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Social Design Talk 8

Using design led approaches in the NHS

Dr. Lynne Maher

Former Director for Innovation and Design

@LynneMaher1

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An overview

• Around 1.4 million people work in the NHS and 54 million people use NHS services

• The NHS costs £100 billion a year and there is an increasing gap between the current trajectory of healthcare expenditure and what will be available to spend

• We need to reduce NHS expenditure by £15 billion in the next three years

• There is a recognised need to transform the NHS from a reactive episodic system into a proactive wellness service

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• The separation of organisations in the NHS is a design flaw

• There has been a lot of pathway redesign over recent years, but with a ‘silo’ single organisation focus that has not yielded big enough improvements for patients.

• There is a lot of unnecessary waste in the current system. Duplication is a key problem e.g. patients being asked the same questions repeatedly when using different services, each part of the silos system using different documentation.

• A lack of real understanding about what the experience is for individuals across their whole care journey has resulted in too many patients having a poor experience.

Context for design

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Our challenge……………

“The government has set itself the aim of a ‘patient-led NHS’. But our health services still have a long way to go before we can say that they are really putting patients first. Being an NHS patient is still too often a frustrating

experience.”

Healthcare Commission

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We need to move away from this....

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We as clinicians and managers worry about this ......

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We think patients want this.....

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• A small number of organisations such as the Picker Institute have been active in this area for along time

• Our work on patient experience started in 2006 and the early pilots resulted in the publication of a book (Bate & Robert) in 2007

• Activity around the world is increasing and producing examples of fantastic practice and research papers

• Research report ‘What Matters to Patients’ published in 2011

• Web resource – Transforming Patient Experience launched March 2012

• Patient Feedback Challenge – launched April 2012

Patient Experience – What has been happening

The ebd approach is…

…about using experience to gain insights from which you can identify

opportunities for improvement

…about experiences not attitudes or opinions

We learnt from designers including…

Deborah Szebeko – Think Public

Ideo, Live/Work, Design Council, Impact Innovation and more

The components of good design

Berkun, 2004 adapted by Bate

Performance Engineering The aesthetics of experience

How well it does the job /is fit for the

purpose

How safe, well engineered and

reliable it is

How the whole interaction with the

product/service ‘feels’/is experienced

Functionality Safety Usability

+ +

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3 Ways to do service improvement

1. Don’t listen very much to our users and we do the designing

2. Listen to our users then go off and do the designing

3. Listen to our users and then go off with them to do the designing

(Professor Paul Bate 2007)

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Experience Based Design is about designing better experiences…

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The ebd approach can make a difference for example .....

• Overall improvement gain- 42 improvements to a service which was considered the best in a hospital

• Quality and effectiveness- streamlined services in hospital and community care

• Safety- identification of the cause of falls for example

• Cost – decision not to create new community services, reduction in non value adding steps

Understanding the needs of people living with Multiple Sclerosis

Hospital Portering services286 ideas came from using this approach

Capture- Observation and narrative The story of the toilet roll holder

Action: Toilet roll holders now on both sides to help the patient feel more independent and be safe.

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Understand the experience

There are three key techniques in this section – they are closely linked and one leads naturally on to the other:

• Identifying emotions

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Emotions

how people feel through their journeye.g. scared

Understand the experience

There are three key techniques in this section – they are closely linked and one leads naturally on to the other:

•Finding the ‘touchpoints’

• Mapping the emotions (highs and lows) to the touchpoints.

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Touchpoints

moments of engagemente.g. finding a car parking space

Planning to improve..

A personal responsibility…

• Hugh McGrath-Patient

• Julie - Clinic Receptionist

• John Pickles-Consultant

Creating and testing (prototyping) ideas together

‘The seating is too

cramped and the

waiting area is awful’,

it looks horrendous

when you come

around the corner

into the clinic’

Clinic Chairs all in a row

Patients &Staff workingtogether

Reviewing their work

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Measuring

“what matters more than raw data is our ability to place these facts in context and deliver them with emotional

impact”Daniel Pink –A whole new mind 2008

“the point is to emphasize that each of the cases involved an actual human being. Describing them as a percentage would dehumanize the physical impact on a real person,

someone's mother, father, sister, or brother”Paul Levy CEO 2008

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The possibilities and limitations….as I see them

• Many possibilities are huge and include:

– These methods create a compelling case for improvement and are highly engaging

– Health services being designed to better meet the needs of those who are using and working within them

– More meaningful engagement with patients and families builds their own confidence

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The limitations….as I see them

• Limitations include:

– We need to build further capability and understanding about how to use the methods

– Need to increase the impact data and think about their presentation. Narrative ‘v’ randomised double blind trial

– Need to ‘scale up’ - expand the support available e.g: Patient Opinion, Centre for Patient Leadership, National Voices and so on.

“The ebd approach is about sharing and understanding the experiences of patients, carers

and staff together to design better services.”

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“The biggest untapped resources in the health system are not doctors but users (of the service). We need systems that allow people and patients to be recognised as producers and participants, not just receivers of systems … At the heart of the approach users will pay a far larger role in helping to identify needs, propose solutions, test them out and implement them, together.”

Source: Design Council, 2004

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The NHS in England before the reforms

NHS Reforms

The NHS in transition

The future NHS putting power into the hands of people and communities

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We do have a vision........The NHS Constitution 2012