Participatory Design, Project Clients, and Healthcare User Groups.

Aim: This study is the third in a series of investigations that explored the role of project user groups and how they impact on the design of a healthcare facility. Previous studies focused on a wide range of users, whereas this study sought the views of project clients.

Background: The "project client" represents the organization responsible for the procurement of a healthcare facility. "Users" will work in or "use" that building. With the input of project clients, this research focused on the user group process required for Australian and New Zealand publicly funded healthcare projects. It sought lessons to improve the process for future projects.

Methods: Previous research findings, and an expanded literature review examining participatory design, were used to develop questions for semistructured interviews with selected project clients. Responses were transcribed and analyzed in terms of themes and subthemes using reflexive thematic analysis to develop a narrative that reports and discusses the findings.

Results: Although not all are recognized, many stakeholders influence design decisions. No history, rationale, terms of reference, or evaluations of the user group process were found, suggesting that although it is a "given," the process could be enhanced. Useful suggestions for improving the user group process are offered.

Conclusions: Evaluating the user group process, and learning from alternative approaches, may improve its outcomes. A project charter and terms of reference would support more effective decision making, while best practice guidelines and education for user group participants should be considered.