Continuity Is Essential: The Experiences of Co-Design Participants During the Implementation of a New Health Service.

objectiveTo explore the experiences of participants in the co-design of a community-based health service for people with frequent hospital admissions with regard to the design process and its outcomes. STUDY SETTING AND

designQualitative semi-structured interview study with co-design participants who participated in co-design meetings during service implementation. Co-design members were healthcare workers, healthcare consumer representatives, and staff in health services management or leadership roles. Co-design activities consisted of online meetings, out-of-session communication and two facilitated face-to-face workshops, which included case studies and small group activities. Health consumer representatives were also contacted out of session to enable them to contribute anything that they thought was important. An interview guide was used, which covered participants' experiences and perceptions of aspects and outcomes of the co-design process during service implementation. Interviews were online, audio-visually recorded, transcribed verbatim, and checked for accuracy. Two investigators independently and iteratively analysed data using components of grounded theory.

participantsInclusion criteria were being involved in the co-design process during service design and service implementation, or being involved in the co-design process after service design, and attending two or more meetings. After applying these criteria, eight people were approached, of whom five agreed to participate.

resultsParticipants were interviewed between December 2023 and February 2024. Two themes were identified: (i) fluctuations in co-design activity impacted engagement and (ii) continuity of co-design processes across service design and service implementation. These themes are integrated into the final theoretical proposition: continuity in co-design is essential.

conclusionThe continuity of people and the continuity of the application of co-design processes are essential to ensure there is a link between design, implementation and evaluation; a 'break in the chain' can impact service implementation. People using co-design could consider ways to maintain engagement during fluctuations in co-design activity. Strategies to minimise co-design team membership turnover may be needed, or, where turnover is unavoidable, ways to effectively onboard new co-design participants. The continuation of co-design processes from service design to service implementation may help ensure that there is a link between the co-design phases. Lack of continuity of co-design processes may lead to a lack of consistent application of co-design principles. PATIENT OR PUBLIC CONTRIBUTION: This was an exploration of the experiences of co-design participants involved in the design of a new service during the implementation of the service. The co-design team included representatives from a university, primary healthcare, acute care services and health consumers. This study was informed by previous qualitative interviews with co-design participants, including two health consumers. These interviews were undertaken during the design phase of the co-design, and their findings were presented to co-design participants (written plain language and an oral presentation), and they gave feedback on these. Two co-design participants were regularly involved in discussions about the research methods, in particular, recruitment and timing of the research. A written summary of the findings from interviews during service implementation was shared with participants, who had an opportunity to provide feedback. One co-design participant contributed to the 'Discussion' section of the manuscript, in particular the implications arising from this study.