John didn’t plan on becoming the pirate Captain Bartholomew “Black Bart” Roberts. By all accounts he was just some Welsh guy who got caught in the crossfire.  Like many self-preserving sailors before him in the 18th century, when the slave trader on which he sailed was boarded and defeated by some actual pirates, he decided to join the victor and live to sail another day.

Within only a few weeks his new (pirate) Captain was ambushed and killed in an attempted kidnapping scheme gone wrong.  The crew gathered together in council and voted John to be their next Captain.  Only six weeks after leaving the merchant navy John chose the name Bartholomew, embarked upon his captaincy and became the most successful pirate captain of all time; capturing and plundering over 400 vessels in 4 years.

Lets just pause here.

That’s about 2 ships a week.

Respect.

This story is not only remarkable in over achieving pirate coolness. What stands out for the modern-day consumer co-design devotee is the striking similarities in method when it comes to inclusion.

Wait, what?

Bear with me. All will become clear.

For a merchant sailor like John in the early 1700s sailing was a miserable existence. Sailors suffered cramped quarters, poor food, brutal discipline, low wages, devastating disease, disabling accidents and premature death.  It was a bit shit really.

In contrast, the merchant ship’s Master was frequently a small part owner of the vessel and possessed near absolute authority. The ship was his virtual kingdom where he ruled like a despot. The comfort and interests of himself and the ship’s Captain and merchant owners were of primary concern in any voyage. Position, rank, privilege, profit and any semblance of self efficacy were completely out of reach for the average merchant sailor in this world.

In John’s previous sailor life he would never have been promoted to Captain after six weeks of service, let alone by a council of sailors. So how’d it happen?

This new appointment was directly due to the governing principles underpinning a pirate’s life. Otherwise known as the Chasse-Partie or Pirate Lore, these set of rules varied only slightly according to pirate ship and prevailing Captaincy during the Golden Age of Piracy. The articles of each code, whether it be under the captaincy of Phillips, Morgan or Roberts were remarkably similar in word and entirely identical in intention.

Just so we are clear, these similarites are not due to pirate-hive-psychic-magic. There was a very long and complex social, political and economic evolution before the rise of the 18th century pirate which led to commonality between codes. I’ll spare you the details; even though they are really cool. What I will say is that it created a new seafaring social movement and power which evolved under entirely different governing assumptions and principles.

Seamen as pirates organised their social world apart from the dictates of mercantile and imperial authority.

Pirates wanted a voice.

Pirates wanted agency.

Therefore pirates created a system in which they decided, collectively and democratically, on matters of the moment.

What does this mean? It means that pirates gathered together in councils to vote on all decisions regarding directions of their pirating; whether it be where they went, whose loot they plundered or how it was shared. This directly contrasted with the merchant sailor’s experience.

The 18th century pirate was the social reinvention of the sailor due to the lack of representation.

In the same way the modern-day health consumer is the social reinvention of the patient due to lack of representation.

And there you have the segue.

Fast forward 300 years and I’m in my office talking to a young adult patient with Type 1 Diabetes named Mikayla. When she told me that transitioning from our paediatric service to the adult service was “a bit shit“, I was taken aback.

“Sam“, she said  “it’s like this, when you’re a kid with diabetes they give you snacks at clinic, you go on camps and once a year you get a free ticket to the circus.  Then you turn 18 and BAM! nothing.“

In the 1000’s of hours I’d spent in clinic listening to people living with diabetes (PWD) there was a reoccurring theme, sometimes this is shit. Feeling a bit more shit because you’ve come to clinic wasn’t the best outcome in my mind. 

I sought out the opinions of other PWD, trying to plumb the depth of experience. Michael was “pissed off” after nearly 30 years of telling and retelling his story to a transient remote clinical community. Matthew felt like he was uncomfortably on display in our waiting room. Ned didn’t like coming because looking at his ‘numbers’ in clinic just made him feel worse.

Had the John Morris Diabetes Centre taken the wrong track ? I knew we were afloat; we were guided by best practice and current standards. But, it hadn’t been smooth sailing.

It’s true there is considerable pressure in the health service. We need to do more with less. Our conditions are cramped and the provisions lean.  We are earnest in our endeavours. However, were we adrift in direction and currency?

Don’t get me wrong, there is no scathing self judgment here, we only know what we know until we know differently right?

In our quest to understand, we found Mikayla’s feelings were mirrored again and again – it was a call to action for this reluctant manager.

So, one evening, we held a consumer forum. Without a doubt every PWD knew exactly how they felt and what they wanted in a diabetes service. We were given a mandate on that night that rang clear, give us a say in our service.

What they were asking for was inclusion. This isn’t new. There was a very long and complex social, political and economic evolution before the rise of the 21st century health consumer movement. I’ll spare you the details. What I will say it that today consumer engagement dominates health guidelines and policies globally.

Taking on board what a few people have told us, we looked to Experience Based Co-Design (EBCD) to incorporate the users voice and improve our service. This tool offered methods to engage, plan, capture, understand, improve and measure the experience of anyone involved in a service.

But wait, where have we heard that before?

It’s important to note that before every journey, another notable Captain, Henry Morgan’s crew routinely agreed on certain articles specific to the journey. The council of pirates would gather (engage) and put in writing (plan) their agreements (capture) for the next journey based on the experiences of all (improve).  This was considered a bond or obligation that all pirates on board observed. After each new conquest they would come together again to assess the haul and divide it accord to agreement (measure).

In all of the major Pirate Lores it stated that every man shall have an equal vote in affairs of moment. It also always notes that the common good was primacy and all issues regarding this should be voted upon.

These decisions always needed the council of pirates.

At the JMDC we formed a council. Well public service dictates means we can’t be a council… so we formed a Young Adults with Diabetes (YADs) Consumer Reference Group (CRG) in the first weeks as part of the EBCD project.  Then due to the ground swell of community interest we had to extend the membership to all PWDs and their significant others.

Our council of pirates was formed!

… or JMDC CRG (I like the pirate council better too!!)

So what have we done now we are listening?

Well, we have new waiting areas, colour coded and co-designed down to the selection of signage font. We’ll be introducing snack vouchers from our onsite coffee shop. We’ve also co-designed an Experience Based Co-Design research project to seek wider and deeper representation in our clinical redesign.

Our engagement is not limited to PWD. Decision making occurs from stern to stern. Whether receptionist, diabetes educator or consultant, the voyage is debated and decided by all.

A fitting end to this tale is to echo the warning  Captain William Fry issued before he swung from the gallows for his mutinous piracy in 1726. Apparently without fear of death he called to all Masters of vessels to pay sailors their dues and treat them better.

Piracy as inclusion was a seaman’s tactic of resistance, a form of self organistation and innovation. The same can be said for consumer co-design.