Ketso in Health & Social Care


Ketso has been used in a range of health and wellbeing contexts, from engaging directly with patients to developing new approaches to amongst health and social care professionals and people working in related fields. You can find out more about Ketso in mental health here

This section includes:

Ketso in palliative care and learning disabilities

Allison O'Donnell,  Practice Development Nurse for Learning Disability Services across NHS Greater Glasgow and Clyde

I have already used Ketso with more than 1000 people.

I use it as part of change processes and for teaching. I have used it with case study questions, care planning, workshops, etc. I find it very adaptable and it encourages interaction amongst the whole group. I like that even the quietest individuals have an opportunity to be involved and are encouraged to voice their opinions.

Ketso encourages people to think about their practice and consider ways of improving or changing. I use it a lot in reflective practice. I believe that when people are involved in these sessions and come up with the solution to problems themselves, they are more likely to be supportive of change.

Learning how medical practitioners access and use information on drugs and prescriptions

Xia Li, Market and Audience Intelligence Analyst, National Institute for Health and Care Excellence (NICE)

Ketso was used in a series of 3 workshops in spring of 2014 with a wide range of medical practitioners, from community midwives, to consultants, to GPS, to discuss the new vision for the British National Formulary. I found that Ketso is a useful tool in systematically gathering feedback from British National Formulary's users within a short timescale.

There were over 2000 ideas generated from 3 workshops. The Ketso analysis tool makes the analysis and reporting easier and quicker. I also found that the visual presentation of Ketso can stimulate participants' interests and encourage them to take part in the group discussion. The feedback from participants about using Ketso was positive.

It has been acknowledged by senior managers in the National Institute for Health and Care Excellence (NICE) that there will be a continued use of Ketso within the organisation to assist with further research and internal strategy development.

Engagement in Healthwatch Cheshire East

Julia McCoy, Volunteer and Service Development Coordinator, Healthwatch Cheshire East

My role as Volunteer and Service Development is to set up and support a signpost service to health and wellbeing organisations for Healthwatch Cheshire East.

I have used Ketso in meetings at work in several different ways for example:

  • Volunteer meeting to plan future projects.
  • Met with a local Multiple Sclerosis (MS) Society and looked at health and wellbeing issues for people with Multiple Sclerosis
  • Service agenda planning (shown in this image)

We have found that using Ketso has helped us to drill down to the root causes of issues and helped us to focus on the actions. Projects have been implemented using Ketso findings and feedback questions have been focussed by using this method.

There are some great advantages of using Ketso.  All participants can have their say by writing and discussing their contribution. It is a very visual way of facilitating group discussion, and people can easily add to the threads.

Feedback has been positive from delegates, they feel that this way they have had their contributions included, whereas their ideas are sometimes lost in pure discussion. By writing the ideas down, they are included and not lost.

I am also a leader in Girlguiding and a Trainer on the Girlguiding North West England Region Training Team. I have used Ketso with Girl Guide leaders in activity planning, planning for camp and a show (Gangshow). It is a very interactive and inclusive tool to get people to focus on a topic.

Bringing the Whole Community Together to Fight Disease In Tanzania

Contributed by Tiziana Lembo (awarded Royal Society of Edinburgh's Patrick Neill Medal) and Jane Coutts Institute of Biodiversity, Animal Health and Comparative Medicine  (University of Glasgow)

Project awarded University of Glasgow’s Engagement Project of the Year 2016 and The Guardian Higher Education Network University Awards 2016 - International projects

Children and young people are the ones who most often die of rabies in rural Africa, but they are not always easy to reach. Many leave school after primary, and many work in agriculture. If they are bitten by a rabid animal, even if they know they need vaccination to save their life, vaccine may be too expensive or too far away. For any number of reasons, they may not receive it, and if they do not receive it, they die.

One of our projects focuses on increasing awareness about rabies prevention, but more specifically on consulting communities about removing some of the barriers to putting this awareness into practice. We were looking for a tool which would allow us to bring a range of stakeholders together, hear their views and help find a common solution; a “whole community” plan to prevent rabies and other diseases.

Children discussing ways of delivering key rabies prevention messages to children and young people (Mkwatani Village, Kilosa District, southern Tanzania; 14 July 2015). Photo: Tiziana Lembo.

