+ Designing
a better personalised health-care service for patients.
Aomruethai Lo-apirakkul Chien-Yu Lin Dasom Kim Zehong Liu
Content
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Introduction
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Project process
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Project Summary
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Project timeline
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Design brief
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Double Diamond
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Project implement
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1. Discover phase
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Research
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Design team
02 Objective
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NHS Strategy
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Background
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Potential area
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What is NHS future?
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Interview healthcare users
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Interview clinicians
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Customer journey map
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Observation
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Age UK
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2. Define phase
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4. Deliver phase
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Implementation
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Stakeholder map
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Quotes
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Service wheel
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Insights and opportunities
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SWOT
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Research question (1)
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Business model canvas
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Potential user
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Service blueprint
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Personas
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UI Design process
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Service flow
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Experience pathway
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3. Develop phase
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Idea sketch
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Main service
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Final design
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Service frame
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Digital prototype
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Idea testing
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Conclusion
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Research question (2)
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Conclusion
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Team reflection
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Bibliography
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Introduction
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Introduction
Project Summary Minoxsys, who specialise in Care Pathway Management systems for monitoring, aims to deliver a simple and powerful software solution to extract vital data and map patient flows across health economies to improve the process of care.
By adopting the Double Diamond model of the Design Council, we initiated the project to try to understand the current NHS system and define problems and issues. Discovered and defined insights from actual users by using design tools such as observation, user interviews and a user Journey map taught us that problems are individual and specific. We restructured the insights to Persona that helped develop ideas. Based on insights observed from an earlier stage, the project specifically aimed to help long term condition patients who need a personalised health care system and after treatment by themselves.
This project, London college of communication’s MA Service Experience Design & Innovation students and Minoxsys, the provider, worked together to try to design a real-time service for a better care-plan for patients in the UK. The challenge was to improve patient’s care journey and consequently get support from the system and to make a digital platform that patients could actively engage in self-care making it easy for users to monitor their Afterwards, Co-design with users and related service care journey. providers helped to generate ideas for the service. From the idea sketch session several related potential users gave us feedback about an entire service flow and structure. A lot of design tools also helped us to frame stakeholders, and service procedure such as Service Wheel and Service blue-print. Also, a business model canvas and SWOT chart showed how this service could become a feasible and viable business.
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Introduction
“ ”
[I was] searching on the internet and found Diabetes UK. It took a while to sink in. I was too frightened to find out, [and I] didn’t know the GP or nurse at the time. I felt like I was being stupid, then I was in denial. It took me a long time to get to grips with it. There is an education day at the hospital, [and I’ve been ] waiting for ages to get referred to the hospital that runs this.
Debbie, mid-20s, diabetes © King’s Fund 2005
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Introduction
Design Brief
User-centred. Communication Collaborating. Interactive.
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visually.
“How Might Minoxsys help long term condition patients manage their personalised health care data with their stakeholders and get support after treatment?�
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Design Team Team 1, tried to communicate and show empathy for deep understanding and collaborating of the each team members. It helped each other to underlined and applied the strength of the individual different backgrounds and skills. We organised and combined each expertises to research and design the better delivered outcome in all the design processes.
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Objective
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Objective
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If you put the right tool in patients’ hands, they really can become experts in their condition and transform the way they use healthcare facilities...
Dr Simon Bourne © The Guardian 2016
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Objective
Background About 15 Million in the UK are living with a long-term condition (Department of health and social care). Long-term conditions or chronic diseases are conditions of patients that cannot currently be cure but can be managed. More than 50 percent of GP appointments are people with long-term conditions. According to The King’s Fund report (2016), mental health is one of the ten particular areas to improve in the UK healthcare system especially regarding people with chronic diseases. There is a significant number that more than a quarter of people with long-term conditions also have mental problem, with depression and anxiety. It also affects many parts of a person’s life, from their ability to work to social relationship. Long-term conditions are considered by the UK government to maintain good health of patient by supporting self-management and using technology. This could also help the patient flow in the hospital as well as the huge amount of NHS spending. Long-term condition patients accounts for a huge proportion of the budget for NHS England; about 70 percent.
