Improving Interpreter Service Uptake and Access to Just Healthcare for CALD Consumers: Reflections from Clinicians and Designers on Animation and Experience-Based Co-design (EBCD)

Abstract

This chapter describes a common problem in healthcare—finding ways to increase the use of interpreter services for culturally and linguistically diverse (CALD) consumers. The team took a threefold approach, beginning with a survey of clinicians, followed by a short (90 min) workshop with clinicians to more deeply investigate their reasons for not using the available interpreter services, and finally the development of an animated resource that could be played and shared to encourage clinicians to schedule interpreter services for their CALD consumers.

The provision of interpreter services is essential for delivering inclusive, equitable, and accessible healthcare to people of Culturally and Linguistically Diverse (CALD) backgrounds. Despite this, there are often barriers to the uptake of interpreter services which can lead to inadequate communication and suboptimal care. This chapter presents an Experience-Based Co-Design (EBCD) project aimed at enhancing access and use of interpreter services in mental health settings. The clinician-led project sought to identify pain-points and barriers to service uptake from a clinical perspective, with the goal of co-designing an engaging, educational, and persuasive communication tool that can effect behavioural change amongst clinicians. By employing EBCD methodology, the project aims to bring together clinicians and designers to collaboratively design a tool that is both meaningful and relevant.

With a desire to develop an educational tool that utilises strengths-based lived experience and narratives of inclusion to encourage wider uptake of interpreter services in healthcare settings, the specific objectives of the project were as follows:

• 1. Gather data/stories/information on the enablers and barriers to interpreter use for multicultural mental health clients from the perspective of staff (clinicians and administrative).

• 2. Identify areas for improving access to the existing service (clinician-led).

• 3. Design an educational tool for improving the existing service based on learnings derived from user engagement and lived experience.

Following an iterative design process, the insights and experiences of clinicians were gathered through a survey in tandem with complimentary EBCD workshops. The resultant education tool represented a 2D animated video showcasing a real-life example of the positive impact that interpreter services have on consumer experience. Since the project’s completion, the animation has received positive feedback from various professional training sessions, ultimately underpinning an expressed desire in healthcare leadership to develop additional animated training resources to address remaining barriers to interpreter access.

1 Context/Problem

Prior clinical incident analysis and data reviews conducted by the Queensland Health Metro South Addiction and Mental Health Services had indicated an ongoing underutilisation of interpreter services by consumers in need of such services. This resultant lack of access to interpreters for healthcare appointments creates significant inequity for CALD consumers, alongside any other individuals who reserve their right to accessible, effective, and equitable healthcare.

Interpreter Services are currently made available to all Queensland Health hospitals and health centres 24 h a day, at no charge to the client, being largely subsidised by Queensland Government agencies, who are required to provide and pay for qualified interpreting services for customers who are hearing impaired or otherwise have difficulties communicating in English. Despite this, some staff continue to hold the belief that the utilisation of interpreter services should be minimised due to associated costs and budgetary constraints. Despite the availability of interpreter services—which also come at no cost to the client—consumers continue to be negatively impacted by both real and perceived barriers which inhibit the uptake of this service. This project, whilst aimed at creating an educational tool to facilitate behaviour change amongst clinicians, is ultimately concerned with facilitating a rights-based approach to service access and inclusion, ensuring that healthcare is Just, ¹ equitable, inclusive, and respectful of the rights and needs of all consumers who rely on such services.

2 Background/Literature

2.1 The Rise of Design in Healthcare

The role of design in healthcare has been growing both within Australian and international healthcare systems. While initially originating through the design of functional aspects of healthcare such as ergonomics and productive workspaces, the last two decades have seen a movement towards the additional use of design thinking as an alternative to the traditional problem-solving approach throughout healthcare provision. In parallel, the field of design has slowly grown to incorporate the experiences and perspectives of non-designers within the design process (i.e., co-design) alongside welcoming a recent advent of focusing on non-tangible or non-object aspects of design (service design), both representing significant areas of relevance and adoption for ongoing healthcare service improvement within Australia and internationally.

