Using the Kawa River Model to engage patients

Using the Kawa River Model to engage patients

The State Hospital carried out patient engagement on a proposed new Clinical Care Model using a focus group structured on the Kawa River Model.

A planned redesign of the State Hospital's Clinical Care Model would affect the configuration of wards, admission, continuing care, rehabilitation and care of people with intellectual disabilities. Managers were keen to get patients' views on the options that had been developed, and to identify any new ideas.

A small group of patients came together to discuss the options. The Kawa River Model was used as a structure to guide the discussion and to record their responses to 3 questions:

  • What do you think works well with this model? 
  • What do you think might not work so well with this model? 
  • What else do you think we need to think about, such as a completely different model? 

The approach was adapted from the Kawa River Model (Iwama, 2006), an Occupational Therapy model of practice which identifies barriers and enablers through the use of images.

To structure their discussion, the patients used:

  • boulders to describe obstacles which are of significant concern
  • pebbles to highlight challenges which exist but which are, in their opinion, moveable
  • boats to illustrate enablers and opportunities for positive change

The patients were also able to give their views on how more person-centred care may be delivered through the service redesign.

The comments from patients were collated along with feedback gathered in one-to-one interviews and the general outreach involvement programme, where the same 3 questions had been asked. Engagement with staff and with volunteers was also carried out.

Similar themes emerged from the patient, carer, volunteer and staff engagement. The opportunities which were identified informed the benefits criteria that were used to score the options, including progression through hospital, the physical environment, specialist staff skills in meeting different patient needs, and individual safety measures. After the scoring exercise, there was further engagement with patients to get feedback from them on the highest scoring option.

Learning points

  • This technique enabled patients, who are key stakeholders in the service redesign, to effectively participate in what can seem a technical exercise 
  • 15 patients were supported by the Person Centred Improvement Team and Patient Partnership Group Chair 
  • This was one method of engagement used alongside one-to-one discussions and the outreach involvement programme. 


Sandie Dickson, Person Centred Improvement Lead, The State Hospital

Last Updated: 2 February 2021