Re-Framing the knowledge to action challenge through NIHR knowledge mobilisation research fellows. Comment on “CIHR Health System Impact Fellows: Reflections on ‘Driving Change’ Within the Health System"

The ambition of the Canadian Institutes for Health Research (CIHR) Health Service Impact (HIS) Fellowship initiative to modernise the health system is impressive. Embedded researchers who work between academia and non-academic settings offer an opportunity to reframe the problem of evidence uptake as a product of a gap between those who produce knowledge and those who use it. As such, there has been an increasing interest in the potential of people in embedded research roles to work with stakeholders in the co-production of knowledge to address service challenges. In this commentary, we draw on research and experiential evidence of an embedded researcher initiative, which has similar intentions to the HIS Fellowships programme: the National Institute for Health Research (NIHR) Knowledge Mobilisation Research Fellowship (KMRF) scheme. We outline the similarities and differences between the two schemes, and then consider the work, characteristics and skills, and organisational arrangements evident in operationalising these types of roles

Vertebral fragility fractures: co-designing solutions to promote independence and quality of life based on the needs of service users

Introduction Vertebral fragility fractures (VFF) affect one in six women and one in twelve men during their lifetime, costing the UK NHS more than £133 million each year (without considering medication). Pain as a result of VFF can last up to 2 years, with up to 20% having another VFF within a year. They impact on ability to do everyday activities, such as getting washed and dressed as well as stopping people going to work, often because people are afraid to move. The aim of this study was to utilise a co-design approach with people living with VFF to identify areas of unmet need and establish whether proof of prototype devices could be co-created that addressed those needs. Methods A participatory and iterative approach was utilised involving ten people with osteoporosis or VFF, plus carers, physiotherapists, industrial designers, design engineers and researchers in a series of workshops. Results In workshop one, we immersed ourselves in the lived experiences of people with VFF, carers and physiotherapists. A series of creative activities captured these experiences visually, physically and emotionally and statements of need were defined. In the second workshop, creative activities were undertaken to generate ideas and concepts, moving from two dimensional to three dimensional visualisations. We are currently in the process of converting these visualisations into concept artefacts. The final workshop (May 2017) will develop ‘brand and marketing material’ for each artefact that will be promoted to a ‘Dragon’s Den’ panel of key stakeholders. Conclusion People with VFF report that services and support (including equipment) do not particularly meet their needs. As a diverse group of patients, carers, designers, engineers and researchers, we were able to develop prototype solutions with supporting materials that could be further developed and tested. We plan to use this this work to underpin the development of a future grant application in 2017

Empathetic design research and development in practice; co-development of an innovative head and neck support for people with Motor Neurone Disease

People with Motor Neuron Disease (MND) experience muscle weakness. The human head can weigh 5kg so when this happens in the muscles around the neck it can become very difficult to hold the head up and result in the head falling forward. The situation can lead to extreme pain, restricted movement, problems with eating, drinking, swallowing, breathing and importantly adversely affect face to face communication. Ideally, a neck collar would help alleviate these important quality of life (QoL) issues. Current neck collar provision can be of limited use for people with MND and are regularly rejected by users as often they are designed to immobilise the head and neck, and can be socially stigmatising. A fundamental reappraisal of the way these physical products are configured and used was undertaken. The project explored the use of open and empathic approaches to the co-design of solutions and further product designs role as developer and explorer of complex multidisciplinary, social and QoL issues. It demonstrates experts working openly together using a range of 'live' research practice methods to arrive at holistically considered optimum outcomes. The project was funded by the NIHR i4i program. The team consisted of clinicians, engineers and designers working with partners including people experiencing MND and their carers. Processes included a range of research through design methods at the heart of which was a series of ten, iterative, co-design workshops. The team developed mutual empathies between project participants. These played a key role in the motivation to reach appropriate solutions

'Seeing' the Difference: The Importance of Visibility and Action as a Mark of 'Authenticity' in Co-production ; Comment on “Collaboration and Co-production of Knowledge in Healthcare: Opportunities and Challenges”

The Rycroft-Malone paper states that co-production relies on ‘authentic’ collaboration as a context for action. Our commentary supports and extends this assertion. We suggest that ‘authentic’ co-production involves processes where participants can ‘see’ the difference that they have made within the project and beyond. We provide examples including: the use of design in health projects which seek to address power issues and make contributions visible through iteration and prototyping; and the development of ‘actionable outputs’ from research that are the physical embodiment of coproduction. Finally, we highlight the elements of the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) architecture that enables the inclusion of such collaborative techniques that demonstrate visible co-production. We reinforce the notion that maintaining collaboration requires time, flexible resources, blurring of knowledge produceruser boundaries, and leaders who promote epistemological tolerance and methodological exploration Keywords: Co-production, Knowledge Mobilisation, Design Approaches in Healthcare, Research Impact, Actionable Tool

Bringing design practice into healthcare

Invited presentatio