Sara Donetto

Experience-based Co-design and Healthcare Improvement: Realizing Participatory Design in the Public Sector

ABSTRACT Over the last decade, growing attention has been paid to the potential value of design theory and practice in improving public services. Experience-based Co-design (EBCD) is a participatory research approach that draws upon design tools and ways of thinking in order to bring healthcare staff and patients together to improve the quality of care. The co-design process that is integral to EBCD is powerful but also challenging, as it requires both staff and patients to renegotiate their roles and expectations as part of a reconfiguration of the relationships of power between citizens and public services. In this paper, we reflect upon the implementation and adaptation of EBCD in a variety of projects and on the challenges of co-design work within healthcare settings. Our discussion aims to contribute to the growing field of service design and to encourage further research into how co-design processes shape—and are shaped by—the power relations that characterize contemporary public services.

Medical students' views of power in doctor-patient interactions: the value of teacher-learner relationships

Medical Education 2010: 44 : 187–196

Medical Students and Patient-Centred Clinical Practice: The Case for More Critical Work in Medical Schools.

In the last two decades, undergraduate medical education in the United Kingdom has undergone several important changes. Many of these have revolved around a paradigmatic shift from ‘paternalistic’ to ‘patient-centred’ approaches to healthcare. Adopting a Foucauldian understanding of power and borrowing from Freire’s critical pedagogy, in this paper I draw upon ethnographic data from one UK medical school to illustrate the recurrence among medical students of narrow and uncritical understandings of patient-centred practices. These understandings highlight a tension between the ideals and frameworks of medical education policy and students’ conceptualisations of professional learning and practice. I explore this tension by tracing some possible links between students’ views of patient-centredness and the teaching practices at the medical school. I argue that more critical approaches to medical learning are sorely needed and suggest some directions for medical education that would help support the personal and professional development of more critically aware practitioners.

Talking about power in medical education

The analysis of professional power in medicine is a central theme in social science scholarship. Discussions of what counts as medical power, how it operates, and through which discourses and practices it circulates and produces tangible effects in everyday life are, however, rather infrequent in medical education research and practice. Gabel’s article in this issue of Medical Education helpfully – and bravely perhaps – draws attention to the often neglected issue of whether we should think and talk about professional power within the undergraduate medical curriculum and how we might go about doing so.

Beneficial effects of gluten free diet in potential coeliac disease in adult population

BACKGROUND To date, potential coeliac disease (PCD) occurring in adults remains an almost unexplored condition. AIMS To explore the prognostic role of Marsh grade in adult PCD patients, and to evaluate the effects of gluten-containing diet (GCD) in asymptomatic PCD patients. METHODS We retrospectively evaluated all consecutive adult PCD patients followed-up for at least 6 years. Patients were divided into: Group A (patients with Marsh 0 histology) and Group B (Marsh 1 patients). Symptomatic patients were started gluten-free diet (GFD), while asymptomatic subjects were kept on GCD and were followed-up. RESULTS 56 PCD patients were enrolled (21 in Group A and 35 in Group B). Forty-three patients were symptomatic and started GFD. Of these, none of 15 patients in Group A and 8 of 28 patients in Group B developed immune-mediated disorders (IMD) during follow-up (P=0.03; OR=4.2). The 13 asymptomatic PCD patients were kept on GCD. During the follow-up, 9 patients developed CD-related symptoms, 6 villous atrophy and 8 IMD. At the end, patients kept on GCD were at higher risk of developing IMD than those following a GFD (61% vs 18%, P=0.03, OR=3.3). CONCLUSIONS Although PCD with normal mucosa seems to be a milder disease, the continuation of GCD places patients at a high risk of developing villous atrophy and IMD compared to commencement of GFD. Adult PCD patients should start GFD even if not symptomatic.

Nursing work and sensory experiences of hospital design: A before and after qualitative study following a move to all-single room inpatient accommodation

Abstract The embodied experience of nursing practice is rarely studied. Drawing on data from an internationally relevant larger study conducted in 2013–14, here we explore the sensory dimension of the embodied experiences of nursing staff working on two acute NHS hospital wards before and after a move to all‐single room inpatient accommodation. We undertook a secondary analysis of 25 interviews with nursing staff (12 before and 13 after the move with half [13/25] using photographs taken by participants) from a mixed‐method before‐and‐after study. This analysis focused on the sensory dimensions of nursing staffs experiences of their working practices and the effect of the built environment upon these. Drawing on Pallasmaas theoretocal insights, we report how the all‐single room ward design prioritises ‘focused vision’ and hinders peripheral perception, whilst the open ward environment is rich in contextual and preconscious information. We suggest all‐single room accommodation may offer staff an impoverished experience of caring for patients and of working with each other. HighlightsDifferences in seeing/hearing patients and staff in open/single room environments (82).The open ward environment is rich in contextual and preconscious information (76).Staff in single rooms prioritise focused vision; peripheral perception is hindered (82).Single room design hinders support, situation awareness and care prioritisation (80).Teamwork can be undermined in single rooms; this may be detrimental for patient care (84).

Taking data seriously: the value of actor-network theory in rethinking patient experience data:

Hospitals are awash with patient experience data, much of it collected with the ostensible purpose of improving the quality of patient care. However, there has been comparatively little consideration of the nature and capacities of data itself. Using insights from actor-network theory, we propose that paying attention to patient experience data as having agency in particular hospital interactions allows us to better trace how and in what circumstances data lead (or fail to lead) to quality improvement.

Response to: ‘A ‘work smarter, not harder’ approach to improving healthcare quality’ by Hayes et al

Hayes et al 1 highlight design-based approaches to healthcare improvement as one means of achieving patient-centred care, describing them as involving ‘co-designing care with patients that result in a better fit with patients’ abilities and needs’. They cite Experience-based Co-design (EBCD) as one such approach. They then go on to argue that those leading improvement work in a healthcare organisation or system should adopt similar approaches with their workforce and that, in doing so, they would gain ‘a more explicit understanding of—and goal—to preserve workforce capacity and reduce the workload associated with change.’1 We wonder whether the authors intended what could be read as an apparent separation between, on the one hand, ‘co-designing’ with and for the benefit of patients and, on the other, engaging with staff to ease the perceived burden of improvement work? If so, is such a separation the most useful framing when thinking about ‘smarter’ ways of improving healthcare quality? The article therefore opens up questions relating to the most fundamental (and radical) tenet of co-design, namely that ‘user and provider can work together to optimise the content, form and delivery of services...[it] entails service development driven by the equally respected voices of users, providers and professionals’.2 …