Downloaded from http://qualitysafety.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Correspondence been involved in the evolution and adaptation of the approach since the initial pilot project in 2005 which was funded by the NHS Institute for Innovation and Improvement. The Point of Care Foundation in England provides training in the EBCD approach and GR contributes to this. Provenance and peer review Not commissioned; internally peer reviewed.
Open Access Scan to access more free content
Open Access This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http:// creativecommons.org/licenses/by-nc/4.0/ To cite Robert G, Donetto S. BMJ Qual Saf 2015;24:407–408. Accepted 27 March 2015 Published Online First 23 April 2015
▸ http://dx.doi.org/10.1136/bmjqs-2014-003673 ▸ http://dx.doi.org/10.1136/bmjqs-2015-004257 BMJ Qual Saf 2015;24:407–408. doi:10.1136/bmjqs-2015-004240
REFERENCES 1 Hayes CW, Batalden PB, Goldmann D. A ‘work smarter, not harder’ approach to improving healthcare quality. BMJ Qual Saf 2015;24:100–2. 2 Bradwell P, Marr S. Making the most of collaboration. An international survey of public service co-design. London: DEMOS, 2008. 3 Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care 2006;15:307–10. 4 Donetto S, Tsianakas V, Robert G. Using Experience-based Co-design to improve the quality of healthcare: mapping where we are now and establishing future directions. London: King’s College London, 2014. 5 Iedema R, Merrick E, Piper D, et al. Co-design as discursive practice in emergency health services: the architecture of deliberation. J Appl Behav Sci 2010;46:73–91.
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6 Robert G, Cornwell J, Locock L, et al. Patients and staff as co-designers of health care services. BMJ 2015;350:g7714. 7 Piper D, Iedema R, Gray J, et al. Utilizing Experience-based Co-design to improve the experience of patients accessing emergency departments in New South Wales public hospitals: an evaluation study. Health Serv Manage Res 2012;25:162–72. 8 Iedema R. Working smarter, not harder. BMJ Qual Saf 2015;24:288–9. 9 Donetto S, Pierri P, Tsianakas V, et al. Experience-based Co-design and healthcare improvement: realising participatory design in the public sector. Des J 2015;18:227–48. 10 Hayes CW, Batalden PB, Goldmann D. Response to: ‘working smarter, not harder’ by Professor Iedema. BMJ Qual Saf 2015;24:289–90. 11 Burton CR, Rycroft Malone J, Robert G, et al. Investigating the organisational impacts of quality improvement: a protocol for a realist evaluation of improvement approaches drawing on the Resource Based View of the Firm. BMJ Open 2014;4:e005650.
Reply to: ‘Harder but smarter? Co-designing together’ by Robert and Donetto We think that Drs Robert and Donetto have touched upon an important issue.1 First, we did not intend to suggest that experiencebased co-design (EBCD) efforts be separate activities—one set for patients, one set for providers. The evidence they point to and, I would say, the lived experience of participants is that having care providers and patients working together to design care processes produces the best value-based outcomes and experiences. We think this stems from the primary drive of care providers—to work with their patients to produce better care and reduce suffering. Having said that, we would argue that there is separation occurring. Examples exist in which EBCD efforts have not adequately involved care providers. For example, imagine an initiative in which a hospital quality department works with families to design an expanded visitor hour strategy with the intent of
having no restrictions. The benefit of this strategy is clear for families and their inpatient loved ones. However, if not designed with care providers, the presence of families 24 h a day could add significant workload to providers which may result in the presence of families being perceived as a burden. If families and providers designed together towards common goals, one might imagine having families sharing in their care of their loved ones, increasing their sense of involvement and offloading work from providers. We also imagine EBCD efforts that do not necessarily need patient involvement. An initiative to reorganise the medication preparation rooms on inpatient wards would have direct impact on nursing and pharmacy and as such the principles of EBCD should be applied. As with the application of LEAN methodologies and the Model for Improvement, the benefits of EBCD will be seen when it is applied as intended. Again this will require, as Drs Robert and Donetto point out, an investment in skill development of those seeking change and those participating in the production of best outcomes. Christopher William Hayes Correspondence to Dr Christopher Hayes, Department of Medicine, St. Michael’s Hospital, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Twitter Follow Chris Hayes at @DrChrisHayes Competing interests None declared. Provenance and peer review Not commissioned; internally peer reviewed. To cite Hayes CW. BMJ Qual Saf 2015;24:408. Accepted 31 March 2015 Published Online First 23 April 2015
▸ http://dx.doi.org/10.1136/bmjqs-2015-004240 BMJ Qual Saf 2015;24:408. doi:10.1136/bmjqs-2015-004257
REFERENCE 1 Robert G, Donetto S. Harder but smarter? Co-designing together. BMJ Qual Saf 2015;24:407–8.
BMJ Qual Saf June 2015 Vol 24 No 6
Downloaded from http://qualitysafety.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Reply to: 'Harder but smarter? Co-designing together' by Robert and Donetto Christopher William Hayes BMJ Qual Saf 2015 24: 408 originally published online April 23, 2015
doi: 10.1136/bmjqs-2015-004257 Updated information and services can be found at: http://qualitysafety.bmj.com/content/24/6/408
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To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Correspondence been involved in the evolution and adaptation of the approach since the initial pilot project in 2005 which was funded by the NHS Institute for Innovation and Improvement. The Point of Care Foundation in England provides training in the EBCD approach and GR contributes to this. Provenance and peer review Not commissioned; internally peer reviewed.
