Including customers in health service design

Using a co-design methodological approach to optimize perioperative nursing care for older adult patients from ethnically diverse backgrounds: a study protocol

This article outlines the use of a co-design methodological approach aimed at optimizing perioperative care experiences for ethnically diverse older adults and their family carers. The research involved three phases. In Phase 1, the foundation was established with the formation of a Core Advisory Group comprising key informants, including health consumers. This initial phase focused on forming relationships and conducting a literature review to inform subsequent stages of the research. Phase 2 progressed to data collection, where a qualitative survey on perioperative experiences was conducted. Semi-structured interviews were held with patients, their family carers, and perioperative staff. Phase 3 advanced the co-design process through a workshop involving patients, family carers, perioperative staff, and key stakeholders. Workshop participants collaborated on potential practice changes, proposing strategies for future clinical implementation. While data analysis and reporting for Phases 2 and 3 are forthcoming, the continued involvement of the Core Advisory Group ensures ongoing consensus-building on health consumer needs. This methodology article adopts a prospective stance, with findings to be presented in subsequent scholarly works. Use of this methodology will help to determine how the use of a co-design approach may impact the development of culturally responsive perioperative nursing care for those from ethnically diverse communities.

Mixed-methods study protocol to identify expectations of people with type 1 diabetes and their caregivers about voice-based digital health solutions to support the management of diabetes distress: the PsyVoice study

INTRODUCTION

Type 1 diabetes (T1D) requires continuous management to obtain a good metabolic control and prevent acute complications. This often affects psychological well-being. People with T1D frequently report diabetes distress (DD). Psychological issues can negatively affect metabolic control and well-being. New technologies can improve quality of life, reduce the treatment burden and improve glycaemic control. Voice technology may serve as an innovative and inexpensive remote monitoring device to evaluate psychological well-being. Tailoring digital health interventions according to the ability and interest of their intended 'end-users' increases the acceptability of the intervention itself. PsyVoice explores the perspectives and needs of people with T1D on voice-based digital health interventions to manage DD.

METHODS AND ANALYSIS

PsyVoice is a mixed-methods study with qualitative and quantitative data sources. For the qualitative part, the researchers will invite 20 people with a T1D or caregivers of children with T1D to participate in in-depth semi-structured interviews. They will be invited as well to answer three questionnaires to assess socio-demographics, diabetes management, e-Health literacy and diabetes distress. Information from questionnaires will be integrated with themes developed in the qualitative analysis of the interviews. People with T1D will be invited to participate in the protocol and give feedback on interview guides, questionnaires, information sheets and informed consent.

ETHICS AND DISSEMINATION

PsyVoice received ethical approval from Luxembourg's National Research Ethics Committee. Participants will receive information about the purpose, risks and strategies to ensure the confidentiality and anonymity of the study. The results of PsyVoice will guide the selection and development of voice-based technological interventions for managing DD. The outcome will be disseminated to academic and non-academic stakeholders through peer-reviewed open-access journals and a lay public report.

TRIAL REGISTRATION NUMBER

This study is registered on ClinicalTrials.gov with the number NCT05517772.

Service design activities in health services: A systematic literature review based on ecosystem perspective and transformative approach

Service Design (SD) represents a breakthrough in searching for solutions to health systems challenges, but the activities that support these solutions remain underexplored. This research investigates how SD has been applied in the healthcare sector based on two conceptual models: multilevel ecosystem perspective and SD transformative approach. First, we conducted a systematic literature review in eight comprehensive databases in March 2021. Eligibility criteria returned 990 articles filtered by a search protocol, resulting in 47 studies. After this, we identified 23 studies (49%) with a transformative approach through a thematic analysis. Also, the analysis of these 23 studies allowed the identification of five key aspects necessary for enabling a transformative character of SD initiatives: (1) identification of all the actors that make up the provision of healthcare services, (2) identification of users by ecosystem level, (3) knowledge about the SD tools arsenal, (4) use of technology, and (5) applying the Experience-Based Design and Co-Design (EBD/EBCD) approach. The study underlines the role of management for the success of SD in the health sector and suggests an instrument (checklist) to help managers implement SD initiatives successfully.

