The Honours Project

EBCD Design Process

  1. Setting up the project;
  2. Gathering staff experiences through observational fieldwork and in-depth interviews;
  3. Gathering patient & carer experiences through observation and 12-15 filmed narrative-based interviews;
  4. Bringing staff, patients and carers together to share experiences of a service and identify priorities for change;
  5. Sustained, priority driven, small group co-design work; and
  6. A review and conclusion event.

About EBCD

Patient and family engagement adds value and is an essential enabler to redesign and reform healthcare to better meet the needs of patients, families, and care givers and is a key strategy to achieve the triple aim in healthcare, namely optimal experience, outcomes and efficiency (1-3).

Traditional healthcare design has focussed on the engagement of best practice and process efficiency while disregarding or undervaluing patient experience with the risk of developing efficient processes yet unpleasant patient experience (4). This approach invites the risk of process failure and poor adherence. By shifting the design objective to the design of patient experience EBCD contributes to the design of processes that are more desirable to patients and families. EBCD is an approach to improving healthcare services that combines participatory and user experience design tools and processes to bring about quality improvements in healthcare organisations. Co-design refers to patients and family advisers (PFA) working in partnership with healthcare staff to improve services (5). The inclusion of PFA in a council including clinical and administrative leadership, staff in decision making in healthcare planning is seen as critical to the delivery of patient centred care (5). EBCD involves the identification and evaluation of emotional touch points that impact experience and attempt to modify these touch points to improve experience. EBCD methodology employs a 6-step process described as engage, plan, explore, develop, decide and change (5).

(Acknowledgements/ Source: Robert Stirling)


  1. Loehrer S, Lewis N, Bogan M. Improving the Health of Populations. Healthcare executive. 2016;31(2):82-3.
  2. Carman KL, Dardess P, Maurer M, Sofaer S, Adams K, Bechtel C, et al. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health affairs (Project Hope). 2013;32(2):223-31.
  3. Epstein RM, Street RL, Jr. The values and value of patient-centered care. Annals of family medicine. 2011;9(2):100-3.
  4. Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Quality & safety in health care. 2006;15(5):307-10.
  5. Tsianakas V, Robert G, Maben J, Richardson A, Dale C, Griffin M, et al. Implementing patient-centred cancer care: using experience-based co-design to improve patient experience in breast and lung cancer services. Supportive Care in Cancer. 2012;20(11):2639-47.
  6. Kohler G, Sampalli T, Ryer A, Porter J, Wood L, Bedford L, et al. Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes. International journal of health policy and management. 2017;6(11):661-8.


Field of Research (FOR): Health Innovation, Patient Experience

Mode of Research: By Hospital Embedded Practice, By Project

Key Methods: Practice Based Research

Theoretical Frameworks (ref Modes of research link): Experience Based CoDesign