Patients and Staff Co-Design Four Tools to Make Emergency Departments Fairer for Ethnic Minorities

Emergency departments are among the most high-pressure environments in modern healthcare, and for people from ethnic minority backgrounds they are often where the system’s inequities become most visible. A new study published in BMC Health Services Research by Magali Goirand of the Australian Institute of Health Innovation at Macquarie University and colleagues reports on a structured effort to change that, not by imposing solutions from above, but by building them collaboratively with the people who use and staff the emergency department. The work, part of the MyED collaborative project funded by the Commonwealth of Australia’s Medical Research Future Fund, set out to co-design interventions that improve communication and health system literacy for ethnic minority adults presenting to emergency departments in a multicultural urban area of Australia.

The scale of the problem the team addressed is well documented. People from ethnic minority backgrounds frequently experience worse outcomes and poorer experiences than the general population when they arrive at an emergency department. Previous strategies to close this gap have included strengthening self-management of health issues, improving communication between patients and carers on one side and emergency department staff on the other, and building workforce capacity. Yet the researchers note that details about such interventions are scant, and, crucially, intervention design has typically proceeded without involving the patients and carers whose lives those interventions are meant to improve. That omission is what Experience-Based Co-Design, the methodology at the heart of this study, is intended to correct.

Experience-Based Co-Design is a participatory approach that treats patients, carers, and clinicians as equal experts in the experience of care. Rather than asking people to respond to pre-formed proposals, it gathers their lived experiences, extracts needs and ideas from that material, and then brings all parties together to prioritise and shape concrete solutions. In this study, the team conducted five workshops with a total of 25 patients and carers from ethnic minority backgrounds, alongside five clinical staff from the emergency departments of the three participating hospitals serving the area. The workshops formed a deliberate pipeline: early sessions generated raw material, middle sessions refined and prioritised it, and the final session produced finished intervention concepts.

The yield from those early workshops was striking. The first two sessions alone gathered 87 distinct needs and 162 ideas from patients and carers for improving their experience in the emergency department. That volume reflects the density of friction points that people encounter when they arrive acutely unwell, often in a second or third language, in an unfamiliar and intimidating institutional environment. Importantly, the needs and ideas were not confined to communication and health systems literacy, the study’s original focus. They also addressed the physical environment of the department and patients’ emotional wellbeing, suggesting that the burden of a difficult emergency department visit is experienced holistically rather than as a single technical problem to be solved.

After the refinement and prioritisation that took place in the third and fourth workshops, the fifth session converged on four concrete interventions. The first is a waiting room digital display, designed to give people waiting for care better information about what is happening and what to expect. The second is a bilingual and visual pain scale, a tool that speaks directly to one of the most fundamental barriers in emergency medicine: if a clinician cannot accurately assess how much pain a patient is in, every downstream decision, from triage category to analgesia, is compromised. A bilingual, visually anchored scale allows patients to communicate pain intensity across language boundaries, reducing the risk that linguistic disadvantage translates into clinical disadvantage.

The third intervention is an informational video about emergency department processes, aimed at demystifying the sequence of events, triage, waiting, assessment, and treatment, that patients often find opaque and anxiety-provoking. The fourth is an information kiosk, a physical point in the department where patients and carers can access guidance. Taken together, the four interventions form a coherent package: they target the waiting period, the clinical encounter, and the general orientation to the system, the three moments where the researchers’ evidence suggested communication and literacy gaps do the most harm.

One of the study’s most sobering findings concerns the relationship between public feedback and institutional memory. Some of the ideas presented by ethnic minority participants were already in place in the departments, or had been tried in the past, without the participants knowing. This is not a trivial observation. It indicates that health services can implement improvements and then lose visibility of them, so that the public continues to experience the gap the improvement was meant to close. The researchers conclude from this that a regular feedback loop between health services and the public is essential, both to improve awareness of what already exists and to keep interventions current as circumstances change. Co-design, in other words, is not a one-off event but a continuous relationship.

The study also offers a candid technical assessment of the limits of innovation in a complex system. Several ideas were inspired by participants’ experiences in other sectors, such as retail or hospitality, where customer-facing information systems work smoothly. The researchers found that these ideas were not easily translated into the emergency department context because of system constraints and the complexity of the environment. An emergency department is not a shop: it operates under clinical governance, legacy information technology, fluctuating demand, and safety requirements that resist simple analogies. This finding matters for anyone designing patient-facing tools in healthcare, because it suggests that the feasibility filter must be applied early, with people who understand the system’s architecture, rather than after concepts have already been embraced by participants.

From that assessment flows one of the study’s clearest recommendations for future practice. Involving emergency department staff from other regions, and support services professionals such as information technology specialists, in the co-design workshops could increase innovative thinking and enable the selection of ideas that are more easily integrated into current systems. The logic is that a wider professional mix at the table would allow the group to distinguish between ideas that are imaginative but unimplementable and ideas that are both imaginative and compatible with the department’s technical and operational reality. It is a reminder that co-design’s promise of inclusivity extends beyond patients and clinicians to the often-invisible professionals who maintain the systems those interventions must run on.

The researchers are equally honest about the social dynamics inside the workshops themselves. Managing knowledge and power imbalance within co-design groups, they report, can prove challenging. When patients and carers sit alongside clinicians and researchers, differences in professional status, technical vocabulary, and confidence can quietly shape whose ideas get airtime and whose get refined. Acknowledging that difficulty, rather than assuming that bringing people together automatically equalises them, is itself a contribution to the methodology. The study was approved by the Local Health District Human Research Ethics Committee, with informed consent obtained from all participants, and it forms part of a broader MyED partnership that includes Western Sydney Local Health District, the NSW Agency for Clinical Innovation, the University of the Sunshine Coast, the University of New South Wales, the Department of Social Services, the NDIS Quality and Safeguards Commission, and Health Consumers NSW. For health services everywhere grappling with ethnic disparities in emergency care, the message is that the tools exist to be built, but they must be built with, not merely for, the communities they serve, and the building must never stop.

Subject of Research: Co-design of emergency department interventions with ethnic minority patients and staff to improve communication and health system literacy

Article Title: Experienced-based co-design interventions in the emergency department for ethnic minority adults

Article References: Goirand, M., Francis-Auton, E., Cheek, C., Hayba, N., Richardson, L., Ransolin, N., Dominello, A., Austin, E., Murphy, M., Mitchell, R., Carrigan, A., Harrison, R., Braithwaite, J., & Clay-Williams, R. (2026). Experienced-based co-design interventions in the emergency department for ethnic minority adults. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15822-2

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15822-2

Keywords: emergency department, co-design, ethnic minority, health equity, health communication, health system literacy, patient experience, Experience-Based Co-Design, health services research, bilingual pain scale, health disparity, Australia