Experiences in a successful implementation of an IS-development model for co-design in a quadruple helix project.
1. Introduction
Information systems (IS) research of the last twenty years has shown a phenomenon of unused research results, for instance IS-development models that do not reach practice. In some cases it may be relied upon that it takes considerable long time to transfer the new innovation from academy to practice. The reason for that could be that there is a lack of relevance for practice. In a quadruple helix project where academy and practice are cooperating to develop IS relevant for practice, a new model for IS-development has been formed. It is a co-design model to bridge the gap between all stakeholders. It motivates end-user involvement at an early stage to catch needs of the IS. The co-design model must therefore be transferred to all the stakeholders of the quadruple helix project and the purpose in this research is to obtain deeper understanding of the model transfer process.
2. Methods
Qualitative interview study of stakeholders in the quadruple helix project, thus practitioners (healthcare workers, system developers, end-users) and academics (researchers).
3. Results
The co-design model is transferred to practice when used by practice. For that it must be understood by all stakeholders. There are many ways to understand the model and to communicate the learnings from using it. Issues remain to get the model transferred completely. Researchers are also exposed to difficulties by having to balance the theoretical model against the practical process of co-design.
4. Discussions
The transfer of the co-design model has been successful as the model have been used in a setting intended for it. Technology/knowledge transfer theories are considered, but still issues in order to succeed transferring the model remains. The knowledge bearers must be included early and all the way through the model transfer, and the diversity of the stakeholders and their professions must be carefully considered. For instance, end-users and technicians in several cases have disparate affiliations in social systems, and thus not a common ground for communicating the transfer issues. Another issue is that the transfer is slowed down if representing stakeholder is not the decision maker.
5. Conclusions
The stakeholders are early adopters of the co-design model and they are all affected by explained and perceived attributes, decisions, time, communication channels and the nature of their social systems. It is motivated to consider the complexity surrounding the co-design model.
6. Lessons learned
There is a need to perform the stakeholder interviews in different ways to recognise information that is capturing for instance conflicts, values, time frames and ways of working among the various stakeholders.
7. Limitations
The credibility of the research can be questioned by the lack of prolonged engagement, thus enough time is not spent in becoming oriented with the evidence of the implementation.
8. Suggestions for future research
A longitudinal research as well as research on model transfer in other quadruple helix projects can give the research width and depth.

Introduction
HealthPathways provides localised clinical and service information to general practices and has limited provision of patient information leaflets (PILs). Current PILs are usually not available in relevant community languages, and rarely provide information on local health services.

Short description of practice change implemented
South Western Sydney Primary Health Network (SWSPHN) developed localised PILs by converting HealthPathways clinical information into health literacy resources. All PILs are reviewed by a local GP and the SWSPHN Community Advisory Committee and are available in English and a range of community languages in both print and audio formats.

Aim and theory of change
The aim was to develop health literacy tools for consumers and a clinical support tool for general practices. The PILs are focused on empowering patients to be active participants in their care and to support a working relationship with their GP. By using HealthPathways content, it ensured that the PIL content was clinically consistent with the content for GPs.

Targeted population and stakeholders
The targeted population is health consumers in south western Sydney, a region with a diverse cultural composition. The target stakeholders were general practices promoting and using the PILs with their patients as well as local community groups and councils.

Timeline
The project commenced in 2017 and is ongoing with 182 factsheets now available. A three-stage evaluation has commenced with stage one completed.

Highlights (innovation, Impact and outcomes)
SWSPHN is the first HealthPathways program to use HealthPathways content to develop PILs as a cost-effective method to develop localised health literacy information.
Stage 1 of PIL evaluation is complete. Compared to PILs provided by the industry leaders, HRD PILs were easier to understand (average Flesh-Kincaid Reading Ease score was 18 points higher (out of 100) and required a lower reading grade level by 3 years) and better met health literacy and accessibility standards.

