Healthcare: NHS Institute for Innovation and Improvement

Feeling your way
to design success

The NHS Institute for Innovation and Improvement supports the UK?s health service to transform healthcare for patients and the public by developing and spreading new ways of working, new technology and world-class leadership.

It provides a national, co-ordinated focus on the biggest challenges to the health service, applying rigorous methodology to turn ideas into workable solutions. Key to its success is its links with innovative thinkers from across the NHS, from industry and internationally. The NHS Institute utilises good ideas from all sources, whether from a nurse on the frontline who has come up with a new way of dealing with an everyday challenge, or a technique from the manufacturing sector that, when applied in the health service, could improve patient care.

A good example of this cross-pollination of ideas is the concept of EBD, which is borrowed from design industries, specifically from service design but with links to architecture, computing, and product and graphic design. The idea behind it is that if you focus on human experience and make the user integral to the whole design process, you can create a more effective product.

The same is true in a health setting. Great gains can often be made through the simplest or smallest of changes. Encouraging patients and staff to work together and share their experiences promises to greatly improve levels of care and a patient?s experience of care.

How does it work?

EBD works by encouraging and supporting patients to tell their stories. It is a way of capturing and understanding how patients actually feel at every point in their journey through the health system. The concept focuses on capturing and understanding patients? and carers? experiences rather than their view of the process, for example positive or negative feelings towards care rather than the speed and efficiency at which they travel through the system.

It deliberately draws out the subjective, personal feelings of the patient and carer experience at crucial points in the care pathway, often demonstrated with words that portray emotions. This information is used to pinpoint parts of the care pathway where the users? experience is most powerfully shaped, known as touchpoints. Carers and frontline staff can then review touchpoints to highlight where systems and processes need to be redesigned to create a better patient experience of treatment.

Results so far : Luton and Dunstable Hospital Head and Neck Cancer Service

In 2007 an EBD test programme was designed, tested and implemented with the Head and Neck Cancer Service team at the Luton and Dunstable Hospital NHS Foundation Trust in Bedfordshire, UK.

A project team which comprised patients, carers, healthcare staff, researchers, service designers and improvement leaders looked at the staff experience of delivering care and the patient and carer experience of receiving care within this service. Both groups shared their thoughts on how the patient experience could be improved and patients and carers alike used film, storyboards, discussion and blogs to bring their stories and experiences to life. When staff and patients reviewed the material together, they created a map to highlight their most positive and negative experiences. This enabled them to identify the touchpoints that formed the key focus for redesigning the service.

Many staff saw parts of the patient pathway previously invisible to them and some surprising insights were uncovered. Both patients and staff felt compelled to take action, leading to the creation of a jointly agreed plan to improve 43 negative touchpoints, while many positive touchpoints were retained

It was possible to redesign many of the improvements quickly and easily while still resulting in a huge difference to the patient experience. For example:

• Moving scales from a public place near the waiting room to a more private room. Patients fed back that being weighed in view of people in the waiting area was extremely embarrassing. Moving the scales to a private area was an inexpensive and immediate improvement that made patients more comfortable and the process more dignified. Many changes like this gave patients a hands-on role. ?The outpatient clinic is so much better,? commented one patient. ?It was dreadful and a terrifying place when I first came down, and now it?s much calmer ...?
• Surgical procedure times were significantly improved. Before the programme it took nurses an average of seven minutes to gather all of the equipment they would need to perform certain procedures. Subsequent to the project team meeting the process was redesigned and all equipment necessary for the procedure was placed in one cupboard reducing time to prepare to less than one minute.
• Patients became empowered to be part of the service design. Developing and revising information literature is an important but time-consuming task that was often undertaken by clinical staff during consultation time or at home. The usual procedure was turned on its head with patients taking on the task of rewriting the information materials rather than staff writing and maybe consulting a patient or two.

One of the patient?s views sums up the perspective of many, ?I chose to be part of the ?psychological support and information? team because as a patient one of the things that really struck me was how poorly written a lot of the patient leaflets and literature were and how a lot of the time they didn?t tell you what you really needed to know.?

Cultivating innovation

To help guide healthcare practitioners and staff to initiate EBD in their own organisations, the NHS Institute is developing a toolkit, which will be available from the end of October. The Guide to Experience Based Design will provide support for healthcare staff to redesign their health services to meet the needs of patients and staff through improving the experience of care. Healthcare organisations in the UK, the US and Australia are already using techniques and principles taken from experience-based design to build active new partnerships. It?s through these partnerships that patients, carers and frontline teams can talk honestly about their own experiences. They then work together to improve care make the experience better and more positive for everyone.

The guide will help guide staff through the journey of gaining feedback from patients and staff, offering advice on how to co-ordinate:

• Face-to-face interviews ? with patients this can often be done at their home;
• Diaries, photo-journals and storyboards;
• Films ? recording both patient and staff stories.

Through these stories, not only can we understand the care journey, but also the emotional journey people experience when they come into contact with a particular pathway or part of the healthcare service. When this is understood and utilised, patients and staff have a powerful new tool for improving care in the ways that matter most to the people who use it and the people who deliver it.

For more information on the NHS Institute
and The Guide to Experience Based Design,
visit www.institute.nhs.uk