Using codesign to engage primary care practices in a participatory change process.

Area of Science:

• Healthcare Implementation Science
• Complex Adaptive Systems (CAS) Theory
• Participatory Design Methods

Background:

• Healthcare interventions often face challenges during implementation due to a lack of context-specific tailoring.
• Engaging practice members in participatory processes is crucial for successful adaptation of external changes.
• Tailoring interventions remains a poorly understood but vital aspect of effective healthcare change.

Observation:

• A pediatric primary care practice's adoption of integrated health services was studied using ethnographic observations.
• Contextual inquiry identified key barriers and facilitators influencing the integration of health services.
• Codesign workshops were conducted with clinicians, informed by observational findings.

Findings:

• Codesign reframes interventions as tools for practices to drive change, aligning with a Complex Adaptive System (CAS) perspective.
• Clinicians identified tensions between patient care motivations and systemic limitations.
• Participant knowledge of the real-world context enabled the identification of practical resources and opportunities for change.

Implications:

• Codesign facilitates context-sensitive, bottom-up change by engaging stakeholders in the design process.
• The reconciliation of ideal care goals with real-world limitations is a key benefit of codesign.
• This approach supports the development, implementation, and evaluation of interventions reflecting real-world complexities.