Open Source-D

OPEN SOURCE-D Ross McIntosh

OPEN SOURCE-D

Exploring open source and open innovation models within the context of patient flow Type: Duration: Core Staff: Group Members:

Group 5 weeks Stuart Bailey & Ian Grout Laura McDonald Luisa Felappi Luis Sousa Xuanyu Chang Ross McIntosh

Introduction In this project, we were to consider how designers co-design with organisations within the context of open source design.

From conducting desk research, user observations and interviews gathered from engaging with staff and patients at University Hospital Crosshouse, we are to develop a design strategy model for how an health service organisation such as NHS Ayrshire & Arran might apply an open innovation design model to develop co-designed and collaborative solutions to problems such as Patient Flow and Access.

We are then to apply our open innovation design model to develop an improved ‘Patient Flow’ user experience and service proposition.

Contents

4//Initial Research 6//Field Research 9//Insights 12//Data Management 15//Tools 18//Year Outcome 22//Presentation 25//Reflection 27//A&A Workshop 28//CareHackathon 31//Further Reflection

NHS X GSA This is a summary document for the group PPJ for the Open Source-D project, I have referenced page numbers to refer to on this page.

NHS X GSA

//3 //14 //15 //16 //44 //48 //50 //52

4

Initial Research For this project, we will be working with University Crosshouse Hospital in association the NHS Ayrshire and Arran to gain research and ideation input for a Hackathon event in 2016

After being briefed for the project, I firstly analysed what ‘Patient Flow’ entails; “delivering the right care by the right professional in the right place at the right time.”

The Open Design model of which this project is structured around appeared to be focused on the “open exchange” of knowledge and learning in which we are to design a process that can be applied by hospital professionals to develop innovative solutions in an open and collaborative manner. By giving them the tools to design, the innovation process will be more sustainable within the organisation on and less likely to come to a halt

once the designers leave the project.

Prior to our site visits, I wanted to gain a holistic understanding of how a hospital functions and undertake some desktop research before visiting the hospital in Kilmarnock.

My aims for the site visits were: - To gain understanding of Crosshouse Hospital.

- Experience first hand the environment of the hospital.

- Establish key touch-points for patients journey.

- Discover experiences from patients and staff - Insights into staff and patient motivations and issues - Create connections and network on site

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Field Research Assigned to undertake field research within the Accident & Emergency department We had many scheduled visits to Crosshouse Hospital to carry out field testing. Once we got there, each group was assigned a department of the hospital to ensure we cover a broad spectrum of departments and services Crosshouse has to offer its patients.

My group were assigned the Accident & Emergency department, this was a rather tough task because A+E doesn’t specify in any particular medical genre like the other wards in the hospital.

A&E departments offer access 24 hours a day, 365 days a year. A&E staff include paramedics, A&E nurses, diagnostic radiographers, A&E reception staff, porters, healthcare assistants and emergency medicine doctors. Medical staff are highly trained in all aspects of emergency medicine. This makes our task of researching this department difficult

because of how diverse and sever the patient cases were in this department. Undertaking research in this high pressure environment should have been difficult but fortunately during our visiting hours the department was quiet for us to conduct field research. Many of the staff and patients at the hospital were generally very open and honest about their experiences at hospitals and could give me in depth knowledge into how the system works from various viewpoints.

From our observations and interviews carried out across staff and patients. There are many friction points within the department. From discussing these issues with staff and patients, many were open to the prospect of change and would endorse interventions were possible to help improve Patient Flow and user experience of the NHS service.

Observations

Interviews

Mapping Journeys

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Insights

Interviews

What are the key issues and feasible design opportunities from my field research? How can I test these on patients and staff at Crosshouse?

Insights & Opportunities

Mapping Journeys

During my site visits at Crosshouse hospital, I carried out observational analysis, various interviews with staff and patients and also mapped the data I received to create user journeys.

From carrying out this user testing, there were many clear friction points that users identified. Also many staff and patients would endorse change to improve Patient Flow and user experience at the hospital. Hospitals structure and models have not evolved like other large industries have to suit the needs of its consumers. For there to be more drastic and innovative change in the NHS we have to communicate our understanding of the service now and compare it with what it could be with viable design interventions.

Through visualising change in this way, both patients and staff can imagine the benefits of implementing design interventions. To test my theory out, I made a quick prototype to one of the responses and asked users to give me hypothetical feedback.

The patient journey map (next page) was regarded as a viable idea for the A+E waiting room to reduce stress by assuring patients of the hospital journey.

This was well received and showed how quick interventions could make a difference.

