Experience Based Codesign at SAAPU

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Experience Based Co-designat SAAPU
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Overview

• What is experience based co-design?
• What we did at SAAPU
• What have been the outcomes to date
• Where to next

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EBCD - SAAPU

• Experience-based co-design, developed by
  Professor Paul Bate (University College London)
  and Glenn Robert
• It is an innovative approach to service
  improvement. It offers a method of capturing and
  understanding how both patients, carers and staff
  feel when they come into contact with a health
  care process, technology, a building or an
  environment.
•  

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What is EBCD?

• It uses that specific form of expertise (called
  experience) to redesign all or part of the
  process in a way that maximises the positive
  emotional response of both those providing and
  receiving a service.
• Experience-based co-design deliberately draws
  out the subjective, personal feelings of
  consumers, carers and staff experience at crucial
  points (touch points) in the care pathway and
  enables patients and staff to then work together
  to bring about sustained improvements in those
  experiences.  

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Guiding Principles

• Immersion pitching in and getting ones hands
  dirty
• Never make assumptions that you know what someone
  else's experience is
• To be rigorous and systematic to be aware of
  your own biases, understandings, beliefs and
  judgements and suspend them as best you can
• To listen and empathise
• To have some FUN the process should be as
  playful as possible 

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Ten Must Dos

• Stay true to core methodology especially the
  notion of co design
• Ensure local improvement specialist has dedicated
  time to coordinate the work and support frontline
  staff
• Engage relevant clinical champions and Senior
  executive support (link back to normal management
  processes)
• Make use of third party to observe and feedback
  on existing services to staff

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Ten Must Dos

• Invest significant time with consumers/carers at
  the beginning of the process and as the process
  continues and improvements begin to take place
• Allow consumers/carers and staff to talk about
  their experiences
• Ensure there are a range of ways for all groups
  to be engaged and get involved and maintain
  involvement
• Use film of consumers/carers and staff wherever
  possible
• Maintain a high profile for the project in the
  organisation
• Plan ahead for each phase and consider
  recruiting new consumers and carers.

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Principles of good Design
Performance Engineering Aesthetics of
Experience
(functionality)
(safety)
(usability)
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In the loop
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• Co-design event
• What staff want
• what consumers carers want
• Change in model of care (widespread changes to
  cover all of the themes)
• Communication (hearing families), environment,
  access, discharge planning etc.

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• Includes both staff and consumers. Those
  involved / experiencing admission to SAAPU are
  coming up with ideas
• I feel respected in regards to my thoughts and
  feelings of the experiences I had in SAAPU
• User centered
• Radical collaboration

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• Working from the ground up ... I feel this will
  make a real difference to improve the experience
  that consumers and families have when using the
  service, whereas other projects seem more about
  improving stats KPIs
• Users and providers of the service can come up
  with better design than experts

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• Coming from staff to management ... seeing
  things from our level that require change
• That ideas have been gathered from users of the
  service as well as staff. There is also a feeling
  that we can achieve whatever we want to
• Staff engagement/buy-in crucial
• Principle of authorship ownership

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• Its exciting to be part of something that gives
  us a shared vision - because what came out of the
  groups reinforced that. Staff, carers and
  consumers want a healthy, sensitive, caring, fun
  (at times) environment
• no one intentionally designs a bad experience
• you dont need an engine when you are the wind
  in the sails

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• I hope the project will begin a change in
  culture for staff and for SAAPU. We need to
  remain focused on what we are trying to achieve
• connection to core objectives
• look at model of care

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• Improvements are locally generated, and so more
  likely to reflect the DNA of our unit.
• As based on local experience, redesign is more
  likely to be a cultural fit with the unit this
  is important no two units or work areas work the
  same.
• It recognises the priorities will be different as
  the improvement goals and solutions are driven
  from the unit not at a network level

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Outcomes

• Re-design plan with 60 specific improvements
• Level of engagement - staff, consumers, carers
• Small vs. more widespread changes
• Managing expectations - needing quick wins to
  keep the project alive
• Majority of improvements low cost or no cost

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Outcomes

• Process was social, interactive, creative - (no
  committees, no surveys).
• Audio-visual component means connection with the
  narrative. It also allows the team to review and
  maintains engagement - new staff coming on board
  gain quickly an understanding of the themes.

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Quick Wins

• Nursing Staff have opened the office doors
  has had a direct effect on the decrease in
  emotional and verbal abuse, decreased perceived
  social isolation
• Ward door is now open Nursing staff aware that
  they have the option to shut the ward for short
  periods while assessing and re evaluating the
  acuity

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Quick Wins

• Rate of seclusion and or consumers going AWOL has
  not increased in the first 4 months that staff
  have opened the ward.
• Group program involving - Occupational
  Therapist, Chaplin, Nursing, Social Work,
  consumer consultant has begun. Psycho-education
  vs Boredom

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Quick wins

• Development of a discharge plan template for
  consumers and carers by Discharge Co-coordinator
• Review of current nursing model to complement
  Medical Model and site visits across the network
  completed
• Purchase of furniture for interview rooms, LDU,
  Men's room.
• Woman's and children's area.

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Where to next for SAAPU

• Implementation of action -improvement plan
  December 09 June 2010 - will see SAAPU redesign
  its models of care across clinical and non
  clinical teams.
• Special focus on improving links with consumers',
  carers and the wider community.
• Special project teams to cover specific themes -
  Groups, Risk Assessment, HDU, Environmental
  Changes, Model of care.

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What remains absolute for SAAPU

• Ensuring consumer carer involvement maintained
  remembering that their contribution exceeds being
  asked the standard what do you think is good bad
  questions.
• To continue to involve consumers, carers at all
  levels of change within SAAPU to fully embrace
  their experience and for SAAPU as a team to
  understand that this knowledge is not only unique
  but precious in changing the way a service
  traditionally implements change.
• Unity as a team embracing our community in
  making a difference to the experience of others.