Studies which focus on how to accelerate healthcare improvement have slowly begun to move away from viewing healthcare systems as rigid, inflexible mechanical systems, instead beginning to view these critical public service infrastructure systems as complex, dynamic, and ultimately, adaptive. In fact, EBCD in healthcare have also been seen as a way to build in the human dimension to healthcare transformation projects [1].

Following this trend, this project looks beyond a mechanical understanding of the interpreter service to understand the human element which may be preventing service uptake. By applying an experience-based lens to better understand the perspectives and experiences of the service users, we can ensure that we develop service design solutions which are most relevant to the service users and capture their ideas for improvement—rather than impose solutions. Furthermore, by focusing solely on clinicians and other healthcare professionals, we can focus on those with the most power to change the situation, internally influencing positive change in direct collaboration with the individuals who contribute to and shape the system from the inside.

2.2 Embedding Lived Experience to Promote a Culture of Access and Inclusion

While service design theory within healthcare has grown rapidly to include a swathe of design-led approaches to service transformation and healthcare quality improvement, this study is concerned with one approach: Experience Based Co-Design (EBCD). According to experts, EBCD involves service users—be that staff, patients, or carers, reflecting on their experiences of a service and working together to identify opportunities for improvement, as well as devising and implementing changes [2]. In this study, this was applied using a strengths-based approach to incorporating service users’ perspectives and lived experience. In other words—rather than highlight on what staff are not doing well (i.e., not adequately utilising the interpreter service) which may lead to decreased sense of belonging and appreciation in the workplace, or imposing solutions (which they already aware of—as discovered in the survey), our strengths-based approach sought to recognise what staff are already doing well as a way of encouraging more of this behaviour. This approach is less about imposing solutions or strategies, and more about removing any of the barriers (including myths) that may be getting in the way of staff providing best practice service and delivering the type of care that that would like to.

Beyond benefits for healthcare improvement, this approach sought to promote positive wellbeing outcomes for healthcare professionals and contribute towards the creation of a safe and inclusive workplace culture which values the input, knowledge, experiences, and skills of its staff [3]. In addition to feeling involved, this approach to co-design enables staff to be part of the story, thus avoiding a top-down communication approach [4], contributing to feelings of ownership over the final product [5, p. 15], and increasing the capacity to generate shared understanding and shared language between participants and designers [6, 7]. Therefore, in the process of designing solutions to enhance inclusion for CALD consumers, this study additionally fosters inclusion of clinicians and other staff through embedding their lived experience and expertise in the design process, in addition to the partnership between designers and the Multicultural Mental Health Coordinators throughout the entire process.

2.3 Education Animation in Healthcare for Informing Behaviour Change

The use of animations as an education tool must consider several key factors. Firstly, the audience needs to be considered, then the message being created and the creative methods or techniques that best communicate that message, and finally how the video or animation will be disseminated [8]. Moreover, the purpose needs to be established: is the video being created for empathy building, behaviour change, policy change, design, or environmental changes? Is the video being created for research, advocacy, storytelling, community building, artistic and creative expression, empowerment, agency, or all of the above? [8]. Fortunately, there is an abundance of literature which explores the role and effectiveness of animations as an educational tool and communication strategy in healthcare. A brief review of this literature indicates the potential of animations for informing behaviour change over other formats—particularly through its capacity for being relatable and inclusive, and for fostering engagement and the retention of information, which all help to increase the capacity for persuasive impact.

In terms of its effectiveness as a communication method, current literature highlights that while animation in healthcare is a novel tool in the field of healthcare education, it does have potential. A study from 2022 involving a systematic review of trials using animations compared with other educational delivery methods, suggests that animations show promise in practitioner education for effects of knowledge [9]. On the plus side, they discovered mostly positive outcomes for their impact on attitude, cognitions, and behaviours [9]. Another systemic review of studies of animation in healthcare conducted in the same year by Yi Su also acknowledged the potential of animations in healthcare, but found that this “powerful media function is not appropriately used” and many of the videos in the healthcare area are “low quality and do not fulfill the intended function” [10, p. 458]. The intended function mentioned here refers to their effectiveness for persuasive impact i.e., the attitude, cognitive, and behaviour change that Knapp and his colleagues discovered in their study.