Observation

KEY INSIGHTS -Patients waiting -Patients confused -Navigation -Unclear process -Lack of treatment plan -Communication

Self Admittance

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999 Triage in the Ambulance

Ambulance

Arrive through designated entrance. Can be brought straight to resuscitation room if required.

Reception 2 Seen immediatly Seen in 10 minutes Seen in 1 hour Seen in 2 hours Not A&E, should go to GP

Triage Room

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4

Doctor

Minor Injuries

Major Injuries

GP

Home

Ward

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1

Information – Whats happening?

Patients are generally overwhelmed after an accident or emergency injury and this makes receiving information and confusing. By simplifying the information exchange process, patients will be more aware and less stressed.

2

Waiting – How to engage & distract Waiting times can be frustrating during the A+E process. Through engaging with others or implementation of distraction tools, patients could become more at ease, less anxious, and cope better with during the waiting period.

3

Awareness – How long will I be here?

A key insight is patients awareness to how long they will spend in hospital, this can lead to patients becoming frustrated and disruptive. If patients were more aware of how long they will spend they can plan ahead and be more calm.

4

Treatment Plan – What will happen to me?

Patients were not given enough information about their treatment in hospital. Through making them more aware of their treatment process, patients can be more understanding of what will happen to them.

5

Patient Navigation – Where am I going?

Hospitals are difficult to navigate; being lost can make patients very distraught and make their condition worse. By making the hospital easier to navigate, patients will find hospitals less stressful and confusing during their stay.

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Data Management As a class, we collaborated together after every site visit to discuss our insights and opportunities during the project, this enables transparency and open exchange of knowledge

Each group was initially assigned a ward to investigate and research in depth. From investigating so many wards, we gathered copious amount of information and data, we mapped and affinitised this data in our groups. As a class however we decided to gain a more holistic view by merging all the groups into one. This was originally difficult to work with but we managed to synthesise or research and identify opportunities.

Doing our ‘Synthesis workshop’ helped us to break down large amount of information and data to make sense of it. The NHS is such a large and vast industry and it is also very complicated, many

systems cross over, many patients are mislead and staff can be easily distraught by rapid changes happening in the healthcare industry through.

As a class we identified, “Communication” as a key area of focus when continuing with the project.

Once we had identified “Communication’ as our main design driver, we broke off into new teams to develop an outcome. As an open design project, we each nominated ourselves for a particular area of the final outcome where our skills were best utilised, I choose to join the ‘Add-on Tools’ team as my strengths are in idea generation and conceptualisation.

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Tools

Having identified as ‘Communication’ as our design driver, we brainstormed possible solutions for an open-source outcome From our observations and interviews with staff and patients at Crosshouse. We identified ‘communication’ as a key issue we would like to address through making an outcome. Poor communication in the NHS could lead to waiting times increasing, more mistakes being made and affects our perception of the NHS as an organisation.

In our ‘Tools’ group we identified three elements within ‘communication’ the hospital should be focusing on improving: Understanding, Trust, and Knowledge. We then made a quick paper prototype of a triangle that helps you evaluate and identify areas of development within the users communication skills.

As a group we developed the ‘Triangle of Communication’ as a tool for non-designers to evaluate themselves critically and gain feedback on there communication skills. By emphasising ‘communication’ as an area for improvement within the NHS service, we would hope that this tool could be used to improve ‘Patient Flow’ and user experience within Crosshouse Hospital.

“The Triangle of

Communication is a tool that we developed to help the hospital staff to break down communication issues and find opportunities for development”

How to Draw the Triangle?

3. Connect the dots with lines.

UNDERSTANDING

1. To evaluate each element, ask yourself on a scale from 1 to 10: A. Knowledge: How accurate was the information?

B. Understanding: How clearly was the information transmitted?

C. Trust: How well did people rely on the information that was being passed?

KNOWLEDGE

TRUST

4. If the corners of your drawn triangle, are close to the centre, then these are the elements that need improving.

UNDERSTANDING

2. Draw dots in the lines with the values of each element.

UNDERSTANDING

KNOWLEDGE KNOWLEDGE

TRUST

TRUST

5. Use the triangle to discuss where could communication be improved.

Example: The triangle represents the best possible communication. All three elements got the highest score (10).

(1) Bad (10) Good Scenario: Alex told his friend Sam to come to the party sometime in the evening. He expected Sam to arrive at 8 but Sam arrived two hours late.

Discussion: — “I think Alex and Sam trust each other because they’re long-time colleagues...We can give Trust an 8” — “Their Understanding seemed to be quite good since they both knew there was a party. It’s a good 7” — “But Alex didn’t was a bit vague about time. He never told Sam the specific time. Let’s give Knowledge a 3.There is an issue here that we can work on”

The lines in the middle represent a scale from 1 - 10 for each element

The new triangle that you have drawn represents communication in the scenario.

