A co-design approach to service improvement resulted in teams exhibiting characteristics that support innovation

Wolstenholme, Daniel; Grindell, Cheryl; Dearden, Andy

doi:10.1080/24735132.2017.1295531

Cited by 22 publications

(17 citation statements)

References 15 publications

(17 reference statements)

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“…One common approachexperience-based co-design -has been widely used to create systems change in emergency medicine and mental health care settings [27,28]. A specific method of experience-based co-design is the Double Diamond Design Approach (DDDA) [29] that has been used to develop service improvements in health and social care [30], patient-centered cancer treatment facilities [31], and organisational medical care [32]. The DDDA draws on recent discoveries on how to optimise both divergent -creating choices-and convergent -making choicescreative thinking processes [29,33].…”

Section: Introductionmentioning

confidence: 99%

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Daly-Smith

Quarmby

Archbold

et al. 2020

Int J Behav Nutr Phys Act

139

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Background: UK and global policies recommend whole-school approaches to improve childrens' inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure 'systems' change, a framework is required that identifies all components of a whole-school PA approach. The study's aim was to codevelop a whole-school PA framework using the double diamond design approach (DDDA).Methodology: Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n = 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n = 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one 'initial' framework. Next, stakeholders reviewed the 'initial' framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire.Results: Following voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers' capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder wholeschool PA.Summary: To the authors' knowledge, this is the first time practitioners, policymakers and researchers have codesigned a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives 'with' schools, while abandoning outdated traditional approaches of implementing interventions 'on' schools.

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Section: Introductionmentioning

confidence: 99%

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Daly-Smith

Quarmby

Archbold

et al. 2020

Int J Behav Nutr Phys Act

139

View full text Add to dashboard Cite

show abstract

“…One common approach -experiencebased co-design -has been widely used to create systems change in emergency medicine and mental health care settings [24,25]. A specific method of experience-based co-design is the Double Diamond Design Approach (DDDA) [26] that has been used to develop service improvements in health and social care [27], patient-centered cancer treatment facilities [28], and organisational medical care [29]. The DDDA draws on recent discoveries on how to optimise both divergent -creating choicesand convergent -making choices -creative thinking processes [26,30].…”

Section: Introductionmentioning

confidence: 99%

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Daly-Smith

Quarmby

Archbold

et al. 2019

Preprint

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Background UK and global policies recommend whole-school approaches to improve childrens’ inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective and sustainable interventions which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure ‘systems’ change, a framework is required that identifies the many components of a whole-school PA approach. The aim of this paper was to co-develop a whole-school PA framework using the double diamond design approach (DDDA); a four-stage reflective process to discover, define, develop, and deliver an innovative solution to a problem. Framework development process Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n=9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n=6) stakeholder groupings. Six draft frameworks were created before stakeholders selected one ‘initial’ framework through an individual voting process. Next, stakeholders reviewed the ‘initial’ framework, proposing modifications. Following the workshop, the original stakeholders voted on eight proposed modifications using an online questionnaire. Following voting, the final Creating Active Schools (CAS) Framework was designed. Summary To the authors knowledge, this is the first time practitioners, policy makers and researchers who understand the powerful driving agents of school systems and teacher and pupil PA behaviour, have co-designed a whole-school PA framework from initial conception. The novelty of the CAS framework resides in formally identifying the multitude of interconnecting elements of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The CAS framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, the CAS framework presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives ‘with’ schools, while abandoning outdated traditional approaches of implementing interventions ‘on’ schools.

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“…An average of four such discussions or planning meetings was conducted at each PHC with the staff before we began implementing the interventions. This participatory approach was inspired by the action research methodology ( Whyte, 1991 ) relevant to QI initiatives, and is known to increase ownership of such initiatives ( Wolstenholme et al , 2017 ). Our role as a research team was to facilitate the discussions.…”

Section: Methodsmentioning

confidence: 99%

Team-based primary health care for non-communicable diseases: complexities in South India

Lall

Engel²,

Devadasan

et al. 2020

Health Policy and Planning

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Chronic non-communicable diseases (NCDs), such as diabetes and cardiovascular diseases, have reached epidemic proportions worldwide. Health systems, especially those in low- and middle-income countries, such as India, struggle to deliver quality chronic care. A reorganization of healthcare service delivery is needed to strengthen care for chronic conditions. In this study, we evaluated the implementation of a package of tailored interventions to reorganize care, which were identified following a detailed analysis of gaps in delivering quality NCD care at the primary care level in India. Interventions included a redesign of the workflow at primary care clinics, a redistribution of tasks, the introduction of patient information records and the involvement of community health workers in the follow-up of patients with NCDs. An experimental case study design was chosen to study the implementation of the quality improvement measures. Three public primary care facilities in rural South India were selected. Qualitative methods were used to gain an in-depth understanding of the implementation process and outcomes of implementation. Observations, field notes and semi-structured interviews with staff at these facilities (n = 15) were thematically analysed to identify contextual factors that influenced implementation. Only one of the primary health centres implemented all components of the intervention by the end of 9 months. The main barriers to implementation were hierarchical arrangements that inhibited team-based care, the amount of time required for counselling and staff transfers. Team cohesion, additional staff and staff motivation seem to have facilitated implementation. This quality improvement research highlights the importance of building relational leadership to enable team-based care at primary care clinics in India. Redesigned organization of care and task redistribution is important solutions to deliver quality chronic care. However, implementing these will require capacity building of local primary care teams.

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A co-design approach to service improvement resulted in teams exhibiting characteristics that support innovation

Cited by 22 publications

References 15 publications

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Team-based primary health care for non-communicable diseases: complexities in South India

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