Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK.
Social Policy Research Unit, University of York, York, UK.
Health Soc Care Deliv Res. 2024 Aug;12(27):1-84. doi: 10.3310/MYHT8970.
BACKGROUND: Local authorities need to find new ways of collecting and using data on social care users' experiences to improve service design and quality. Here we draw on and adapt an approach used in the healthcare improvement field, accelerated experience-based co-design, to see if it can be translated to social care. We use loneliness support as our exemplar. OBJECTIVES: To understand how loneliness is understood and experienced by members of the public and characterised by social care and voluntary sector staff; to identify service improvements around loneliness support; to explore whether accelerated experience-based co-design is effective in social care; and to produce new resources for publication on Socialcaretalk.org. DESIGN AND METHODS: Discovery phase: in-depth interviews with a diverse sample of people in terms of demographic characteristics with experience of loneliness, and 20 social care and voluntary staff who provided loneliness support. Production of a catalyst film from the public interview data set. Co-design phase: exploring whether the accelerated experience-based co-design approach is effective in one local authority area via a series of three workshops to agree shared priorities for improving loneliness support (one workshop for staff, another for people with experience of local loneliness support, and a third, joint workshop), followed by 7-monthly meetings by two co-design groups to work on priority improvements. A process evaluation of the co-design phase was conducted using interviews, ethnographic observation, questionnaires and other written material. RESULTS: Accelerated experience-based co-design demonstrated strong potential for use in social care. Diverse experiences of participants and fuzzy boundaries around social care compared to health care widened the scope of what could be considered a service improvement priority. Co-design groups focused on supporting people to return to pre-pandemic activities and developing a vulnerable passenger 'gold standard' award for taxi drivers. This work generated short-term 'wins' and longer-term legacies. Participants felt empowered by the process and prospect of change, and local lead organisations committed to take the work forward. CONCLUSIONS: Using an exemplar, loneliness support, that does not correspond to a single pathway allowed us to comprehensively explore the use of accelerated experience-based co-design, and we found it can be adapted for use in social care. We produced recommendations for the future use of the approach in social care which include identifying people or organisations who could have responsibility for implementing improvements, and allowing time for coalition-building, developing trusted relationships and understanding different perspectives. LIMITATIONS: COVID-19 temporarily affected the capacity of the local authority Project Lead to set up the intervention. Pandemic work pressures led to smaller numbers of participating staff and had a knock-on effect on recruitment. Staff turnover within Doncaster Council created further challenges. FUTURE WORK: Exploring the approach using a single pathway, such as assessing eligibility for care and support, could add additional insights into its transferability to social care. TRIAL REGISTRATION: This trial is registered as Current Controlled Trials ISRCTN98646409. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128616) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 27. See the NIHR Funding and Awards website for further award information.
背景:地方当局需要找到新的方法来收集和使用关于社会关怀使用者体验的数据,以改善服务设计和质量。在这里,我们借鉴并改编了医疗保健改进领域中使用的一种方法,即加速经验为基础的共同设计,以了解它是否可以转化为社会关怀。我们以孤独支持为例。
目的:了解公众对孤独的理解和体验,以及社会关怀和志愿部门工作人员对孤独的描述;确定孤独支持方面的服务改进;探索加速经验为基础的共同设计在社会关怀中的有效性;并为在 Socialcaretalk.org 上发布新资源。
设计和方法:发现阶段:对具有孤独经历的不同人群进行深入访谈,包括人口统计学特征,并对 20 名提供孤独支持的社会关怀和志愿工作人员进行访谈。从公众访谈数据集制作催化剂电影。共同设计阶段:通过一系列三次研讨会,探讨加速经验为基础的共同设计方法在一个地方当局地区是否有效,以达成改善孤独支持的共同优先事项(一次为工作人员,另一次为有当地孤独支持经验的人,第三次为联合研讨会),随后由两个共同设计小组每 7 个月举行一次会议,以改善优先事项。通过访谈、民族志观察、问卷调查和其他书面材料对共同设计阶段进行了过程评估。
结果:加速经验为基础的共同设计在社会关怀中具有很强的应用潜力。参与者的多样化经验和社会关怀与医疗保健相比的模糊边界拓宽了可以被视为服务改进优先事项的范围。共同设计小组专注于支持人们恢复到大流行前的活动,并为出租车司机开发脆弱乘客的“黄金标准”奖。这项工作带来了短期的“胜利”和长期的遗产。参与者通过这一过程和变革的前景感到被赋予了权力,地方领导组织承诺继续推进这项工作。
结论:使用一个不对应单一途径的范例,孤独支持,使我们能够全面探索加速经验为基础的共同设计的使用,并发现它可以适用于社会关怀。我们为未来在社会关怀中使用该方法提出了建议,包括确定可能对实施改进负责的人员或组织,并为建立联盟、发展信任关系和理解不同观点留出时间。
局限性:COVID-19 暂时影响了地方当局项目负责人设立干预措施的能力。大流行期间的工作压力导致参与工作人员人数减少,并对招聘工作产生连锁反应。唐卡斯特议会的员工流动率造成了进一步的挑战。
未来工作:使用单一途径(如评估护理和支持的资格)探索该方法,可以为其在社会关怀中的可转移性提供更多见解。
试验注册:本试验在 Current Controlled Trials ISRCTN 注册,编号为 ISRCTN98646409。
资金:这项拨款由英国国家健康与保健研究所(NIHR)健康与社会保健交付研究计划(NIHR 拨款参考:NIHR128616)资助,并在《健康与社会保健交付研究》中全文发表;第 12 卷,第 27 期。请访问 NIHR 资助和奖项网站以获取更多奖项信息。
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