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Year Outcome Our final outcome consists of a set of tools that should be used in conjunction with hospital staff to help improve ‘communication’ within hospitals

As a class we compiled an intervention for use at Crosshouse hospital. Our final outcome consists of a set of tools that should be used in conjunction with hospital staff to help improve the quality of service they offer and understand a patient journey from the patients point of view.

With response to the other tools in the Open Source Kit were insight cards, from which we gathered our insights form our observations and compiled them into little stimulus cards to engage in creative speculation and problem solving concepts and ideas to arise. These concept cards are only a starting point to build on and to help people see how they can think about

other issues they themselves have identified within the hospital, there is adaptability to this system through use of blank cards that can be utilised for new insights around the hospital.

Through use of Role-play scripts we try to engage the healthcare professionals by getting them to imagine being a patient by playing a character, this allows an opportunity for the doctors to understand what patients go through and how best they can help ameliorate their experience.

Together these tools work well together and ensured we had a strong concept to present to Crosshouse from which they can build and augment the more the tools are used by staff.

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Presentation

OSD Presentation 2015 Friday 11th December Crosshouse Hospital

As a class we presented our Open Source concept and facilitated a workshop in order to test out our tool-kit and receive feedback

Our last deliverable for this project was to make a Group presentation based on our findings from our research, identified opportunities of incorporating improved ‘Patient Flow’ models, we communicated how our proposal works though our presentation, through visual advertisements in the form of posters and also we facilitated a workshop to test out our Open Source Tool-kit on hospital staff.

The presentation was well attended given the hospital was scheduled on a peak hour for emergencies. We had a range of staff from different departments who could we could test our ‘tools’ with.

Our presentation began with an oral presenta-

tion for some members of our class who talked us through our process and then we divided up into workshop groups. I facilitated the ‘Add on Tools’ workshop and demonstrated our evaluative tools on many members of staff at the hospital.

From testing our tools in situ with healthcare professionals, we could see how they responded to our tools and gained feedback from them after they completed activities.

There was plenty of GSA students around to help them understand and utilise the tools to the best of their potential and help me visualise the long term benefits if the system was integrated into the structure of an NHS hospital.

Reflection

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Looking back on how well I performed during this project and what I have learnt from the process and outcome During this project, we learned about how Open Design concepts and structures work by creating our own Open Design outcome.

As a class we choose to embrace this method by uniting as one for this project. There were some benefits to this model like by conducting our research in this way we managed to get to decisions quicker but we also struggled working in such a large group. It has also been stated that this project operated on a flat hierarchy, which I struggle to justify, there was a class system within our class where a certain group ran the project and decisions, while the rest of us were given menial tasks to do.

Working in such a large group was always going to have consequences and like many other Open platforms, there can be flaws, whoever said that Democracy was fair?

However by practicing open organisation ourselves, we could see how the model could benefit certain parts of the hospital. Communication is always a struggle in large organisations and that our solution should be subtle as the opportunities we have identified are too broad and complicated to fully understand or comprehend a viable solution that works across every member of the organisation.

Although this project was seen as a success by the class, I still believe it was unfinished; although we gave them tools to identify design opportunities, but there is little to facilitate further development or delivery of an actual product or service. I feel giving them cards and leaflets was a little underwhelming and while use of role-play can be seen as effective during the presentation, as someone who used to study Drama, I feel it is a very frivolous approach to understanding a character and could be deemed useless without further facilitation of the design process.

Furthermore, during our interim presentation with Karen and Hans, they explicitly stated that they would like to have seen some outcomes rather than tools, quite often we require tools to do something but when we receive the tools we are clueless without instruction or an example.

I believe we should have submitted a similar open model but also have demonstrated how to take an open concept and turn it into reality or action. I think without any further facilitating these tools could be wasted and undervalued.

This would be disappointing considering how hard we have worked on creating these solutions for them. But just like the NHS, when you cram too many heads into the one room, the result likely will not be positive or beneficial.

Although I struggled to cooperate with the ‘flat’ hierarchical structure of this project, I did thoroughly enjoy researching users in Crosshouse Hospital. I do not believe that these tools alone will be able to improve ‘Patient Flow’ but do think they can help facilitate gaining insights and opportunities from staff. I believe the audience would have been more interested of we had interventions we could apply in situ and allow them to document user behaviour and interaction similar to the ethnographic research we undertake to discover insights and opportunities.

