Co-designing to Improve Practice in Treating Urinary Tract Infections: a case study of reducing inappropriate antibiotic treatment


  • Guillermina Noël
  • Daren Pasay
  • Denise Campbell-Scherer
  • Lynora Saxinger



human-centred design, co-design, collaboration, healthcare, clinicians, urinary tract infections, asymptomatic bacteriuria


Although co-design has made important contributions to practice in many fields, healthcare has only recently employed it for shaping best practices. This paper explores an aspect of medical practice that challenges many hospitals: the decision-making process for ordering urine testing and the use of antibiotics, specifically, in treating Urinary Tract Infections (UTI) and Asymptomatic Bacteriuria (ASB). The case investigates how physicians and nurses make decisions about testing urine for infection and the use of antibiotics. To explore the issue, the researchers conducted three co-design workshops to (1) uncover the medical decision-making process in ordering urine testing and treating UTI and ASB, (2) determine the needs of clinicians as they make such decisions, and (3) collectively design a decision aid that would fit users’ cognitive, emotional and physical needs. The case shows how human-centered design approach led to an evidence-based decision-making tool – guiding clinicians to improve their practices by reconsidering when and if to order urine testing and prescribe antibiotics.

Author Biographies

Guillermina Noël

Dr. Guillermina Noël holds a PhD in Design Sciences (University IUAV of Venice, Italy). She applies a human-centred, evidence-based, and outcomes-oriented design approach to improve healthcare. At the Physician Learning Program in the Faculty of Medicine & Dentistry, University of Alberta, Canada, Guillermina supported healthcare teams by helping them to move beyond problem’s symptoms, understand the people’s capacities and needs, and co-designing to achieve better health outcomes. She is also the Director of the Health Design Network. Since 2019, she is the Head of Design Management International programme at the Lucerne University of Applied Sciences and Arts.

Daren Pasay

Darren Pasay is the Drug Stewardship Pharmacist for Alberta Health
Services, Central Zone. His interests in Antimicrobial Stewardship, geriatrics,
knowledge translation, transformation change and research lead him into
the role as the Project Lead for the Appropriateness of Care: Asymptomatic
Bacteriuria project. He previously spent 13 years as a clinical pharmacist
and pharmacy manager in rural hospitals in Alberta and 3 years as a Clinical
Associate Professor at the Faculty of Pharmacy and Pharmaceutical Sciences
at the University of Alberta.

Denise Campbell-Scherer

Dr. Denise Campbell-Scherer is a Professor in the Department of Family Medicine, and the Associate Dean of the Office of Lifelong Learning and Physician Learning Program at the University of Alberta. With a background in evidence-based clinical practice, she has been active internationally in education of multidisciplinary learners and is an Associate Editor of BMJ-Evidence-Based Medicine ( Campbell-Scherer’s research leads and interdisciplinary research team focused on innovations to advance clinical practice.

Lynora Saxinger

Dr. Lynora Saxinger is an academic Infectious Diseases specialist, her career outside patient care is focused on antimicrobial stewardship and antimicrobial resistance, with involvement in hospital, health system and national collaborations to improve antibiotic stewardship practice, resistance and utilization surveillance. She is a founding member and past chair of the Antimicrobial Resistance and Stewardship Committee of the Association of Medical Microbiology and Infectious Diseases Canada. She is Associate Professor of Medicine, University of Alberta, and Medical Lead of Antimicrobial Stewardship for Northern Alberta, with Alberta Health Services.






Journal Article