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How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study


Woodward M, Dixon-Woods M, Randall W, et al. How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study BMJ Quality & Safety Published Online First: 12 December 2023. doi: 10.1136/bmjqs-2023-016196

See here for full list of authors

Why it matters

Charts, forms, and other clinical tools are routinely used in day-to-day clinical practice. Despite being widely available, many suffer from poor design – so they are not as effective or easy to use as they could be and can even lead to safety risks, especially in highly pressured situations. The design problems are compounded by a tendency to exclude clinicians, patients, and others in the tool development process.

Well-established methods and principles are available to improve design and to involve users in design and development of tools. Important examples of these approaches include user-centred design methods and co-design principles. However, what’s been lacking is practical guidance about how to apply them. We aimed to address this need.

Our approach

We organised user-centred design methods and co-design principles into a single framework to guide the development of clinical practice tools to the point of readiness for large-scale testing. This framework for co-design of clinical practice tools, known as FRESCO – includes the following five steps, with each step informing the next:

  1. Establish a multidisciplinary advisory group
  2. Develop initial drafts of a prototype
  3. Conduct think-aloud usability evaluations
  4. Test in clinical simulations
  5. Generate a final prototype informed by workshops

We illustrated use of the framework in a case study of the co-design of a “track-and-trigger” chart for maternity care. This tool sought to support detection (“track”) and response (“trigger”) to a baby having difficulties during labour.

What we found

The case study showed that the FRESCO (framework for co-design of clinical practice tools) framework was very helpful in supporting the co-design of a prototype track-and-trigger tool in an area of pressing need. A particularly welcome feature of the case study was that patient and public involvement and engagement helped to make improvements in design of the tool based on input from maternity service users.

FRESCO is likely to be helpful when designing clinical tools in many areas. It makes explicit the need to consider the priorities and preferences of those using the tool in practice, while applying design methods that support safety, effectiveness, and efficiency. The framework can also support inclusive ways of co-designing prototype clinical practice tools.  

Although further evaluation is needed, the framework appears to be very helpful for pragmatic, flexible and inclusive co-design of clinical practice tools, using methods that can be standardised, replicated, and scaled.

Other contributing authors to this article:  

  • Akbar Ansari 
  • Alison Powell 
  • Annabelle Olsson 
  • Caroline Walker 
  • Cathy Winter 
  • Charlotte Davies 
  • Chloe Hughes 
  • Giulia Maistrello 
  • Imogen A.F. Brown 
  • Janet Willars 
  • Jenni Burt 
  • Joann Leeding 
  • Lisa Hinton 
  • Louise Dewick 
  • Natalie Richards 
  • Rachna Bahl 
  • Sarah Blackwell 
  • Tim Draycott 
  • Wendy Randall  

With thanks to the Authorship Group members

Aiesha Lake, Amar M. Karia, André Sartori, Andy Paterson, Anna M.A. Croot, Bethan Everson, Bothaina Attal, Carlo Personeni, Charity L.K. Khoo, Charlotte Vale, Clare Shakespeare, Cossor Anwar, Daniel Wolstenholme, Daisy V. Westaway, Emma Crookes, Evleen Price, Georgina Brehaut, Hannah K. Twinney, Hannah Sharpe, Helena Bull, Ilaria Medda, Jayden J. Mills, Jennifer Jardine, Jordan Moxey, Julia F. Bodle, Julie McKay, Karen Hooper, Katarina Tvarozkova, Katie Cornthwaite, Libby Shaw, Louise Houghton, Lucy M. Saunders, Luke Steer, M. Nwandison, Margaret Blott, Mary Edmondson, Megan Gailey, Nina Johns, Pauline Hewitt, Phil Steer, Ruth Cousens, Sophie Relph, Subhadeep Roy, Susanna Stanford, Theresa Fitzpatrick, Zeba Ismaeljibai, Zenab Barry

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