Experienced-based co-design interventions in the emergency department for ethnic minority adults

People from ethnic minority backgrounds often have worse outcomes and experiences than the general population when presenting to an Emergency Department (ED). Previous strategies to improve the experience of ED by people from ethnic backgrounds include strengthening self-management of health issues, improving communication between patients and/or carers (patients/carers) and ED staff, and building workforce capacity. However, details about interventions are scant, and intervention design typically does not involve patients/carers. The current study aimed to co-design, with patients/carers from ethnic minority backgrounds and ED staff, interventions to improve communications and health system literacy for ethnic minorities presenting to the ED. We conducted five workshops with a total of 25 patients/carers and five ED clinical staff using Experience-Based Co-Design method. Patients/carers were ethnic minority adults residing in a multi-cultural urban area in Australia. ED staff worked at the three participating hospitals serving the area. The first two workshops gathered 87 needs and 162 ideas from patients/carers for improving their experience in ED, which were refined and prioritised in the third and fourth workshops. Four interventions were developed in the fifth workshop: a waiting room digital display, a bilingual and visual pain scale, an informational video about ED processes, and an information kiosk. The identified needs and ideas addressed the ED physical environment and patient emotional wellbeing, in addition to communication and health systems literacy. Some ideas presented by ethnic minority participants were already in place or had been tried in the past, indicating the importance of a regular feedback loop between health services and the public to improve awareness and keep interventions current. Ideas inspired by experiences in other sectors were not easily translated into an ED context because of system constraints and the complexity of the environment. Involving ED staff from other regions and support services professionals, such as Information Technology (IT), in the co-design workshops could increase innovative thinking and enable the selection of ideas that are more easily integrated in current systems. Managing knowledge and power imbalance within co-design workshops can prove challenging.