1. What is Experience-Based Co-Design?

Experience based co-design (EBCD) is an approach that enables staff and patients (or other service users) to co-design services and/or care pathways, together in partnership. The approach is different from other service improvement techniques in the way that the experience and knowledge of patients is central, and is used to make change.

EBCD involves gathering experiences from patients and staff through in-depth interviewing, observations and group discussions, identifying key ‘touch points’ (emotionally significant points) and assigning these positive or negative feelings.

A short, edited film is created from the patient interviews, and sometimes the staff interviews as well. This is then shown to staff and patients first separately, then together, conveying in an impactful way how patients experience the service. Staff and patients are then brought together to explore the findings and to work in small groups to identify and implement activities that will improve the service or the care pathway.

The approach was designed for and within the NHS to develop simple solutions that offer patients a better experience of treatment and care. Similar user-centric design techniques have been used by leading global companies for years.

Within health care, the approach has already been used in a range of clinical services, including cancer, diabetes, drug and alcohol treatment, emergency services, genetics, inpatient units, intensive care, mental health, orthopaedics, palliative care and surgical units. The Point of Care Foundation has supported the EBCD approach to be used in other maternity settings:

Vermont Oxford Network of Neonatal Units
Improving fetal monitoring, a three year programme funded by NIHR

Throughout the maternity toolkit we refer to ‘women’ but this also applies to their partners, friends and family members who might also bring their experience to a project.

Adaptations

Over time the approach has evolved and has been adapted in different ways by different sites. One major adaptation is accelerated EBCD, which replaces the individual patient videos with existing videos from an archive, which have been found to have a similar impact despite requiring half the resources of the full approach. The original toolkit describes this here.

During the Covid pandemic, when it was not possible to meet face-to-face the approach was adapted to be carried out online. To see how this was done, visit https://www.thisinstitute.cam.ac.uk/research-projects/davinci/

The EBCD process

The experience-based co-design process follows a number of steps or stages. They are often set out like this, as a sequence of steps.

The New Beginnings project described their stages like this:

Stages of New Beginnings:

Set up a steering group (anaesthetist, obstetrician, theatre nurse, midwife, junior doctor, general manager and someone from the QI team plus a patient representative) to plan and oversee project.
Established a core working group who conducted the project.
Undertook training in patient centred QI approaches and methods.
Mapped stakeholders to ensure all perspectives were reflected and they mapped closely to their organisational values.
Gathered data to understand baseline and current experience of patients using St George’s maternity services.
Interviewed a sample of women who had been recent patients and shadowed a sample of current patients to construct a view of the current position.
Devised a driver diagram to prioritise areas of improvement, and check for overlaps with current improvement work in the trust.
Established co-design groups to work on priorities for improvement in collaboration with patients.
Implemented improvements using small tests of change.
Follow-up evaluated the impact of the improvements.

Is Experience Based Co-design for you?

Experience-based co-design (EBCD) is an approach to service improvement which is different from many others, because it captures the experiences of patients, carers and staff through discussion, observation and filmed interviews.

Key points about EBCD:

EBCD focuses on patient and staff experience and emotions rather than attitudes or opinions.
The approach uses storytelling to identify opportunities for improvement and focuses on the usability of the service for patients and staff.
It empowers staff and patients to make changes.
Because the approach is qualitative, not quantitative, it provides rich insights into the experience of patients and staff. By filming the stories of people’s experiences, and then bringing staff and patients together to prioritise areas for improvement and define key actions, it becomes extremely focused and leads to clearly demonstrable results. There is a growing body of evidence showing the effectiveness of the approach.
EBCD is adaptable. It can be tailored to different situations.

To hear why Emma and Andrew (the project leaders for New Beginnings) chose EBCD as their approach for New Beginnings, watch here: