MY NHS
02 | CJ MAISIE MCDOWELL
How to use this book Activity title Description
Problems & Solutions
Feedback
Personal reflection
The Key Collaborators
Pharmacists St Nicholas Hospital
Jonathan Milner TAG Design Agency
Dr Michele Badenoch Private GP
Bel Reed The Design Council
The self medicating community
University peers and lecturers
Contents
INTRODUCTION Context & Project Timeline CHAPTER 1 The Final Outcome CHAPTER 2 Service Design CHAPTER 3 Re-design For Tablets
CHAPTER 4 Re-design For Creams CHAPTER 5 Re-design For Liquid Medication CHAPTER 6 Graphic Design For Outer Packaging CHAPTER 7 Validation & Personal Reflection
My Timeline March
April Develop Concept Details Customer Journey Map
Finalise Concepts Service Blueprint
Collaborators
Creams Testing Models For Tablet Idea Development
Liquids Testing Model Specifications
May
Create Graphic Guidelines Storyboard For Service Video Collaborators Outer Packaging Ideation
Final Deliverables
Create Final Nets Visualise Service
Cinema 4D Model Making Tests
Film Video
The Collaborators Dr Michele Badenoch Private GP, Blossoms Healthcare, London.
Michele has expertise in the service provided by both GPs and pharmacists and can give valuable insights into the topic of patient compliance.
Jonathan Milner Director, Tag Packaging, Leeds.
Jonathan’s expertise lies in packaging and branding having had a career within pharmaceutical packaging and graphic design. He has also contributed towards the writing of the book ‘A guide to the graphic design of medication packaging’ published by the NHS.
Ella McDowell Pharmacy Student, Liverpool John Moores.
Ella has a breadth of knowledge in the making and packaging of pharmaceutical medication as well as the service and more specifically labelling provided by the pharmacist.
Steven Routledge Specialist Pharmacy Technician, St Nicholas Hospital. Working within the hospital infrastructure, Steven can provide information on both inpatient and outpatient medicators which will affect the way the packaging is distributed and used.
Bel Reed Programme Manager, The Design Council.
The Design Council are currently undertaking a project that aims to improve the quality of care in the UK. Bel has expert knowledge and contacts in the field of care and in the area of service design.
Context Background / scope:
Pharmaceutical packaging has many problems which are difficult to solve due to its rigorous packaging and graphical rules laid out by the MHRA. From a pharmacist’s perspective the packaging serves its function well as it can be manufactured and packed with minimal effort and maximum efficiency. However, from a patient’s point of view this is not the case. My aim was to establish the most problematic factors and solve them through a redesign of both the service and packaging given when prescribing to patients.
UK Statistics
01
02
In 2012 2.7million items were prescribed a day, equalling 1900 a minute
The average cost per head in 2012 was ÂŁ159.33 amounting to ÂŁ15bn overall
03 On average each person was prescribed 18.7 items in 2012
04 It is estimated that one in six people aged 65+ takes ten or more sets of medication Patient.co.uk
Latest Updates The latest newspaper articles based around GPs and pharmacists look into the relationship between the two and how they could communicate better to provide a greater service i.e. pharmacists being allowed to prescribe to patients for minor ailments meaning GPs have more time for one on one appointments. This stream of articles validates the MYNHS+ service design proposal.
It is great to be constantly backed up and validated by recent newspaper articles and debates on the news as it proves that my project is very current and relevant.
1 The Final Outcome
Packshot MYNHS+ aims to improve compliance through personalisation of pharmaceutical packaging and concordance by bridging the communication gaps in the current service.
The Packaging - Tablets This packaging is designed to provide medication to patients in their personalised doses.
The Packaging - Creams This packaging is designed to ease the use of cream tubes by dispensing a set amount of medication when the top is pressed down and allowing application without having to use the hands.
The Packaging - Liquids This packaging is designed to make liquid medication less bulky. It provides a dose of medication in a liquid 'pearl' that can either be placed in the mouth, popped and swallowed or dissolved into a hot drink.
The Service MYNHS+ is a service designed to improve the communication gaps between the GP, pharmacist and most importantly the patient. It provides the patient with more control and knowledge to ameliorate their future medical experiences.
The Principles These are ten principles that were created to lay out the rules for everything that must be considered when designing pharmacy packaging.
The Brand MYNHS+ is a brand designed to visualise the service. Through bright colours and positive imagery it aims to be bright and friendly whilst also being clean and professional.
MY NHS
2 Service Design
Development of Service A session was conducted to design the more detailed areas of the service plan. This included thinking about exactly how the user becomes aware of the service, joins the platform, the different ways they use it and then how feedback is gained to improve the service in the future.
I ended up very confused by the end of this session as i could not work out how to make a seamless service that was original in the way the user interacted with it. I then sought some advice!
Finalise Service Design Concept A meeting with Laura helped to bring the service back on track and prevented over complication. Here the full service experience was described and a discussion was held to improve the areas that were felt to be weaker.
Laura Warwick: ‘Don’t doubt your service. If it’s seamless then that’s exactly the aim. I think adding a card as a means of signing up and holding information is an unnecessary complication.’
On reflection my service idea was solid and i did not need to do unnecessary development and add complication. Having now finalised my concept the next step was to start mapping it out.
Design For Care - The Design Council A taster session day at The Design Council was attended. The topic was based around improving the quality of care in the UK. The day consisted of a number of exercises that provoked conversation and ideation around how care could be improved.
Bel Reed: ‘There were a lot of good design proposals shown at the taster day. This could be good for you to take inspiration from and develop upon any details you thought were interesting.’
This day was great to see how other people would tackle my project and helped me to develop some of the areas of my service. I aimed to stay in touch with the design council throughout the rest of my project.
Service Blueprint To fully understand the scope of the online platform a service blueprint was drawn up.
This really helped me to clarify the vital stages of my service, however if I were to repeat this exercise I would have not spent time drawing it up as I feel this time could have been better used.
Customer Journey Map A customer journey map was also drawn up to explain to stakeholders and collaborators a potential scenario the user would experience.
Laura Warwick: ‘I think that both your service blueprint and customer journey map are basically the same thing. Maybe it would be better to stick with the customer journey map but do a number of scenarios.’
Moving forward I decided that the most beneficial thing for me to do would be to re-do the customer journey map with three scenarios and create a separate diagram that explains not just the service but the packaging too.
Customer Journey Map - My NHS
Repeat the service
The patient sees the advertisement on an NHS self diagnosis website.
The patient signs up online and creates their own unique identity
The patient goes through the navigation tour of the website
The patient looks up their medication on the online BNF (pharmaceutical reference book)
The patient looks up their medication on the online BNF (pharmaceutical reference book)
Throughout the of medication patient updates on how they are and if they are w
Patient takes new medication for a period of time
Project Blueprint A full project overview was drawn up highlighting the different areas of design conducted in both the packaging and the service. This diagram also explained the benefits that each area brings to the project.
Steven Routledge: ‘This is really helpful for me to understand the full scope of your project and how you are dividing up your time.’
This was a really valuable thing to do at this point in the project. I felt that it helped both myself and collaborators/tutors understand the key aspects of the project and the weightings of each. Before the diagram I felt that the packaging was the bigger part of the project but after drawing it out I now see that they are equally balanced.
Customer Journey Map V2 A second customer journey map was drawn up with three different scenarios.
Laura Warwick: ‘This is so much clearer and it shows you really understand what the service is providing to the user. It’s also great to show that if the patient is disinterested they can still reap some of the benefits.’ Dr Michele Badenoch: ‘I really like the examples you have chosen to give, they explain the service well. It is important to consider at this point if the doctors and pharmacists platforms will change or will these remain the same.’
Moving forward I used these scenarios to help develop a storyboard that will provide the scenes for my final video that will explain the service.
GP, NHS Website, advertisments in surgerys, word
Customer journey maps:
MY NHS
Pre-service information
Initial awareness
Persona 1
Patient has a one off ailment (thrush) that reoccurs again 6 months later.
The patient goes to the doctors and gets a prescription for thrush medication.
The problem re-occurs.
Patient looks up their symptoms on the NHS self diagnosis website.
The patient sees the advertisement for the online platform.
Problem treated.
Patient take medication
Persona 2
Patient has a repeat issue (eczema) that needs treating on a regular basis.
The patient calls the GP surgery and books an appointment.
The patient hears about the online platform through word of mouth but is not interested.
The patient goes to the GP surgery and signs in.
GP appointment talks loosely about problems. Doctor dictates prescription to the patient.
GP recommends the online service and explains its features to the patient.
Persona 3
Patient has a one off ailment (chesty cold) and is disinterested in joining the online site.
The patient has a chesty cough and considers visiting the GP
The patient is not interested in signing up online.
The patient collects their medication in the pharmacy by stating their name and D.O.B to the pharmacist.
Patient recieves the new packaging personalised and packed in doses.
Service Detail Development Areas of the service design that were proven to be weaker, when drawing up the project blueprint and customer journey map, were developed and refined further to strengthen the customer’s experience.
the weaker areas that were defined were the awareness and feedback sections. I had put too much focus on the user joining and using the service but I hadn’t focused enough on how they would hear about it or how I could go on to improve the service once it was in use. Detail was added to these areas such as advertisments on nhs websites and optional online surveys to give feedback.
Business Case Consideration was given to who would support the service and to packaging designs. The choice had to be made between a private independent company or integrating it into the NHS.
Conversations were held with collaborators and self medicating individuals to gauge a general consensus of what would be best. It was decided that the service and packaging would be integrated into the NHS service currently provided.
I had already thought about the business case briefly at the end of cj1 therefore i was aware of all the options my service and packaging could fit into. This was an easy decision given that the customer journey maps already defined the service as running alongside the NHS showing that my project had already found its natural path. Integrating my project into the NHS was the more challenging option but also the right option.
Storyboard A storyboard was drawn up to establish the different scenes that would take place in the service video. This was also used to decifer which website screens would need to be designed and navigated through. To create the story two customer journeys were combined.
This was a quick task as the customer journey maps already defined the patient’s path through the service. From this I felt it was time to begin the website design and therefore began to draw up initial brand logos.
Logo Design An exercise was conducted to create a number of logo variations around the selected name for the service - My NHS+.
20 members of the self medicating public were asked to select their favourite logo after a small description of the brand, why it exists and its values. The two most popular were taken forward for development.
Speaking to members of the community, which will inevitably be the users of the service, was really helpful to the development of the brand. On reflection consulting them before designing the logos would have also been beneficial to me.
Logo Refinement A combination of the two most popular logos was developed.
‘I prefer the simpler logos. They are just so much easier to recognise and understand.’ Peers: ‘Why not My NHS+ rather than My NHS. It shows the extras you are adding. I like your idea of using the arrows as it shows your intent for the service to be a constant cycle.’
Although I wanted to spend a lot of time perfecting and developing the brand and logo I am pleased that I didn’t dwell on it for too long. This then gave me more time to focus on the actual site.
Brand Values The brand values were established to understand exactly what the graphic identity and therefore website should look like.
Dr Michelle Badenoch: ‘The website needs to be really simple and easy to use in order to attract all age groups. I think layout and colour will be the largest considerations for you as it needs to appear friendly and straightforward.’
Although this seemed a simple exercise it was harder than i first anticipated. however with this in place I was then able to understand relatively quickly what I wanted my website to say and how i wanted it to look. If i had more time on this exercise I would have consulted some self medicating individuals on how they would want the website to look.
Brand Guidelines A book of brand guidelines was created to show the details of the brand and how it would be communicated across a range of media.
Steven Routledge: ‘I love the branding. It’s really punchy, it tells you what you need to know, sort of trips off the tongue. I like the logo as well, it makes the statement of a continous service, which I assume is what you want.’
THis was a little self indulgent but I feel it helped me to understand exactly what my website and adverts should communicate to the user. it also helped me convey my brand and its values easily.
Website Design A range of website page mock ups were designed to begin creating the visuals for the final video. The screens created were demonstrating a simple journey through the service. These were then shown to collaborators to gain feedback for development.
Steven Routledge: ‘The first thing that jumps out at me is the image, and that woman does not look happy. I think a different image would work much better. You want to portray happiness and satisfaction to encourage compliance.’
i am very content with how the web pages turned out for the first draft and feel positive that the constructive criticism given to me will help to improve these even further. yet i was conscious to not spend too much more time on these.
Advertisement A sample advertisment was drawn up in order to communicate how the service would be publicised in doctor’s surgeries and pharmacies.
This advert was valuable to have when speaking to collaborators and I feel it shows consideration of the broader spectrum of communicating the service to the patient. If i had more time i would have liked to develop the advertising further.
Re-engaging With My Collaborators
Peers: ‘I really like the colour scheme and the imagery. Perhaps bigger page titles would make it even clearer.’
