I came across Helen Baxter recently and we had a really interesting conversation on Experience Based Design (EBD). It struck me that this approach is similar to ours and that Community Reporters can be a key part for the capture part of the process. What is useful about EBD is that is a structured process for patient experience and has the elements of creating the conversations for change which have the potential to really impact on services. Something we are keen to encourage. But its relevance is not just in the heath field. We see great potential is using this in any fields which want to listen to there service users. So it can be easily used in housing to support tenant participation in co-producing services and also in the education sector in listening to the voice of students.
Helen explains below more about EBD and how it can be used by Clinical Commissioning Groups.
Experience Based Design for Clinical Commissioning Groups – Helen Baxter
Experience Based Design (EBD) is a methodology for working with patients, families, carers and staff to improve services. The approach has been specifically developed for use within health care settings, but is also applicable to a wide range of other environments as it is based on user centred design thinking.
Healthcare quality has three main tenets; patient safety, clinical effectiveness and patient experience. The interaction of patients with the services they access, how the service ‘feels’ or is experienced, is given equal importance alongside safety and effectiveness. Experience Based Design allows us to gather insight into how services are experienced based on the person’s emotional response to the interaction. It helps individuals and teams to challenge assumptions and perceptions about what we think the patient or family member feels and needs. It is a method of designing improved experiences of healthcare for patients, carers, families and staff. All of these people work in partnership to co-design better health services. As well as improving the usability of the service, ebd enables commissioners to improve safety and clinical effectiveness, from the patients’, carers’, families’ and staff perspective.
The involvement of patients and staff throughout EBD projects is more profound than that in traditional patient involvement approaches. Using the insights that are captured, patients, families and staff work together to ‘co-design’ improvements to the services. The co-design approach assures that improvements made are aligned to patient, carer and staff experience and truly add value by ensuring that the services provided better meet the needs of those who access them, and those who provide them.
EBD is an approach that allows you to understand the whole pathway, how patients and families and carers interact with health and social care services. It helps to ensure that any initiative does not purely focus on the technical or efficiency related components of the pathway, but the reality of using the service.
The phases of an EBD project:
Getting Started: Setting the scope for the project, engaging with key stakeholders, developing a project plan and baseline measures. Engaging staff, patients and carers in the project
Capture: Gather patient and staff stories and experiences. This is done through using a variety of tools that are chosen to fit the specific environment. At the heart of the capture are semi- structured interviews with patients, carers and staff. One component that should also always be included is observation of the services being provided, as this gives a different, unique perspective. Using video to record the patient stories is valuable for the understand phase of the work as well as engaging wider groups of stakeholders.
Understand: Assimilating the experiences that have been gathered and developing emotional maps to identify areas that have opportunities for improvement. Prioritise areas for improvement with patients and staff.
Improve: Generating ideas for improvement, selection and testing of ideas to try out before any solutions are fully implemented. EBD projects usually highlight a range of different improvement opportunities, some which are ‘just do it’ and others which need more work to improve.
Evaluate: Reporting and evaluation of differences made and the sustainability of improvements
How EBD supports the work of CCGs:
Moving beyond simply talking to patients, to the next stage of actually involving them in designing and procuring services
Experience based design facilitates commissioners’ understanding of the patient journey and how patients interact with services, as well as understand what it is like for those delivering care. The technique will enable commissioners to then, co-design the opportunities and solutions with patients, families and staff.
As clinical commissioning groups consider their vision, values and culture, it is important to consider these co-design principles. There are enormous benefits to be had from operating a co-design culture from the start.
Supporting development of a culture of trust between patients and staff so that they are confident to share problems and truly involve them in co-designing solutions.
There can often be a reluctance to engage patients until the clinicians are all signed up to a particular process solution, which is too late. Using patient stories and understanding patient, staff and families/carers experience is a great tool for engaging all groups of staff. EBD is about understanding the patient journey, through the use of narrative and observation. Usually, seeing a video or reading about a patient’s experience can help to engage staff in using the approach.
For example, using experience based design to design a service for people with long-term neurological conditions gave one organisation a much clearer understanding of how the service was actually delivered, rather than what it thought was being delivered. This led to the design of a well co-ordinated community service, rather than a new consultant-led community neurology centre, which was seen as the early solution by some professionals.
Making efficient use of the time and resources we have for what can be seen as a time consuming approach?
Investing in understanding and co-designing services with patients and their families will save time in the long run. These methods have been shown to “get it right, first time” as they enable commissioners and providers to work in partnership to understand the challenge properly and identify solutions that will be sustainable.
What often happens in innovation and improvement is that we jump to solutions and then quickly implement a change, which, later, requires lots of re-work to try and improve things.
If we understand the problem properly at the beginning, which will take longer at the outset, the solution is more likely to be a better solution that really addresses the challenge. The solution will be of more value and will reduce the amount of re-work that we often see in improvement projects.
Supporting senior managers to involving patients, which can seem threatening, as it can be thought to introduce unpredictability into the process of service redesign.
Often, when engaged in service re-design, staff groups and patient groups identify similar themes. For instance, a problem with a waiting room space may be having an impact on the working life of staff as much as the experience of patients. If the process is managed well, each ‘group’ has an opportunity to air their thoughts and ideas before coming together.
Experience has shown that this process helps to expose what patients really think rather than what staff “think they think”. EBD is about using experience to gain insights from which you can identify opportunities for improvement. It is about uncovering experiences, not attitudes or opinions, so reduces the risk of people taking any apparent criticism personally.
This approach is not about patients, carers and families providing a wish list; it is about using their experience of services to understand where the opportunities for improvement are.
The engagement tools help by explaining to patients, families and carers that we want to learn more about their experience of the service from their perspective to identify areas and opportunities for improvement. In our experience, understanding the patient journey helps to identify unnecessary steps and non value-adding activities.
Developing approaches for working with ‘hard to reach’ groups (such as ethnic minority communities, people who don’t have English as their first language, or have particular health conditions)?
The EBD approach is about understanding experience and gaining insights, from which we can discover opportunities for improvement. It lends itself well to working with seldom heard groups.
We would encourage you to focus in on particular groups/communities, where necessary.
This can, potentially, yield extremely useful feedback. For example, when working with maternity services, one organisation identified that a particular ethnic group was recording a high rate of stillborn babies. Using ebd, it identified that this was due to the obstetrician being male, which was unacceptable within this community’s culture. The interim solution was to develop community clinics led by a midwife. Subsequently, a female obstetrician was recruited, which resulted in reduced rates of still births in that ethnic group.
Raising the profile of patient experience a central tenet of healthcare quality.
Patient experience is one of the core tenets of delivering services, along with safety and quality, it is why we are in the business of patient care. It should be a core part of our role in commissioning and delivering high quality services.
If you want further information on EBD please contact Helen at Helen@tessellates.co.uk and take a look on her web site