44The Three Ps of Co-Designing Person-Centred Care for Frail Older People in Acute Care Settings: Public, Patient and Practitioner Involvement

Abstract

Background: Frail older patients are vulnerable to adverse effects of hospitalisation, including deconditioning, immobility and loss of independence [1]. It is a priority of the national programme for older persons to develop pathways and processes aimed at improving care for this patient cohort. Healthcare policy increasingly emphasises the importance of patient-centred care and of involving public/patients in healthcare design and implementation. However, our knowledge of how to do this has not advanced substantially. This study developed democratic partnerships between public/patient stakeholders as well as practitioners and researchers in a participatory action approach to codesigning person-centred care for frail older people. Method(s): The participatory action design employed in this study was guided by principles of authentic collaboration with older people and representatives of frail older people. Ten participants were recruited from the membership of community-based patient and public advocacy organisations. Eight healthcare practitioners were involved on a rotating basis along with three academic researchers from UCD. Six co-design workshops were held over a two-year period running parallel to the implementation and evaluation of a frailty pathway within the study site. Result(s): Participants identified patient-centred care outcomes including: access to hydration; clear communication of holistic care plans which include social and activity prescription; daily written plans; separate space for frail older people and; accessibility and signage modifications. The group also identified the need for ongoing public education on frailty to be prioritised. Conclusion(s): This co-design process is informing the continuing development and implementation of a care pathway in the acute hospital via iterative cycles of Plan-Do-Study-Act. The PDSA cycles are targeting improvement in these patient-centred outcomes. The benefit of this collaborative participatory approach is knowledge translation between those charged with delivering care and potential end-users.