Jonathan Milner ‘The website is a great idea, especially the removal of handwriting. Have you asked any GPs what they think? I get the feeling that they would want an excuse to see the person in person as often as possible to check on current status before writing a repeat.’ Dr Michele Badenoch: ‘I like the branding of the website and I think the whole thing looks really professional. How are you going to tie this into packaging and bring them together as one design proposal?’
Graphical Updates After consulting various collaborators about the webpage designs the visual imagery of the website was updated and some of language adapted to communicate the brand values better.
Jonathan Milner: ‘The website is a great idea. The graphic design really communicates what your brand is all about and the simplicity of the layout should appeal to all ages. You don’t want to alienate certain markets.’
making these changes to the website proved challenging as I really had to consider what was best to attract all age groups rather than just creating something that was visually attractive. Taking this forward and shooting a video around it meant that I needed to ENSURE MY STORYBOARD DEMONSTRATED THE BEST OF THE WEBSITE DESIGNS.
Customer Journey Map V3 Another customer journey map was drawn up to reflect the branding of the service and simplify the graphical communication to make it easier for collaborators to understand.
Pre-service information
Patient has a one off ailment that then reoccurs 6 months later
The patient goes to the GP and gets prescription for medication
Initial awareness
The problem re-occurs
The patient looks up their symptoms on the NHS self diagnosis website
Ailment treated
Patient has a repeat issue that needs treating on a regular basis
The patient calls the GP surgery and books an appointment
The patient goes to the appointment - explains symptoms to the GP and is given a prescription
The GP recommends signing up to the service
Patient has a one off ailment and is disinterested in signing up to the platform.
The patient develops a one off ailment and considers visiting the GP
The patient is not interested in signing up
The patient collects their medication in the pharmacy by stating their name and D.O.B
The adv MY tha me
Storyboard Updates After designing the website and seeing first hand how a patient would work through it, the storyboard was then updated to make a more realistic and seamless experience.
Mark Bailey: ‘Why would the patient go in for a second appointment? Could they not have a phone call to overcome the problem.’ Examples of changes made to the storyboard: a sign on the GP’s desk to explain the new online prescription process, a phone call instead of a second GP appointment and the GP recommending that the patient join the service.
After designing the website I was unhappy with the storyboard as it felt clunky and unnecessarily long. the video is the main deliverable to demonstrate and communicate the service therefore I realised I needed to spend some time on improving and designing the small details. Making simple changes made the whole concept feel a lot stronger.
Filming A video was then filmed in order to communicate the final service idea to collaborators and tutors.
Filming was much harder than expected however I managed to finish this within the time planned. I was very grateful for the amount of planning I had done before hand which meant that the scenes ran smoothly and there were no complications or last minute problems.
Reflection At the beginning of this project I hadn’t even considered that I would be handing in a service as a part of my design proposal, however, I am really pleased that this is the direction I took. I thoroughly enjoyed designing the service and learnt a lot through doing so. Looking back, I should have opened up to the idea of designing service earlier therefore allowing my exploration research to be even more focused in the areas I needed it to be. I would have also begun branding the service much sooner than I did which would have meant that I could spend longer developing the brand into a stronger proposal with a more powerful message. I am very happy with the outcome of the service and I feel that the brand works for its purpose as it is bright and happy whilst being simple and professional. Yet I do think there are still areas of the service that need improving e.g. the signing up process and the way the pages all link together into one service on the website which would make the service process smoother.
News Update It was important throughout the project to regularly keep updated on the news to monitor key problems in the pharmaceutical industry.
3 Re-design For Tablets
Concept Refinement Having selected the tape concept, a plan was drawn up for the next steps.
a plan was drawn up in order to understand where I needed to start. This explored obvious areas such as the outer packaging structure and the structure of the tape reel, but also areas such as potential winding mechanisms, materials, amount of medications dispensed in one pack and dosage separation within the reel. All of these things are required to be considered in order to create a well thought out design.
Outer Packaging Design An exploration into a variation of possible outer packaging designs was undertaken. A hexagonal shaped design was selected to develop as it fits well with the shape of the reel and is ergonomically better for the patient.
Simon Scott-Harden: ‘You need to think about the size of this outer packaging depending on how many pills are in one reel. You should consider creating a few standardised sizes that fit all.’ Dr Michele Badenoch: ‘I like the hexagonal shape as opposed to a simple square box. It is more efficient for stacking etc and ergonomically it works really well.’
I found this task a difficult one and ideally I would have liked to spend more time on this. on reflection i would have selected a design sooner and spent more time on the development.
Structural Modelling Testing and modelling exercises were conducted in order to determine which was the best method of laying out tablets in a roll.
James Thomas: ‘The only way I can think to make these is if you made some sort of press out of wood and used a guillotine.’ Howard Fenwick: ‘I would think you would have to make these out of a standard plastic and replicate a foil look. Try vacuum forming with 0.5 and 0.25 plastic.’
Quick modelling helped me to understand how to create the best folding method for a reel of tablets, however, it did bring up many problems that i then needed to work on and solve.
Testing - Vacuum Forming Vacuum forming exercises were conducted in order to determine which was the best method of laying out tablets in a roll.
this task proved that vacuum forming was not the right path to choose in order to create the product I would like. The plastic did not move in the way I would have hoped. back to the drawing board.
Dosage Separation Whilst experimenting with different tape reel structures thought was given as to how these tablets would be split up into the correct dosage and how this would be communicated to the patient.
Looking at the tape reel structures I had modelled so far I was worried that there would be no clear way of defining a dosage. this spurred me to rule out blister pack reels and consider completely different ways of packaging medication.
Turning Point
My current designs aren’t working as well as I had hoped.
Here I decided to leave behind a continous roll of blister packed tablets and look at new ways of holding tablet medication.
Sachet Design Taking what had been learnt from previous modelling and testing, an exercise was conducted to design other methods of packaging tablets in a roll. Sachets were selected as the best design.
Jonathan Milner: ‘The tape concept itself is fantastic, think about how you will colour differentiate for drug and dosage and also how you can make the days of the week clear and easy to identify too.’
i felt much more confident with this idea and how this could work commercially. moving forward i thought about how i could differentiate this to other products on the market that separate medication into doses.
Size Decisions Taking forward the sachet idea, decisions were made about both the dimensions of the individual sachets and the size of the rolls. This then determined the size of the net needed for the outer packaging. A conversation was conducted with a trainee pharmacist to validate the dimension decisions.
