Health systems regularly undertake large-scale service redesigns to improve efficiency and quality. However, health system strategic and clinical leaders may make service decisions without necessary input from and testing by staff, patients, and the community — those who are most affected by these decisions. Truncating this process impedes the rate and ease of implementation, resulting in a transformation that may not achieve its objectives, is unsustainable, and disengages vital system stakeholders.

Hywel Dda University Health Board (UHB) is an integrated care system that serves 384,000 people in western Wales. The system funds and manages acute, primary, community, mental health, and dental care, as well as disability services. In 2017, Hywel Dda began a decade-long process to transform from a “health system” into a “wellness system.” This involved a full clinical redesign of services and access points across hospitals and the community.

Hywel Dda’s transformation team knew that they needed to get system stakeholders to see and believe in the vision early on, so their redesign could be successful. Instead of redesigning the system around the provider, they redesigned it around the patient. To accomplish this redesign, the team ceded control of clinical redesign to the patients, staff, and community stakeholders who are most affected by these decisions. To ensure they redesigned services with the patient in mind, Hywel Dda created a family of avatars — the Jones Family — that reflected patients’ lived experiences. They used these avatars to test new clinical pathways and communicate changes to the public.

After failing twice to reconfigure services in the early 2000s due to stakeholder pushback, Hywel Dda implemented its transformation based on the clinical designs that staff and community stakeholders produced. Hywel Dda has optimized clinical services, repurposed beds for community care, and created dedicated staff support resources by leveraging its clinical redesign strategy. Hywel Dda’s patient-centered approach secured system-wide stakeholder buy-in for the system transformation and gained the organization international attention.