The impact of status and social context on health service co-design: an example from a collaborative improvement initiative in UK primary care

Ian Litchfield,Sheila Greenfield,Ann Hill,Richard Lilford,Richard J Mcmanus,Louise Bentham

doi:10.1186/s12874-018-0608-5

Abstract

BackgroundIncreasingly, collaborative participatory methods requiring open and honest interaction between a range of stakeholders are being used to improve health service delivery. To be successful these methodologies must incorporate perspectives from a range of patients and staff. Yet, if unaccounted for, the complex relationships amongst staff groups and between patients and providers can affect the veracity and applicability of co-designed solutions.MethodsTwo focus groups convened to discuss suggestions for the improvement of blood testing and result communication in primary care. The groups were mixed of patients and staff in various combinations drawn from the four participating study practices. Here we present a secondary mixed-method analysis of the interaction between participants in both groups using sociogrammatic and thematic analysis.ResultsDespite a similar mix of practice staff and patients the two groups produced contrasting discussions, seemingly influenced by status and social context. The sociograms provided a useful insight into the flow of conversation and highlighted the dominance of the senior staff member in the first focus group. Within the three key themes of social context, the alliances formed between participants and the fluidity of the roles assumed manifested differently between groups apparently dictated by the different profile of the participants of each.ConclusionsFor primary care service improvement attention must be paid to the background of participants when convening collaborative service improvement groups as status and imported hierarchies can have significant connotations for the data produced.

Highlights

Collaborative participatory methods requiring open and honest interaction between a range of stakeholders are being used to improve health service delivery
Over the last decade, healthcare has seen a move toward greater teamwork across traditional staff and patient boundaries [1,2,3] and more recently reflected in a similar shift in quality improvement strategies
Establishing uninhibited working groups of patients and staff is not necessarily straightforward [14], participants often have a range of motivations for becoming actively involved [15] and the complex relationship between academics, NHS staff, patients and the public is rarely considered [16]

Summary

Introduction

Collaborative participatory methods requiring open and honest interaction between a range of stakeholders are being used to improve health service delivery. To be successful these methodologies must incorporate perspectives from a range of patients and staff. If unaccounted for, the complex relationships amongst staff groups and between patients and providers can affect the veracity and applicability of co-designed solutions. Previous studies have explored how characteristics of participants, can influence the complex social context of heterogeneous focus groups analogous to those used in co-design [17, 18]. Constituting collaborative groups requires careful consideration, previous work has described the advantages to pre-existing groups [17], for example, they’re easier to recruit and their familiarity facilitates discussion. Existing advice on recruiting extends only to recruiting a range of appropriate participants [24, 25], there has been no explicit discussion as to how the prior relationship of participants might influence the outcomes of co-design initiatives

Methods

Results

Discussion

Conclusion