Ella McDowell: ‘A month of medication in one box would be the best outcome, which works for most prescriptions. I think the best way to cater for people that take more than one dose of medication a day is to provide fornightly packaging with either a delivery service or give them more than one pack at a time.’
I was not completely happy with the outcome of this discussion therefore I felt i needed to give it more thought and allowed myself some extra time to work out the details of this service.
Business Model Consideration Thought was given as to how providing medication in this way would work in terms of the pharmacy and its business.
Simon Scott-Harden: ‘Could you propose a regional set up in the beginning whereby all the prescriptions are packed out and sent from there? Then once it is more established and pharmacies have had time to gain the necessary equipment it can be done at each pharmacy.’
This was a short exercise and after considering the options it was clear that I wanted this project to be a part of the nhs and something that is offered to everyone not something that is only available to an elite few.
Case Study: Diskus Inhalers A case study was conducted to look into how diskus inhalers use and dispense sachets of medication.
The method used by diskus inhalers is very interesting however due to the amount of plastic and mechanisms it uses it was not suitable for disposable packaging design.
Material Decisions Collaborators and materials companies were consulted to gain materials advice.
KM Packaging: Provided sample materials for the manufacture of the sachet tape roll.
Chris Ashcroft, Dechra manufacturers: ‘The “usual” plastic is PVC or PVC with PVdC. This can be replaced by aluminium on both sides (Alu-Alu - pockets and top) as you may have seen in some products.’
After ringing around many places I was very grateful for the help I received from km packaging. The materials advice and samples they provided helped me to make the tape reel look very professional.
Prototype 01 A first prototype of the sachet tape roll was created using samples of foil (alu) laminated to a polythene (PE) and clear polyester (PET).
This proved that the sachet reel would work, however, the foil was too thin therefore looked scrunched and unprofessional when finished. I then went back on the hunt for some more materials advice and samples.
Prototype 02 A second prototype of the sachet tape roll was created using a thicker plastic film and alu alu foil. This was heat sealed at the edges and middle. A small slit was cut in the back of the foil to fill the pouches.
I was really pleased with this model. It looked a lot more professional than the previous and i felt it was of a high enough standard to present as a final model. Moving forward, I needed to consider how I was going to apply graphics to the sachets.
Labelling Graphics were then drawn up to test the information needed on each sachet, font and colour sizes etc. These were printed onto clear sticker paper and applied to the transparent plastic side of the reel. In reality these graphics would be printed straight onto the plastic in the pharmacy.
This was more successful than expected and when stuck on they were very effective at allowing the patient to view their medication whilst providing clear information. Finalising the tape reel and its size meant that I then had the measurements to focus on the outer packaging.
Net Design A variety of hexagonal net structures were drawn up and tested to see which formed the strongest and cleanest box.
Information Placement Experiments were conducted whereby graphics were added to the net and re-arranged until they felt balanced and simple.
This was a very long exercise with many iterations. Ensurng that the patient can find the correct information immediately was a large part of my exploration research and therefore it was crucial that i used this knowledge and applied it. Each face has its own information sector which breaks down the information into readable chunks for the patient.
Information Placement Braille face Retrieval of medication and warnings face Calendar face List of included medication face Branding face Name and administration instructions face
Dispensary information face
Introduction to the new packaging face
Model Development Tests of the model were conducted in order to refine elements that proved unsatisfactory. The image on the right shows how the panel in which the sachets are accessed had warped due to it being too close to the fold lines. These issues were amended and models were built and tested until satisfactory.
This exercise proved very important as it highlighted a lot of issues I would never have noticed from on screen. Looking back I would have started doing this earlier in the development stages to save time at this point in the project.
Portability The advantage of portability was incorporated into each of the packaging designs. For the tablet roll the patient can rip off the number sachets they need and carry them separately to the main box. The necessary information is still provided on the sachet.
Although this is not crucial to the core of the project It was an added advantage that I believed really complemented the problems I was trying to tackle. I would have liked to provide more prescription instructions on the sachet however this would have been overwhelming and overcrowd the simplistic graphic approach.
Final Model The image to the right shows the final model created to demonstrate the design for tablet medication.
Reflection This packaging concept feels the strongest out of the three. Its creative structure in terms of both the sachets and the hexagonal net mean that it stands out as something completly different. This was a very challenging concept to develop as it involved making many pharmaceutical decisions that I wasn’t always 100 percent sure about. However, with the help of collaborators and my exploration research I feel I managed to create a feasible concept. I am very happy with the final outcome and feel that I did manage to cover all the design principles in fine detail. Had I had more time I would have liked to create a more finalised model to present. Unfortunately on my final model the fold lines could not be pressed into the net therefore they caused slight ripping in the paper when assembled. The sachet strip could not be printed onto meaning that transparent stickers were used to apply the graphics and the tablets could not be filled before heat sealing the sides and middle therefore small slits had to be cut in the back. These are errors I would have liked to rectify.
4 Re-design For Creams
Mechanism Ideation Ideas were drawn up and experimented with to understand how the concept of adding a ‘deodorant roller ball’ to a medication tube would work best.
Simon Scott-Harden: ‘I like the idea of this clicking when the right amount of cream has been dispensed but I don’t think optics technology would work. Have you thought about a pump mechanism or taking inspiration from the plastic tootpaste tubes?’
From speaking to tutors and collaborators I realised that my idea was just not strong enough. I needed to look at how the creams could dispense a dose in more detail.
Turning Point
This mechanism could not dispense a set dosage for the patient.
Here, I decided to adapt the mechanism from a roller ball to a pump. This would allow the patient to get a set dosage size each time.
Mechanism Ideation Further research and designing was conducted into pump mechanisms and how this could be adapted to cream medication tubes. An idea was selected and developed.
Jonathan Milner: ‘The cream idea is great. Dispensers do exist but I have never seen the domed top before. You need to consider if this will affect the life of the cream if exposed to the air for too long.’
This idea feels much stronger and more realistic. next i needed to model and test whether the viscousity of the cream was going to affect the performance of the mechanism.
Testing An experiment was undertaken to test whether the viscosity of creams would affect the performance of the mechanism. Hydrocortisone cream was used and the amount dispensed was also measured.
This was a very quick exercise to validate the design. from this I planned to create a proper model that would communicate the idea to collaborators in order to gain constructive feedback.
Modelling A model was created using basic materials in order to communicate the idea with collaborators.