While the goal of animations for entertainment purposes is to achieve expressive impact (effective functioning or mastery of the medium), animations in healthcare are generally made with the intention of creating ‘persuasive impact’, which Su defines as information, which is “effectively communicated, resulting in a change in the mental status of the audience and subsequently influencing behaviour” [10, p. 459]. Su also adds that low-quality healthcare animated videos are typically those which solely rely on traditional expressive means, without consideration of persuasive impact. This research by Su [10], explains how the effectiveness of an animation for achieving persuasive impact is not merely about how beautiful an animation is (although that certainly helps) but more about how closely it relates to the audience’s condition, and highlights the importance of an taking an inclusive, audience-centred approach. Enabling clinicians to imagine themselves as the characters in an animation increases its capacity for persuasive impact and retention by increasing its relatability, as described by the phenomenon called the self-referential effect wherein “people process information by relating it to aspects of themselves” [11, p. 724]. Furthermore, as an accessible medium, videos can also break down attitudinal barriers from unconscious bias, stigma, and stereotypes which often exist in healthcare [7].

Besides fostering inclusion through the content, the animation format is also known for its capacity to enhance accessibility and inclusion. Because a visual language will always be more accessible than text [12], all people—regardless of literacy levels, will find benefit in visual communication methods for ‘reducing cognitive load’ over those which are text-laden [13]. This is also highlighted in research on healthcare education conducted by Yi Su who indicates that “animation shows a reasonable degree of inclusiveness” compared with text-based animation tools [10, p. 461]. While cognitive load is one way to look at it, attention spans also have a role to play in the choice of animation for educational purposes. Research in the field of visual communication reveal the average human to have an attention span of only 8 s, with a capacity to process visuals 60,000 times faster than plain text [14].

Finally, animations which use a narrative structure, as used in this project, are a useful tool for presenting instructional information in a way that is not only more engaging, but far more likely to be retained. Research conducted by Moreno and Mayer on the impact of personalised multimedia for active learning reveal that instructional information presented as a narrative, or ‘conversational style’ are more engaging than those in formal style (e.g., on-screen text)—otherwise referred to as ‘personalisation principle’ and have the potential to increase deep information processing by reducing the cognitive load [11].

3 Project

3.1 Design Process/Stages

The project engaged administrative staff and clinicians from Queensland Health Metro South Addiction and Mental Health Services across the Metro South Health region in South-East Queensland, Australia through a short qualitative survey. This survey provided insight into their frequency of booking and using interpreter services and experiences of using the service, alongside any barriers or enablers in relation to either booking or engaging interpreters through the service, and ideas for improving the uptake of interpreter usage. The experience-based survey enabled patients’ perspectives to be told through clinician accounts and stories of their experiences, thus enabling the project team to centre the experience/s of the patient in the resultant animation.

Additionally, in April 2021, a selection of survey respondents (service users) further participated in a rapid 90-min online workshop which involved interactive quizzes, primarily focusing on ‘Myth-busting and Truth-Sharing’ in order to clarify some of the findings from the survey. Workshop participants also engaged in rich conversations surrounding possible ideas for ‘Tools & Resources’ and ‘Training & Support’ which could increase the effectiveness of the interpreter service system, ultimately informing any efforts to increase service uptake.

Following the results of the qualitative survey, the design team co-developed a storyboard for an educational animation, the basis of which emerged from a story shared by a clinician in the survey. The last phase of the workshop provided participants with an opportunity to share their feedback on a storyboard which was turned into an educational animation video² for Metro South Health staff, and possibly the first of a suite of new training videos which are directed at increasing interpreter service uptake (see Fig. 1).