Effectiveness of a service design training program to improve clinical nurses’ compassion and problem-solving in Korea

Service design is an innovative tool used to improve the quality of patient experience, therefore, making it necessary for nurses to be able to implement it. The aim of this study was to examine the effects of a training program for patient experience-based nursing service design (PEN-SD) on clinical nurses’ compassion and problem-solving ability. This study employed a mixed-methods design: a one-group, pretest-posttest design was used as the quantitative approach, and structured interviews were used as the qualitative approach. The participants were 21 nurses recruited from a university hospital in Korea. A PEN-SD training program was conducted from September 1 to October 6, 2018. After the training program, the participants’ compassion significantly improved (p = .025) but there was no significant difference in their problem-solving ability (p = .313). In the structured interviews, majority of the participants (n = 17) felt that they were able to consider problems from the patient’s perspective. They also reported being able to identify solutions to problems through careful observation (n = 5). The PEN-SD training program was effective in improving compassion among nurses.

Knowledge translation strategies for sharing evidence-based health information with older adults and their caregivers: findings from a persona-scenario method

Background

By understanding the information seeking behaviors of older adults, we can better develop or iterate effective information technologies, such as the McMaster Optimal Aging Portal, that provide evidence-based health information to the public. This paper reports health-related information seeking and searching behaviours and provides strategies for effective knowledge translation (KT) to increase awareness and use of reliable health information.

Methods

We conducted a qualitative study with eighteen older adults using the persona-scenario method, whereby participants created personas and scenarios describing older adults seeking health information. Scenarios were analyzed using a two-phase inductive qualitative approach, with the personas as context. From the findings related to pathways of engaging with health information, we identified targeted KT strategies to raise awareness and uptake of evidence-based information resources.

Results

Twelve women and six men, 60 to 81 years of age, participated. In pairs, they created twelve personas that captured rural and urban, male and female, and immigrant perspectives. Some scenarios described older adults who did not engage directly with technology, but rather accessed information indirectly through other sources or preferred nondigital modes of delivery. Two major themes regarding KT considerations were identified: connecting to information via other people and personal venues (people included healthcare professionals, librarians, and personal networks; personal venues included clinics, libraries, pharmacies, and community gatherings); and health information delivery formats, (e.g., printed and multimedia formats for web-based resources). For each theme, and any identified subthemes, corresponding sets of suggested KT strategies are presented.

Conclusions

Our findings underline the importance of people, venues, and formats in the actions of older adults seeking trusted health information and highlight the need for enhanced KT strategies to share information across personal and professional networks of older adults. KT strategies that could be employed by organizations or communities sharing evidence-based, reliable health information include combinations of educational outreach and materials, decision support tools, small group sessions, publicity campaigns, champions/opinion leaders, and conferences.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02588-x.

Future Health Today: codesign of an electronic chronic disease quality improvement tool for use in general practice using a service design approach

OBJECTIVE

To codesign an electronic chronic disease quality improvement tool for use in general practice.

DESIGN

Service design employing codesign strategies.

SETTING

General practice.

PARTICIPANTS

Seventeen staff (general practitioners, nurses and practice managers) from general practice in metropolitan Melbourne and regional Victoria and five patients from metropolitan Melbourne.

INTERVENTIONS

Codesign sessions with general practice staff, using a service design approach, were conducted to explore key design criteria and functionality of the audit and feedback and clinical decision support tools. Think aloud interviews were conducted in which participants articulated their thoughts of the resulting Future Health Today (FHT) prototype as they used it. One codesign session was held with patients. Using inductive and deductive coding, content and thematic analyses explored the development of a new technological platform and factors influencing implementation of the platform.

RESULTS

Participants identified that the prototype needed to work within their existing workflow to facilitate automated patient recall and track patients with or at-risk of specific conditions. It needed to be simple, provide visual snapshots of information and easy access to relevant guidelines and facilitate quality improvement activities. Successful implementation may be supported by: accuracy of the algorithms in FHT and data held in the practice; the platform supporting planned and spontaneous interactions with patients; the ability to hide tools; links to Medicare Benefits Schedule; and prefilled management plans. Participating patients supported the use of the platform in general practice. They suggested that use of the platform demonstrates a high level of patient care and could increase patient confidence in health practitioners.