Working with the NHS on this project was really interesting as we gained lots of insight into how a large scale organisation is run, we discovered during the course of this project, that the design process we applied, as well as the concepts that are developed and presented at the end of the project, will form the research and idea on input to a Hackathon event in February 2016. The purpose of the event is to provide a forum for healthcare professionals to engage with representations from different backgrounds within a creative environment that encourages free thinking without boundaries in order to challenge existing mental models.

I hope to revisit this project to review how successful our tools have been and if we can add more value to the outcomes we produced before.

Overall, although I am not satisfied with our outcome, I know there is many opportunities and interventions that could revolutionise the ‘Patient Flow’ and user experience at Crosshouse Hospital and the wider NHS in general.

A&A Workshop “Working Together to Improve Respiratory Care” Further to our Open Source D project. We were invited as a class to attend a workshop that NHS A&A (Ayrshire and Arran) were hosting with the aim of initiating improvement around primary care for those with long term conditions and in particular COPD (Chronic Obstructive Pulmonary Disease). I was very enthusiastic to attend such an event due to enjoying the previous engagement of working with a mixed audience at Crosshouse Hospital, this workshop would integrate GPs, Community Pharmacists, Care Workers, Hospital Specialists, Nurses and most importantly Patients (users of these services) together to assess what can be done to improve current services. As a carer for my mother who is diagnosed with COPD herself, I believed this workshop would be insightful as I understand the struggle and uncertainty that diagnosed patients currently experience within the healthcare system. The nature of this workshop follows on from the pedagogy of the Open Source D project due to lack of hierarchy during the event and that the results of their surveys resembled the findings that we uncovered in the Open Source D project. This ensured us that our research data was accurate and useful that we were on the right track.

Our roles in this workshop would be as facilitators with opportunity to use some of the tools we designed in the Open Source D project to work around some of the emerging issues we uncover during the workshop.

This would help us to build narratives around certain themes from the last project and test our concept with real users. I hoped this workshop would help evaluate how well we performed as a class during the Open Source D project as we assess how our tools work at the event.

On the day, as participants flooded through the doors, we all mingled prior to the event. To begin with, we were greeted with a rather long and arduous speech and slide presentation from Dr Hans Hartung, detailing the results of the data survey they issued out to participants around patient centred integration. This data was a lot more quantitative that the data we conducted and hoped this event was to conduct some qualitative feedback that NHS Ayrshire and Arran can utilise more effectively than their survey results. After the presentation, we were free to openly discuss the data. Many of the participants (and us included) found it all too perplexing. From experiencing

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Tuesday 26th January 12:30-16:30 Rugby Park Hotel Kilmarnock

this presenting style, I have learned the importance of being clear and concise during presentations to effectively convey to an audience, especially an audience of mixed ability and understanding of the project.

Later in the day we managed to facilitate little workshops to dig deeper into the research and uncover some design opportunities from the insights arisen. I was in a group with Braden who could test his ‘triangle of communication’ tool he invented during the Open Source D project. The participants at our table were mixed but it was clear to see that the healthcare professionals overshadowed the conversation and that the patients felt undermined. As a facilitator, I managed the initial group discussion to try and balance the group dynamic.

Emerging insights were similar to our own; like, lack of communication, poor understanding and trust. These insights were perfect for Braden to test his ‘triangle of communication’ tool, but like my hypothesis, once a user had evaluated their situation, their was no facilitation for design development and outcomes. This ‘tool’ only stated the obvious in most situations and users didn’t dig any deeper into the root causes or consequences as to why the problem arose, never mind how to fix it!

Without our facilitation, I believe these tools would be overshadowed and useless, rendering the project a failure in terms of outcome and societal/organization impact.

Instead of squeezing our design tools more, I thought to lead the group discussion to a more general brainstorm about the issues faced by patients. This delivered a more relaxed tone and platform for open discussion.

At this point, my aims of the workshop had changed to just discover and define keys issues rather than to solve them. For the time we had and resources available, I felt that this was the only outcome achievable by the end of the day. Moreover, that participants felt valued and shared openly their experience and opinions. This workshop demonstrated the importance of establishing relationships with our audience as it will affect the quality of outcome. This is why I believe the data sampled with the survey wasn’t entirely accurate and neither was our project data; instead events like this were the real catalyst for change and that empowering each participant to be a little more proactive about how they interact with health services in order to initiate improvement and innovation.