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For several years, the NHS has had a strong vision about using technology in the health and care service. Since, technology has become an essential gadget and directly connected with people’s life. According to the NHS strategic plan, the technology has been adopted to get closer with people to empower personalised management. The plan is called ‘NHS five year forward view’ (2017), the major work programme is to improve the technology for supporting people in managing in their own health, increase the number users of the application to help people to manage their own health properly.
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Objective
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In near future , People want access to healthcare....
“Smart assisted technology will help people stay in their homes longer rather than move into nursing homes or residential care...”
“In the shopping mall, at home, or in the workplace, with hospitals reserved for highly specialist care ... “
“My condition will be monitored by teams of specialists hundreds of miles away who converse with remotely, supported by inhome care where needed...”
“Nurses take over many of their other tasks, and non-clinical work is delegated to other team members.”
“ Patients, individuals are going to be caring for each other in networks and using peer-to-peer care.”
“Responsive and flexible as ‘online shopping’...”
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Project process
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Project Process
Project timeline
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Project Process
Double Diamond Every design has a different approach but there is a commonly creative process which is wellknown as the double diamond model. It is established by the design council (2014) that provides 4 stages; discover, define, develop and deliver. There are two ways a long process which are convergent .These methods of design thinking support designers in the identifying of the challenge and subsequently guide the project through the design process.
Discover
Discover stage is the start point of the project that helps to address the problem to new insight. Desk research, gathering the information from interviews with actual users, observation of users’ behaviour are the common design tools that conducted in this stage.
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Define stage
Define
is the stage to define the problem and get new opportunities for designing the service. Also, this stage is the step that figures out what could be the most crucial design challenge for the next step, and think the service’s feasibility.
Develop
Develop stage
Deliver
is the stage of developing the ideas’. Also where solutions or concepts are created and idea prototyping and testing process are iterated throughout co-design. This process of errors help to direct and improve the service quality.
Deliver stage
is the final stage to deliver the service that address the actual need of users. the result of a product, service or environment will be produced.
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Project Process
Team process implement summary Further research
Clusterring topic
Define Oppotunities
Observation Framed question
Discover
Research
Define
Brainstorming Interview
Further interview
Objective Discover stage NHS problem synthesis throughout user interview, related people(GP,Hospital) interview and secondary research such as the service in the actual market what people can get nowadays. 24
Define stage Synthesis all collected information from previous stage. Identifying pain point of user experiences in the service. and, grouping the related insight in the same theme(topic). Afterwards, deliver research question which is based on the opportunity area.
Prototype Finalise
Ideation Feedback
Develop
Deliver
Concept
Brainstorming
Research Idea testing
Develop stage
Deliver stage
Idea brainstorming among team members. Deliver finalised idea and conducting iterative prototype for service quality. Idea-testing and iterate to get rich feedback from people. Improve the service based on feedback and further research.
Deliver the final proposal which is achieves the aim also, indicate further implementation of the service. Deliver business model canvas, service blueprint, SWOT and service wheel for the service business opportunities. 25
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Desk & Secondary Research We started to research to get the deep understanding of NHS system. Related articles, journals and reports reviewed for the synthesis of potential opportunities in this stages.
“Using the ability of technology.” Engaging patient to be more active in their own health and care by using application.
“Supporting service between patient and stakeholders.” promoting well-being and independence need to be the key outcomes of care.
“Integrate healthcare around people.” A good integrated care model should always put users at the centre, and facilitate collaboration and communication between departments.
“People demand change.” People want access to healthcare that is responsive and flexible as online shopping.
“Internet is the most accessible way for this era.” Every day, 160 million searches are made on Google for healthcare related issues.
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NHS: FIVE YEAR FORWARD VIEW Simplify and improve the process of booking hospital appointment.
Increase the use of digital apps to help people manage their own health.
Help patients take more of an active role in their own health and care.
Make patients’ medical information available to the right NHS staff wherever they are.
Needs of supporting service between patients, families, carers, communities.