Fig. 1

Animation storyboard

The project followed a standard design process which can be characterised into four standardised stages: (1) reflection, analysis, diagnosis, and description; (2) imagination, visualisation, and improvement process; (3) modelling, planning, and prototyping; and (4) action and implementation [15].

4 Reflections on Co-design and Service Design Process

This project produced innovative approaches to inclusive practice, investigating what happens when we ask people about their experience of interpreter services or lack thereof [16]. The project responded to an identified need and demand, as access to interpreter services is still very limited and there are many misconceptions about this service in QLD Health. As we describe, by putting the lived experience and narratives of patients and clinicians at the centre, this project also neatly focused on the adoption of EBCD in effective healthcare service improvement.

What we found—through focusing our approach on lived experience and emphasising the value and importance of creative practice—is that EBCD increases engagement from all stakeholders to create a culture of inclusion and promote just access to healthcare, as demonstrated in our reflective sections below.

4.1 Ruby Chari, Multicultural Mental Health Coordinator

We first put our submission in September to get specialist access to designers from the QUT Design Lab through the CEQ Bridge Labs initiative.

Background of problem:

Our health service district is the largest multicultural district in Queensland where every other person either speaks a language other than English or their family of origin is from a Culturally and Linguistically Diverse (CALD) background. Providing an equitable service in such a district needs an extremely high level of awareness and commitment. Working with interpreters in the provision of care has been a vital part of the service delivery but there have been several challenges. Some of the barriers were obvious, but most of the information based on ‘corridor’ conversations were unclear. As the multicultural mental health coordinators (MMHCs), our need, before we were aware of this opportunity, was to get a better understanding of what the barriers were—perceived and real—with the aim of then working towards solutions to these barriers.

Challenges of doing quality improvement ourselves:

Together my colleague and I had limited idea of how we could go about this process and had decided that putting together a survey would be a good starting point. Coincidentally, at the same time clinical incident analysis revealed an underutilisation of the interpreter service and it was a priority at the executive level, and we stumbled upon this opportunity by word of mouth. The eligibility criteria for the submission were broad and therefore fit our clinical dilemma. The requirement for application was clear and simple. This made it easy to put together in a time constrained environment of being a clinician with limited research experience. Once we got accepted, the meeting with the design staff really prompted us to further clarify our problem clearly. We felt ready to accept ‘outside’ assistance as we felt the need for new and innovative solutions after many years of trying to address the issues by ourselves. In the initial stages, we were able to collate all the current resources and look for ‘what can we do differently.’

We approached these sessions with a range of emotion: excitement, or eagerness to find out more, a bit of anxiety or feeling of uncertainty if there was really anything further, we could do but always with an openness to accept what we would be offered. We felt design was a way to look for solutions outside our current way of thinking. Along the way we faced challenges establishing these new relationships with COVID lockdowns and stretching time constraints.

What took me by surprise was the enthusiasm from clinicians to be involved in the co-design process and their eagerness to provide feedback in a one on one, confidential setting. Working with the design group was interesting. The storyboard method was a new experience for me, and it really made the clinicians provide feedback on specific and bigger picture issues. All the information we received during that session was valuable and are trying to incorporate these into our role. The time we had during the design process felt short and we would have benefitted from further engagement and support. We have used the end product animation in some presentations, and it was well received and would like to use this in a more structured training package. Our involvement in this project gave the issue of interpreter access further visibility.

4.2 Karen Beaver, Multicultural Mental Health Coordinator

As a Queensland Health clinician I was very excited to have the opportunity to work with the QUT Design Lab and Clinical Excellence Qld (CEQ) on a Healthcare Excellence AcceLerator (HEAL) collaboration.

There was some extra meetings and time spent in the initial interface allocated to building relationships between MMHCs and QUT designers and researchers, and of course understanding the aim of the project. This included focusing on what is achievable and in scope of the MMHC clinical role within MSAMHS.

