Table 1

The MH ECO methodology

Engagement *MH ECO final methodology did indicate that an experiences survey developed with service users and carers could be used to identify touch points.	Setting up Meetings with staff explaining project and identification of a project lead. Engagement of staff and determining the best method for collection of experience data.
Information gathering *MH ECO final methodology did not include observations of care or service experiences to understand the person’s journey.	Collecting experience stories Interviewing or surveying (depending on the service’s choices) service users and carers about experiences. Review of interview (or survey) responses to identify the repeated themes (strongest response areas), shared across those interviewed. Themes comprise the touch points, of which the top three areas to improve on are selected.
Understanding experience *MH ECO final methodology did not include the creation of films or showing visual accounts of experiences to develop shared understanding of areas for improvement. Statements of touch points were also presented neutrally as a way of checking member’s connection with the touch point—that is, feeling strongly or less strongly about an area for improvement.	Sharing experiences in focus groups The top three touch points identified from interviews (or survey) developed into neutral statements. Neutral statements are explored with individual groups (service users, carers and staff meet separately) to determine feeling strong or less strongly around these. The strong emotions are used to prioritise areas for improvement for each group. Touch point priority areas for each group are reviewed and points of connection across the groups determined.
Training for codesign	Learning to work together Orientation for service users and carers about group processes and exploring power dynamics of working together with staff. Staff join with service users and carers and collectively learning about the codesign process.
Establishment of collaboration group A strategic group of six to eight people that comprised senior leaders within an organisation to facilitate best chance of implementation of changes, plus service users and carers. *MH ECO final methodology included a collaboration group of senior leaders within organisations to ensure better chance of improvements being implemented.	Meeting 1—setting codesign objectives The collaboration group is provided with the prioritised touch point areas from the focus groups. They review these and discuss the touch points. This group is supported to formulate codesign objectives (ie, which touch point and what is the objective for change around this, also referred to as an improvement objective). This objective is handed over to the codesign working groups.
	Meeting 2—developing an implementation plan The collaboration group develop an implementation plan when they receive the codesign working groups’ action plan (explained below). Implementation plans establish further how to take the suggested changes from the action plans and identify who is responsible within what time frames co-designed changes might be implemented.
	Meeting 3—review of implementation Collaboration groups review what was implemented, by when and what the barriers were to that implementation.
Establishment of codesign groups Working groups of eight people with project staff, service users and carers to codevelop an action plan for changes. *MH ECO final methodology suggested that there could be up to three codesign groups to each work on up to three touch point areas for improvement.	Meeting 1—process mapping Examine the objective for which an action plan will be developed (discuss, create process map to identify the problem areas or sticking points).
	Meeting 2—brainstorming Look at other solutions and brainstorm for codesigned solutions. In the implementation of MH ECO for the study in question a number of evidence syntheses were prepared to support decision-making within the group and ideas generation for changes.
	Meeting 3—action plan formulation The group is facilitated to codevelop an action plan for changes which includes the identification of strategies to achieve the objective for change, the tasks that are required to get there and identifies who is responsible and by when.

MH ECO, Mental Health Experience Co-design.