Ketso provides exactly the right facility for our approach. We organised rabies community workshops in villages in southern Tanzania, two days with the whole community and one day with primary and secondary school teachers. We were keen to avoid a common approach where only schools are targeted, as many of the older children have already left school or have never been to school. The Ketso kit helped assess their existing knowledge about rabies, and reinforced key messages. It formed the basis for a community discussion about the best ways to approach young people in the villages, so that the community could own the solutions and be supported in taking them forward.
The participants looked at the main messages on rabies prevention, the best media for delivering them and who in the community could provide the young people with a support network in the longer term. The workshop brought together government representatives (health and veterinary officers), parents, grandparents, village leaders, livestock herders, religious leaders, a traditional healer, representatives of VICOBA (women’s micro-financing groups), teachers and young people themselves.

Community workshop to develop a community-based plan for rabies prevention (Mkwatani Village, Kilosa District, southern Tanzania; 15 July 2015). Photo: Tiziana Lembo

These workshops were a middle stage in a broader project, which will culminate in a wide range of information delivery on rabies prevention to young people in the village, involving the support network of key stakeholders who were identified using the Ketso kit.

Ketso has allowed us to bridge the divide between high-level government officers and key stakeholders in communities. For example, we have been using it to develop national and locally-specific plans for the prevention and control of foot-and-mouth disease in Tanzania, a disease which severely impacts livestock development and livelihoods. We gathered key decision makers, such as senior government representatives, and participants from the commercial, traditional and wildlife sectors. They discussed incentives, benefits, barriers and solutions related to foot-and mouth-disease control in Tanzania.

Government representatives, researchers and pastoralists discussing barriers and solutions to preventing foot-and-mouth disease in Tanzania (Morogoro, southern Tanzania; 15 April 2015). Photo: Tiziana Lembo

The government representatives particularly appreciated the participatory and interactive approach of the Ketso kit, which helped them engage in bilateral dialogue with the people most affected by the disease on the ground. They also enjoyed commenting on other groups’ ideas, and sometimes criticising them! It sparked further discussions. We looked at who should take responsibility for agreed actions, and the government representatives went home with a long list.

The kit makes it easy to bring together people of different backgrounds, ages and levels of education, and helps them to speak on equal terms. They are able to develop a clear plan and solutions, which are viable for their particular geographical and social context. People were so relaxed during Ketso sessions that one man in Kilosa stood up and improvised a rabies prevention song.

Learn more in this blog.

Rabies workshops were funded by the “Communities Against Rabies Exposure” project (UBS Optimus Foundation grant to the Global Alliance for Rabies Control and University of Glasgow).
Foot-and-mouth disease workshops were funded by the Wellcome Trust Afrique One consortium, MSD Animal Health, the Boyd Orr Centre for Population and Ecosystem Health and the BBSRC / DFID / Scottish Government (Combating Infectious Diseases of Livestock for International Development initiative).

Patient invovlement - Feedback from older patients

Noreen Caldwell, Local Officer, Scottish Health Council, Ayrshire and Arran

We have used Ketso to gather feedback on patients’ experience of using the Occupational Therapy service in Ayrshire. The group were older people, and at first I worried they would struggle, so I ensured I was there to write on the leaves if they wanted. I was quite pleased to find that they all seemed to like the idea and happily wrote their experiences on the leaves.
We got good qualitative information from this group and it only took  two hours (that included tea and cake!)  By using the felt as a visual aid,  it kept the short time we had focused on the subject, with minimal straying into matters that weren't relevant to the real experiences of these patients.

NOTE: The innovative work in co-production that  Scottish Health Council, NHS Ayrshire & Arran and East Ayrshire Council have doing has led to a nomination of 'best poster' at the International Conference for Integrated Care (25-27 March 2015, Edinburgh).


Patient involvement - Ketso in HealthWatches (formerly LINks)

In addition to its use in patient involvement in NHS Trusts, Ketso has been used by two LINks (now HealthWatch), which were set up to bring together community members and voluntary groups working to improve help and to offer a conduit for the voice of these groups to the NHS. HealthWatch Brighton and Hove (formerly Local Involvement Network BH LINk) has used Ketso as one of their suite of engagement tools.

Claire Stevens, Brighton & Hove LINk Manager says:

"We pride ourselves on our innovative approach to engagement and find Ketso fits in well with our ethos of "creative engagement." We have found that people are initially more willing to join a Ketso workshop to find out what it is and when they participate the feedback we have received has been very positive. Those who have used our Ketso have said they had fun, it made the workshop more interesting and they found it easy to participate.

Ketso is easy to transport on buses etc. as it has a handy shoulder strap and as a 10:10 pioneer we also appreciate the fact that it is environmentally friendly - unlike conventional flip chart type resources. You simply wipe clean the leaves and it's ready to use again."

