Service Design - an approach to innovate public healthcare

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Some 1.4 million employees Costs ÂŁ105bn to run ÂŁ21bn spending cuts whilst increasing quality


Some argue that the current reform is a privatisation against the country’s most valued institution.


Recent news of poor hospital service undermines confidence...


Using service design to innovate NHS health services together with patients and staff @juliaschaeper Former Service Design Lead at the NHS ICSSI 2013


01 The NHS 02 Service Design as a way to innovate 03 Building internal design capability


01 The NHS


July 1948 Solidarity, public interestedness & fairness


The NHS now


1 million patients every 36 hours


466 people every minute



Medical advances

1948

2008

Maternity hospital stay

13.5 days

1.9 days

Operations

5514

49.500


Being an NHS patient is still too often a frustrating experience. The government has set itself the aim of a ‘patient-led NHS’

Source: Healthcare Commission 2005


“Certain areas that staff and hospital managers think are performing well and meet all their targets - even our flagship services do not always deliver a good patient experience. Cate Hillmann, Service Improvement Lead, Milton Keynes Hospital


A patient’s story ‘I went to my Doctor about my back and right shoulder being extremely painful and asked for a referral to a Physio through the NHS. I attended my appointment, the Physio looked at my back, and then I asked about my shoulder. She said ‘Oh the Doctor hasn’t put that on the form so I can't look at it’. I was advised to go back to my doctor, another appointment, and ask him to refer me regarding my shoulder! So I did this and again within a few weeks the referral came through and off to the Physio I went again. This time she said I would need to get an X-ray. For this I had to go back to my Doctor and ask for a referral: the Physios can't do this even though they suggested it! This required yet another Doctor appointment as it can't be done over the phone. I now have to collect a letter and take it to the X-ray dept, then the results will be sent to my Doctor, who will forward them to my Physio.’


There is a lot of unnecessary waste in the current system. Duplication is a key problem, i.e asking patients the same questions repeatedly, and each silo department using their own set of forms.


“Patients and families are the biggest untapped resource in the NHS� UK Design Council

www.institute.nhs.uk | Assisting the NHS in transforming healthcare


The NHS is changing faster than it’s ever done. In the current economic climate, NHS budget holders at all levels are being asked to be more resourceful with their money.


£35 billion spend in 1997 £105 billion in 2011/12 £126 billion needed by 2014 £105 billion in real terms


ÂŁ21 billion funding gap We need to save ÂŁ90 million a day


It is clear that we need to - rethink the way we do things - share what we know already - become more patient-led - find innovative approaches to increase quality & productivity whilst reducing costs


Innovation is business critical. Service Design helps us innovate


02 Service Design as a way to innovate


Service Design Helps NHS organisations figure out where, when and how they can improve their health services to create better conditions for patients.


As Service Designers we visualise, formulate and choreograph solutions that are not yet available. They watch and interpret needs and behaviours and transform them into potential future services. Prof. Birgit Mager


Source : http://thisisservicedesignthinking.com


A proven and repeatable problemsolving methodology. It’s not ‘design a car’ but design for ‘personal mobility’. The goal of the definition stage is to target the right problem to solve, and then to frame the problem in a way that invites creative solutions.


Source : NHS Institute for Innovation & Improvement


Source : NHS Institute for Innovation & Improvement



Characteristics Diverging & converging Co-creative: with not for Iterative by prototyping Learning from observation e

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Observation The thing people say and what they actually do are often not the same thing. Observation is useful for getting beyond what people say to understand what people do and feel.


73% of doctors say they wash hands before patient contact


73% of doctors say they wash hands before patient contact 9% actually do


When we used observation while working with hospitals looking for ideas to help reduce infection rates...


Patient was left overwhelmed having to use the blood pressure machine on his own. Publicly exposed he had to ask the nurse a couple of times to help - it took more than 10 minutes to complete compared to 2 minutes as part of the doctor consultation.

Important information disguised behind plant. Patient kept interrupting receptionist because of unclear signage and not knowing which of the four waiting areas to go to.

Wasteful pockets Useful information left ignored in surgery. It was sent via post again to patients.

Nurse kept searching for equipment adding unnecessary extra time to the consultation


What I hear I forget What I see I remember What I do I understand Lao Tse


Role playing a new portering service


People

Organisation

Technology


Useful Usable Desirable Reliable Efficient Sustainable.


Source : Engine Service Design


Service Design in the NHS to - gather insights to inform service innovation - design new pathways to sustain health services - build skills & capability to innovate and sustain changes


03 Building internal design capability



A methodology that enables patients and staff to use service design in order to improve their own services.


About gaining insights from experiences (not attitudes or opinions) to identify opportunities for improvement



42 improvements to a service which was considered ‘the best’


Design framework


Building capabilities


Journals & diaries


Using observation


Time saved during ward meal round 60 45 30

- Duplication in work - Wasteful activities - Inefficient communications - Inefficient labeling & handover

15 0

Before

17 min saved 38% -

Improved procedures Fewer interruptions Correct labeling Reduced admin

After


Used for incremental service redesign and new service development


Improving MS services Enable - a community service for people with long term neurological conditions


Where does this leave us in the context of the productivity challenge?


Emerging evidence shows that high quality patient experience is linked with lower overhead cost & shorter lengths of hospital stays. Source : ‘Building the business case for patient-centered care’, Charmel, Frampton, Healthcare Financial Management, 2008


Quality & effectiveness - Better patient experience - Improved staff satisfaction - Streamlined services in hospital and community care, fewer interruptions - Increase of 41.6% in direct care time (increasing by 17.7% from a baseline of 42.5%)


Safety - Identification of the cause of falls for example (i.e. toilet roll holder)


Cost - Reduced staff sickness & absence - Reduction in non value adding steps - Reduced (same diagnosis) readmissions



In summary: Whilst Service Design methods - Create a compelling case for improvement - And more meaningful engagement with patients & families, building their confidence...


We need to keep working on - Increasing impact data - And at a time of radical reform, ensure to ‘scale up’ & expand the support available e.g through Patient Opinion & National Voices


Start to see patients as a resource.


Move away from thinking that patients want services we cannot deliver...


And start to think about how you could involve patients more in healthcare improvement and service design.


Thank you hello@juliaschaeper.co.uk @juliaschaeper www.institute.nhs.uk | Assisting the NHS in transforming healthcare


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