Open Access Scan to access more free content
Open Access This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http:// creativecommons.org/licenses/by-nc/4.0/ To cite Robert G, Donetto S. BMJ Qual Saf 2015;24:407–408. Accepted 27 March 2015 Published Online First 23 April 2015
▸ http://dx.doi.org/10.1136/bmjqs-2014-003673 ▸ http://dx.doi.org/10.1136/bmjqs-2015-004257 BMJ Qual Saf 2015;24:407–408. doi:10.1136/bmjqs-2015-004240
REFERENCES 1 Hayes CW, Batalden PB, Goldmann D. A ‘work smarter, not harder’ approach to improving healthcare quality. BMJ Qual Saf 2015;24:100–2. 2 Bradwell P, Marr S. Making the most of collaboration. An international survey of public service co-design. London: DEMOS, 2008. 3 Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Qual Saf Health Care 2006;15:307–10. 4 Donetto S, Tsianakas V, Robert G. Using Experience-based Co-design to improve the quality of healthcare: mapping where we are now and establishing future directions. London: King’s College London, 2014. 5 Iedema R, Merrick E, Piper D, et al. Co-design as discursive practice in emergency health services: the architecture of deliberation. J Appl Behav Sci 2010;46:73–91.
408
6 Robert G, Cornwell J, Locock L, et al. Patients and staff as co-designers of health care services. BMJ 2015;350:g7714. 7 Piper D, Iedema R, Gray J, et al. Utilizing Experience-based Co-design to improve the experience of patients accessing emergency departments in New South Wales public hospitals: an evaluation study. Health Serv Manage Res 2012;25:162–72. 8 Iedema R. Working smarter, not harder. BMJ Qual Saf 2015;24:288–9. 9 Donetto S, Pierri P, Tsianakas V, et al. Experience-based Co-design and healthcare improvement: realising participatory design in the public sector. Des J 2015;18:227–48. 10 Hayes CW, Batalden PB, Goldmann D. Response to: ‘working smarter, not harder’ by Professor Iedema. BMJ Qual Saf 2015;24:289–90. 11 Burton CR, Rycroft Malone J, Robert G, et al. Investigating the organisational impacts of quality improvement: a protocol for a realist evaluation of improvement approaches drawing on the Resource Based View of the Firm. BMJ Open 2014;4:e005650.
Reply to: ‘Harder but smarter? Co-designing together’ by Robert and Donetto We think that Drs Robert and Donetto have touched upon an important issue.1 First, we did not intend to suggest that experiencebased co-design (EBCD) efforts be separate activities—one set for patients, one set for providers. The evidence they point to and, I would say, the lived experience of participants is that having care providers and patients working together to design care processes produces the best value-based outcomes and experiences. We think this stems from the primary drive of care providers—to work with their patients to produce better care and reduce suffering. Having said that, we would argue that there is separation occurring. Examples exist in which EBCD efforts have not adequately involved care providers. For example, imagine an initiative in which a hospital quality department works with families to design an expanded visitor hour strategy with the intent of
having no restrictions. The benefit of this strategy is clear for families and their inpatient loved ones. However, if not designed with care providers, the presence of families 24 h a day could add significant workload to providers which may result in the presence of families being perceived as a burden. If families and providers designed together towards common goals, one might imagine having families sharing in their care of their loved ones, increasing their sense of involvement and offloading work from providers. We also imagine EBCD efforts that do not necessarily need patient involvement. An initiative to reorganise the medication preparation rooms on inpatient wards would have direct impact on nursing and pharmacy and as such the principles of EBCD should be applied. As with the application of LEAN methodologies and the Model for Improvement, the benefits of EBCD will be seen when it is applied as intended. Again this will require, as Drs Robert and Donetto point out, an investment in skill development of those seeking change and those participating in the production of best outcomes. Christopher William Hayes Correspondence to Dr Christopher Hayes, Department of Medicine, St. Michael’s Hospital, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Twitter Follow Chris Hayes at @DrChrisHayes Competing interests None declared. Provenance and peer review Not commissioned; internally peer reviewed. To cite Hayes CW. BMJ Qual Saf 2015;24:408. Accepted 31 March 2015 Published Online First 23 April 2015
▸ http://dx.doi.org/10.1136/bmjqs-2015-004240 BMJ Qual Saf 2015;24:408. doi:10.1136/bmjqs-2015-004257
REFERENCE 1 Robert G, Donetto S. Harder but smarter? Co-designing together. BMJ Qual Saf 2015;24:407–8.
BMJ Qual Saf June 2015 Vol 24 No 6
Downloaded from http://qualitysafety.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Reply to: 'Harder but smarter? Co-designing together' by Robert and Donetto Christopher William Hayes BMJ Qual Saf 2015 24: 408 originally published online April 23, 2015
doi: 10.1136/bmjqs-2015-004257 Updated information and services can be found at: http://qualitysafety.bmj.com/content/24/6/408
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
