Insights informing the HWL Ripple Toolkit

1. Lived experience

Firstly, an important initiative by Scottish Government, highlighted in HWL December bulletin is the focus on co-design to inform future service needs.

The National Care Service recently invited applications for a Lived Experience Experts Panel, to understand the changes that are needed and checking that changes are possible and practical. This is what co-design means – working alongside the people who use and deliver health and social care services to ensure everyone get a future organisation that works for all.

“The complexities of getting this right should not be underestimated. People with experience of the current system, whether in receipt of health and care support or delivering it, are the experts. We particularly need to hear those voices.” Kevin Stewart, Scotland's minister for social care.

2. Future trends

Secondly, the recent Resolution Foundation Who Cares and Reimagining Care Commission reports both highlight care workforce needs and issues where a co-design ethos will be a critical factor in driving meaningful change that is embedded in the culture of care homes.

Jobs in social care have many positive aspects of working in the sector, including the ability to form deep personal connections with clients, job security, and greater levels of flexibility and autonomy than are possible in many low-paid jobs. But there are many challenges too. Pay is low – and likely unlawfully low for many workers in the domiciliary sector once their travel time is accounted for.

This, along with funding constraints and the particular demands of the Covid period, have contributed to a staffing crisis which is having serious negative knock-on effects on workload and safety.

Employee ownership

Employees owning their own co-design process and doing it to themselves with their colleagues just need the confidence and skills to navigate their way through a change journey. And if the experience is enjoyable, rewarding and productive it’s more likely colleagues will come on board. That’s what we created the HWL Ripple co-design toolkit to do.

In their shoes

It’s late and you’ve just finished a long shift, working overtime as a colleague is sick and you’ve a handover to make. This isn’t an ideal moment to start thinking about change. So, we’ve built the HWL Ripple co-design toolkit that’s adaptable to real workplace constraints including:

1. In-house. Workers can’t take time out for off-site workshops, so change sessions need to happen in the workplace as employees are always on call.

2. Mini-breaks. Employees may only be able to grab half an hour over a coffee break with colleagues and don’t have the luxury of taking time out for 2-3 hour workshops.

3. Mindset. Change sessions need to be fitted into the working day as staff often aren’t very receptive or energised after an exhausting shift.

4. Tools need to work for impromptu drop-in sessions, idea-pinboards in staff areas, or as takeaways, so staff can think quietly during breaks or personal time.

5. Shift workers. It’s often not possible to get the care team together at the same time as employees are on shift rotas and ideas need to developed with contributions at different times.

Bottom-up change

Care workers are time poor and work in a stressful, emotionally intense settings so we wanted to make change fun and involving. In all workplaces there are employees who are ‘champions’ – the drivers of change; ‘agnostics’ – those who go with the flow; and ‘saboteurs’ – sceptics who resist change.

So, changes designed to improve working practice can’t rely on managers imposing top-down approaches and expect them to be adopted. The HWL Ripple co-design toolkit is designed to be inclusive and generates group enthusiasm.

People leave their manager not their job

In many organisations often the personalities and hierarchies get in the way of change, leading to resistance and friction. We wanted to find a way through this, removing barriers to encourage effective and rapid collaboration between leaders, managers and staff.

Co-Design for Care: HWL Ripple toolkit - inspirational, accessible and easy to use

Co-design can crack wicked problems in care

Co-design theory and practice has been adopted by industry in change consulting, in a TRL context, and in public service transformation. However, it’s not particularly familiar to care home sector leaders and if used by external consultants is often perceived as expensive and challenging to commission.

To understand where co-design can drive improvement by empowering employees, HWL has identified four key challenges care homes face:

1. Recruitment - Care workforce recruitment and attraction - enabling care home providers to better recruit staff

2. Retention - Care provider capacity building - enabling care home providers to develop, upskill and increase the value and motivation of their employees

3. Effectiveness - Care provider operational effectiveness – enabling care home providers to improve service delivery, scheduling and commercial impact

4. Wellbeing - Care patient improved experience – enabling care home providers to improve customer experience and improve customer satisfaction

HWL has invested in the development of a Co-Design approach tailored to the healthy ageing market that harnesses a raft of existing, proven innovation and change tools in a structured, flexible framework that makes co-design inspirational, accessible and impactful.

The approach - known as the HWL Ripple Co-design Toolkit - has been successfully used in a a diverse range of care home environments - from small independent homes, medium sized groups and corporate villages - with powerful results as evidenced by our interview with care managers.

Hear about co-design from one of partner care managers:

Have you ever used a co-design toolkit like this before?

A Carol mentioned "She had no idea what Co-design as it was a new thing.  As a group we was a bit frightened as we didn't know what to expect". 

What were the benefits of using this kind of toolkit to action improvements?

Carol saw the benefits as  "I think there's an openness about the whole team which I found quite rewarding and I felt good about that".  

Has this kind of approach changed the way you work with your team?

Carol noted "I would be more inclusive before myself and Carol would make decision. We will now take into account other people's ideas and fears about going forward". 

Hear about the impact of co-design from more care managers. 

Getting change started

One big challenge of change is how to get started. There are so many tools and methods out there if you know where to look. So, it’s almost an impossible task for care home front line workers and managers who aren’t experienced in co-design to select the appropriate tool for them and their situation.

We identified over more than 300 different innovation and management tools alone, so it rapidly became clear we needed to provide care workers with a holistic vision of co-design process so they could make informed choices for themselves.

Stress of choice

The whole gamut of change tools is daunting, so to make employees feel comfortable we started using a handful of the tools such as the “Care home of the Future” or the Circle of Care” rather than the whole framework.

Round pegs in round holes

The HWL Ripple co-design toolkit is designed so that the right tool can be selected for the right situation or team. We’re agnostic about individual tools because they have multiple applications for instance De Bono’s Six Hats maybe used in a people or systems setting.

Try stuff out

Working with specific tools gives employees the experience of trying out different methods in a safe setting to develop the experience to select the right ones that suit them. The HWL Ripple co-design toolkit is designed to build self-belief that staff can be co-designers who don’t need to rely on external experts.

Adopting Ripple widely

The HWL Ripple co-design toolkit has the potential to be applied to whole raft of personal, system and operational issues. The Circle of Care for instance could be adopted for job induction.

Self-sufficiency

Care workers are naturally super-busy people so we don’t expect them to all become consultants overnight. However, as change-makers in their own organisations if employees can’t be entirely self-sufficient, then Ripple will certainly save a huge amount of precious time and energy.

Play at work

Change in a highly regulated workplace can create real anxiety where the learning curve for external consultants is too great or are affordable for small care businesses where often the need for improvement is most acute. The change may require new roles, working practices and lead to uncomfortable conversations. The HWL Ripple co-design toolkit provides a way for care workers to imagine a better future for themselves and together.

Outsiders are valuable

Naturally there is still huge value in external, experienced and objective co-design facilitators to act as critical friends to stress test ideas or predict issues. The HWL Ripple co-design toolkit provides a powerful way of employees to get started and maintain momentum when budgets are tight and specialists with the right experience are rare.

Academic and enterprise collaboration

The cultural difference between academic settings and business can lead to contrasting approaches and friction that prevents collaboration. The HWL Ripple co-design toolkit cuts though the differences and unites different cultures and roles in a shared sense of purpose, creating synergies that enable more effective collaboration.

Small changes

In a user-centred environment many desired improvements are micro, day to day adjustments that can make a big difference. The HWL Ripple co-design toolkit can help overcome these small problems quickly and easily as well as address systemic transformations.