From Micro to Macro: How Older People’s Experiences of Care Informed Service Redesign and System Strategy

Background: Older people living with frailty often access multiple services that do not communicate effectively, leading to confusion, duplication, and poor experiences of care. A significant proportion of healthcare resources are spent on emergency admissions that may be avoidable, and people with severe frailty frequently tell us they do not want traditional hospital care. As part of a wider transformation programme to improve services across Surrey, we aimed to ensure that the voices of older people and their carers directly informed both service redesign and strategic planning.

 

Approach: We used a range of co-production and experience-based design (EBD) methods to embed the perspectives of people living with frailty at the heart of service development.

EBD questionnaires and emotional mapping were used to capture patient experiences on the older people’s short-stay unit, identifying emotional highs and lows along the care journey.

 

A “Whose Shoes?” co-production event brought together older people, carers, executives, and frontline staff to explore shared experiences and priorities for improvement. Conversations were captured live by a graphic artist, helping create shared understanding and momentum for change.

Same Day Emergency Care (Frailty SDEC) services were co-designed with older people from inception, with EBD questionnaires embedded into ongoing improvement cycles.

Feedback from these activities was used to create emotional maps, highlight priorities, and test changes through iterative improvement cycles across the frailty pathway.

 

Results: Improved patient experience: Emotional mapping revealed that multiple bed moves were a major source of anxiety and fatigue. Process changes reduced unnecessary transfers, improving continuity of care.

 

Empowered co-production: The Whose Shoes? event generated 35 pledges from staff and service users to improve communication, carer involvement, access, and person-centred care. Themes included “see me, the person,” partnership working, technology, and tackling isolation.

Informed system strategy: Findings from the Whose Shoes? event was used to directly influence the development of the Ageing Well strategy within the Surrey Heartlands Integrated Care System, embedding co-production principles at a system level. Themes were used to inform workshop activities to develop the strategy and the final strategy included the ambition: The experience of people living with frailty and their carers informs and improves how we provide care and support.

 

Sustained engagement: Co-production tools are now routinely used in new frailty service developments, including Hospital@Home and Urgent Community Response services.

Implications:

Understanding and acting on the lived experiences of older people can transform both service quality and system design. Embedding EBD and co-production approaches enables staff to see services through the eyes of those they support, strengthening empathy, collaboration, and ownership. Our work demonstrates how micro-level insights from patients can inform macro-level strategy, helping to align operational improvement with strategic transformation. This approach offers a transferable model for integrated care systems internationally, showing how partnership with older people and carers can create more responsive, person-centred, and sustainable health and care services.