1. Introduction
Ehealth solutions are in great need in the community of elderly in general, as patients or home carers, however a design approach that delivers this is illusive. In this research we present the experiences from a set of design processes targeting elderly’s needs of support or home care, based on a co-design approach. The purpose is to present guiding principles for how to work with elderly in a co-design process, to be used as basis for future set up of co-design processes.

2. Theory and Methods
Co-design stresses the equal cooperation between end-users, professionals, technical personnel and other key groups. It moves beyond more traditional participative design approach, with user involved in design, to a process were decision making, leadership are shared with end-users.
Empirical material consists of 3 case studies, including field notes, recordings of design sessions, and experience of the design process leaders, gathered by design leaders/action researchers. The material is analysed using current co-design theory and best practice on how to structure co-design processes.

3. Results
Case studies included co-design groups: 1) 10-15 persons designing self-care system for heart failure, 2) 5-10 persons designing home carers educations system and 3) 5-10 persons designing fall prevention systems. In the meetings, both professionals and technical experts were present. The design processes consisted of about 5 to 10 meetings during 6 to 12 months. A number of patterns were observed. Central themes include: 1) motivation: to contribute to, improve, complain about, or influence the development of the health care system, 2) to be social: interact with peers and experts, and meet people, 3) technology interests: both due to personal knowledge or lack of knowledge about technology, and to be informed, use technologies 4) being heard and recognized as an individual, with a focus on personal health situation, 5) the possibility to contribute in decision making, and giving back something to the community.

4. Discussion
The co-design approach makes many of these driving forces possible, enabling elderly to be active and interested in designing. The social context is also important, but seems not to be an important part of current theory of co-design. Co-design needs to prepare for processes of learning and socialising with fellow elderly and professionals and experts, and to enable knowledge development for all parties.

5. Conclusions
Co-design process need to take into account a number of key factors and dimensions for the elderly as co-designers, including motivation, social interaction, technology ability, the elderly as a person and the ability of the elderly to be a part of decision making.

6. Lessons learned

Working with elderly as end-user representative demands a co-design process adapted to their needs, restrictions, interests and values.

7. Limitations
The study is based on a set of single cases, and thus only limited generalisation is possible.

8. Suggestions for future research
Systematic follow up on effectiveness of co-design, when it comes to both resources spent on development and the usefulness of the resulting system, is very limited.

1. Introduction

Many health services report high no-show rates and low enrolment numbers for group self-management programs. Statistics also indicate there is poor adherence to evidence-based treatment recommendations across various healthcare settings. This presentation will provide examples of how health services have used a systematic methodology to deliver health literacy for better patient engagement.

2. Practice-change

Service delivery changes were implemented after organisations used a person-centred care methodology to analyse current clinical practice and administrative processes. Scripts were developed for telephone-based support programs, changes to information sent to referrers and customised checklists developed to assist clinicians to prioritise and check health literacy information.

3. Aim

Many behaviour change models and theories exist. However, how do clinicians know when to use which aspects of these models with the client sitting in front of them? The HealthChange® Methodology bridges the gap between behaviour change theory and practice by guiding clinicians to enhance the patient’s health literacy in a way that builds their motivation.

4. Target population

The Methodology is suited to clinical consultations, care planning and co-ordination; patient education, rehabilitation and telephone-based programs. It applies to any health consultation and suits staff who enrol patients within the programs as well as the front-line clinicians delivering the services. Examples of research trials with improved patient engagement will be presented.

5. Timeline

Implementation can take a few days to a several months depending on the context. Various projects timelines will be discussed.

6. Highlights

Results from a study showed 72% of patients referred to the program actively engaged in it. It documented that 51% of patients had their surgery deferred due to poor self-management after being on the waitlist for 12 months, but only 34% of patients were deferred post-HealthChange® Methodology implementation. Cardiac-related deferrals declined from 29% to 10%. Further insights will be presented.

7. Sustainability

Clinical practice change requires regular on-going support and some organisations have implemented the Train-the-Trainer Model while others have created dedicated roles to health-behaviour change.

8. Transferability

Once the HealthChange® Methodology is learned; it is easily applied across contexts and roles. It is a flexible framework with transferable principles and associated skills.

9. Conclusions

To achieve effective change at the clinical practice level, clinicians need more support, the HealthChange® Methodology is one way of supporting this change process. Patient data shows improved patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) across a range of services and disciplines. It appears to indicate that embedding a systematic person-centred practice methodology adds value to any health service delivery.

10. Discussions 11. Lessons learned

Front-line service providers find it easier if they receive structured assistance that assists them in identifying key health literacy messages for overall improved patient engagement and service success. It is a flexible, patient-centred framework that makes it easier for clinicians to help patients to obtain better health outcomes. The adaptation of programs and services to align with HealthChange® Methodology achieves improvements in patient outcomes and satisfaction as well as improved clinician satisfaction, reduced staff burnout and turnover.