The MMHC role receives clinical referrals from internal and external services to provide primary, secondary and tertiary consultation for culturally and linguistically diverse (CALD) consumers and their families. The MMHC role also in involved in workforce training and development and maintaining partnerships with local care providers and community-based resources for CALD consumers.

We really wanted to explore some new ideas and add value to what has already been tried in terms of enhancing the access to interpreters and understanding the barriers to uptake, both real and perceived by MSAMHS staff. We started by identifying opportunities to incorporate any resources or strategies developed in the project, in to ongoing MMHC role activities eg. professional development sessions or one on one mentoring.

I was surprised by the willingness of staff to participate and openly respond to the survey questions. I think it was helpful that we in our MMHC roles already had rapport with staff and that trust existed to share their experiences of engaging interpreters for their CALD consumers.

I think it was very beneficial to have the designers (external to MSAMHS) involved in the cofacilitation of the co-design workshop. But at the same time, it was also very important to have the clinician-led (MMHC) input to make it relevant for the service and workforce. In this co design workshop with staff, we could identify what resources would be achievable and realistic to develop.

My final reflection is that I would like to explore opportunities to develop additional animated resources to address other barriers to accessing interpreters, which were identified through the survey and co-design workshop. It has been a wonderful learning opportunity and I really appreciate the QUT Design Lab support as well as the time they spent on collating the survey and codesign workshop feedback and summation of the project into a report.

4.3 Janice Rieger, Designer

This project was done during the COVID-19 pandemic—entirely online and at a distance—using entirely online/digital engagement tools—online survey, online workshop, and delivering an animation which can be shared virtually or used in online/virtual training delivery.

While designers are no stranger to engaging in online data collection and engagement methods, there is a tendency towards face-to-face methods, especially for workshops. While, in this project, the workshop was not the most effective aspect of the project, it wasn’t a detriment to the project at all, and we still managed to develop a deeper insight into some of themes which came out of the survey, and to get feedback on the storyboard for the animation.

We found ourselves using a variety of online or digital engagement methods, which we came to discover was also far more useful/appropriate/effective for accessing participants—for enabling participation from people who are famously busy and, in these circumstances, located across multiple locations across the South Brisbane region which Metro South Addiction and Mental Health Services are responsible for. Regardless of whatever challenges COVID presents, getting clinicians and other members of staff to come together in one location would always be difficult.

A survey was extremely helpful for enabling as many people as possible to participate and was a familiar method of engagement which is presumably more in-line with the way in which this particular group usually shares feedback. By starting off with an experience-based survey, we were able to ground the entire process and outcomes in their experiences.

Designers need to listen more to understand clinicians’ expertise and respect their experience of working in this system day to day. As designers, we have the ability to bring a diverse perspective, but we can never understand the challenges and barriers in complex systems. Designers can only start to map the system to collaboratively identify pain points and places for opportunities with clinicians. As a senior designer with 25 years’ experience working across several continents and with diverse industries, I would argue that working with health care systems and all of the stakeholders is one of the most challenging. I had the opportunity when I was a junior designer to work with a senior project manager on a large new Children’s Hospital and it was extremely rewarding to see all of the different stakeholder groups, the diverse stakeholder meetings, and how under one project it brought together people from almost every sector. As an example of this, because this was a hospital in a city that is multicultural, a chapel in the hospital was not felt to be appropriate. The hospital had patients and their families from diverse religions and cultural backgrounds and so the design of the ‘prayer’ space was of extreme interest to create an inclusive prayer space. So, a stakeholder group with representatives from almost all religions and spiritual groups was brought together to try to design a space (and its colors, shape, use of icons, artefacts, and water) so that it would be an inclusive space for all patients and families to come and use. This kind of engagement and inclusive co-design is an example of best practice that drives me to use creativity to unpack complex problems and to create inclusive design—a.k.a. design for all (DfA) [17].

