Six lessons from participatory approaches in a pandemic
It may be stating the obvious, but you need people for participatory approaches. And people are in short supply during a pandemic. When those people are healthcare practitioners you can bet they are preoccupied with more important things — rising waiting lists, high sickness rates and scant resources — to name but a few.
So when we were tasked to take a participatory approach to developing a digital strategy for an NHS trust, we would need to get creative. How could we engage health and care practitioners in meaningful and engaging ways that didn’t add to the pressure?
Here are six lessons we are learning along the way:
[1] Make it relatable — clinicians don’t really care about a digital strategy. But people do care about having a say about things that matter to them; they do care about reducing annoying technology workarounds; and they definitely care about making things better for citizens. We might be worn out by the pandemic, but mitigating its impact is on everyone’s minds.
With this in mind, we’re focusing on making the project relatable — avoiding technology hype and hyperbole — and focusing on the things that matter most to practitioners.
[2] Go to people where they are — we set out by designing day-long workshops to involve citizens and practitioners in co-creation activities. However, as our calendar invites were left unread, we quickly recalibrated and reduced them to half a day; then to two hours; then we ditched them altogether.
We were dead set on co-creating with practitioners, but there wasn’t a chance we could do this in the usual way. So we went back to the drawing board and created pop-up workshops in community hubs, where people could pass by for 10 or 20 minutes and have their say.
We broke the workshops up into stand-alone chunks — so that if people could only take part in one or two of the activities, we could distribute participation to cover every aspect of the session. We made the activities interactive, and visible — a room covered in posters and post-its. This encouraged participation and helped to present a room full of active and engaged colleagues to anyone passing that might be inclined to join us.
This approach worked really well and we’ll continue with these micro-workshops as we check and validate the insights and ideas generated over the course of the project.
[3] Do the leg work — any number of emails and cascade communications promoting our participatory work didn’t have much impact. It took leg work to pique people’s interest. We went to the community hub, put up posters, chatted to staff and started to build relationships. We knew that many of the staff we’d encountered worked through their lunches, so we bought sandwiches and snacks on the day and put a note in the kitchen tempting people to pop by during their break. As each person put their heads round the door, we asked them to tell another person. It was the in-person people stuff that made it work in the end. And it takes graft.
[4] Spend time with people in their work — ethnographic activities were only a small part of our initial concept for understanding how health and care practitioners use technology in their working lives. However, spending time with people, observing the devices they use, their frustrations with connectivity and the workarounds they employ, gave us more than any conversation could.
In a pandemic, this took extra planning, and we had to ensure we complied with NHS covid rules and secured consent from citizens who welcomed us into their homes. But it was well worth it — this work helped us identify and confirm key frustrations and opportunities that recur across different teams. An unforeseen benefit of spending time with multiple teams, has been identifying a solution that one team might have devised to a problem, that other teams are still facing.
[5] Give primacy to the secondary — whilst it has been a challenge finding ways to involve practitioners, it has been even harder to secure participation of citizens. Community clinics encourage people to not hang around before or after their appointment; masks and social distancing are the norm; there are less people in these settings and they are less keen to have a conversation.
We’d originally counted on a captive waiting room audience to gather insights from the public, and have had to rethink our approach to citizen research. We’ve gone the extra mile sourcing existing research (for example Healthwatch reports and Joint Strategic Needs Assessments) and relying on lots of rich insight that has been previously generated through local projects and programmes.
We’ve been fortunate that when we were shadowing practitioners, the vast majority of citizens consented to observation, so we were able to gain insight into their experiences..
[6] Secure the elusive mandate — making sure there is senior buy-in from the get-go is essential to any participatory work. Having people at the top of the management hierarchy understand what you are doing and being open to the insight you will share with them, is fundamental. Without it, you risk raising people’s expectations of change, only for it to fall on fallow ground.
We had hoped to have a senior mandate workshop but it proved impossible to convene. Instead we set up short sessions on Teams and slots in management meetings to secure support. We made sure to understand what was important to managers, so we could generate insights that would be relevant and relatable to them.
Finally, we underestimated the amount we would have to flex and baked this in from the beginning. With regular standups and strategy sessions with the team, we are continually adapting our approach.
We’ve also been open about it. We have recorded our first lunchtime Show and Tell on Teams where we shared what we have done, what we have learnt and how we are adapting along the way. It’s fair to say that not many people came along, but it’s there for transparency and an open record of the journey.
As this project unfolds we are learning everyday. We are adapting and flexing; we are doing some things well and some things not so well. We are learning about how you enable busy people to participate in a pandemic.
