Using a national archive of patient experience narratives to promote local patient-centered quality improvement: an ethnographic process evaluation of 'accelerated' experience-based co-design.

OBJECTIVES: To evaluate an accelerated form of experience-based co-design (EBCD), a type of participatory action research in which patients and staff work together to improve quality; to observe how acceleration affected the process and outcomes of the intervention. METHODS: An ethnographic process evaluation of an adapted form of EBCD was conducted, including observations, interviews, questionnaires and documentary analysis. Whilst retaining all components of EBCD, the adapted approach replaced local patient interviews with secondary analysis of a national archive of patient experience narratives to create national trigger films; shortened the timeframe; and employed local improvement facilitators. It was tested in intensive care and lung cancer in two English National Health Service (NHS) hospitals. A total of 96 clinical staff (primarily nursing and medical), and 63 patients and family members participated in co-design activities. RESULTS: The accelerated approach proved acceptable to staff and patients; using films of national rather than local narratives did not adversely affect local NHS staff engagement, and may have made the process less threatening or challenging. Local patients felt the national films generally reflected important themes although a minority felt they were more negative than their own experience. However, they served their purpose of 'triggering' discussion between patients and staff, and the resulting 48 co-design (improvement) activities across the four pathways were similar to those in EBCD, but achieved more quickly and at lower cost. CONCLUSIONS: Accelerated EBCD offers a rigorous and relatively cost-effective patient-centered quality improvement approach.

Facilitating an accelerated experience-based co-design project.

This article describes an accelerated experience-based co-design (AEBCD) quality improvement project that was undertaken in an adult critical care setting and the facilitation of that process. In doing so the aim is to encourage other clinical settings to engage with their patients, carers and staff alike and undertake their own quality improvement project. Patient, carer and staff experience and its place in the quality sphere is outlined and the importance of capturing patient, carer and staff feedback established. Experience-based co-design (EBCD) is described along with the recently tested accelerated version of the process. An overview of the project and outline of the organisational tasks and activities undertaken by the facilitator are given. The facilitation of the process and key outcomes are discussed and reflected on. Recommendations for future undertakings of the accelerated process are given and conclusions drawn.