Blog # 27- Adopting Experience-Based Co-Design Strategies to Improve the Quality of Health Care Services In The United States

Health care in the United States is expensive, and yet we have highly qualified and trained medical personnel treating individuals and families every day. However, we still experience decreased life expectancy and poor health outcomes which have consequences surrounding independence and quality of life among many people. While environmental conditions, lifestyle factors, and genetics are key determinants in health and well-being, the quality of care being provided can make all the difference in promoting optimal levels of self-care and independent living. Quality of care has been an issue for individuals and families in the United States I think due to some individuals and patients having negative care experiences, and also, some health care organizations do not have the infrastructure or the tools to amend workplace culture, values, and behaviors. The Commonwealth Fund and the Institute for Healthcare Improvement (IHI) have, “established the International Program for US Health Care System Innovation” (Van Citters, 2017). The objective of the program is to analyze and collect the data and information regarding innovations and methodologies that other countries around the world have utilized to promote effective health care practices to individuals and families that could also be utilized in the United States to improve access, costs, and quality of health care. The Commonwealth Fund and the Institute for Healthcare Improvement (IHI) have identified one potential improvement approach towards generating more positive experiences and outcomes for medical personnel and patients which is called Experience-based co-design (EBCD). 

EBCD (experience-based co-design) is, “a quality improvement approach that combines narrative, participatory-action research with service design methods to improve patient and staff experiences of care” (Van Citters, 2017). The goal is to draw patient and staff experiences and feedback to determine whether health organization workplace cultures, values, and behaviors are effective, and if not, what needs improvement. Ideally the, “positive and negative health care experiences of patients and staff, and brings patients and staff together in co-design teams to improve health care services” (Van Citters, 2017). Experience-based co-design (EBCD) separates from, “the traditional quality improvement methods by focusing on human experiences, rather than workflows; using service design methods to discover and change processes; and establishing a new type of collaborative relationship between patients and staff” (Van Citters, 2017). I believe implementing EBCD (experience-based co-design) allows medical personnel and patients to collaboratively see each other’s points of view in relation to the quality of health care delivery as a whole. 

With Experience-based co-design (EBCD), there are six steps that medical personnel and patients have to follow to promote strategies in improving patient and staff experiences from a humanistic perspective. The first step is setting up which means to, “Establish governance and project management arrangements” (Van Citters, 2017). Determining research methods, supplies, tools, participants, timing, and locations is essential to delivering data and information that is objective, reliable, and valid in which does not promote any sense of bias. 

The second step is gathering staff experiences in which we, “Observe the clinical service delivery area” (Van Citters, 2017), and we acquire information from several staff regarding their initial thoughts and feedback from their work experiences. 

The third step is similar but instead of gathering staff experiences, we gather patient experiences in terms of their care. 

Patients and medical staff then meet together to identify strengths and areas that need improvement regarding the humanistic experience of both these groups of individuals. As an example, let’s suppose a patient has a language barrier and cannot comprehend the information that is being conveyed by the doctor who does not speak that patient’s language. In this instance, this would likely involve a negative care experience. Perhaps the organization does not have sufficient funds or resources for translation services, could they look into free resources to support translator and translation needs for patients from state and federal agencies and organizations? What if a patient with a disability has a visual impairment and cannot comprehend information verbally from a medical provider? Again, this would promote a negative care experience. Perhaps looking into low tech or high tech devices might help support the patient’s care experience. On the other side, what if medical personnel have never been trained on caring and supporting patients with autism and epilepsy? Would it make sense then to provide disability awareness training? Generating ideas and solutions to improve patient and medical staff outcomes is key behind these meetings. 

After ideas and solutions are developed, if feasible and effective, then patients and staff are assigned into smaller groups in which one group focuses on X, another may focus on Y, and the other group may focus on Z but all these groups work together towards one goal, to improve patient and medical staff care experiences. As an example, one group might work to improve the translation services provided to patients who speak different languages, another group might work to provide disability awareness training to improve care experiences for patients with autism and epilepsy.   

The final step is for co-design teams to discuss the results and their accomplishments and establish additional goals and objectives for the future in identifying additional areas and trends in health care delivery that could utilize improvement. 

EBCD (Experience-based co-design) originated in the United Kingdom and with the implementation of this quality improvement approach it has been, “used in a range of clinical services, including cancer, diabetes, drug and alcohol treatment, emergency services, genetics, inpatient units, intensive care, mental health, orthopaedics, palliative care and surgical units” (“Experience-based co-design”, n.d.). Experience-based co-design (EBCD) can be utilized for any medical condition or service area, for any clinic or hospital whether inpatient or outpatient, and it can be used in any country in the world. One independent study from Australia in emergency departments, “showed that using EBCD enabled staff to learn new skills, better appreciate the impact of health care practices and environments on patients, engage patients in new ways, and implement co-created solutions” (Van Citters, 2017). 

Community, individual, and population engagement in improving the methods and systems of health care delivery is essential, especially in the United States. What is interesting to note is that, “patients are rarely engaged as partners in designing services; metrics used are often not seen as timely or clinically relevant; and most survey methods do not enable patients to describe what matters most to them. As a result, services often reflect the perspectives of payers, providers, and the larger health care system” (Van Citters, 2017). What is the main purpose of having a U.S. health care system? To support the health and well-being of all people. 

What can the United States do to adopt and utilize experience-based co-design (EBCD)? Interview and patient care techniques need to be both utilized and recorded for educational purposes, assuming that both patients and staff consent to these activities. Assigning facilitators is also critical in implementing effective EBCD (experience-based co-design) strategies to improving patient care experiences as you need leaders that can promote authority and direction to make sure that the projects and tasks are generated which produce changes and results that improve the quality of health care systems, and they must be objective, reliable, and valid. EBCD (experience-based co-design) should be implemented in the role and mission of an organization. Analyze and evaluate the conditions and service areas, and that includes gathering the data, information, and statistics in terms of common patterns, sequences, and trends, and then establish teams to identify the strengths and areas of need associated with the conditions and service areas to be focused on. Searching for funding and grants through the state level and the federal level, even evaluating programs and departments from the Department of Health and Human Services (DHHS) might be worth considering. 


Van Citters, A., (2017). Experience-Based Co-Design Of Health Care Services. 

Cambridge, Massachusetts: Institute for Healthcare Improvement.

What is Experience-based co-design?. (n.d.). The Point Of Care Foundation.