Patients and staff as codesigners of healthcare services.

Over a decade ago Don Berwick suggested that healthcare “workers and leaders can often best find the gaps that matter by listening very carefully to the people they serve: patients and families.” Health professionals are now familiar with a range of approaches—surveys, storytelling, focus groups, online feedback (to name a few)—that can help them listen. Aminority use other techniques, such as shadowing patients and observing staff-patient interactions, to find out how and why services work well or not, and how they might be improved. But healthcare staff don’t routinely use such data to improve the quality of their services unless they have support. Often the patients are only given a passive role with staff making all the decisions about how to respond. Here we argue that patients can and should take a more direct and ongoing role in identifying, implementing, and evaluating improvements to healthcare services. We discuss examples of projects in which patients and staff have worked together and suggest that codesignmethods have the potential to make patient centred services a reality. 6 Growing attention has been paid to the value of applying design thinking to improve public services. This is usually based on direct face to face user and provider collaboration to codesign products or services, and includes a focus on the aesthetics of a service—how it looks and feels. Though gaining in popularity, rigorous research into the implementation and impact of design thinking in the public sector remains fragmented and limited in several important respects, not least because of ongoing debates about how it is best interpreted, applied, and evaluated in practice. In healthcare the term codesign refers to patients and carers working in partnership with staff to improve services. Here we focus on one particular approach called experience based codesign (EBCD), a six stage process that usually takes 9 to 12 months to complete: • Setting up the project