Engagement in social care in South Lanarkshire

South Lanarkshire Council experienced Ketso in January 2012, at a workshop entitled 'Learning from Renfrewshire’s Community Planning Conference success’ hosted by COSLA. They have since been using Ketso in a range of internal and external engagement, with great success. Internally it has been used for focus groups, manager’s workshops, debriefs and training. Externally it has been used with community service user groups.

In South Lanarkshire, the Council has been working with Ketso with Community Links, a community engagement charity that are involved in extensive consultation work – particularly in Blantyre and surrounding areas of South Lanarkshire.  Paul Hayward, Community Links’s Social Marketing Officer, says:

“As ‘being innovative’ is one of our core values, the Ketso toolkit provides a perfect opportunity to expand our consultation services and further engage members in our consultation work. 

One project in particular, the ‘Making it Work’ project - we consulted with lone parents with children aged between 3-5 years old in areas of South Lanarkshire and looked at opportunities and barriers of returning to the work place.  The Ketso toolkit provided an interactive way of engaging these participants, as they said themselves that being able to ‘physically’ write a comment or suggestion on one of the leafs, making them each feel like they were part of something more than just a discussion. They were able to speak about their views as  everyone had to wait their turn.  It also gave them an opportunity to each voice views that were important to them, which may be lost in a traditional focus group setting.

Community Links feel that using the Ketso toolkit gives those using it a ‘voice’ and the leaves acts like giving each participant a ‘microphone’ to use as a platform for discussion.  Community Links intend to use the toolkit again this month, this time for workshops for NHS project, First Steps.  These workshops will include first time mums discussing how First Steps services can be expanded and improved. 

Considering the target group, the Ketso toolkit provides a wonderful, colourful ‘storyboard’ which is guaranteed to maintain their focus and interest as opposed to a traditional workshop setting.  It allows the participants to physically build on each other’s ideas again and again, making them feel like they have taken part in more than a discussion. 

Community Links feel that the Ketso is a fantastic toolkit, and from an evaluation point of view, it makes it easier for the facilitator to capture important statements by eliminating the possibility of misinterpreting any comments made.”

Specific examples Ketso in external engagement include:

  • 08/08/2012 – To Re-develop the South Lanarkshire Council Blue Badge Assessment Process : 3 ½ hr session with 11 participants - Occupational therapists, team leaders and  administration staff.
  • 11/09/2012 – To gather a response to “The Same as You” Government consultation by the Partners in Practice Carer's Group: 1hr 15minute session with 17 participants -14 Parent/carers and 3 staff members
  • 06/12/2012 - Risk Assessment tool kit development to support day care staff: 2 ½ hr session with 6 participants - mix of social care assistants and day centre officers.

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Roger Kincaid, Planning & Development Officer, South Lanarkshire Council, Social Work Resources says:

"It has been great to see how the kit has enabled people to get their ideas on the table and to see how we can work together to improve services. I used Ketso leaves to gather feedback from participants on the process, and it has been overwhelmingly  positive, with the main negative feedback being that people wanted more time to discuss the ideas developed.

Comments included: “Good for eliciting a response from a wide range of users; Easy. Non threatening. Engaging; Everyone made to think; Very innovative; Good way of everyone getting a say.” Suggestions for improvement included: “More days like this”'.  

Given the success of the approach, more staff within my team are to be trained in Ketso facilitation and we have also placed an order for our own kit for our resource. It has been interesting for me to see how an idea that has come from community planning has been useful in the health and social care sector."

Equality and diversity in the National Health Service

Ketso is being used in several NHS Trusts to enhance equality and diversity, both as a toolkit for engagement in ongoing planning and in evaluating progress towards equality and diversity. For instance, in April 2013 an Equality and Diversity Officer in an NHS Trust commented:

"We used the Ketso toolkit at a recent event when we invited members of the local community to come along and take part in rating us on our performance of delivering Equality and Diversity within our hospital.

The Ketso encouraged people from different communities to engage with us and each other.  The visual toolkit was refreshing and created a safe environment for people to express their opinions.

The feedback we received was positive and we have been analysing the information gathered to shape our strategy".

The Equality and Diversity Assistant for Lancashire Care NHS Foundation Trust, Joe McMahon, commented after using Ketso in his work:

"I have used Ketso at 2 different events, and at both events it was categorically the best way to involve everyone sat around the table to completely engage and get involved.  The events included people from completely different backgrounds, with different political views and opinions, and I can’t think of a better tool to get everyone positively engaging. 

Because of the success, my employers have purchased 2 kits."