Introduction:
Though the connection between overweight and obesity and ill-health is well recognised, its prevention and management is not well understood. The City of Cockburn faces an overweight and obesity crises, with 79% of those aged 16 year and over either overweight (46.1%) or obese (32.9%) compared with 67% of adults Australia-wide. (1)

Cockburn Integrated Health commenced an audit of existing programs and services focused on overweight and obesity operating within the City of Cockburn and identified a broad range of service providers from local to federal government initiatives to private practitioners. Nevertheless, there was an absence of integrated, affordable, person-centred and ongoing care.

Practice change implemented:
Service provider and community consultation identified that what was required was an integrated service model that provided ongoing support to clients and access to a wide range of program options.

Aim and theory of change:
The Cockburn Healthy Lifestyle Program (CHLP) was founded to assist clients to choose healthy lifestyle behaviors that promote the maintenance or attainment of a healthy weight. A designated coordinator recruits clients, collaborates with service providers to form referral pathways and mobilizes primary health providers to ensure referral pathways are utilized according to individual client’s needs. Clients are given access to regular health assessments during which their progress is evaluated and are referred to a range of low cost programs. It is theorized this approach will prove an effective measure for preventing and managing overweight and obesity.

Targeted population and stakeholders:
City of Cockburn residents of all ages are eligible. Particular effort is made to attract participants from vulnerable, hard to reach communities. Services cover nutrition, physical activity and psychology and stakeholders range from universities to councils to private practitioners.

Timeline:
Currently, participants are offered access to the program for a period of 12 months.

Highlights:
The CHLP is innovative where it offers a coordinated, multi-disciplinary, person-centred, low cost and longer term approach to the prevention and management of overweight and obesity.

Sustainability:
Critical elements of the CHLP include a host organization that values the delivery of integrated health services, an operational budget to assist with the employment of a coordinator and allow for program delivery costs, an engaged primary health provider able to provide health assessments and connect participants to appropriate referral pathways and a network of engaged service providers.

Transferability:
There is good reason to suggest this model could be transferred to other localities given the aforementioned requirements are met.

Conclusions, discussion and lessons learned:
As of June 30th, 2019 the CHLP had 212 active clients attending at least one health assessment. A recent client satisfaction survey showed that 79% of respondents felt that their health would improve after the care that they received. Among those who had attended a review health assessment 56% had reduced their weight. Effective communication including a shared database are critical to this integrated approach.

References
1. South Metropolitan Health Service. City of Cockburn Health and Wellbeing Profile 2019. Perth: South Metropolitan Health Service; 2019. 25 p.

Introduction:
The Gold Coast Integrated Care (GCIC) program was a patient-centred integrated model of care designed to produce optimal patient outcomes for those with complex and chronic conditions by supporting their GPs in managing their conditions. The program focused on the Gold Coast community to examine whether an integrated care model could improve coordination of care and services between primary and secondary care providers at no additional cost to the health system.

Practice changes and innovation:
The program brought together multidisciplinary teams within the Gold Coast Hospital and Health Service (GCHHS), general practitioners (GPs) from 15 network practices affiliated with the program, and community based health services to provide holistic management of high risk patients and enhance communication between their service providers. This was supported by improving data linkage between service providers using innovative information and communications technologies.

Aim and theory of change:
The program aimed to demonstrate enhanced proactive and reactive care that would reduce potentially avoidable admissions to hospital and improve clinical management and access to a range of services; patient health outcomes; patient experience and satisfaction with care; and staff experience and satisfaction. The conceptual foundation of the program was aligned with the continuous quality improvement mantra of providing the right care, by the right person at the right time for the right patient.

Targeted population, stakeholders, and timeline:
The four year program targeted those with complex and chronic conditions considered high-risk of hospitalisation. Stakeholders included the local HHS, PHN, Queensland Health and GPs. The Commonwealth Department of Health provided financial support for the program evaluation, which was undertaken by the Centre for Applied Health Economics, Griffith University.

Innovation, impact and outcomes:
A community coordination centre was established to provide patient holistic assessment and care planning by a multidisciplinary team of medical practitioners, nurses, service navigators, physiotherapists, occupational therapists, social workers, pharmacists and psychologists. This team adopted a generalist approach to linking and supporting clients to extend their health network and improve communication between health providers. The approach included promoting a tailored self-management approach that improved continuity of care, as well as addressing behavioural and psychosocial situations which often led to readmissions, chronic exacerbations and inability to manage condition at home. Preliminary evaluation data indicate high levels of patient and staff satisfaction with care.

