13. Running the co-design groups
Co-design groups are small working groups of patients and staff designing and implementing solutions to the priority issues highlighted at the joint patient–staff event.
By now you will have several groups in place made up of patients and staff – usually, one group for each priority area for service improvement. The meetings are very practical. Use an agenda to provide structure – first, identifying a realistic and achievable focus, then asking what needs doing, by whom and by when. (See the co-design group meeting agenda template.)
Identify someone to facilitate and organise each group. One person may facilitate all the groups, or separate ‘co-leaders’ may run each group, overseen by the central facilitator. Each group facilitator needs to be present to encourage discussion, help the group develop ideas into concrete actions, and ensure that those actions are followed up.
In experience-based co-design, the facilitation role goes beyond usual service improvement facilitation. This is because neither patients nor staff are accustomed to working alongside each other, so they may need particular help to overcome barriers, such as brief training in service-improvement techniques. This means the facilitator may need to encourage particularly dominant participants to listen, and enable others (often patients) to speak up.
There are many different ways to facilitate, and many facilitators will already have their own tried and tested methods. However, here are some methods that facilitators have used to help EBCD groups develop their service improvements:
- brainstorming – identifying problems and solutions (in two separate sessions) while suspending judgement to encourage creative ideas to emerge from the group
- writing down options on sticky notes and moving them around into categories to help organise ideas visually and identify emerging themes
- weighing up the benefits of each option for different groups of stakeholders and by checking that they are SMART (specific, measurable, attainable, relevant, time bound)
- quality circles – a participatory management technique that brings people together in groups to find solutions to organisational problems
- voting systems to help participants make decisions
- informal discussion leading to natural consensus.
For more practical information about running co-design groups, see the Health Service Co-Design website from New Zealand.
Each group needs to meet sufficiently often to maintain the momentum, but with enough time for outcomes to be achieved in between (for example, fortnightly, moving to monthly, for about six months).
- If numbers are low by this stage, you might need to recruit some new participants. These could include staff and patients who were unable to attend the joint patient-staff event, and key staff who are able and committed to taking actions to improve the service. If you need to, you can also recruit patients from existing patient groups.
- If the group gets ‘stuck’ on criticising the existing system, try using visual aids or other creativity tools to encourage them to reframe those thoughts into positive solutions. (More information about creativity tools is available on the archived NHS Institute for Innovation and Improvement website).
- It can help to ask patients to focus on points where they experienced confusion, and think about what could be done to change that feeling.
- Meeting notes in the form of ‘next steps’ can make it clear who is going to do what. (See co-design group notes template.)
- To make the most of the unique features of experience-based co-design, you need to keep involving the patients throughout the process and asking ‘Is this what you had in mind? Does this work in the way you envisaged?’ and then fine-tuning the solutions accordingly.
- Be aware of areas of sensitivity – for example, a patient may have had a negative experience of a particular staff member, or may associate a part of the hospital or a process with a traumatic life event. They may need support to focus on what can be changed rather than focusing on the past.
- Some patients may not be familiar with the conventions of workplace meetings, so set out expectations clearly – for example, if they need to bring any documents with them. Make it clear what refreshments will be provided and that travel expenses will be reimbursed.
- Encourage involvement from everyone through the meetings, so that everybody has space to contribute. Make sure as many patients can attend as possible, so that you get a range of views.
- Do allow people the time to voice their thoughts. Having invited them to speak, it is important that they have the time to speak without feeling rushed.
- Talk to facilitators of other groups in between meetings, in case there is any duplication of effort. Some facilitators have discovered that both their groups were planning to run the same service-improvement activity, for the same service!
- It may be helpful to plan the co-design groups at a regular time, so people can plan around them.
- Especially if you are coordinating a number of improvements, maintain a log detailing each area of improvement, activities taken or planned, timeframes, barriers to implementation and what will happen next, and update it after each meeting.
- For examples of the discussions and actions from our co-design groups, see examples of what co-design groups have achieved.