How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study

Matthew Woodward, Mary Dixon-Woods, Wendy Randall, Caroline Walker, Chloe Hughes, Sarah Blackwell, Louise Dewick, Rachna Bahl, Tim Draycott, Cathy Winter, Akbar Ansari, Alison Powell, Janet Willars, Imogen A. F. Brown, Annabelle Olsson, Natalie Richards, Joann Leeding, Lisa Hinton, Jenni Burt, Giulia MaistrelloCharlotte Davies, Thiscovery Authorship Group, ABC Contributor Group, Jan W. van der Scheer

Research output: Contribution to journalArticlepeer-review


Clinical tools for use in practice-such as medicine reconciliation charts, diagnosis support tools and track-and-trigger charts-are endemic in healthcare, but relatively little attention is given to how to optimise their design. User-centred design approaches and co-design principles offer potential for improving usability and acceptability of clinical tools, but limited practical guidance is currently available. We propose a framework (FRamework for co-dESign of Clinical practice tOols or 'FRESCO') offering practical guidance based on user-centred methods and co-design principles, organised in five steps: (1) establish a multidisciplinary advisory group; (2) develop initial drafts of the prototype; (3) conduct think-aloud usability evaluations; (4) test in clinical simulations; (5) generate a final prototype informed by workshops. We applied the framework in a case study to support co-design of a prototype track-and-trigger chart for detecting and responding to possible fetal deterioration during labour. This started with establishing an advisory group of 22 members with varied expertise. Two initial draft prototypes were developed-one based on a version produced by national bodies, and the other with similar content but designed using human factors principles. Think-aloud usability evaluations of these prototypes were conducted with 15 professionals, and the findings used to inform co-design of an improved draft prototype. This was tested with 52 maternity professionals from five maternity units through clinical simulations. Analysis of these simulations and six workshops were used to co-design the final prototype to the point of readiness for large-scale testing. By codifying existing methods and principles into a single framework, FRESCO supported mobilisation of the expertise and ingenuity of diverse stakeholders to co-design a prototype track-and-trigger chart in an area of pressing service need. Subject to further evaluation, the framework has potential for application beyond the area of clinical practice in which it was applied.
Original languageEnglish
JournalBMJ Quality and Safety
Early online date12 Dec 2023
Publication statusE-pub ahead of print - 12 Dec 2023


  • Healthcare quality improvement
  • Human factors
  • Obstetrics and gynecology
  • Quality improvement methodologies
  • Trigger tools

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