Ruth Cousens, CEO at THIS Labs, and Prof Mary Dixon-Woods, Director of THIS Institute, discuss this key Darzi report theme for enabling meaningful change in health and care and propose a framework for what this could look like.
Written by
Ruth Cousens and Prof Mary Dixon-Woods
Lord Darzi’s independent investigation of the National Health Service in England, published last week, sets out the scale and depth of the challenge faced by the NHS, the drivers of current performance and themes and strategies for improvement.
The first major theme for the forthcoming 10 year health plan identified by the report is:
This goal aligns with his analysis of performance drivers highlighting the lack of patient voice, “patients’ concerns not being heard and acted upon” and disengaged, exhausted, traumatised staff as significant factors in care failures.
The report – and all the evidence behind it – makes clear that any meaningful change in health and care must start with patients, staff and the public. This is not just as a matter of principle and values, but a matter of pragmatic necessity. These are the people whose knowledge, experience and expertise will ultimately enable the NHS to reinvent and renew itself.
What does real, practical engagement and empowerment look like? We at THIS Institute and Thiscovery have spent much of the last five years delivering this kind of work in practice. We’d like to offer a framework that we believe could form the basis for involving patients, staff and the public, at scale, in the significant work that lies ahead. It’s been tried and tested for improvements and innovation including:
The first stage is listening to truly understand the current experiences and priorities of staff and patients – what works well and what doesn’t, and what matters to whom and why. This can be done at scale by using online approaches that people already find comfortable and familiar – for example as text, audio, and video – to express their views. AI transcription and analysis tools can help to quickly identify the key areas where action is needed.
The next critical step is to give people proper, inclusive opportunities to contribute to creating a vision for the product or service. People need to be enabled to suggest ideas and comments based on their own lived and learnt experience, to prioritise options, and to advise on how trade-offs should be handled. Techniques such as online consensus-building and discrete choice experiments are powerful ways of ensuring this kind of inclusion.
Using tried and tested design techniques online and at scale can generate practical, actionable solutions. Testing these solutions offline using techniques like simulation ensures solutions are fit for purpose in the real world.
Evaluating solutions is critical to ensuring their effectiveness, value for money, and acceptability to staff, patients and carers. Perhaps running alongside traditional research methods such as trials and economic analyses, real-time evidence can be collected online and can help to iterate and further improve solutions.
This framework of understanding problems, creating shared visions, co-designing solutions, and testing them offers a highly practical approach to re-engaging staff and empowering patients.
It respects the expertise and experience of staff, giving them the chance to influence their day-to-day work and the strategic decisions that underpin it, and enabling them to feel heard and valued.
For patients, this framework puts their lived experience and practical knowledge of their illness and the health system at the heart of NHS reform.
Over nearly 5 years, we have engaged more than 7,000 people in this type of improvement and innovation work. These patients, staff and carers have given their time, expertise and experience willingly to benefit others. The people who work in and use the NHS are a huge asset. Let’s use this framework to release their potential to deliver the reform needed.
.png)
