Analyzing and Improving Design Practice in Services for People with Intellectual Disabilities

Eva-Maria Hempe

PhD Project - October 2008 – September 2011

Supervised by John Clarkson, Terry Dickerson and Tony Holland

SSI Symposium

22 March, 2010

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Health and Care Services for People with Complex Needs

Services for people with intellectual disabilities have to effectively and efficiently meet the often complex and interrelated needs of a very

heterogeneous group of people.

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Shortfalls

“thorough understanding of the

needs and expectations of

individuals and the combined needs and

expectations ofpeople in the local

area”

“shift in the way specialist

healthcare services are

commissioned and provided”

“lacking strategic

approach”

gaps in knowledge, planning and monitoring

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Hypotheses

• Current service provision has not or not adequately been designed.

• A design process allows for a more structured and holistic approach to problem solving and might thus be the key to better designed structures which deliver the safe, quality services for those who need them most, in line with the vision set out in “Valuing People”.

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Research Design

Build analysis framework

Describe current design practice

“to be” scenario

Identify key elements of the design process

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Phase 1: Analysis Framework

Design process(structured process of meeting the demands

placed on care delivery)

Care process(the way in which care

is delivered)

Care(the service that the user

receives)

defines

produces

Design capacity(an organization's

capacity to define & practice good design) defines

analysisinspires

analysisinspires

Design

Care Delivery

analysisinspires

controls

defines

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Phase 1: Analysis Framework - Topics

1. Explore literature context for this modela. Are there similar models in (health) care?b. In other industries?

2. Piloting3. External validation

a. Does this model capture the experience of people with experience of designing (health) care services?

b. Do they think it is feasible?c. Is the separation design and delivery sensible?

Outcomes:

1. Rationale for the model2. Identifying significance of information flow between

the different steps

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Phase 2: Description of current design practice in specialist services for people with intellectual disabilities

Exploratory study

Design process(structured process of meeting the demands

placed on care delivery)

Care process(the way in which care

is delivered)

Care(the service that the user

receives)

defines

produces

Design capacity(an organization's

capacity to define & practice good design) defines

analysisinspires

analysisinspires

Design

Care Delivery

analysisinspires

controls

defines

analyze

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Phase 2: Description of current design practice - Topics

1. Description of current design practicea. Which key issues in care delivery are caused by

underlying design failures?b. Are there examples of good design?c. Is there a design process? How are services

developed?d. Which organizational features enable/ inhibit good

design2. Description of the relationships between elements of

current practice1. What is the relationship between care and care

processes? 2. Which contextual issues have influence on the

design process?3. What is the relationship between care delivery

and the design process?

ideal services

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Phase 3: “To Be” Scenario

good services

Providers of default care

Health: GPsSocial care: family and

professional carers

Experts

Researchers, policy makers

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Phase 3: Methodology - Delphi Study

Definition framework

Concept: This definition seeks to capture the role of learning disability services in meeting the health and social care needs of people with learning disabilities.

Population: Valuing People defines a learning disability as including the presence of: (i) A significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), with; (ii) A reduced ability to cope independently (impaired social functioning); (iii) which started before adulthood, with a lasting effect on development.

Purpose: The purpose of the role definitions is to provide a solid base for a discussion of how these services should be structured and how they should be designed and implemented.

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Phase 3: Methodology - Delphi Study

Round 1: “What is the role of the service? What makes it good?”

Round 2: Rank and rate(clear, feasible, appropriate?

minimum/ core/ additional/ optional)

Round 3: Rank and rate

Round 4: Ideas for implementation Focus Group: Ideal service

Analysis Feedback

Feedback

Feedback

Analysis

Analysis

Literature Review: Role of specialist services for people with intellectual

disabilities

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Phase 3: “To Be” Scenario - Topics

1. Develop a "to be" scenario for the service provision based on key perspectivesa. Experts (Delphi study)b. GPs (Delphi study)c. Carers (Delphi study)d. Service users (presentation)

2. Implications of conflicting views (if present)

Outcomes:

1. “To be” scenario based on a set of minimum, core and additional requirements

2. Insights into commensurability of key stakeholders’ viewpoints

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Phase 4: Key Elements of a Design Process

As is To be?

Design process(structured process of meeting the demands

placed on care delivery)

Care process(the way in which care

is delivered)

Care(the service that the user

receives)

defines

produces

Design capacity(an organization's

capacity to define & practice good design) defines

analysisinspires

analysisinspires

Design

Care Delivery

analysisinspires

controls

defines

literature

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Phase 4: Key Elements of a Design Process - Topics

1. Key elements of the design processa. Requirements for transition from “as is” to “to be”b. Views of experts, GPs and carers on how to design ideal

service provisionc. Literature review - exiting design processes and toolsd. Implications for the design capacity of the organization

2. Utility of rationale capture to document the transition from ideal to real services and to react to changing circumstances (experiment/ game with 3 groups of commissioners)

Outcomes:

1. Conceptual design process2. Requirements for addressing context and constraints in real

services

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Thank you

• Cambridgeshire Learning Disability Partnership

• Peterborough and Cambridgeshire Collaboration for Applied Leadership in Health Research and Care

• National Institute for Health Research

• Dr Isabel Clare, Mark Hall, Liz Jones, Sallyanne Broughton, Alison Lillywhite

Any Questions ?

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Typical Service Design

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The Framework as an Engineering Design Process