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Where is the potential area that we can improve the patient’s service? Basically, there are three stages of healthcare journey. The first is ‘primary’ which is well-known as GP (general pratice) service. The second is ‘secondary’, including A&E follwed by secondary care parallel with specialist, surgery, inpatient respectively. Some patient might go to only the primary care, but some might go through whole stages of healthcare and exist. From this map we were able to see the potential and possible areas to improve and offer a patient’s service.
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Interview: Tell me about your story. After observation phase, various people interviewed thought the project, the initial interview implemented very spontaneously ask to interviewees ‘could you tell me about your experience of GP/Hospital service’. rather than explain what we are conduct and why we are doing this project, As beginned open questions, we could pull out various responses and several touch points that helped us making potential ideas afterwards.
Woman (21) / International student She is an international student in London, one day she felt horrible stomached for few days. went to the GP and had to wait for 5 days. during the waiting time she was very ill and got some medicine from pharmacy but she didn’t feel that is the right medicines for her. When she saw the doctor, she wasn’t very satisfied with diagnosis cos, doctor seemed not to examine her. She got some medicine during when she felt uncomfortable but, she thinks ‘What if I have a really serious one?’ ‘is this system trustworthy?’ and also, she decided to not to go to the hospital. and she said, she has started take care herself a lot these days.
Woman (33) / Has a son Shared her experience of midwives at GP. She told us, generally had a good service. But, she felt very nervous and cautious everything. she joined communities very often. but, had to informed by clinicians every time and there wasn’t a system for booking.
Woman (26) / Student Once she went to the sexual health clinic, assumed herself having a bladder infection. Had to wait for getting a test for 2 weeks. She could have gone to A&E, but had a experience waiting for the service for 6 hours so she gave up. When she finally met the doctor, she got a urinalysis and received medicines. Few days later clinician called her for letting her know the disease. but it was the one she thought before. She said, she didn’t need to go to.
Man (23) / Student He had severe back pain. He couldn’t walk properly. He asked to his friend brought him to the hospital without appointment. He got a physical examination. Waited for 2 hours the doctor made his diagnosis in 10 minutes and told him do more exercise. He thought the doctor made misdiagnosis in order to see him in very short time. The only thing he could do was buy a pain reduction cream. 35
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“we should save patient’s time by technology”
“Strongly recommended about ‘patient self-management’ and ‘self-prevention’..” see their physician.)
“Physicians face difficulties in understanding patients with multi-condition and multi- treatment as the information governance.”
“Using a mobile phone or Youtube is a good way to engage people also sharing information from clinician to patient.”
“CIC want to prevent people visiting hospital/ A&E through community and social care service.”
(e.g. patients could prepare before they go to
(nowadays, older people are able to use it.)
“Ideal platform should be clear for multi-conditions.”
“Most old people suffer from multi-condition, not only physical but also mental problems.”
“Cost is the important restriction of NHS.”
“Enable to Share information from one patient to others with agreement.”
(because nowadays if you have more than 1 condition you have to go to the hospital separately to do in a month also separately do a blood test.)
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Customer Journey & Emotional Map
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Project Process
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All of the users’ stories were written in a mess on the paper. In terms of designer, as a team, we visualised and organised users’ stories into the customer journey map which was a tool that help us to transform all raw information visually and easier to understand. We transformed raw information into customer journey to get a clearer understanding and find the common dissatisfaction of the experience among interviewees. We separated the phase of journey into seven phases; ‘awareness’, ‘plan to visit’, ‘appointment’, ‘reception’, ‘diagnosis’, ‘treatment’ and ‘after treatment’. Then we created an emotional graph to draw the emotional line to find the common pain point from each user.
Long waiting time There are 2 frustrations which are 1. In case of waiting time after appointment People think it is too long to see a doctor for some serious illness (but not emergency). Sometimes, people can feel better be fore seeing a doctor. 2. In case of waiting time at GP or A&E People are bored because they cannot pre dict that how long they have to wait.
After treatment This issue is interesting because when people receive the follow-up service after treatment they feel really satisfied. Meanwhile, when people do not get any follow-up after treatment they might feel frustrated to face with dilemma situation.