In terms of what recommendations I would have for clinicians who want to work with designers, I would say that a symmetrical relationship needs to be set up from the start. Designers tend to want to lead design workshops and to create innovative solutions but often this is not done taking into consideration the lived experience and knowledge of clinicians and other users. I would also just recommend to clinicians to open themselves up to innovative and create ideas as often designers’ ideas might not seem obvious or tangible, but it is in this collaboration and openness that great ideas emerge. So, it is a symmetrical and dependent relationship between clinicians and designers.

4.4 Sarah Johnstone, Designer

Designers are well-versed in the practice of getting comfortable with the uncomfortable or unknown, and often find themselves working in diverse industries, contexts, and circumstances. In the co-design process, we embrace this by drawing upon the expertise of those we are designing with, leaning into our role as facilitators or guides in the design process. In some projects it can be a case of providing a set of fresh eyes who can offer a unique perspective or solution to a seemingly obvious situation. This was certainly the case in this project where my colleague, Janice and I were invited to partner with Multicultural Mental Health Coordinators Karen Beaver and Ruby Chari from Metro South Addiction and Mental Health Services (MSAMHS) to uncover potential barriers preventing consumer access to interpreters when accessing healthcare services. While my previous design research experiences have had a specific focus on increasing engagement from the perspective of people from Culturally and Linguistically Diverse (CALD) backgrounds, this project was a new opportunity for me to co-design strategies to enhance access from the perspectives and experiences of those who deliver services as part of an innovative healthcare improvement strategy (HEAL) which brings designers and healthcare professionals together to bring design thinking to wicked problems within the healthcare environment.

Going into this project, I had no prior knowledge or experience of the interpreter system, or the broader service design at MSAMHS. Despite preliminary findings from our partners indicating that misinformed concerns over costs and budgetary constraints may be discouraging staff from using interpreter services, I was eager to keep an open mind. While the survey confirmed these concerns, it also revealed the deep awareness and understanding the survey respondents had of not only how to use the system, but also the importance of the service for CALD and other (e.g., Indigenous or hearing impaired) consumers who require additional communication support. I was excited to see the level of detail provided in the survey by clinicians and administrative staff about what worked, what didn’t work, and their detailed ideas for how to improve the system overall. I did not anticipate that the survey would provide such deep and diverse insight and ideas for how we can improve the system at the outset of the project, many of which could be implemented right away, indicating the value of drawing upon the expertise of those who use the system.

As designers, and outsiders of the system, I believe we were able to identify some of the less obvious factors, which not only have a negative influence on service uptake but are much more difficult to solve, and in some cases rely upon education and behaviour change strategies to create change over time. One example of this was a brief story shared through the survey by a clinician about a situation in which one of their clients was so grateful to have been provided an interpreter that she cried, after not having one at previous appointments. We realised that this story was an opportunity to apply a strengths-based approach, rather than a deficit or criticism-based approach, for encouraging positive behaviour change and fostering a culture of inclusion. We achieved this in the animation by highlighting the value of having an interpreter available for CALD clients (such as the one in this story) rather than placing blame on the clinicians within the team who had not previously booked an interpreter for this client. This story further demonstrates the benefit of having an interpreter present to enhance understanding and the importance of offering one, regardless of any assumptions about the need based on appearances or presumed English proficiency.

While it is too early to determine the impacts of the education animation on service uptake, this design approach demonstrates the potential of designing solutions based on the lived experiences of those who used the service in addition to centring the thoughts and feelings of those who the service most seeks to impact—the consumers. From my experience, I found this project to be a great example of the benefits of co-design for healthcare service improvement for drawing on the unique skillsets and experiences of both designers and health professionals for creating innovative design solutions.

4.5 Thalia Brunner, Animator

The HEAL Interpreter project was part of my HDR internship with QUT. I saw this project as an exciting opportunity to explore my creative skills within a collaborative environment whilst extending my understanding of current, important healthcare matters. The project began for me with an initial meeting with Janice and Sarah. It was at this point where I gained an important understanding of the aims, objectives and how animation could be best used as a communicative tool to improve the understandings and usage of interpreter services within healthcare. I learned a lot about the healthcare challenges for CALD clients during this first meeting. This helped inspire me to create and deliver an animation that could help minimise these barriers by improving understanding and healthcare experiences for the clients.