The model communicated the idea well, however, it did not represent the scale. my next step was to work out how I was going to create a scale model for the final hand in.
Materials Consideration Research was conducted and collaborators were consulted in order to gain advice on how to create a model to represent the final design outcome.
Simon Scott-Harden: ‘For this model you are just going to have to piece together parts of different products.’
Chris Ashcroft, Dechra Manufacturers: ‘It would take an awful long time to make a model to the desired standard with the machines available to you. Is there any way to show this design in a different format?’
at this point in the project I felt very unhappy and undecided as to how i was going to represent this model for the final hand in. to move forward I decided to consult my tutors for advice,
Further Modelling Further modelling was conducted to explore the outcome of combining numerous products to create a model. The outcome of the model showed the function well however did not show the desired appearance.
Mark Bailey: ‘Have you considered doing numerous models to show this product?’
At this point i made the decision to create three models to show this product; a functional model made up of various parts of existing products, a 3d printed appearance model and a 3d render.
Design Development Further development was conducted to design the desired appearance for the creams model including design around elements such as cleaning the top and creating an air tight seal.
At this point I realised that I had been overlooking the cream’s appearance and was solely focusing on its function. I needed to take a step back and consider how this was going to be an appealing product for the consumer. Here I removed the ‘roller ball’ concept for a simple plastic dome which was easier to clean and kept the product air tight. the decision was also made to provide a lid for the product to ensure maximum freshness.
Outer Packaging The outer packaging was developed to match the graphical appearance of all the other designs. This design focused on simplicity, clear information and instructions and plenty of white space for a calming influence.
Dr Michele Badenoch: ‘I almost like this packaging design more than the tablets. The simplicity is lovely.’
As the graphics for the tablets packaging had already been drawn up it was relatively simple to roll it out across this box. three versions were drawn up before this one was settled on. The versions differed on font sizes and information layout.
Labelling The graphic layout was also rolled out across the label for the creams tube. This was designed to be very minimalistic and clean. In a commercial situation these graphics would be printed onto the tube rather than stuck on.
Steven Routledge: ‘The creams tubes currently on the market are often overcrowded with completely unnecessary information. Getting rid of all of that is a very good idea.’
to allow the patient an easy experience with the packaging my aim was to not alienate or overwhelm them through the overcrowded graphics found on pharmaceutical products currently on the market. using a simple block font and a pure white backdrop makes the product look medical and professional whilst being friendly to the user.
Modelling Three models were created to display the function, the appearance and the labelling for creams medication. To create the appearance model a number of parts were drawn up in Solidworks and 3D printed, primered and spray painted.
Functional Model The functional model was created using mechanisms and materials from a variety of different existing products.
I was pleased with the outcome of the model. After a series of unsuccessful and ‘ugly’ function models I believe this one shows the mechanism well whilst being somewhat representative of the final outcome. This model was quick and simple to make therefore a good use of my time and a good way of communicating with collaborators and tutors.
Appearance Model The appearance model was created using 3D printed parts that were sanded and sprayed.
I believe this model was somewhat of a failure. Although it effectively shows the desired appearance of the creams tube it took a long time to make and it is still not of the desired standard.
Reflection This is a concept I would have liked to focus more of my time and attention on. Although I am very pleased with the idea, I think the development and execution could have been much more thorough. I believe the concept could be more ergonomically designed, making it easier to push on the top dome. It could also be designed so that it is permanently air tight and it is easy to pull apart and clean if necessary. These are all details that I wanted to look at during the design development stages but being on a strict time scale other details were prioritised over these. The outer packaging could be a little more creative to match those that were developed for the tablets and liquids medication.
5 Re-design For Liquid Medication
Idea Confirmation After selecting the ‘bath pearls’ concept a plan was then made of points to be explored.
Questions to be answered: How can these be tested? How will these be packaged? How much liquid medication will be in one ‘pearl’? Will they be individually packaged?
This idea proved harder to test and model than the others. I am conscious that as it is a conceptual idea, society may not be quick to accept it. Moving forward I had to think hard about How this product would be accepted in society and how I could make it more attractive to the patient.
Testing Experimentation was conducted using three different processes to see which was most effective for containing liquid medication. Out of spherification, reverse spherification and frozen spherification, freezing the liquids proved most effective.
Richard Watters, ex DFI student: 'I used methods called Spherfication and Reverse Spherification which are used in Molecular Gastronomy and Molecular Mixology. It can be quite a fiddly thing to master.’
I am very grateful that richard was able to guide me on how to test this idea. The outcome was great, however, if these were to become commercially available, a method of creating a much stronger membrane would need to be established.
Outer Packaging An ideation session was conducted to create concepts for the outer packaging of the liquid medication. The idea of creating a packaging that mimicked a small suitcase was explored further.
This exploration session felt fairly unsuccessful, however, having found a creative packaging net I liked I decided to take inspiration from it and try and develop it to fit my product.
Modelling Taking inspiration from this existing packaging net, a structure for liquids outer packaging was created and tested.
A variety of self medicating individuals were consulted to gauge opinions on the packaging net and what they would want from it. ‘I would like something that isn’t going to fall apart or rip when I open it.’ ‘I like packaging that is a little bit creative so that it feels like a new experience.’
I feel that this net needs more work. Opening the pack is difficult as there is no clear area to open and the flaps will obstruct somebody trying to access the medication.
Development The net was developed further to make it easier for the patient to open.
The packaging still doesn’t feel like it is appropriate for the content. Here I considered whether it was worth taking forward and adapting or if I needed to start again. I chose to take certain features from the structure but fundamentally start the design again.
Turning Point
This outer packaging structure is not as suited to the product as it should be.
Here I decided to re-design the packaging structure, keeping in mind the simplistic rectangular box shape but changing the design of the opening.
Re-design Of Net A re-design of the liquids outer packaging structure was conducted. Various ideas were experimented with around the original box structure. The idea of creating a smaller portable case from the larger outer case was selected as the most popular.
Dr Michele Badenoch: ‘I really like the idea of allowing the patient to create a smaller case from the wasted cardboard. You need to think about the dimensions and whether this would all fit in one box.’
This felt like a really strong idea in comparison to the last therefore I was glad to have taken the time to re-design the net. Looking back I should have followed my instincts sooner and not tried to force the first net to work.
Portability With the outer packaging for liquids medication being somewhat large, the design was developed to look at how this could be made portable for the patient. A small box was created at the top of the net that folds up and acts as a lid to the main box. This is ripped off along the perforated edge to open and can then be used as a stand alone box.