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Observation
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After we had noticed that the common issue of interviewees were long waiting-time. We planed to do contextual research at healthcare centres which are A&E and Walk-in centre, that could help us to get an actual experience by ourselves, also receive an up-to-date information from there.
In terms of time consuming, the average waiting time is around 10-15 minutes, and all patients have their queue number. While patients waited, they were playing on their phone, reading book, newspaper or etc. Thus, a long waiting time was not the main pain point of patients.
During user observation for one hour, we were looking at what people actually do while waiting. We were looking around to record all facilities offered to patients. Additionally, we were counting the length of waiting time. As a result, the environment of waiting area was really good. Patients are able to understand the process information which is hung on the wall. Additionally, there is free water, newspapers, and a quiet room in case some patients did not want to be disturbed.
We determined to remove this issue for further development due to the result. So there is only one issue that we would like to explore onwards.
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Age UK Service experience design & innovation students and elderly people at Age UK conducted workshop session for finding user’s behaviours. It was the crucial point that we could observe and listen elderly people’s daily life and circumstance who the most frequently visit at the GP and Hospital. Used various tools with them helped us feel at ease communicate.
(1) Activity question lists. 1. Find out their thoughts about Healthcare. ● What healthcare facilities do you use in your vicinity? ● Have you ever had to use a hospital? ● What mode of transport do you use in those facilities? ● Are there any of those you would never use and why? 2. Find out about fitness and technology. ● How do you feel about your health care system? ● How do you feel about going to the GP? ● How do you feel about your assigned doctor/GP? ● How do you feel about the waiting times to see a GP? ● How do you feel about your NHS facilities? 3. Choosing a ideal healthcare service.
(2) Key-findings Elderly people usually go to the GP or assigned hospital regularly. They said generally satisfied with healthcare system at the GP and hospital, but also they mentioned the ideal service for them should be more informative, attentive and easy to approach. The other point were about ‘listen carefully’, ‘check the medical history before diagnosis personally’, and ‘explain as much as possible’. Some people also talked about it needs some improvement of service and funding. The remarkable point of elderly people’s behaviour was some of them live independently without carers and not convenient using a technology so, they only prefer to call booking an appointment.
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How did we conduct define phases?
Collecting ‘Quotes’
Clusterings related topic ‘Quotes’
We had several different stories from our interviewees who are actual users of the NHS services, we heard new touch points that were unexpected for us that became our potential ideas. Pulling out the interviewees emotional changing points or problem segments or even very positive points were very crucial for defining the current system. There are several related quotes, which were mostly about waiting times for an appointment, diagnosis in the short term and data keeping and so on.
After the first process of the define stage, we could cluster all related touch points together and summarise in to several topics, it directed us as to how to narrow the research topic and conduct next stages. The first category was about ‘Prevention & Early Diagnosis’ that indicated people has problem, don’t know well how to do when they feel uncomfortable, how to get a treatment or how to care themselves, not rely on GP and hospital service. the second one was ‘Personalised health management’. that demand of sharing data and manage their own health.
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How Might Monoxsys?
Who will be potential user?
With the defined problem, we used ‘How might we’ and made design questions for the idea. ‘How might we’ questions made us brainstorm together and put each team member in the same page. Using a unified question made sure we thought together for the solution. It also brought positive effects that lead us to have a productive communication about our aim and objective. Design Questions that we saw the opportunities. (1) How might we help patients know about their symptoms and potential treatment before going to see a doctor? (2) How might we let patient’s carer do more to assist their patient? (3) How might we help multi-condition patients express their physical situation to each doctor well? (4) How might we help doctors to know Patients’ information in great depth in a short time? 51
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help the long-term con manage their ‘Personal
with stakeholders and get support ‘afte
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ndition patients lised health-care’ data
er treatment’ ?
