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

Engineering Design Centre2 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.

Engineering Design Centre3 Shortfalls “thorough understanding of the needs and expectations of individuals and the combined needs and expectations of people in the local area” “shift in the way specialist healthcare services are commissioned and provided” “lacking strategic approach” gaps in knowledge, planning and monitoring

Engineering Design Centre4 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”.

Engineering Design Centre5 Research Design Build analysis framework Describe current design practice “to be” scenario Identify key elements of the design process

Engineering Design Centre6 Phase 1: Analysis Framework

Engineering Design Centre7 Phase 1: Analysis Framework - Topics 1.Explore literature context for this model a.Are there similar models in (health) care? b.In other industries? 2.Piloting 3.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 model 2.Identifying significance of information flow between the different steps

Engineering Design Centre8 Phase 2: Description of current design practice in specialist services for people with intellectual disabilities Exploratory study analyze

Engineering Design Centre9 Phase 2: Description of current design practice - Topics 1.Description of current design practice a.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 design 2.Description of the relationships between elements of current practice a.What is the relationship between care and care processes? b.Which contextual issues have influence on the design process? c.What is the relationship between care delivery and the design process?

ideal services Engineering Design Centre10 Phase 3: “To Be” Scenario good services Providers of default care Health: GPs Social care: family and professional carers Experts Researchers, policy makers

Engineering Design Centre11 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.

Engineering Design Centre12 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 implementationFocus Group: Ideal service Analysis Feedback Analysis Literature Review: Role of specialist services for people with intellectual disabilities

Engineering Design Centre13 Phase 3: “To Be” Scenario - Topics 1.Develop a "to be" scenario for the service provision based on key perspectives a.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

Engineering Design Centre14 Phase 4: Key Elements of a Design Process As isTo be ? literature

Engineering Design Centre15 Phase 4: Key Elements of a Design Process - Topics 1.Key elements of the design process a.Requirements for transition from “as is” to “to be” b.Views of experts, GPs and carers on how to design ideal service provision c.Literature review - exiting design processes and tools d.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 process 2.Requirements for addressing context and constraints in real services

Engineering Design Centre16 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 ?

Engineering Design Centre17 Typical Service Design

Engineering Design Centre18 The Framework as an Engineering Design Process