Conclusions, sustainability, transferability:
This presentation, from the perspective of clinicians, will focus on shared decision-making, the co-production of health and health services and supported self-care. It will feature the voices of participants and their carers to illustrate both the need for and impact of integrated care programs, which we believe, exemplifies person-centred care.

Background
Globally, Primary Health Care (PHC) is recognised as central to improving health for all, yet COPD patients in Nepal are not receiving adequate PHC, because of limitations in the six building blocks of the health system as proposed by World Health Organisation in 2007. Therefore, there is a need to strengthen the capacity of community-level health institutions and health professionals by facilitating integrated care to improve self-management support for COPD patients.
Objectives
We aimed to develop and prototype a model of care linking primary and tertiary care components to improve self-management practices(SMPs) of COPD patients in Nepal.
Methods
Based on a survey and qualitative study in 2018, we have developed integrated care and intervention to address locally identified problems. We refined our model (prototyping) in two small stakeholders meeting and a final co-design workshop in May-June 2019 with 60 stakeholders consisting of patients, carers, providers, researchers, and policymakers. During the co-design workshop, a series of presentation and a 50-minute brainstorming session was conducted in groups of six participants to collect their inputs on the proposed model of care and intervention components.

Results
Through a facilitated workshop using consensus decision making, patients, local government, primary health care workers, policymakers, academics, and community representatives worked together to refine an integrated model of care. The resultant integrated model will include: screening of COPD at the community and management of symptomatic patients at primary health care, establishing referral pathway for severe cases to tertiary level health care and establishing community care. Our presentation will include: steps in the co-design process and results from prototyping with stakeholders.

Conclusion
Our integrated, contextually-appropriate model of care and intervention should improve the quality of care and quality of life for COPD patients.

Lesson learned
Engagement of patient, carers, providers, and policymakers in developing a model of care creates a sense of ownership among the stakeholders.

Suggestions for future research
This refined Integrated Self-management Intervention Program will be tested to improve SMPs, quality of care, and quality of life for COPD patients.

Introduction
Ward rounds present an opportunity for patients to be involved in their treatment planning. However, often this opportunity is not realised, thereby missing a vital opportunity to deliver integrated person-centred care. Multiple factors influence whether person-centred care rounds are achieved, including: being invited into the discussion through clinician questions; clinicians’ language use; and the physical capacity of patients to discuss their care. The study aim was to explore patient experiences of rounds to identify how rounds facilitate and integrate patient-centered care and reveal potential for improvement from the patients’ perspective.

Methods
A multi-method study across two inpatient specialties was conducted in a metropolitan hospital in Sydney, Australia. Staff from two acute medical and two rehabilitation units participated. Ward rounds were observed, and then semi-structured interviews were conducted with patients from each round observed. The focus of the observations were processes and patterns of communication. Interview questions included: description and purpose of ward rounds, attendees and roles; advantages and disadvantages of rounding processes; collaboration between the healthcare team and patient; and suggestions on how rounding processes could be improved. Descriptive and thematic analysis of observations and interviews were undertaken.

Results
Similar experiences of ward rounds were described by the 14 participants observed and interviewed. Participants described rounds as an opportunity for patients and doctors to interact but designed to meet the needs of the healthcare team. Those with chronic conditions or frequent admissions described greater satisfaction with rounds as they had learnt how to prepare for rounds and discussions. This experience enabled participating patients to engage in greater conversation with the medical officers about their medical condition and goals. Just under half (43%) of participants reported not understanding the doctors’ medical terminology which restricted their ability to participate in conversations. Participants acknowledged hospitals were busy environments and unpredictable but did suggest preparing patients for the discussion and providing a time for rounds would be beneficial to reduce anxiety around the unknown.

Discussions
Although ward rounds are an opportunity to deliver person-centred care, patient experiences expose the challenges for healthcare teams to deliver it. Patient uncertainty around rounding expectations results an imbalance in the clinician–patient relationship. Uncertainty can impact on patients’ abilities to participate, in turn affecting their satisfaction.

Conclusion
Clinicians influence person-centred care during rounds through language and relationship building. Patients become more independent and take on responsibility during the round the more exposure they have to them. Providing patients with knowledge on what to expect during a round facilitates inclusion in conversation and leads to more person-centred rounds.

Lessons learned
Patients can offer unique insights in how to integrate the “person-centred” aspect into rounds.

Limitations
Participants were frail aged or acutely unwell which meant greater exploration into their responses and longer interview times were not appropriate.

Suggestions for future research
Exploring patient experiences can shape how ward rounds can be more person-centred. Understanding perspectives of both patients and clinicians can lead to more collaborative care planning processes.