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Potential user
From two different types of the opportunities, we had to think about who will be our service potential users. Throughout our interviews and desk research, there are 4 different types of user groups which were (A) patient who has the lack of information about GP, (B) patient who has multi-conditions, (C) carer’s who takes care of elderly multi-condition patient, (D) Family member who takes care of the other member (more than one person). When we faced to choose a certain patient’s user, we thought about who could use our service frequently and who wants to engage actively. Among the our A,B,C and D lists, we decided to conduct about Long-term condition disease patient’s who use the health-care service frequently and have a motivation about themselves. The most of the long-term condition patients are lack of confidence of health management also they did not clearly understand of their own condition cause the unhealthy behaviour. Our challenge was to improve the service to engage patient enable to manage their own health confidently, and to change unhealthy behaviour to the desirable behaviour by personalised management information.
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Idea sketch
After making design questions for the developing stage, our team implemented an idea sketch session. This step helped us think systemically how to conduct the next step which turned blank paper into a vivid output. Each member pulled out ideas of touch points from the early stages such as interviews and a customer journey map and also from the market research. As a result, the idea sketch session shortened the interval of our concept direction in order to use a visual material which helped us put in the same page.
Idea #1 Creating a visually enhanced pathway (by colour), patients can do self-care such as diet control, event of treatment, set notification etc. Idea #2 Live chat with clinician, directly check symptom by symptom check-list and make an appointment and get notification. Idea #3 Connecting with NHS choices service, order testing directly at GP and see clinicians when they ready to examine. Idea #4 Using a platform that has patient data for an accurate and efficient system for both sides.
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Service frame & prototype Prototyping helped us to think about invisible service in a visual way and could communicate and get a lot of feedback from people who are not main users or even not related. Throughout the idea-sketch and co-design phases, we decided what kind of service contents could be contained in our later design process and started to frame out service structure. Using a mobile frame, we drew several main services and sub-services that we sketched and brainstormed in the previous steps. Also, we started thinking about what is the best interface in a user-centred way, how do people want to use this service sustainably, how could we help them actively engage in our service in visual way.
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Digital prototype
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Idea testing With patients / relatives(carers) • Observing user’s behaviour. • Understand the gap between design and realistic. • What does user consider more? With pharmacist / prescriber • How to build up more efficient process for patients to manage a medicine? • What is the important point to chronic patients? With clinicians • Which data does doctor expect to see in regular diagnosis? • What is the important to the long-term health management? • What could help the communication in diagnosis?
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Idea testing with, 2 3 3 1 2 1
Chronic patients. Other potential users. Pharmacists. Doctor. Relatives of chronic patient. Health magazine editor. 77
empower the long-ter capacity to do self hea before and after diagn to achieve better healt
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rm condition patient’s althcare management nosis th maintenance?
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Stakeholder map
What is the advantage of having this service? User’s view -
Convenient to monitor and review self-healthcare history, data. Empower user’s ability to do diet and medication management. Convenient to communicate with doctor during diagnosing. Convenient to record important information that user need in each treatment.
NHS’s view - Reduce the cost on long-term condition patients. - Reduce the frequency of patient visiting A&E and GP. - Empower ability of self-healthcare management on long-term condition patients.
Minoxsys’s view - Simplify the user interface - Increase user’s motivation to record their healthcare data
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Service wheel
Pre-service There are three possible ways to access the platform; The first one is simply through the NHS advertisements that could be shown on social media, leaflets, or etc. Otherwise, the doctor or clinicians suggest their patients use the platform after treatment for discovering their health or rehabilitating due to their condition. The last one is the introduced by relatives, friends, or clinicians. If patients want to be a user of the healthcare platform,They have to register with the NHS to give them permission to link users’ data to the application for tracking users’ health and providing personalised management.
During-service After going through registration process as users. They can create the personal character which will be shown on the home screen of the Application. The character is a representative of the currently healthy status of users. There are three main services that patients check up which are ‘set a goal’, ‘medicine’ and ‘symptom diary’. (1) ‘Set a goal’ is the service that patients keep looking after the personal health whilst set the habit, medicine log. (2)’Medicine’, patients can check what sort of medicine they have at the moment and how much, when they need to take. Also, it gives a notification for remembering the time which is connected with the carer’s device. (3) Symptom diary helps patients to communicate well with GP, that tracks what kind of distinctive symptom happened and when was it. And also, Community service which is to share information with local people who have a similar symptom or disease to keep in touch and get a support.
