Testing experience based co design: Understanding patient and staff experience  of experience based co design on an accute mental health ward to promote patient centred service improvement

: A multiple methods study

Abstract

Background There is little evidence on using patient experience to improve psychiatric hospital care. Patient involvement in the design of health care is a key policy initiative but few empirical studies address this. Aims and objectives The main aims were to: (1) study the implementation of a service user-led Experience-Based Co design (EBCD) intervention on a psychiatric ward; (2) explore whether EBCD can be successfully implemented in this setting; (3) measure the impact of EBCD in terms of the ward atmosphere; and (4) explore the role and impact of a service user group (Research Net) leading the implementation of EBCD. Methods A multiple methods study, including non-participant observation of key EBCD events (approximately 11 hours) and 18 semi-structured interviews with 11 participants in the EBCD events. Observational and interview data were analysed using thematic analysis. The Ward Atmosphere Scale (WAS) survey instrument was fielded on the ward both before and after the EBCD intervention and analysed using an unpaired t-test. Findings Awareness of EBCD varied between staff and members of Research Net; Research Net were optimistic that EBCD would improve care, staff were pessimistic. Nonetheless, EBCD caused anxiety for both staff and Research Net. Co design helped break down barriers but highlighted power imbalances between staff, managers and service-users. Adhering to the EBCD toolkit enhanced likely success of EBCD implementation but adaptations were required in a mental health setting. There were significant differences pre/post intervention on the WAS for patient experiences (p<0.005) of the ward but not for staff experience (p<0.04). Benefits and concerns were raised regarding the role of Research Net in implementing EBCD. Conclusions EBCD can be successfully implemented in a mental health setting. Service-user leadership of the project was positive, but more consideration needs to be given to fully involving staff in the process.

Date of Award	2018
Original language	English
Awarding Institution	King's College London
Supervisor	Glenn Robert (Supervisor) & Niall McCrae (Supervisor)