Abstract
There are a number of things that I really like about the reviewed study. The first lies in the title, ‘co-designed’. My attraction to all healthcare things ‘co-designed’ stems from a quote I heard a number of years ago: ‘We cannot solve our problems with the same thinking we used when we created them’, and is attributed to the great Albert Einstein. Ever since I heard this quote, I have been intrigued with different and alternative perspectives and what they can offer healthcare improvement. Although ‘co-designed’ and ‘Experience-Based Co-Design’ (EBCD) are currently en vogue in healthcare quality improvement circles (and the literature), it most certainly was not the case during the period of this particular study (2004–2014).
In truth EBCD really only came into nursing’s focus through the work of Bate and Robert (2006) when they eloquently described what ‘patient-centred’ really meant when designing or redesigning healthcare services. The reviewed study epitomises EBCD as it accurately describes the development of a distance learning programme (DLP) for auxiliary nurse midwives (ANMs) over a number of stages. The most interesting part for me, as a reader, is the description of how the authors ‘tweaked’ the DLP at a 3-day workshop to make it fit for purpose.
The second alluring element of the paper is the ‘action research’ method that was deployed. Action research and action evaluations are usually performed to give decision-makers facts and feedback about a programme or a reform (Ovretveit, 2002). In the case of this paper, the evaluation itself did not change anything. It merely provided the authors and DLP participants the evidence and a more informed basis for ‘tweaking’ the programme. It highlighted the need for a blended approach to learning for the ANMs and resulted in ‘ring-fenced time’ in an environment conducive to study where the DLP material could be facilitated with face-to-face interaction. The authors are a little modest when they report ‘some success’ despite the fact that the DLP did translate (to some degree) into practice and policy.
The final aspect of the paper which I find compelling as a reader is the absolute honesty that the authors bring to their paper, study and experiences of action research/action evaluation as a method. Action research projects by their very nature tend to be complex, disjointed, unstructured, subjective and the findings much less generalisable and less certain than conventional research/evaluative methods. The authors do a sterling job navigating the reader through much of the complexity in the study by providing honest appraisals of the context, the processes, stages and iterations of the programme and the study. We really need this type of informative detail to help us understand the decisions that were made in order to make the changes that were required for the development, delivery and impact of the DLP. One reassuring element for me as a reader (and a researcher), are the reported problems that were encountered with relationships, partnerships and collaborations over the duration of the study. I thought these things only ever happened to me!