Co-design in acute care is challenged by the inability of unwell patients to participate in the process and the often transient nature of acute care.
We undertook a rapid review of the literature on co-design, co-production and co-creation of solutions for acute care that were developed with patients. We found limited little evidence for co-design methods in acute care.
We adapted a novel design driven method (BASE methodology) that creates stakeholder groups through epistemological criteria for the rapid development of interventions for acute care. We demonstrated feasibility of the methodology in two case studies:
A mHealth application with checklists for patients undergoing treatment for cancer and a patient held record for self-clerking on admission to hospital.

References

1. Farrugia G, Plutowski RW. Innovation Lessons From the COVID-19 Pandemic. Mayo Clin Proc. 2020;95(8):1574-1577. doi:10.1016/j.mayocp.2020.05.024
2. Innovate UK. Design in Innovation Strategy 2020-2024. London; 2020.
3. Bradley P, Willson A, Buss P, et al. Achieving Prudent Healthcare in NHS Wales.; 2014.
4. Rix A, Marrin K, Lewis P, Jones R, Shorrocks O. Prudent health care and patient activation An appraisal prepared for the Planned Care Programme Acknowledgements Acknowledgements are due to of the Planned Care Programme for their support and patience, and to Mike Spencer (1000 Lives) and Ruth Dineen (Co-production Wales) for their advice on Patient Experience and Co- production respectively. 2015.
5. Clarke D, Jones F, Harris R, Robert G. What outcomes are associated with developing and implementing coproduced interventions in acute healthcare settings? A rapid evidence synthesis. BMJ Open. 2017;7. doi:10.1136/bmjopen-2016-014650
6. Nesta. People powered health co production catalogue. 2012:89.
7. Gallagher M, Wales H, Dineen R, Wales C-P. Seeing is Believing: Co-production Case Studies from Wales (version 06 - 12 January 2016). 2012.
8. National Voices. Realising the value: how should we think about value in health and care? 2015;(September):20.
9. Batalden M, Batalden P, Margolis P, et al. Coproduction of healthcare service. BMJ Qual Saf. 2015;(pii: bmjqs-2015-004315.).
10. Alsem MW, van Meeteren KM, Verhoef M, et al. Co-creation of a digital tool for the empowerment of parents of children with physical disabilities. Res Involv Engagem. 2017;3(1). doi:10.1186/s40900-017-0079-6
11. Davies N, Mathew R, Wilcock J, et al. A co-design process developing heuristics for practitioners providing end of life care for people with dementia. BMC Palliat Care. 2016;15(1):68. doi:10.1186/s12904-016-0146-z
12. Bringing User Experience to Healthcare Improvement: The Concepts, Methods and Practices of Experience-Based Design: Amazon.co.uk: Bate, Paul, Robert, Glenn: 8601200768732: Books. https://www.amazon.co.uk/Bringing-User-Experience-Healthcare-Improvement/dp/1846191769. Accessed June 22, 2020.
13. Joseph-Williams N, Lloyd A, Edwards A, et al. Implementing shared decision making in the NHS: lessons from the MAGIC programme. BMJ. 2017;357:j1744. doi:10.1136/bmj.j1744
14. Melnick ER, Probst MA, Schoenfeld E, et al. Development and Testing of Shared Decision Making Interventions for Use in Emergency Care: A Research Agenda. Acad Emerg Med. 2016;23(12):1346-1353. doi:10.1111/acem.13045
15. Flynn D, Knoedler MA, Hess EP, et al. Engaging patients in health care decisions in the emergency department through shared decision-making: A systematic review. Acad Emerg Med. 2012;19(8):959-967. doi:10.1111/j.1553-2712.2012.01414.x
16. Simpson N, Milnes S, Steinfort D. Don’t forget shared decision-making in the COVID-19 crisis. Intern Med J. 2020;50(6):761-763. doi:10.1111/imj.14862
17. Contreras CM, Metzger GA, Beane JD, Dedhia PH, Ejaz A, Pawlik TM. Telemedicine: Patient-Provider Clinical Engagement During the COVID-19 Pandemic and Beyond. J Gastrointest Surg. 2020. doi:10.1007/s11605-020-04623-5
