Dr Joe Langley’s three year fellowship explored the added value of design and making as a form of facilitating co-produced research, and of sharing, synthesising and activating knowledge within participants, systems and organisations. This work resulted in personal development in co-design and co-production and had a particular focus on the impact activities could have on relationships and systemic power structures.
National Institute of Health Research (NIHR)
NIHR CLAHRC YH, Royal College of Midwives, The University of Sheffield, Bradford Royal Infirmary, Sheffield Children’s Hospital, NIHR Devices for Dignity HTC, TITCH Network
Dr Joe Langley
Background to the NIHR Fellowship programme
£8 billion per year is spent on health-related research and there is increasing pressure to demonstrate a return on this investment. Yet translation of health services research knowledge into everyday practice remains a challenge.
The fellowship programme aims to advance knowledge and understanding about research use, influence and impact. It looks at how research can be blended with other knowledge, such as professional practice and patient experiential knowledge. This opens the door for participatory and co-produced research methods in particular.
Through the Knowledge Mobilisation Research Fellowships, the NIHR enables up to five individuals to explore the mechanisms, barriers and enablers of Knowledge Mobilisation and to mobilise some health services research knowledge into everyday practice.
“Making things together is a great leveller.”Prof Jo Cooke, mentor
Joe Langley’s three year Knowledge Mobilisation Research Fellowship was the first to be awarded to a researcher from outside the health disciplines. The fellowship has explored the added value of design and specifically making, within the context of co-produced research; of sharing, synthesising and activating knowledge within participants. Joe’s interest in this is focused on the creative, practical activities of ‘making’ employed by designers and applying them in participatory health research and innovation.
During the course of the fellowship, Joe’s research began to focus in particular on the impact those activities could have on relationships, systemic power structures and hierarchies in health and in wider society. The prevailing mode of communication within many such hierarchies is written and spoken language, a mode of communication associated with knowledge – and therefore power.
“This was an amazing opportunity for me to really get ‘inside’ this complex and, initially, slightly alien field. I have a far greater understanding, met some inspirational people, established great relationships and have been able to open doors to expand the work I do.”(Dr Joe Langley)
Language is often used (consciously and unconsciously) as a means of excluding different ‘tribes’ of people, creating impenetrable barriers of sounds or ciphers that demonstrate (often academic or intellectual) ‘expertise’ whilst ignoring expertise by lived experience.
Design uses a visual language form of communication to share ideas, knowledge, information and complex concepts. In addition, design practice also uses the activity of making things (prototypes, doodles, mock-ups) as a means of thinking, reflecting and considering specific questions and challenges.
When such practices and techniques are shared with other stakeholders in a co-design initiative, and designers or design researchers take on a facilitating role, it achieves two principal things:
- practical, making activities enable people to reflect on questions, experiences and complex ideas before they respond to the question or challenge posed. Hence their responses are more considered and they often realise tacit or unconscious knowledge about their experiences that may not have been revealed through other, more direct forms of enquiry
- the things they make become part of the visual mode of communication that augments their ability to collaborate with others from different backgrounds, creating a more level playing field
This fellowship brings together knowledge, understanding and expertise from multiple worlds:
- clinical practice (healthcare delivery)
- health services research
- implementation, knowledge translation or knowledge mobilisation research
- design practice
- design research
“I am still challenged and sometimes frustrated by a common academic view of the Journal paper as the end goal; as ‘impact’. Sometimes this view is held because it is just very difficult to translate knowledge (words on paper) into actions. There is no escaping this; it is hard. But this is what designers and engineers do. Their disciplines are translational, and there is an opportunity for more academics to collaborate with designers and engineers in their research from the start, not as an afterthought.”Dr Joe Langley, Knowledge Mobilsation Fellow
Some of these worlds were less familiar to Joe. Hence, Joe’s methods were aimed at increasing familiarity with the first three areas and then experimentally utilising the design methods within them (in co-design settings) to gain an understanding of what was happening from a Knowledge Mobilisation (KMb) perspective.
“I come from an engineering background and now use design and co-design practises within my research, working with Health Research Scientists, clinicians and patients. This gives me opportunities to use hybrid methods drawing on all these areas. This fellowship has given me a far broader appreciation of how different disciplines, expertise and world views can be woven together to create holistic knowledge that is pragmatic, relevant and works in-practise-in-context.”Dr Joe Langley
A literature review, which focused on the area of Implementation and KMb, together with participation at a range of national and international research, clinical and innovation forums in these areas (including Garfield Innovation Center, Kaiser Permanente, San Francisco; Karolinska Institutet Stockholm, Mayo Clinic, Rochester, USA), rapidly increased Joe’s understanding of Knowledge Transfer (KT), Implementation Science and KMb (in the field of healthcare). Immersive experiences in a Metabolic Bone centre in Sheffield Teaching Hospitals NHS Trust, collaborations with YH CLAHRC and undertaking a number of case studies increased Joe’s understanding of clinical practice and health services research.
During the fellowship, Joe was mentored by experts from different fields of expertise
- Prof Jo Rycroft-Malone (Pro Vice-Chancellor, Research & Impact & Professor of Implementation & Health Services Research, Bangor University) – implementation science
- Prof Jo Cooke (Deputy Director and Capacity Lead, NIHR CLAHRC Yorkshire and Humber and Honorary Professor of Health and Social Care Research, Sheffield Hallam University) – applied health research
- Prof Paul Chamberlain (Director of Art and Design Research Centre and Lab4Living) – design research
“When Joe was awarded his knowledge mobilisation fellowship the contribution of design thinking and science to implementation research had not been explored. This has changed significantly, largely due to Joe’s work in raising the profile and potential of design science.