Feedback from the evaluation forms used at these events included:

  • Excellent format that fully allowed participation
  • Very interactive opportunity for everyone to participate
  • Really good way to engage people

See this page to learn more about Ketso's contribution to equality and diversity.

LINk: Black and Minority Ethnic (BME) Workshop for Women

Claire Stevens, Link Manager at Brighton & Hove Local Involvement Network

Brighton and Hove LINk (BH LINk) is the independent health and adult social care watchdog for the city. We are a member of the BME Health Forum which facilitates the involvement of BME community groups and individuals in the planning, design, delivery and monitoring of health services and the wider health policy agenda.

The Forum is a collection of diverse individuals, groups and organisations from the community and voluntary sector and statutory sector, who have a shared interest in the health care needs and provision of services to BME communities.

Claire Stevens, the manager of BH LINk, agreed to facilitate a workshop using Ketso at a BME Health Forum event with the assistance of Nora Mzaoui a Development Worker Health and Support with People Can (formerly Novas Scarman). About twenty women from BME communities attended the workshop on women’s health. The team used an interpreter for one group of women from the Chinese community.

A comment from an anonymous evaluation form was:"method of capturing people’s view very good. Should be used for future workshops".

You can download the report from the event here.

Health and Wellbeing Boards - an Ageing Dimension

Fifteen participants from local authorities, health agencies and consultants working in health and wellbeing from across England attended a workshop on the 26th September 2011, which launched the Ageing Well – health and wellbeing programme (part of the Ageing Well Programme, of the Local Government Group). Participants worked in teams to discuss ways to include an ageing dimension in the shadow Health and Wellbeing Boards that are in the early stages of development across the country.

Since then, the Centre for Public Scrutiny, which ran the programme with the Local Government Group, has used their Ketso kit with roughly 300 participants. Su Turner says: "The Centre for Public Scrutiny uses the kit to extract  learning from programme participants and use this to develop publications such as the LGAs Ageing Well Publications".

In the initial workshop, branches were used to provide themes for organising the ideas. The starting point for these themes was the New Economic Foundation’s (nef) Five Ways to Wellbeing:

  • Connect
  • Be Active
  • Take Notice
  • Keep Learning
  • Give

The discussion throughout the day was lively and involved some searching debate about the role of local authorities and the various bodies involved in health and wellbeing. There were some serious questions asked about changing cultures and practices. Whilst there was recognition that these were difficult times, there was also a sense of hope that opportunities to share ideas such as this workshop offer an opportunity to question assumptions and could lead to new ways of working.

The workshop lasted for two hours, and a total of 215 ideas were developed and discussed. You can download the results here:

The interactive nature of the workshop was seen to support such dialogue and debate, as one participant commented: “Ketso offers a simple way to get everyone talking, with a bit of structure and a way to make connections between ideas.”  Steve Pitt, Consultant on the Health and Wellbeing - an Ageing Dimension Project.

Health and wellbeing -learning from each other in a time of change

Ketso is running a series of workshops looking at health and wellbeing. TheResearch Institute for Health and Social Change at Manchester Metropolitan University hosted two interactive dialogues run by the Ketso team on Feb. 10th, 2012, and a further one on May 11, 2012. On April 19th, the School of Health, Nursing and Midwifery at University of the West of Scotland hosted a workshop around the same theme in Paisley.

To date 110 participants have taken part, from health practitioners, the NHS, NGOs, companies working in the health field and academia.

The following themes were discussed:

  • Access & equality - who is this for?
  • Prevention & cure - what are we trying to achieve?
  • Joined-up working and the bigger picture - how can we work smarter to achieve it? What are the broad contextual challenges and opportunities we should consider?
  • Community engagement – how to involve people?
  • Resource & cost effectiveness - how can we pay for it?

You can find useful resources from these events here, including a ‘Brief Guide to some Terms and Upcoming Structures in Health Care’ and the PowerPoint slides used in the workshop.

You can find a summary of the results, and download the full sets of results from each workshop on this page.

We will be developing a synthesis report after the series of workshops are finished.

Health and Wellbeing - Open Space

Katie Stevens, Health and Well Being Project Manager at Groundwork South West

Groundwork South West (GWSW) have employed a Research Associate to undertake a research activity in partnership with University of the West of England, Bristol to develop an evaluation toolkit to assess the health benefit of community-based programmes delivered by GWSW. GWSW have used the Ketso kit as part of consultation work in a programme funded by Marks and Spencer (M&S). The activity involved community members discussing what the programme will involve and ideas for improving an open space. M&S employees then assessed these ideas against each of the health and well being outcomes of the programme proposal.