I felt that this was a strong design proposal that was very well suited to the product it was packaging. the portable box fit really well within the net and would hopefully engage the customer to read the instructions and take some enjoyment from the originality of it.
Information Layout The graphical style was applied to the liquid’s outer packaging. Dispensary information was placed on the bottom of the pack, branding on the sides of pack and braille on the back. The graphics were applied in the same style to the portable box.
This followed many of the same rules as the creams outer packaging therefore it was easy to apply. the size of the packaging meant that font sizes could be large and there was plenty of white space.
Testing Once the graphics were applied the packaging was printed and tested.
There were some minor details that needed adapting such as the width of side panels and the placement of branding on the sides. I also decided to remove the handle from the packaging as it was a waste of space and over complicated a simplistic packaging design.
Individual Packaging Individual sachets were mocked up to show how the balls would be wrapped.
These individual wrappers were mocked up very quickly in order to show that they would be individually wrapped. If i had more time to work on the project I would have liked to spend time designing a more creative wrapper for them.
Spherification Representations Two spheres were wrapped up in order to demonstrate different aspects of the 'liquid pearls'. A bath pearl was chosen to represent the texture and structure. A spherical sweet was chosen to represent the size.
Final Model The image to the right shows the final model created to demonstrate the design for liquids medication.
Reflection This design concept was very blue sky. Therefore, when I chose to take it forward for development I was a little sceptical of how successful it would be. To improve this idea from the offset I think that more research in the development stages to gauge how the public would react to this idea could have been very helpful. I am very happy with the outcome of the outer packaging and believe that the creative structure of the net lends itself really well to the pharma packaging industry. To improve this concept I would have liked to experiment more with the process of spherification and developed the medication with a thicker membrane so that testing could have occured. This would also help me to see whether the public would accept this idea.
6 Re-design For Graphics
Initial Ideation A quick exercise was conducted to start considering the graphical content of the outer packaging.
Howard Fenwick: ‘I think you could go a little bit more blue sky with the outer packaging. This looks good but why not think about where they will be placed or how they could show how much medication has already been used?’ - From this I decided to incorporate the idea of portability into all of my designs.
ON reflection this exercise was merely completed to start the ball rolling and was quite pointless. to Move forward I went back to the drawing board and tried to do some out of the box thinking.
JUSTINE COLLINS ASPIRIN - TAKE ONE TWICE A DAY 250mg ORAL USE
TAKE AFTER FOOD
Graphical Development Several versions of graphics for outer packaging were drawn up to experiment with different layouts, fonts, colours and textures.
I experimented for a while with various layouts and colour schemes and after multiple versions, Landed on a basic first edition of the final layout. Although this was a time consuming activity i am happy that I spent so long to get it right.
The 10 Principles
01 FONT Must be a bold, sans serif typeface. Minimum 12pt for important information. Jonathan Milner: ‘Minimum recommended type size is 12 point. However, 14 point is more accessible for patients with sight difficulties.’
It was very challenging to create a graphical layout that was not overcrowded with large fonts. However, (as shown in my 10 principles leaflet) I managed to achieve at least 12pt text for everything the patient deemed important - mainly administration instructions. The creams and liquids packaging proved much easier as they had a larger surface area.
1. Title font: Facile
2. All other text: Din Alternate
3. Packaging font: OldSansBlack
02 LAYOUT Must be a simpler layout with plenty of blank space. The packaging must also be standardised across all medication.
Throughout the development of the packaging it was difficult to find the right balance between colour and white space. using a block black font on a white backdrop helped to simplify the packaging further and create a less patronising medical feel whilst still being clean and professional.
03 BRANDING Leave a specific place for branding on the packaging but do not allow it to override key information.
Steven Routledge: ‘I do not think it would be a popular decision to remove branding from the packaging altogether as the companies manufacturing the medication need somewhere to advertise their business.’
Originally I wanted to completely remove branding from the packaging, however, after a variety of conversations with collaborators I realised that this was not the right decision. When designing the graphical layout the smaller, more insignificant faces were chosen to place company branding, giving them the choice to do what they like with the space.
Keep out of reach and sight of children
Certain panels on each packaging were left blank for branding to be applied.
Dispensed: Boots SKIPTON (1363) 01756 797590
Service provided by:
MY NHS
Medication provided by:
04 Colour Subtle use of pastel colours to personalise the medication for each patient.
Self medicating individual: ‘I have so many boxes with brash colours on them that don’t mean anything and confuse me. The colours are too similar for two of my medication boxes and I often pick up the wrong one.’
WHen considering how to use c0lour in my packaging I considered the different ways that colour coding could be used e.g. to show strength, medication name, brand. However, I decided that colour could be used as more of a personalised experience, by patients being able to differentiate their medications from others, by choosing their own colour. The application of the colour is subtle yet bold and noticeable.
05 LABELLING The box is the label - the box is therefore printed in store and personalised for each patient.
Steven Routledge: ‘This is a perfectly plausible idea. The process of printing a box is merely the same as printing the label and applying it. There are machines capable of this and financially it would not differ from label printing.’
This is a more controversial design proposal within my project as it requires a re-structure of the current manufacturing, printing and packing system adopted by the pharmacy. However, although it would make drastic changes to manufacturing companies in the long term it would simplify the process, cut costs on shipping and packing etc. The entire process could be completed by robots therefore there is no need for extra staff.
Medication provided by:
Keep out of reach and sight of children Dispensed: Boots SKIPTON (1363) 01756 797590
Service provided by:
MY NHS
06 P.I.L*
*Patient information leaflet
Provide a more approachable format for the patient as well as the traditional P.I.L.
The paper p.i.l was a last minute addition to the project as I had previously focused only on the information being provided by the service. It was a mistake to overlook the paper leaflet and this is something I should have noticed earlier and then spent more time developing something a little more creative.
07 Structure Each individual medication is packaged so that the patient is provided with a personalised dosage in a simple and user friendly manner.
Dr Michele Badenoch: ‘Packaging concepts, particularly the ability to decant smaller quantities into a separate container is a practical idea and one that is ill-served in the current market.’
This was by far the hardest principle to adhere to as it look a lot of development and testing to create working ideas that would improve what was currently provided on the market. If time had allowed i would have liked to refine my materials and mechanism knowledge for each concept.
