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Co-designing healthcare improvements during and beyond the pandemic

Putting many wise heads together can lead to better solutions in healthcare. But people with the right knowledge are often spread far and wide.
Jan Van Der Scheer
Dr Jan van der Scheer
Senior Research Associate

Putting many wise heads together can lead to better solutions in healthcare. But people with the right knowledge are often spread far and wide. Here’s a way to make the most of diverse expertise to build improvements collaboratively, remotely, and at scale.

When the pandemic hit, many established clinical processes needed to be adapted for COVID scenarios. But those adaptations needed to be made quickly, taking advantage of the best possible expertise, and in a way that avoided the waste associated with every unit having to come up with its own solution.

Collaborative approaches can work very well when the aim is to co-design new adaptations to clinical processes. Such approaches can work very well to combine academic rigour with the real concerns of the people who use and work in the NHS. But many traditional approaches were not going to work during the pandemic. NHS staff were even more pressured than usual. Standard techniques – such as in-person group workshops, interviews and ethnography – were not possible. Consensus-building methods often only involve small groups of people with similar backgrounds. And the mix of expertise needed to come up with the best possible solution is rarely going to be available in one place.

We realised that we needed a new, online approach – one that could engage with professionals and patients at scale, involve many forms of expertise, experience and knowledge, minimise participant time and effort, and demonstrate a participatory ethos. That’s what we set out to do: to come up with an innovative approach that can be used for improving many other healthcare processes for the future.

Developing such an approach usually works best by trying things out in practice. By talking to colleagues of the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, we identified a most urgent opportunity to test our approach. In April 2020, as the pandemic first hit, NHS staff were urgently seeking online resources and training. One important example involved obstetric emergencies such as post-partum haemorrhage (heavy bleeding after birth), where new processes were needed to keep people safe and still deliver high quality care and experience.

THIS Institute offered the capability – through its online Thiscovery platform – to facilitate collaborative design of a consensus-built solution at speed and scale. The project was up and running within weeks, supported by ongoing user-testing to make sure that the Thiscovery activities were fit for purpose.

Working with stakeholder organisations, we engaged with over 100 experts in maternity care, infection prevention and control, and human factors to take part – all this during a time of extreme pressure on these people. They first provided hundreds of suggestions to improving practice shown in a short training video, then rated a set of 22 synthesised recommendations, and rated them again in light of the scores of others. Using this process, it only took a few weeks and minimal effort for the participants to collectively establish 16 high-quality recommendations to improve practice. We then worked with stakeholder organisations to illustrate these recommendations in a short video and other resources, which you find can in a short video and other resources.

It’s most exciting and very pleasing to hear from our clinical colleagues how useful these resources have been, and that the video has been watched already over 20,000 times.

The feedback we are getting is that it is also very valuable well outside the maternity field, and has relevance in many clinical areas.

Very easy to use. Encouraging that I have been asked to review the film. Thank you. Maternity care participant

This is great! Well done. May be a good way to teach infection prevention and control through simulation after COVID too. IPC participant

A gold standard Martin Bromiley, Patient Safety Advocate, Clinical Human Factors Group

This is excellent work. Professor Jennie Wilson, President, Infection Prevention Society

The resources produced by the project have been of immediate practical value to the NHS. The video has been widely praised by my colleagues across the service, including the Chief Midwife for NHS England, the head of learning & safety for NHS Resolution as well as maternity professionals at the coal face. Professor Tim Draycott, Vice-President for Clinical Quality, Royal College of Obstetricians and Gynaecologists


If you’d like to experience this consensus-building exercise yourself, then that’s possible! Just head over to, sign in or register for an account, and then click on demo projects.

The enthusiasm of participants, strength and impact of the outputs of the project, and the learning we gained from it were tremendously helpful for creating a new formal methodological approach. This approach can be used many times over to improve or adapt processes in healthcare.

Our new paper in BMC Med Res Methodol describes this in detail. The paper features a five-step framework to help develop process improvements – the changes needed to make a healthcare process better. You can read a summary here on our website. We’ll also be visualising the five-step framework in some new exciting ways very soon, so watch this space or sign up for our newsletter!

Finally, on a personal note, I have been truly impressed by what the Thiscovery team and other colleagues at THIS Institute were able to achieve in such little time while the pandemic and remote working were still very new. I feel many of us have been very glad to have been part of the pandemic response. Also deserving a lot of credit are all the people who were part of the consensus-building and the volunteers from the NHS who gave up their time for the filming of the videos.

Finding best possible ways to collaborate around a common cause is something I am very passionate about. I hope this approach can be one of many great ways of achieving that!

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