18. Stevens DP, Marshall BC. A decade of healthcare improvement in cystic fibrosis: Lessons for other chronic diseases. BMJ Qual Saf. 2014;23(SUPPL1):i1-i2. doi:10.1136/bmjqs-2014-002871
19. Crandall W, Kappelman MD, Colletti RB, et al. ImproveCareNow: The development of a pediatric inflammatory bowel disease improvement network. Inflamm Bowel Dis. 2011;17(1):450-457. doi:10.1002/ibd.21394
20. Berry SK, Siegel CA, Melmed GY. Quality Improvement Initiatives in Inflammatory Bowel Disease. Curr Gastroenterol Rep. 2017;19(8). doi:10.1007/s11894-017-0581-x
21. Piper D, Iedema R, Gray J, Verma R, Holmes L, Manning N. Utilizing experience-based co-design to improve the experience of patients accessing emergency departments in New South Wales public hospitals: An evaluation study. Heal Serv Manag Res. 2012;25(4):162-172. doi:10.1177/0951484812474247
22. Bowen S, McSeveny K, Lockley E, Wolstenholme D, Cobb M, Dearden A. How was it for you? Experiences of participatory design in the UK health service. CoDesign. 2013;9(4):230-246. doi:10.1080/15710882.2013.846384
23. Schenkel S. Promoting patient safety and preventing medical error in emergency departments. Acad Emerg Med. 2000;7(11):1204-1222. doi:10.1111/j.1553-2712.2000.tb00466.x
24. Hogan H, Healey F, Neale G, Thomson R, Vincent C, Black N. Preventable deaths due to problems in care in English acute hospitals : a retrospective case record review study. 2012;(July). doi:10.1136/bmjqs-2012-001159
25. Vennik FD, Van De Bovenkamp HM, Putters K, Grit KJ. Co-production in healthcare: rhetoric and practice. Int Rev Adm Sci. 2016;82(1):150-168. doi:10.1177/0020852315570553
26. Parkinson JA, Eccles KE, Goodman A. Positive impact by design: The Wales Centre for Behaviour Change. J Posit Psychol. 2014;9(6):517-522. doi:10.1080/17439760.2014.936965
27. Tricco AC, Antony J, Zarin W, et al. A scoping review of rapid review methods. BMC Med. 2015;13(1):1-15. doi:10.1186/S12916-015-0465-6/TABLES/6
28. Design Scenarios - Communicating the Small Steps in the User Experience | Interaction Design Foundation. https://www.interaction-design.org/literature/article/design-scenarios-communicating-the-small-steps-in-the-user-experience. Accessed July 13, 2018.
29. Rasoulifar R, Thomann G, Villeneuve F. Scenarios and the design process in medical application. CIRP Des Conf Compet Des. 2009;6.
30. Carroll JM. Five reasons for scenario-based design. Interact Comput. 2000;13(1):43-60. doi:10.1016/S0953-5438(00)00023-0
31. Reeder B, Demiris G. Building the PHARAOH framework using scenario-based design: A set of pandemic decision-making scenarios for continuity of operations in a large municipal public health agency. J Med Syst. 2010;34(4):735-739. doi:10.1007/s10916-009-9288-3
32. Valaitis R, Longaphy J, Ploeg J, et al. Health TAPESTRY: Co-designing interprofessional primary care programs for older adults using the persona-scenario method. BMC Fam Pract. 2019;20(1):1-11. doi:10.1186/s12875-019-1013-9
33. Institute of Medicine (US) and National Academy of Engineering (US) Roundtable on Value & Science-Driven Health Care. Healthcare System Complexities, Impediments, and Failures. In: Engineering a Learning Healthcare System: A Look at the Future. National Academies Press (US); 2011.
34. Ou L, Chen J, Assareh H, Hollis SJ, Hillman K, Flabouris A. Trends and Variations in the Rates of Hospital Complications , Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales , Australia , 2002-2009. 2014;9(5):2002-2009. doi:10.1371/journal.pone.0096164
35. Taenzer AH, Pyke JB, McGrath SP. A review of current and emerging approaches to address failure-to-rescue. Anesthesiology. 2011;115(2):421-431.
36. Seys D, Wu AW, Van Gerven E, et al. Health Care Professionals as Second Victims After Adverse Events : A Systematic Review. Eval Health Prof. 2012;36(2):135-162.
