as such

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CO-DESIGN LIMITATIONS Design methods are not ‘value neutral’ Ethnography in particular has a long history of use by colonial powers Design its self is deeply intertwined with politics of class and social hierarchy - who gets to design depends on who has access to the process and the time to contribute Methods and approaches should not come pre-packaged, but should be tied to local knowledge and practice

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THE FUTURE OF CO-DESIGN? Co-design can stand in contrast to established ways of ‘doing things’ We need new ground rules for community engaged research and innovation.

Engagement and the benefits of power-sharing are increasingly recognized by funders.

Co-design as the future of community-based work?

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Visit: huddleinnovation.com/blog1/AOHC18

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THANK YOU!