08 Vital Info Only use the information which patients have identified as vital on the front of the pack. All additional requisite information can be displayed on the back and sides of the pack. Information provided to make these decisions was extracted from a questionnaire conducted during the exploration project.
This principle was more straightforward as it consisted of me applying knowledge given to me from the questionnaire onto the packaging. Selecting designated faces for each information sector proved more of a challenge as i had to consider which order one tends to view the faces and how each individual perceives the information.
09 Visuals Use the service to provide a more visual approach to a patient’s medical experience.
Initially I interpreted this principle as how i would apply visual images to the physical packaging, however, after much consideration I decided that applying visuals to the packaging would be ineffective. I then focused on how i could use visual imagery to bring the service to life and make patients feel more comfortable with it.
10
THE SERVICE
Create a service that gives the patient more knowledge and control over their medical experiences.
Jonathan Milner: ‘Personally, my thoughts on the site are that there has to be some additional research on maximising practice efficiency vs. the personal touch.’
throughout the project the importance of the service element grew until it rivalled the packaging itself. I am very happy that I decided to move forward with the service and create the website, however, I do believe there are still many areas that could be further refined and developed.
Tablets Outer Packaging The image to the right shows the final net design for tablet medication outer packaging.
The tablets’ packaging proved more difficult than that of the creams and liquids due to its structure and surface area. Providing all the patient’s medication in doses meant that space must be left for numerous medications. Lines were introduced above and below the patient’s name to create a clear hierarchy of information.
ASPIRIN 250mg MICROGYNON 50 LORAZEPAM 100mg Oral Use - Take After Food
Medication provided by:
MY NHS 1
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Sachet Design The image to the right shows the final design for tablet medication sachets.
This sachet design proved difficult when designing, as, if a patient takes more than 4 medications in one dose the sachet quickly becomes over crowded with information. If i were to do this design again i would have created a number of prescription scenarios and designed for each. due to time contraints a generalised design was drawn up to match the outer packaging.
Creams Outer Packaging The image to the right shows the final net design for cream medication outer packaging.
Medication provided by:
Dispensed: Boots SKIPTON (1363) 01756 797590
Service provided by:
MY NHS
Keep out of reach and sight of children
Liquids Outer Packaging The image to the right shows the final net design for liquid medication outer packaging.
Medication provided by:
Keep out of reach and sight of children
Service provided by:
Keep out of reach and sight of children
MY NHS
MY NHS
Provided by:
Dispensed: Boots SKIPTON (1363) 01756 797590
Braille A short exercise was conducted to learn the basics of braille in order to apply it to the packaging. This like all other graphical attributes of the packaging had its own designated face on the outer packaging.
Going into this exercise a little sceptical of how long it would take me I actually found it quite simple and very interesting. Had i had longer to work on this section I would have liked to look at tactile materials and how they could have enhanced the efficiency of receiving the information.
Anti Tamper Packaging Anti tamper packaging is very important in the pharmaceutical packaging industry. Throughout the project this was considered as a benefit the products must have.
THe personalisation of the packaging has allowed the products to show any proof of tampering without intention. This was a great addition to the project and something that will appeal to the pharmacies. with more time I would have also liked to develop an anti counterfeit indicator.
7 Validation & Reflection
Things I Should Have Done 1. Created a proper business plan to work out how the packaging and service would fit into the current NHS and what equipment they would need to make this happen. 2. Given more consideration to creating a childproof design for each of the packaging concepts. 3. Given more consideration to ergonomically designing the packaging (especially with the creams medication). 4. Create the website rather than just mock up screens therefore giving me better insight of the flow between the different sections. 5. Put more thought into how people would hear about the service - simply relying on word of mouth from the GP may not be enough.
Validation Dr Michele Badenoch Bsc,MBBS,DCH,DRCOG,MRCGP Private GP, Blossoms Healthcare, London. Michele has expertise in the service provided by both GPs and the pharmacists and can provide valuable insights in the topic of patient compliance.
I am a General Practitioner with responsibility for an on-site Pharmacy in our clinic complex and have had the privilege of being involved with Ms McDowell’s Research Project since its inception in November 2014 when it was in the research stage until the Spring of 2015 when she finalised the design element of the project. We have had regular contact throughout this time although work pressures and distance have meant that most of our contact has been via Skype. Ms McDowell’s approach to her research has been thoughtful and questioning from the start and she has managed to gain a great understanding for her subject in a relatively short space of time. I am particularly impressed with her comprehension of the issues surrounding patient behaviour and compliance and the challenges posed by the stringencies of regulation in
medical products and packaging. She has been undeterred by these many set-backs and occasional pitfalls and has approached this task with a maturity and depth of understanding beyond her years. The scope of her project has been wide as she has tackled the design of packaging of creams, tablets and liquids in a very original way. This has required thorough development, testing and modelling of each concept and she has shown both courage and energy in rejecting designs which have not come up to her own high standards. She has also been most mature in her response to criticism but also prepared to argue her point of view with vigour and intelligence. Regarding her designs, I have particularly liked the concept of personalisation which is original and particularly valuable in patients struggling with deteriorating Cognitive Function and in children on long-term medication within a school setting. Interestingly, child safety is one of the areas that could have been developed further if time constraints had allowed. Our pharmacist felt the cream dispenser had great potential, particularly for steroid and staining tar-based creams that need to be limited to affected areas only. Spherification is also a very original concept and I would be interested to see a further study investigating patient acceptability with this product. Packaging concepts,particularly the ability to decant smaller quantities into a separate container is a practical idea and one that is illserved in the current market. The concept of an accurate, peer-reviewed on-line database is much needed as patients often present having acquired inaccurate information on-line often resulting in poor compliance. I have thoroughly enjoyed being involved with this fascinating and stimulating project and look forward to hearing news of Ms McDowell’s future career in which, I am sure, she will have every success.
Validation Jonathan Milner Director, Tag Packaging, Leeds.
Jonathan’s expertise lies in packaging and branding having had a career within pharmaceutical packaging and graphic design. He has also contributed towards the writing of the book ‘A guide to the graphic design of medication packaging’ published by the NHS.