37. Johnson JK, Farnan JM, Barach P, et al. Searching for the missing pieces between the hospital and primary care: mapping the patient process during care transitions. BMJ Qual Saf. 2012;21 Suppl 1(Suppl 1):i97-105. doi:10.1136/bmjqs-2012-001215
38. Johnson JK, Barach P, Vernooij-Dassen M, HANDOVER Research Collaborative. Conducting a multicentre and multinational qualitative study on patient transitions. BMJ Qual Saf. 2012;21 Suppl 1(Suppl 1):i22-8. doi:10.1136/bmjqs-2012-001197
39. O’Donnell D, Ní Shé É, McCarthy M, et al. Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting. BMC Health Serv Res. 2019;19(1). doi:10.1186/S12913-019-4626-8
40. Hospital A, Chan RJ, Green T, et al. Use and reporting of experience-based codesign studies in the healthcare setting: a systematic review. doi:10.1136/bmjqs-2019-009570
41. McKinney A, Fitzsimons D, Blackwood B, White M, McGaughey J. Co-design of a patient and family-initiated escalation of care intervention to detect and refer patient deterioration: Research protocol. J Adv Nurs. 2020;76(7):1803-1811. doi:10.1111/jan.14365
42. Strickland W, Pirret A, Takerei S. Patient and/or family activated rapid response service: Patients’ perceptions of deterioration and need for a service. Intensive Crit care Nurs. 2019;51:20-26. doi:10.1016/J.ICCN.2018.11.007
43. Newell K, Corrigan C, Punshon G, Leary A. Severe asthma: emergency care patient driven solutions. Int J Health Care Qual Assur. 2017;30(7):628-637. doi:10.1108/IJHCQA-09-2016-0127
44. Noble A, Nevitt S, Holmes E, et al. Seizure first aid training for people with epilepsy attending emergency departments and their significant others: the SAFE intervention and feasibility RCT. Heal Serv Deliv Res. 2020;8(39):1-190. doi:10.3310/HSDR08390
45. Blackwell RW née, Lowton K, Robert G, Grudzen C, Grocott P. Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes. Int J Nurs Stud. 2017;68:83-94. doi:10.1016/j.ijnurstu.2017.01.002
46. Subbe CP, Tomos H, Jones GM, Barach P. Express check-in: developing a personal health record for patients admitted to hospital with medical emergencies: a mixed-method feasibility study. Int J Qual Heal care J Int Soc Qual Heal Care. 2021;33(3). doi:10.1093/INTQHC/MZAB121
47. Blackwell RW née, Lowton K, Robert G, Grudzen C, Grocott P. Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes. Int J Nurs Stud. 2017;68:83-94. doi:10.1016/J.IJNURSTU.2017.01.002
48. Piper D, Iedema R, Gray J, Verma R, Holmes L, Manning N. Utilizing experience-based co-design to improve the experience of patients accessing emergency departments in New South Wales public hospitals: An evaluation study. Heal Serv Manag Res. 2012;25(4):162-172. doi:10.1177/0951484812474247
49. Time to Act - Severe Sepsis: Rapid Diagnosis and Treatment Saves Lives. London ; 2013.
50. Ham C (Ed), Berwick D (Ed). Organising Care at the NHS Front Line: Who Is Responsible? London; 2017.
51. Johnson JK, Haskell HW, Barach PR. Foundations for Core Competencies Case Studies in Patient Safety. Burlington, MA 01803: Jones & Bartlett Learning; 2016.
52. Diamond D. The Impact of Applying Design Thinking. 2020.
53. Share and engage with the Design Sprint Community. https://designsprintkit.withgoogle.com/methodology/phase3-sketch/crazy-8s. Accessed May 17, 2020.
54. Jones H V, Smith H, Cooksley T, et al. Checklists for Complications During Systemic Cancer Treatment Shared by Patients, Friends, and Health Care Professionals: Prospective Interventional Cohort Study. JMIR mHealth uHealth. 2020;8(9):e19225. doi:10.2196/19225
55. Subbe CP, Tomos H, Jones GM, Barach P. Express check-in: Developing a personal health record for patients admitted to hospital with medical emergencies: A mixed-method feasibility study. Int J Qual Heal Care. 2021;33(3). doi:10.1093/INTQHC/MZAB121
56. Donabedian A. The Quality of Care How Can It Be Assessed? JAMA . 1988;260:1743-1748.
57. Gooberman-Hill R, Jinks C, Bouças SB, et al. Designing a placebo device: Involving service users in clinical trial design. Heal Expect. 2013;16(4):100-110. doi:10.1111/hex.12043
58. Armstrong N, Herbert G, Aveling EL, Dixon-Woods M, Martin G. Optimizing patient involvement in quality improvement. Heal Expect. 2013;16(3). doi:10.1111/hex.12039
59. Lawton R, O’Hara JK, Sheard L, et al. Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention. BMJ Qual Saf. 2017;26(8):622-631. doi:10.1136/bmjqs-2016-005570
60. Knowles S, Hays R, Senra H, et al. Empowering people to help speak up about safety in primary care: Using codesign to involve patients and professionals in developing new interventions for patients with multimorbidity. Heal Expect. 2018;21(2):539-548. doi:10.1111/hex.12648
61. Hibbard J, Gilburt H. Supporting People to Manage Their Health: An Introduction to Patient Activation.; 2014.
62. How to Prototype a New Business – IDEO U. https://www.ideou.com/blogs/inspiration/how-to-prototype-a-new-business. Accessed June 22, 2020.
63. Peters BG. What is so wicked about wicked problems? A conceptual analysis and a research program OPEN ACCESS. Policy Soc. 2017;36(3):385-396. doi:10.1080/14494035.2017.1361633
64. Buchanan R. Wicked Problems in Design Thinking. Vol 8.; 1992.
65. Rittel, H.W.J. WMM. Rittel, Horst W. J., Dilemmas in a General Theory of Planning, Policy Sciences, 4:2 (1973:June) p.155. Policy. 1973;2:155.