Comments on sustainability
The sustainability of this program is high as it has proven to be a cost-effective solution for developing health literacy resources and builds upon the investment SWSPHN has already made into HealthPathways. Additionally, it ensures quality control for the PILs as these are reviewed as part of the clinical pathway review cycle.

Comments on transferability
Feasibility and amenability have been explored by other HealthPathways regions exploring how this system can be adopted elsewhere, including potential cost-sharing models.

Conclusions (comprising key findings)
SWSPHN identified a cost-effective method of developing high quality PILs that provide local service information and content that is clinically consistent with HealthPathways. Utilising quality control measures has ensured readability and accessibility of these health literacy resources which surpasses comparable PILs from the industry leaders.

Discussions
Further evaluation regarding the PILs is needed to evaluate GP and consumer experience in their use, as well as the exploration of developing cultural-specific resources.

Lessons learned
Implementing a clear PIL development process and outsourcing components to experts (e.g. graphic design, etc.) resulted in faster development and overall reduced costs without a compromise in quality.

1. Introduction
The Northern Sydney Primary Health Network is operated by Sydney North Health Network (SNHN). The region covers almost 900km2, a total population of over 925 thousand people. SNHN Needs Assessment identified vulnerable groups with poorer health outcomes.
2. Short description of practice change implemented
The SNHN Strategic Plan identifies Community Activation as a strategic priority, to improve health literacy in our most vulnerable populations. Consultation with these groups clearly stated that the community wanted health information and wanted it delivered by “experts”. Workshops are delivered to community groups, by experts that speak their language, and understand each groups culture.
3. Aim and theory change
Current workshops aim to address specific objectives, these are measured after each workshop. Objectives include improving knowledge about the topic, benefits to changing behaviour, how to change that behaviour.
4. Target population and stakeholders
The target cohorts include CALD, Aboriginal and Torres Strait Islander peoples, people living in social housing, people living with mental illness, youth and their parents, new arrivals including refugees, seniors and people that have left the armed forces.
Key stakeholders delivering the programs in partnership include: local councils, not-for -profit organisations, NGOs, social housing providers, and other community groups.
5. Timeline
The program commenced in 2017. Ongoing consultation with the most vulnerable populations, has helped to adapt and streamline the program to meet the changing needs of these communities. The program continues today, with increases year on year.
6. Highlights (innovation, impact and outcomes)
Improved health literacy in vulnerable populations, engagement from local communities, joint delivery with key stakeholders are highlights from this program
Outcomes of this work will be seen in the long term. Some of the community groups that have received workshops are keen to engage again over time, giving the SNHN the opportunity to follow -up for some medium-term impact.
7. Comments on sustainability
All of the workshops are run in partnership with local stakeholders, reducing costs, allowing a modest spend for broad delivery. Health Professionals are remunerated; however, venues, marketing, and resources are provided in kind.
8. Comments on transferability
The program would easily transfer to other metropolitan locations and could be adapted by the use of web-based communication for the rural and remote areas.
9. Conclusions (comprising key findings)
The vulnerable communities in the region have many issues that impact on their health. Consultation with these populations indicates they are both interested in their community’s health, and a willingness to improve health and wellbeing. Clear messaging, cultural relevance, and taking the information to the people, contribute to the success of the program.
10. Discussions
This program continues to evolve with new topics being developed to meet health needs of the community. Being responsive to the community and sharing the success with them has ensured ongoing engagement and consultation.
11. Lessons learned
Today’s program looks very different to the original idea. The input from the target communities informing the development. Flexibility in the delivery of the program is key, as is stakeholder’s engagement and commitment.

Hosted by health consumers and carers, Kitchen Table Discussions are an opportunity for community members who don’t normally attend formal consultations to have their say in a safe, friendly and supported environment. Invited by the host, participants will have a particular interest or experience of the consultation topic.
Health Consumers Queensland has utilised this method to support state-wide and diverse consultation with consumers and carers with success.
To date, 42 health consumers and carers have hosted discussions resulting in 387 community members being consulted on three projects for Queensland Health.