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CareHackathon “Re-imagining unscheduled care in Ayrshire & Arran” During our Open Source D project, we were made aware that our research findings would be used as the basis for a ‘Hackathon’ event later in the year. Fortunately, I was selected to take part in this two-day event that aimed to develop innovative solutions that deliver the right care at the right time. This event will focus specifically on unscheduled or unplanned health or social care. This means care that can’t wait, and includes emergency support to people in their own home; booking of urgent GP appointments; 999 ambulance services; and emergency visits to hospital, including A&E. The ‘Hackathon’ hosted by service design agency Snook, follows on from our Open Source D project using a creative, person-centred approach – focusing on people’s stories of seeking, receiving and delivering unplanned care, and developing ideas for new approaches to improve people’s experiences and outcomes.

Prior to the event, myself and 5 other GSA students were invited along to Snook’s offices for a training event for the project. Here we met many of the professionals involved with the previous project and we were all assigned facilitator roles for the Hackathon. Snook detailed the event and took us through some of the exercises the participants would be presented at the event. This workshop followed on from our project with user journeys and insight analysis similar to our own project. During the event, I networked with many of the healthcare professionals and was partnered with a member of parliament throughout the training, this gave me an interesting insight into what was expected of the Hackathon event and more perspectives on the current issues within the healthcare system.

On the first day of the ‘CareHackathon’, I was very eager to get started and meet the participants. To my surprise, the event attracted over 150 members of NHS Ayrshire and Arran, it was quite a turn out! To begin the day, we were assigned stations of participant interest; at each station was a typical user journey and participants were to discuss issues around the situation and make suggestions for change using post it notes. I was assigned A+E (non urgent) and Admissions Ward stations to facilitate. After a presentation, I was surprised to see how engaged all the healthcare professionals were to this task. During the exercise, everyone got involved

Friday 29th April & Saturday 30th April McLellan Galleries Glasgow

and from speaking to many from different occupations, they were all very determined to initiate change and vent their frustrations on the current healthcare model.

I thoroughly en-joyed this task as it correlated my key insights from working in the A+E department at Crosshouse last year and was exciting to speak to many more members of the NHS outwith hospitals. Later in the day, we reviewed each station situation and comprised some stimulus points for participants to group together in an attempt to solve the problem. I choose to work within the “accessibility to right care” team. This team attracted 16 participants and as the only facilitator, I had to manage the group discussion as best I could. The team started off very enthusiastically and driven to solving the problem but with so many voices, it was hard for the group to come to a consensus by the end of the day to define what they should design and create to solve the problem. I felt I could have facilitated more but within such a big group with many professional superiors, it was hard to be valued.

On the second day, I wanted to gain more control over my group to ensure we man-aged to create a solution.

I encouraged the group to keep to a strict schedule to en-sure targets were met. At the start of the day, we made real progress. I encouraged the group to stop discussing their idea and move onto prototyping it. From a diagram of an idea made yesterday, I encouraged them to set up how their system would look and act. This method worked very well and even attracted the attention of the chief executive of the NHS during rehearsals. Towards the end of the day, discussion crept in and the group frantically started to restructure their already good idea.

I tried to intervene but the group started to panic under the deadline and this resulted in our presentation being more tell and not enough show. Critically though, the group mentioned that they understood more about why I was making earlier suggestions and that they should have listened to me more. Also I felt I should have been more forceful as a facilitator for the presentation but in general I felt I per-formed well enough for them to acknowledge their own faults and understand where issues went wrong in the process. This teaching can later be applied to their own practice and hopefully stimulate improvement over time.

Further Reflection

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Looking back on how the further events have went and what I have learnt from the process and outcomes of these Since the finale of the Open Source-D project, I am glad that I have had further chances to continue to collaborate with NHS Ayrshire & Arran. I feel that these experiences have been more valuable in terms of personal development and progression as a designer that just that of the Open Source D project alone. Within the time allocated for the project, I feel our outcome was poor and desperately needed testing in order to prove its effectiveness. That been said, I feel this project was designed to be extended and feel I have benefited from further participation within the field.

I believe the Respiratory Care workshop highlighted many of the shortfalls of our own project as it didn’t provide the scope for change or improvement during the time allocated. Also both our presentations were not active enough and relied heavily on talking rather than doing change!

However, I would regard the Care Hackathon run by Snook to be a great success, over this two day workshop, I really managed to connect and network with a variety of industry professionals all hungry for change. It was refreshing to see so much enthusiasm towards improving current systems and access to care. Towards the end of this project, I and others could really see some ideas coming to life and more importantly, we could demonstrate the value to so many. These events could potentially spark real change and improvement to health care moving forward.

For this I would wholeheartedly accept more opportunities to work within this field and a further within health and social care. I am excited to develop the concepts arisen at the ‘Post-Hackathon’ event on 3rd June 2016 and am eager to see this project through to fruition going forward.