What an amazing effort Maisie – very well done. A very strong concept very well executed and I could see it working from a patient perspective. The one that stands out by far to me is the dispensing concept. Whilst one should never refer to medication and children’s sweets in the same sentence, this reminds me very much of the hard boiled sweets with sherbets inside that are often found in continental Europe on the long strips. The concept works!! A few points using my commercial mind-set, which all too often takes the sizzle away, however, please don’t let it – the best ideas come from blue-sky thinking. The challenge afterwards is then, how can we make this stack up. The tablet pouches would need to be easy to open from an elderly
perspective, but also incorporate some child resistance. There would be a significant level of investment here, not necessarily from the personalisation of printing the name and combinations on the packaging as personalised print costs are reducing all of the time, but with regards to hygienically packaging the medication. One pouch size won’t capture all, some people have many tablets to take and yet the people who take few, we’d need to keep an eye on reducing material wastage so they may need a smaller version. Product and dosage differentiation would be an important next step in this project for me as the products all look very similar yet contain very different medication – I accept that the focus on this project was delivery of product, however the dangers are ever present and if these were being presented to Pharma professionals this would be picked up, possible to the detriment of the concept. Maisie’s work ethic is fantastic and she has produced a great project. I love the tape dispenser concept, I think this is very strong and has some legs as a concept to explore further. It was good to see thoughts about creams and liquids too. Personally, my thoughts on the site are similar to before in that there has to be some additional research on maximising practice efficiency vs. the personal touch. I for one try to avoid the Dr surgery. But if I really need to go, I would like to see my Dr in person until I am fixed. Maybe for people with longer term illnesses the repeat system could work, but the Drs job is surely to help get people off medication and to do this they’d need to review in person? My area of expertise is packaging rather than surgery so I’m not really the best person to comment.
Validation Steven Routledge Specialist Pharmacy Technician, St Nicholas Hospital. Working within the hospital infrastructure, Steven can provide information on both inpatient and outpatient medicators which will affect the way the packaging is distributed and used.
Summary of approach Throughout my meetings with you, you have always presented yourself extremely professionally, and demonstrated an excellent work ethic. You have shown an earnest interest in the world of pharma packaging, and obviously had both an in depth knowledge of the physical mechanics of medication delivery methods, but also a reassuring interest in improving patient experience. You have responded positively to all constructive criticism and shown extremely innovative thinking throughout. Your problem solving has been first class and you have responded to challenges to your principles of design with a will to learn more and develop your designs, rather than becoming defensive in any way.
You have incorporated all suggestions into your designs and shown that you appreciate both the challenges that patients face when taking medication, as well as the legal requirements of pharmaceutical packaging. Overall you have been a pleasure to work with, and a credit to yourself and the teaching staff you work with. Summary of opinion The world of pharma packaging has stagnated for many years, with established designs of medication delivery appearing to stand still in most areas. This piece of work has looked at the root causes of the very real problem of lack of compliance in patients, with a view to what can the world of packaging design can do to turn this around, leading to real financial benefits as well as improving clinical outcomes and patient experience. Maisie has demonstrated a thoroughly innovative approach within the constraints of patient compliance and legal requirements to produce packaging which would not only work in the real world, given the required investment, but which might deliver significant benefits in terms of compliance. Correct dosages of creams and ointments is a constant problem, and having a metered dose ‘roll on’ applicator could significantly increase compliance and efficacy whilst reducing wastage. The innovative design of liquid and solid preparations is also extremely interesting and would help to solve compliance issues which are currently met by conventional compliance aids. New packaging and delivery methods would incur substantial costs and long term investment by the industry and the NHS alike, but without exploring new approaches to pharma packaging, nothing will change for the better.
Validation
15 self medicating individuals were asked their opinions on the project.
“ I love it. The personalisation part is my favourite as I am forever getting mixed up with my husbands medication.” “The service part of the project really appeals to me. I hate having to ring the doctors and put on hold for ages. This would simplify my life a lot.” “I like the way you have made it all look. It is much more friendly and patient centered than what is offered to us at the moment.”
“Looking at the packaging I am concerned that my child would think these are sweets. But other than that it is all very appealing.” “I am very forgetful and being provided everything already in its dose is just fantastic. I particularly like the creams tube as I have to use a lot for my skin problems and I hate having to get it all over my hands.” “I struggle to use the internet a lot of the time as I get confused easily but this is so simple I think even I could manage it!” “I love that the box is now the label. I can never read my label and the ink always smudges so half the time I have to guess what it says!” “I love the branding. Medicine packaging can be so dull and uninteresting which is a shame when we are meant to be reading what is on it. I think I would actually want to read this.” “The text is a good size. It’s very annoying when I can’t read anything on the box especially the label with my instructions on.” “I think both are great additions to the NHS. I would love a little bit more personalisation in the service I receive.”
How Could I Improve It?
15 self medicating individuals were asked the question above.
“ I think the website could be advertised better so that people would hear about it easier.” “As I said before, some of the packaging makes it look like sweets, so maybe consider some child proof features on the outer packaging.” “I would like to know if this would increase the cost of my prescriptions, as they are already ridiculously expensive. That may be something to consider.”
“Maybe create a number of sizes of the packaging so that if you don’t take as much medication the box doesn’t need to be so big.” “I think it’s great. I can’t think of anything to improve at the moment.” “If I were to take sachets out of the tape reel then I wouldn’t have all my administration instructions on me which could be an area to improve.” “Could you personalise the medication more for different problem sectors such as paediatrics or dementia patients?” “I would like the name to be a little smaller as although it is important I don’t want it to scream that it is mine.” “On the website, maybe an online chat option would be good so that if it is a minor question and it is not worth requesting a call, a professional would still be able to answer it. This would cut down on unneccessary calls.” “Could you make your video into more of an advertisement and play it on TV therefore more people would hear about the service quicker?”
Personal Reflection Overall, I am really pleased with the outcome of the project. There were many points throughout where I wanted to give up on certain aspects and simplify the project to include just the service and/or packaging but I am very glad that I perservered with both. I am proud of the breadth of work I have achieved in what felt like a small space of time and although I know there is much room for improvement I feel confident in the work that I have done. Through collaborator feedback I also know that it has been accepted by the medical community as a strong proposition which is very humbling. I am happy that I completed the project fully as although it was a very challenging problem, topic and amount of work it was all worth it in the end. I feel through this project that I have found my true strengths in design and even found some skills I didn’t know I had! I would like to say a few thank yous to people that have been invaluable to me throughout the project: • To Charlotte Payne and Katy Green for putting up with my constant talking and questioning of every single thing I did and every decision I tried to make. • To my peer group, Mark Bailey and Laura Warwick for their motivation throughout. • To my collaborators for their excellent advice throughout. • To my best friend Harriet and my dad for being wonderful actors in my video. • And finally to my mum and sister for always being a phone call away.