Post-service The post service is all about maintaining and strengthening the users themselves. Users can control their health and keep fit continuously. In terms of appointment, users are able to make an appointment through our service, and they can go to see the doctor at the appointed time without long waiting time. Besides that, users are able to re-prescribe and collect the medicine at the nearest pharmacy or pay extra for the delivery. In case users need to get a special service with private sector (as provider offers a premium service), they will be asked for an additional fee to get a personal assistant onwards. Finally, the service let users give a feedback based on their experiences for improving.
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SWOT
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Business Model Canvas
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Service Blueprint
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UI design process
Digital prototype layout
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UI design version. 01
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Service flow
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Experience pathway
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Main Service
Gain experience point & Level up If the user keeps good self-care behaviour on updating health data, following the prescription and achieving personal goal, the user can get a experience point as the reward. The user can get more options for changing the character’s hair-style or clothes as level-up service.
Collect a badge If the user keeps good self-care behaviour for a long time, the user can get different badges when they achieve the others.
- Manage the user’s ‘Daily goal’ and ‘Reminder’ - Generate a regular report - Book an appointment for users
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Final design
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Final design
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Conclusion
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Conclusion
Conclusion / Project Our design objective was to create a valuable service to empower the personalised health management especially for people who are living with a long-term condition. We found how it would be of vital value for both Minoxsys, a service provider, as well as the National Health Service (NHS) of the UK, to build a platform that remotely supports the better health of patients. We believe our service could help the current problems in NHS, because we could say more than 50 percent of GP appointments are people with longterm condition and, those patients are not feel at ease manage their condition very well as they desire. As patient’s demanding of interaction on their data, using Minoxsys will help patients take care of themselves rather than rely on the service. It could support people to be an active user to suggest them to have a great in-depth of their own information.
/ Process Internally, the design process went through the double diamond, but actually, there was agile management included, which is the iteration process. We did several interactions to make sure that we built the right service to address users’ need and properly understand market trends. the iteration process supported eliminating the worst mistake through the project implementation. Throughout the undertaking of this project, we developed an in-depth comprehension of user-centred methodology which is to design based upon an explicit understanding of users. We developed the service to fill the gap of discontinuity in healthcare between NHS and patients after treatment.
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Team Reflection
PROJECT How to get insight through the interviews In the very first step of a design process, we had to find the pain point from the real stories of user experiences. Hence, the user interview was the most effective way for receiving rich data. We did research and prepared the open-end questions that require an answer as a lengthy explanation, and such answer lead us to synthesise and analyse them to identify insights.
Be flexible, embrace uncertainty, anything is possible. Along the process, there were many uncertain situations for both internal and external areas. But it is true that the good idea could happen in any context when we were facing uncertain situations or unpredictable outcomes, we took a step back to look at the whole picture again and spent time on the issues. Embracing uncertainty taught us to slow down and look at the issues again from all its angles.
Visual skills help to understand well with multi-stakeholders. A lot of original information from the research was abstract and messy. Regarding designer, as a team, we transformed that raw data to visual data, that helped us to understand it clearly. It also empowered communication skill among team members when we were facing language barriers.
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TEAM How to collaborate with the different background people in a team.
Our team members had different backgrounds and different opinions at some point along the process. At the first stage, we provided each member’s expertise, and then we underlined and applied the strength of individual differences and skills for the better outcomes.
Be empathic not only for the users but also teammates.
The empathic thinking was the crucial method that has carried us through the project, we understood the personality of each member, and when there was a problem, we did not hesitate to talk and compromise. The more we talk, the more we understand.
Stay open-minded and Be a good listener. Open-mindedness is critical to project success. It helps us to take risks, find opportunities, understand others, and manage uncertainty. There is four expertise among the team members, we have learned and listened to each member, then we found many good ideas after discussion. Some creative ideas have been created by team brainstorming based on open-minded and listening to others’ opinion.
references
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