shared sense of purpose

Care Design 2016 is a piece of work being undertaken by NHS England Horizons and the Nuffield Trust to develop a set of universal design principles for new care models in health and care. This aim of this work is to build a community of people who want to share insight, ideas and experience to help us create a set of ‘redesign principles.’ This report sets out the context to this work, an update on the findings so far and a proposed plan to support its successful completion.

If we look across the world at the experience of new care models to date, we can start to see recurring themes in the principles upon which they are being designed. The aim of this work is to bring together new insights from people across the world who wish to share their design experience of introducing new models of care. Our ambition is to identify these recurring themes in new care models and create principles that provide a template of what a new care model looks like, and thus guidance on how they can best be designed.

The intention is to introduce principles that are universal, so they are not limited to the NHS but can be equally used throughout the world regardless of the health system or the specific challenge they face.
The five aims of our call to action are to:

Distil a new set of design principles to accelerate the implementation of models for care that are truly based on the wants and needs of people who use the care system, patients and families.

Organise the principles in a way that makes them accessible and highly useable to people designing new care models.

Identify examples from across the world of the design principles in action.

Signpost tools, methods and resources that can help in the implementation of the design principles.

Demonstrate the power of design thinking for health and care transformation.

We introduced an expert panel early on in the process. These are individuals chosen for their knowledge and contribution to this emerging area of work. The role of the panel is to reflect and develop the ideas surfaced through the crowd; helping to sort and prioritise those ideas at the end of each stage.

In addition, we introduced a design approach that is seldom applied in the field of health and care to support this process called Crowdicity. This method of engagement and participation online is based on a number of givens.

If you really interested in developing new forms of engagement to listen and hear what your patients, carers, and staff think and feel then you will be continuously in search for new methods and approaches to achieve this. In a more digital age, crowdsourcing takes participation in design work to new levels as it encourages participants to vote for and against ideas as well as contribute their comments.

We assessed the value of this method and identified the following features that were useful to this work:

The expertise for developing these principles lies within the crowd with people who volunteer to share their ideas and experiences.

The power lies with the audience to tell their stories, share their ideas and generate new threads.

As an on-line platform participants are encouraged to see themselves as co-producers, and innovators.

This is a smarter and more cost ¬effective ways to harness the intelligence of your crowd at scale.

Anyone can take part in helping to shape these principles, whether they are a health and care professional or not.

There should be no barriers to anyone who wants to contribute by suggesting ideas, signposting resources and voting for the best ideas.

People are willing to learn as well as to challenge the opinions of others.

Crowdsourcing is a useful data collection method and like most methods it has its limitations. We found that analysing large data sets that tend to be highly individualised can be problematic. It can be difficult to see the key trends and ideas that are innovative may not be attract high levels of votes. We looked across the principles to assess the number of contributors, votes, volume of responses, and made an initial assessment of the top level findings.

We quickly identified contributions that stimulated deeper discussions, as well as resources and reference points that could be used to support on-line learning and sharing. We began to tag principles that participants felt duplicated with others as well as comments that made requests for clarification and definitions. A number of data filters were used to refine comments and contributions so that we could identify key statements that expound a principle and bring a shared sense of meaning and interpretation. Through consultations with our expert panel and the Horizons Team one of the key challenges is the language used to describe a principle and the extent to which this led to duplication in responses and whether this was meaningful to people delivering care. A key learning on design is that people from across health and care should be able to connect at ‘heart’ and ‘minds’ level to the care design principles in order that their true value in shaping health care practices be realised. The end result of this project is a revised set of principles that are highly accessible in terms of language and meaning and that has potential to be a key reference point to individuals designing care systems in the future:

Care Design Principles 2016

Understand who needs care and what they need – identify common needs across the population and design services to meet those needs

Design care so people can flourish

From supply side (service led) improvement to demand side (citizen-driven) change

Design care so that when people need it they flow effortlessly through they system

It’s a complex world: plan for emergent not just certainty

Technology enabled

Networks/sharing spaces and organisations

Measure outcomes that matter

Mobilising and valuing the people and assets in the local place

Continuous improvement and attention to detail. Standardise where you can, customise where you need.

Ensure environmental sustainability

We are now looking at case study examples of similar methods that have been used to improve health and care as well as resources that can be used by practitioners to support their learning and engagement on this important area of work.

Our expert panel will also be invited to contribute their ideas and resources as well as blogs. The methods and resources collated will be available on the Edge and we will continue to encourage people to build these principles into their change efforts.

Janet Wildman and Carol Read
Horizons NHS England