During this time it has been a pleasure to work alongside Joe. His creativity, energy and enthusiasm has brought some much needed fresh thinking to how we can improve health and care services through genuine partnerships and the co-creation of knowledge.”Professor Jo Rycroft-Malone, Mentor
Five case studies emerged through the collaboration with YH CLAHRC and enabled Joe to apply and ‘play around with’ design and co-design practices in health service and health services research initiatives.
- Improving midwifery services with and for mid-wives and expectant women – see below
- Developing a mental capacity assessment support tool (MCAST) with and for speech and language therapists in community and hospital settings – see below
- Development of a testicular volume assessment tool and training kit – see below
- Designing gamified smart inhalers with and for school age children – resulting in concepts and working prototypes
- Designing an emotional support tool with and for patients on an acute cardiac ward – resulting in concepts and working prototypes for a complex support tool that includes peer networks, paper and digital based components for patients and family members.
Case study #1
Better Births by Design: Improving midwifery services with and for mid-wives and expectant women
In this case study, which focused on improving midwifery services, two midwifery teams (one community team in Colchester and one hospital based team in Preston) participated and were trained and mentored in using co-design as a means of improving their services. An evaluation was carried out by an independent academic from Bangor University nine months later with positive outcomes.
2 years on and both teams still tweet about their co-design and improvement activity.
Case study #2
MCAST: Developing a mental capacity assessment support tool
A toolkit for assessing mental capacity has been developed with and for speech and language therapists in community and hospital settings. The toolkit is currently being tested/evaluated via a clinical trial in Sheffield Teaching Hospitals.
2 years on and both teams still tweet about their co-design and improvement activity.
“I have really enjoyed working with Joe. Using design in health services research has been highly insightful and formative in our thinking about co-production in the CLAHRC, as you can ‘see’ authentic partnership working in action. The process of making things helps to uncover people’s ideas and thoughts, to share them, and provide opportunities for synergy. Making things together is a great leveller and pays attention to power issues in the sharing process.
Design and design thinking should be an important consideration in the shape of future health service research teams.”Professor Jo Cooke, Mentor
Case study #3
Testicular Volume Assessment: Development of an assessment tool and training kit
In this case study, a prototype simulation model was designed and built to test the accuracy of paediatric endocrinologists’ volume assessment. Once data was collected and evidence of inaccuracy established, we explored alternative approaches to training, co-designing (with endocrinologists and students) a package that included simulation and physical analogies based on everyday objects.
This was piloted in 2017 with one cohort of trainee Paediatric medics and is currently being revised based on the feedback.
Related research on Sheffield Hallam University’s Research Archive
- Brocklehurst, Paul, Langley, Joseph, Baker, Sarah, McKenna, G, Smith, C and Wassall, Rebecca (2018). Promoting co-production in the generation and use of research evidence to improve service provision in Special Care Dentistry. British Dental Journal.
- Cooke, J., Langley, J., Wolstenholme, D., Hampshaw, S., ‘Seeing’ the Difference: The Importance of Visibility and Action as a Mark of ‘Authenticity’ in Co-production ; Comment on “Collaboration and Co-production of Knowledge in Healthcare: Opportunities and Challenges” International Journal of Health Policy and Management (IJHPM), 2016.
- Elder, Charlotte J., Langley, Joe, Stanton, Andrew, DE Silva, Shamani, Akbarian-Tefaghi, Ladan, Wales, Jerry K. H. and Wright, Neil P. (2018). A simulation study assessing the accuracy and reliability of orchidometer estimation of testicular volume.Clinical Endocrinology.
- Langley, J. (2015). Using design to mobilise knowledge from health research into practice In: CHRISTER, Kirsty, (ed.) Design4Health 2015. Proceedings of the 3rd European Conference in Design4Health. Sheffield 13-16th July 2015. Sheffield, Sheffield Hallam University.
- Langley, J., Wolstenholme, D., Cooke, J, ‘Collective Making’ as knowledge mobilisation: the contribution of participatory design in the co-creation of knowledge in healthcare, BMC Health Services Research, 2018, 18:585 https://doi.org/10.1186/s12913-018-3397-y
- Langley, J., Wolstenholme, D., Partridge, R., Gwilt, I., Using Knowledge Mobilisation Theory to inform the design of the co-design workshop for healthcare research and innovation Design4Health, Melbourne, Australia, Dec 4-7 2017
- Langley, J., Wolstenholme, D. Partridge, R., Wheeler, G., Bec, R., ‘How can creative co-production processes help to elicit, share and blend different forms of knowledge?’ a workshop for UK Knowledge Mobilisation Forum, Bristol, 6-7 Mar 2018
- Ward, V., Harris, J., Carter, L., Dziedzic, K., Jones, C., Lang, I., Langley, J., Wye, L., “Using a story method for critical reflection: lessons and insights from NIHR Knowledge Mobilisation Research Fellows”, Organisational Learning, Knowledge & Capabilities, St Andrews, Scotland, 26-28 April 2016.
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