Innovation and the NHS - Lynne Maher
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Transcript of Innovation and the NHS - Lynne Maher
© NHS Institute for Innovation and Improvement, 2012© NHS Institute for Innovation and Improvement, 2012
Social Design Talk 8
Using design led approaches in the NHS
Dr. Lynne Maher
Former Director for Innovation and Design
@LynneMaher1
© NHS Institute for Innovation and Improvement, 2012
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
© NHS Institute for Innovation and Improvement, 2012
• 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
© NHS Institute for Innovation and Improvement, 2012
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
© NHS Institute for Innovation and Improvement 2006
© NHS Institute for Innovation and Improvement, 2012
We need to move away from this....
© NHS Institute for Innovation and Improvement, 2012
We as clinicians and managers worry about this ......
© NHS Institute for Innovation and Improvement, 2012
We think patients want this.....
© NHS Institute for Innovation and Improvement, 2012
• 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
+ +
© NHS Institute for Innovation and Improvement 2009
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)
© NHS Institute for Innovation and Improvement 2009
Experience Based Design is about designing better experiences…
© NHS Institute for Innovation and Improvement 2009
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.
© NHS Institute for Innovation and Improvement 2009
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
© NHS Institute for Innovation and Improvement 2009
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.
© NHS Institute for Innovation and Improvement 2009
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
© NHS Institute for Innovation and Improvement 2006
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
© NHS Institute for Innovation and Improvement 2008
© NHS Institute for Innovation and Improvement, 2012
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
© NHS Institute for Innovation and Improvement, 2012
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.”
© NHS Institute for Innovation and Improvement 2010. All rights reserved.
“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
© NHS Institute for Innovation and Improvement 2009
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
© NHS Institute for Innovation and Improvement, 2012
We do have a vision........The NHS Constitution 2012