CONCLUSION

Study participants worked together to design a platform that is clear, simple, accurate and useful and that sits within any given general practice setting. The resulting FHT platform is currently being piloted in general practices and will continue to be refined based on user feedback.

Disconnected relationships between primary care and community-based health and social services and system navigation for older adults: a qualitative descriptive study

Background

There are gaps in knowledge and understanding about the relationships between primary care and community-based health and social services in the context of healthy aging at home and system navigation. This study examined provider perspectives on: a) older adults’ health and social needs; b) barriers to accessing services; c) the nature of relationships between primary care and health and social services; and d) ways to facilitate primary care and health and social services navigation to optimize older adults’ health.

Methods

Four focus groups were conducted involving providers (n = 21) in: urban primary care clinics and health and social services organizations serving older adults in Hamilton, Ontario, Canada. Purposive sampling was employed to recruit community health and social services managers, directors or supervisors and primary health care providers in a Family Health Team via email.

Results

Health and social services needs were exacerbated for community-dwelling older adults with multiple chronic conditions. Strong family/caregiver social support and advocacy was often lacking. Access barriers for older adults included: financial challenges; lack of accessible transportation; wait times and eligibility criteria; and lack of programs to address older adults’ needs. Having multiple providers meant that assessments among providers and older adults resulted in contradictory care pathways. Primary care and health and social services linkages were deficient and complicated by poor communication with patients and health literacy barriers. Primary care had stronger links with other health services than with community-based health and social services; primary care providers were frustrated by the complex nature of health and social services navigation; and care coordination was problematic. Health and social services referred older adults to primary care for medical needs and gathered patient information to gauge program eligibility, but not without challenges.

Conclusions

Results point to strategies to strengthen primary care and health and social services system navigation for older adults including: using a person-focused approach; employing effective primary care and health and social services communication strategies; applying effective system navigation; building trust between primary care and health and social services providers; advocating for improved program access; and adapting services/programs to address access barriers and meet older adults’ needs.

[Design of Services for Improving the Quality of Care of Hospitalized Children with Acute Diseases]

PURPOSE

This study was conducted to design services for improving the quality of care of hospitalized children with acute diseases.

METHODS

The service design process had four phases: discovery, definition, development, and delivery. The participants were 23 mothers of hospitalized children with an acute disease, and seven nurses and three doctors working at a pediatric hospital. Data were collected through self-report questionnaires, in-depth interviews, and observations. The data were analyzed using content analysis and descriptive statistics.

RESULTS

The participants reported needs for explanations about the treatment, skillful nursing, and environmental improvements. The concept of the services was familiarity and enjoyment, aimed at solving the problems of unfamiliarity and boredom. A six-guideline was presented for improving the quality of care of hospitalized children with acute diseases: improvement of awareness, development of educational materials, improvement of skills, environmental improvements, play activities, and evaluations of user satisfaction.

CONCLUSION

These findings indicate that nursing services should deliver familiarity and enjoyment to hospitalized children and their families. The findings of this study emphasize that the service design methodology can be used to improve the quality of care of hospitalized children with acute diseases.

Health TAPESTRY: co-designing interprofessional primary care programs for older adults using the persona-scenario method

Background

Working with patients and health care providers to co-design health interventions is gaining global prominence. While co-design of interventions is important for all patients, it is particularly important for older adults who often experience multiple and complex chronic conditions. Persona-scenarios have been used by designers of technology applications. The purpose of this paper is to explore how a modified approach to the persona-scenario method was used to co-design a complex primary health care intervention (Health TAPESTRY) by and for older adults and providers and the value added of this approach.

