Patient centred services and patient experiences have increasingly been related to service quality and efficiency of care. As a way to have patient centred services, healthcare organizations started involving patients in service improvement. Proper service design is another factor that influences service quality. Healthcare services, however, have presented issues in this aspect. Human Centred Design approaches can be a way for healthcare organisations to properly design services and deliver patient centred care. In this paper, we investigate through a literature review, what methods have been used to design or improve healthcare services and how they contributed to patient centred care. With literature analysis, we identified that Service Design, co-design and other design related approaches were used to bring patient participation, and highlighted improvements and barriers involved in their use. Although these processes faced some barriers, they had positive effects to services being patient centred, improving patient satisfaction and care. Despite the effort of using structured approaches to patient participation and service improvement, the organizations might still be (re)designing their services with inadequate processes.
Healthcare services face difficulties in using structured methods for service design and having patient participation in such processes. There are few models on healthcare service design and even less focused on Primary Health Care (PHC) in the literature. Therefore, this paper contributes to this domain by presenting the proposal of a co-creative model to design PHC services. The proposed model was constructed based on the study of reference models in PHC and co-design. Plan-Do-Check-Act cycle and the Experience-Based Co-Design approach were used to structure the model. The resulting model contributes to (a) continuous improvement, (b) improvement analysis and registry, (c) identification and solution of PHC users' real needs, (d) community participation and empowerment, (e) creation of experience-focused and patient-centred services. The model's use of co-creation enables patients and PHC staff to understand each other's needs and challenges, and to create together appropriate solutions to their communities and act toward more satisfying services.
Healthcare services from western economies use patient and public participation to promote quality improvement. In Brazil, community participation is a guideline for the public healthcare system. However, community participation is little developed and few efforts are made to improve it. Through a case study, we described and analyze the service improvement process used in SUS primary care units of Florianopolis and the community involvement in this process. Semi-structured interviews with healthcare professionals, and community representatives were conducted. Results show that improvements are made in local improvements or in an annual planning process, and the community participation in them is low. The annual planning process have deficiencies in its methodology and conduction. The adoption of co-creative methods can improve community participation on SUS and strengthen its participation policy. These methods can also help better structure improvement processes.
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