Towards effective and efficient participatory systems approaches to healthcare work system design

Context: The study is focused on patient and public involvement in the regional service development process in one county in the UK, with a wider scope provided through review of literature. Objectives: The research has two main objectives: firstly to investigate the current state of service user and staff participation in the regional health service development process in the UK; and secondly to critically analyse the level of participation and systems awareness in the participatory methods used. Methodology: A single case descriptive case study is used alongside a scoping review of relevant literature that follows a systematic approach. Main results: The case study explored a complex service development process with the main findings being: i) varied levels of collaboration between multiple organisations of commissioners, providers and user representatives; ii) incomplete information loops with an unclear structure of information flow from service user/staff into the development process and a lack of feedback on changes made to service users; iii) difficulties in representing the views of a diverse population of service users, compounded by some single issue focus amongst service development participants; iv) an engagement gap with staff for service development events. The literature review uncovered practical issues in the application of participatory approaches and a lack of application of systems methods and models in the most widely used participatory approaches. Conclusion: The review of literature and description of practice found a gap between the practical application of participatory approaches in healthcare system design and theory on systems approaches to healthcare. We propose it would be beneficial to bridge the gap between structured systems approaches to healthcare system design and the current efforts of participatory design occurring in practice.