Methods

The persona-scenario method involved patient and clinician participants from two academically-linked primary care practices. Local prospective volunteers and community service providers (e.g., home care services, support services) were also recruited. Persona-scenario workshops were facilitated by researchers experienced in qualitative methods. Working mostly in homogenous pairs, participants created a fictitious but authentic persona that represented people like themselves. Core components of the Health TAPESTRY intervention were described. Then, participants created a story (scenario) involving their persona and an aspect of the proposed Health TAPESTRY program (e.g., volunteer roles). Two stages of analysis involved descriptive identification of themes, followed by an interpretive phase to extract possible actions and products related to ideas in each theme.

Results

Fourteen persona-scenario workshops were held involving patients (n = 15), healthcare providers/community care providers (n = 29), community service providers (n = 12), and volunteers (n = 14). Fifty themes emerged under four Health TAPESTRY components and a fifth category - patient. Eight cross cutting themes highlighted areas integral to the intervention. In total, 414 actions were identified and 406 products were extracted under the themes, of which 44.8% of the products (n = 182) were novel. The remaining 224 had been considered by the research team.

Conclusions

The persona-scenario method drew out feasible novel ideas from stakeholders, which expanded on the research team’s original ideas and highlighted interactions among components and stakeholder groups. Many ideas were integrated into the Health TAPESTRY program’s design and implementation. Persona-scenario method added significant value worthy of the added time it required. This method presents a promising alternative to active engagement of multiple stakeholders in the co-design of complex interventions.

Electronic supplementary material

The online version of this article (10.1186/s12875-019-1013-9) contains supplementary material, which is available to authorized users.

A stakeholder co-design approach for developing a community pharmacy service to enhance screening and management of atrial fibrillation

Background

Community pharmacies provide a suitable setting to promote self-screening programs aimed at enhancing the early detection of atrial fibrillation (AF). Developing and implementing novel community pharmacy services (CPSs) is a complex and acknowledged challenge, which requires comprehensive planning and the participation of relevant stakeholders. Co-design processes are participatory research approaches that can enhance the development, evaluation and implementation of health services. The aim of this study was to co-design a pharmacist-led CPS aimed at enhancing self-monitoring/screening of AF.

Methods

A 3-step co-design process was conducted using qualitative methods: (1) interviews and focus group with potential service users (n = 8) to identify key needs and concerns; (2) focus group with a mixed group of stakeholders (n = 8) to generate a preliminary model of the service; and (3) focus group with community pharmacy owners and managers (n = 4) to explore the feasibility and appropriateness of the model. Data were analysed qualitatively to identify themes and intersections between themes. The JeMa2 model to conceptualize pharmacy-based health programs was used to build a theoretical model of the service.

Results

Stakeholders delineated: a clear target population (i.e., individuals ≥65 years old, with hypertension, with or without previous AF or stroke); the components of the service (i.e., patient education; self-monitoring at home; results evaluation, referral and follow-up); and a set of circumstances that may influence the implementation of the service (e.g., quality of the service, competency of the pharmacist, inter-professional relationships, etc.). A number of strategies were recommended to enable implementation (e.g.,. endorsement by leading cardiovascular organizations, appropriate communication methods and channels between the pharmacy and the general medical practice settings, etc.).

Conclusion

A novel and preliminary model of a CPS aimed at enhancing the management of AF was generated from this participatory process. This model can be used to inform decision making processes aimed at adopting and piloting of the service. It is expected the co-designed service has been adapted to suit existing needs of patients and current care practices, which, in turn, may increase the feasibility and acceptance of the service when it is implemented into a real setting.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2947-7) contains supplementary material, which is available to authorized users.

Bill of Services (BOS)

Bill of Services (BOS) is a novel management tool designed to support service organizations in developing their services and planning resources to satisfy management's target service level. This paper presents a methodology for configuration of the BOS in a manner similar to configuration of the Bill of Materials (BOM) in a manufacturing organization. Definition of the BOS enables management to calculate the capacity of the resources needed to satisfy service demand and support the cost process of any service category in the organization. The BOS may also support management during the phase of negotiations with potential customers by testing various service alternatives. The BOS assists management in the day-to-day planning and control of activities, and facilitates a professional management infrastructure in service organizations. The paper presents a detailed example of a hotel BOS and elaborates the advantages of using this management tool.