My role as an animator on this project was to create a 2D animated video comprising of two parts: appointment and post-appointment, designed from discussions between the creative team and appropriate clinicians and clients. The first stage of my creation process involved designing a storyboard (an illustrated shot-by-shot plan for the animation) to establish the desired messages and visual themes. This was then discussed within the co-design workshops and healthcare teams before animation began. It was valuable to spend time on this phase to explore different perspectives and approaches as part of the co-design approach.

Projects of this nature often have the challenge of communicating all the important information into a short timeframe, but this is where animation is particularly powerful and the perfect visual medium. Animated storytelling devices can transform the viewer’s experience, offering a unique perspective of concepts such as those discussed within this project, and connect people to messages in ways words cannot.

While animation itself is a powerful method of visual communication, the approach of a co-design model intertwined within the animation process enabled a unique form of creation that allowed for the project to dynamically evolve. Constant feedback from the target audience ensured that the visual aesthetics and narrative structure delivered a strong, effective message.

I was very pleased with the outcomes of this project, the viewer/team response, and what I was able to achieve working as the sole animator. In addition, this has been a valuable personal learning experience where I was able to increase my understanding and awareness of healthcare experiences for CALD clients and gain an insight into the different perspectives. I enjoyed the experience animating for the HEAL Interpreter project and the opportunity to utilise my skills within an important context whilst working within a collaborative environment.

5 Discussion

A number of techniques can be used to gather the experiences of service users in healthcare; however, healthcare staff and researchers often default to more traditional quantitative methods rather than qualitative, often adding constraints to the richness of insight and depths of understanding of the experiences of users such as how it feels to deliver or be the recipient of care [18]. By emphasising the value of lived experience, alongside authentic and equitable collaboration between designers and clinicians, the participatory methods of Experience Based Co-Design may become a new salient and efficacious approach in healthcare quality improvement [19]. Actively and deeply engaging with users ultimately enables co-design because it ensures “all aspects of subjectively experiencing a product or service—physical, sensual, cognitive, emotional, kinetic and aesthetic” [1, p. 308] are identified and addressed, thus improving the service experience [19].

The collaborations between clinicians and designers to solve complex problems in healthcare and to promote Just access to healthcare is an example of best practice—evidenced by the recent recognition of two national awards in Australia—National Good Design Award Australia for Social Impact, Australia, 2021 and National Good Design Award Australia for Design Excellence, Australia, 2021.

Co-design processes represent not the act of paternalistic leading, but collaborative and inclusive following: we did not intend to create animations to increase the uptake of interpreter services, nor did we intend to create a new exploration of experience-based service design. Through allowing the process and participants to wholly contribute we were able to capture the experience of patients as well as the experience of clinicians and administrators through narrative explorations ultimately informing the resultant output and outcomes of the project. Co-design is a journey often without a predetermined path and it is important for everyone involved to come together and to trust in one another and the process. Experience became central to our process in understanding the limited uptake of interpreter services for clients who identify as CALD or those that are Deaf. By drawing on the knowledge, skills and lived experiences of service users, we were able to redefine experience-based service design beyond just an improvement method.

6 Conclusion

The project involved creative interventions (animations) to demonstrate the potential benefits of storytelling and creative engagement to enhance service design and uptake of interpreter services, ultimately providing direction for designing more inclusive engagement practices [12]. This project was a great example of how the co-design process can allow for the inherent knowledges and skills sets of both clinicians and designers to merge and create innovative and appropriate design solutions.

By bringing forth the lived experience and first-hand insights and stories of clinicians, and the problem solving and creative skillsets of designers, we can arrive at new ways of addressing complex service and systemic problems to transform healthcare, and to uphold the right to just access to healthcare for all.