The Participatory Zeitgeist: an explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement.

Healthcare systems redesign and service improvement approaches are adopting participatory tools, techniques and mindsets. Participatory methods increasingly used in healthcare improvement coalesce around the concept of coproduction, and related practices of cocreation, codesign and coinnovation. These participatory methods have become the new Zeitgeist-the spirit of our times in quality improvement. The rationale for this new spirit of participation relates to voice and engagement (those with lived experience should be engaged in processes of development, redesign and improvements), empowerment (engagement in codesign and coproduction has positive individual and societal benefits) and advancement (quality of life and other health outcomes and experiences of services for everyone involved should improve as a result). This paper introduces Mental Health Experience Co-design (MH ECO), a peer designed and led adapted form of Experience-based Co-design (EBCD) developed in Australia. MH ECO is said to facilitate empowerment, foster trust, develop autonomy, self-determination and choice for people living with mental illnesses and their carers, including staff at mental health services. Little information exists about the underlying mechanisms of change; the entities, processes and structures that underpin MH ECO and similar EBCD studies. To address this, we identified eight possible mechanisms from an assessment of the activities and outcomes of MH ECO and a review of existing published evaluations. The eight mechanisms, recognition, dialogue, cooperation, accountability, mobilisation, enactment, creativity and attainment, are discussed within an 'explanatory theoretical model of change' that details these and ideal relational transitions that might be observed or not with MH ECO or other EBCD studies. We critically appraise the sociocultural and political movement in coproduction and draw on interdisciplinary theories from the humanities-narrative theory, dialogical ethics, cooperative and empowerment theory. The model advances theoretical thinking in coproduction beyond motivations and towards identifying underlying processes and entities that might impact on process and outcome. TRIAL REGISTRATION NUMBER: The Australian and New Zealand Clinical Trials Registry, ACTRN12614000457640 (results).

Improving healthcare through the use of co-design.

AIM: This paper describes how co-design methods can be used to improve patient experiences and services within healthcare organisations. Using the Patient Co-design of Breast Service Project as an example, we describe how patient experiences were captured and understood, the improvements made and implications for future work. METHOD: We used a six-step process: engage, plan, explore, develop, decide and change. Tools and techniques employed were based on service design approaches. These included patient journey mapping, experience-based surveys and co-design workshops. RESULTS: Information, communication, navigation and co-ordination, and environment emerged as key themes for the Breast Service. And as a result, a suite of improvements were made. Key methodological learnings included using co-design alongside traditional quality improvement methodologies, engaging with patients early, the importance of staff buy-in and the necessity of trying things outside one's comfort zone. CONCLUSION: Use of co-design within the Breast Service has resulted in tangible improvements and has demonstrated the value of engaging patients and focussing on their experiences. It is recommended that: evaluation phases are factored into future co-design work, further research is conducted on sustainability and funding and support is given to allow co-design to become more widespread throughout New Zealand.