The Ketso Kit was a relevant tool for this activity as the group could logically work through the ideas and assess them against the programmes outcomes, and staff could contribute their ideas on the Ketso Kit without being influenced by each other. The Ketso Kit kept the group engaged and focused throughout the discussion workshop, as each person was involved in contributing their ideas.

GWSW now plan to use the Ketso Kit with staff at GWSW as part of the research project we are undertaking. We will use the Ketso Kit to answer the following questions:

  1. What community-based programmes being delivered by GWSW promote health or have a health aspect?
  2. What aspect of health can be evaluated in these community-based programmes?
  3. How can these health aspects be measured?

This activity will get staff in GWSW to begin thinking about how their programmes are incorporating health and to begin thinking of ideas of evaluation. The Ketso Kit allows the Research Associate to demonstrate to staff practically how the Ketso Kit works, it also allows for all staff to input their ideas into the research project. These findings will lead on to developing a database based on the information given by staff. GWSW have two Ketso Kits so are able to use each of the workspace felts with 8-10 people on each one, so the whole organisation are able to participate.

A participant from from M&S, who was at the consultation workshop with community members commented: "It was an interactive and colourful way to get the opinions of myself and local residents."

Alcohol reduction in the community

In early 2011, Paisley West and Central Community Council asked various departments of Renfrewshire Council, the Community Health Partnership, Renfrewshire Community Health Initiative (RCHI), the Police, local schools, Strathclyde Fire and Rescue and local elected members to support them in trying to change the way that alcohol affects lives in the West-end of Paisley.

Together, they agreed to seek the views and opinions of local residents about how drinking alcohol could be made more positive and less harmful, and to get them involved in the process.

As a result, a small community-led working group organised an event which used Ketso to gather input from participants into this issue. A representative cross-section of more than forty residents participated and a Member of Scottish Parliament and local councillors were also in attendance.

Extracted from report by John Wilby, Chair at Paisley West & Central Community Council.

To download report, click here.

Dialogue and communication amongst professionals in healthcare

There are many examples of Ketso promoting more effective dialogue amongst diverse groups of professionals and stakeholders in health care.

Stakeholders from disabled people, to refugees, to the National Trust and nursing students have used Ketso in discussing how to help disabled and disadvantaged people to access heritage sites (a Somalian refugee is shown adding her ideas to the Ketso here).

The Faculty Training Manager in Medical and Human Sciences at the University of Manchester has used Ketso kits with clinicians and researchers to map out how they are going to effectively communicate their research findings to multiple different audiences (patients, patient groups, researchers, family, support groups etc).

The MerseyCare team is also using Ketso in team meetings and planning events. The following quote is a reflection from Berenice Gibson (Programme Support Manager, Creativity & Wellbeing/ Arts Co-ordinator, TIME Project, Mersey Care NHS Trust) about using Ketso in such planning:

"For me as the organiser it has been great being able to have such a visual record of each meeting, we’ve taken photos of the sheets after each meeting and then circulated them as you would minutes. In addition at each meeting the photos of the previous meetings are up on the walls giving people an instant recap of the meeting before we move forward. We used the action planning felts yesterday to plan the day and the sessions, and again that worked very well."

A Healthy London - a dialogue

Twenty-three professionals involved in health and social care met on March 16, 2011 to explore how Ketso could be used in promoting health and well-being and engaging with the diverse stakeholders who are involved in the health arena.  As well as learning new tools for creative involvement of stakeholders in working out ways to improve health, participants learned a different way turn ideas to action and create an action plan on a collaborative Ketso.Healthy_London


The workshops yielded 430 ideas in under three hours. Assets which could help London to be healthier that were highlighted as significant were: ‘polyclinics’, ‘patient support groups’, ‘banning chicken shops within 400m of schools’, ‘smoking ban and help to stop smoking’ and ‘walking routes’. 

A problem that was highlighted as significant was: ‘NHS taken for granted’. Ideas that were clustered around this issue were: ‘ignorance about entitlement’ and ideas to improve this problem were: ‘get rid of Quangos and train media staff better’ and ‘stop whingeing culture’. An overarching goal to emerge from this discussion was ‘NHS awareness’.

There was a general sense of the need to involve the community more in health planning, and to develop more locally based projects with the aim of improving health. There was recognition though, that there was a lot of good work already going on in this area, and that there had been an ‘increase in public consultation’.

Please download the full report (pdf) of this workshop. An exel spreadsheet containing all the results from the workshop is available to download here (xls).