From Stories to Systems Understanding

What began as a project to understand Emergency Department (ED) use in Plymouth quickly expanded into something deeper. We weren’t just collecting stories—we were beginning to trace the systems behind them.

Cathy McCabe shared early on, “The aim is to understand more fully the lived experience and challenges facing people who are high-intensity users of Derriford ED.”

To do that, we trained community researchers, developed trauma-informed practices, and created new approaches to ethical safeguarding. “The messaging the NHS gives to potential participants, and the one we share as community researchers, need to be consistent and clear,” Stephane reminded us.

At the same time, we began noticing patterns. Amanda Nash and Karen Pilkington helped lead a process to understand the broader system dynamics—from healthcare pressure points to community-led alternatives. “We need a version of the system that’s accurate enough for conversation,” Karen reflected, “but simple enough that it doesn’t need a PhD to decode.”

And it wasn’t just about insight—it was about support. Our team developed new training guides, safeguarding protocols, and flexible tools like the “conversation wheel” to help interviewers navigate difficult moments. “I’ve found the wheel helpful when conversations start to spiral,” one researcher noted.

From workshops in St Budeaux to sessions on mental health, we kept refining how we facilitate, how we process, and how we support each other in complex spaces.

These insights are feeding directly into health commissioning, neighbourhood planning, and our growing sense of what a human-centred system might look like.

It started with one question about ED use. But it led to bigger ones: What systems do people move through? And how can we reshape those systems together?