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Why co-design?

Steven Edwards Lancashire Care NHS Foundation Trust 22 October 2014

Steven Edwards, patient experience manager and quality improvement lead for Lancashire Care NHS Foundation Trust, reflects on the impact Experience Based Co-design has had in his organisation and why he thinks it’s a particularly useful tool in mental health settings.


At Lancashire Care, my journey with Experience Based Co-design (EBCD) began in 2010 with our involvement in a story-gathering initiative run by the regional Mental Health Improvement programme. We used video booths to gather feedback from inpatients, which was edited into a film and shown to staff using an adapted form of The King’s Fund’s EBCD toolkit.

For those who don’t know, EBCD is a method of service improvement that captures the experiences of patients, carers and staff through discussion, observation and filmed interviews. By enabling patients and service users to tell their stories, EBCD often reveals unexpected areas for improvement and helps to build consensus about how these issues can be overcome.

Co-designing the patient pathway – from admission to recovery

The results from our first story-gathering initiative were so encouraging that a full programme was funded by the trust to carry out recordings at all our inpatient facilities, including interviews with frontline staff and carers. The process led to some changes in practices, including a greater emphasis on therapeutic activities and support for frontline staff so they could spend more time engaging with patients.

However, it was clear the methodology had to apply to the full length of the patient pathway – from admission to recovery – to bring about real improvement. As one manager said to me, you have to listen to what happens after someone is discharged to fully evaluate the quality of the inpatient experience. To do this, the trust sponsored a small scale pilot assessing the experiences of patients after they were discharged from inpatient services. All the participants were invited to an introductory workshop where we jointly designed the interview process, including what questions they wanted to be asked and how they would like the information to be used.

Using a basic audio recorder, eight narratives were collected and shared back with the participants and the project sponsor at a co-design workshop. With support from staff at the School of Mental Health at the University of Central Lancashire (UCLAN), we used an adapted form of co-design to map key points on the patient pathway which had the potential to be emotional, important or in need of change. Each stage of the patient journey was coloured by the quality of relationships between patients, staff and carers. What struck me and my colleagues was often how simple things were missed which could have saved considerable time, money and anguish for patients and carers.

Simple changes

For example, the process revealed the need to involve carers much earlier in the patient journey. We realised we needed to work with them from day one to agree meaningful discharge arrangements so that service users could get home as quickly as possible into a well-supported environment. It also demonstrated that people who had the most contact with service users were the members of staff who had the least training, so we sought to shift that balance.

The case for EBCD

Co-design provides the narrative evidence for managers often struggling with clinical and operational data – mostly in raw numbers. It brings this data into focus and starts to create the compelling case for how we redesign our clinical pathways with patients, co-producing new models of care.

More than anything, it provides a human face to the patient and carer experience, enabling staff to reflect on aspects of care they are often too pressured to notice, helping to bring about attitudinal, behavioural and cultural change. Finally it provides a safe space for these human aspects of care to be shared and connected with other managerial or clinical priorities.

EBCD feels a natural fit for mental health services as it draws on established practices in psychology and related therapies. Communication, engagement and partnership run throughout a good experience of mental health services and are the core components of a successful co-design programme. In many ways, it’s like a triple lock preventing the involvement process from being short-circuited or patient narratives being hijacked by external agendas. In protecting the integrity of the narratives, co-design is a litmus test of an organisations commitment to listen, learn and partner with patients and carers on what matters most – the care and treatment they receive.

Tell us about your experiences of using Co-design of similar methods in your organisation. What were the challenges? What were the results?

Want to know more about EBCD? Attend our joint conference with The King’s Fund on November 5, entitled “Transforming Patient and Staff Experience.” There is also a LinkedIn group for people interested in EBCD.

Biog: Steven Edwards is a Patient Experience Manager and Quality Improvement Lead for Lancashire Care NHS Foundation Trust. He is currently carrying out research into the use of Co-design to improve experiences of patients and carers in Adult Mental Health Services and Learning Disability Services. He is also part of an EBCD research group which seeks to champion the use of Co-Design in Mental Health Services. For more details see: