Non-participant observations in experience-based codesign: an example using a Case Study Research approach to explore Emergency Department care

Previous reviews of experience-based codesign (EBCD) projects have shown non-participant observations (NPOs) are omitted or unreported in the majority of studies, despite academics’ insistence of their value. We undertook Stage 1 of an EBCD project using a Case Study Research approach to organise the inquiry. NPOs were used as the first object (frame of analysis) of the case subject, exploring and understanding the experience of users and providers of ED care. 162 hours of NPOs were conducted by six research team members across three hospital Emergency Departments (EDs), representing a local nested case. The four principles of EBCD were used to guide the inquiry, providing rich understanding and description of the context, and valuable insights into critical issues. Summarised NPO narratives allowed the research team to familiarise themselves with the different physical environments, workflows, and processes, as well as think more deeply about work and interactions. Conducted within complex healthcare settings, this example demonstrates the value of observing Work-As-Done and has advanced knowledge of institutional logic that will be critical in considering realistic and sustainable change initiatives. Commitment to intentional design and well-reported research methods for exploring and understanding lived experience can satisfy academic audiences of the study integrity and provide comprehensive information for those undertaking accelerated EBCD.