PERSONAL PROJECT JOURNAL M E N G X I YA N G D E S I G N I N N OVAT I O N & SERVICE DESIGN NHS24 PROJECT
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PREFACE PERSONAL PROJECT JOURNAL M E N G X I YA N G D E S I G N I N N OVAT I O N & SERVICE DESIGN NHS24 PROJECT
In this project we were asked to explore an 'alternative now' of NHS24, which aims to provide out-of-hour medical services in Scotland through telecare and telehealth services. The 'alternative now', as addressed in the brief as well as in my understanding, is not to merely define single problems and solve them, but to consider the structure and system of the service in a holistic view. Only in this way can we come up with the solutions radically instead of doing tiny amendments. On the other hand, it is not pure imagination, but an implementable future based on existing scenarios and foreseeable trends. As designers, our role is not inventing something from nowhere, but understanding people's personal and social behaviours and bring them more favourable experiences.
As for our teamwork, I would like to thank especially Quinie and Jessica for their fabulous contributions. Quinie is very good at logical thinking and was responsible for structuring the presentation every time. By discussing with her, I can see a clear path of how our project has been developed from the beginning to the end and gain a definite confirmation of every evidence of our articulation. Jessica has a strong ability in doing researches. She is very strict about the precision of data we used in evidencing our design and can always find valuable references to inform our project. I learned a lot from both of them. I also found myself making great progress in critical thinking and project management in this semester. The working methods I have learned from the first semester and the specialism were well used in this project. By proposing group discussions, context mapping and brainstorming, I am glad that I was able to push our progress forward and every time we could generate rich production.
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WEEKS NHS111
Desk Research
2
User Research
User Research
Desk Research
Selfmanagement Omni-channel
User Journey Mapping
Chatbot
User Journey Mapping
User Journey Mapping
Storyboarding
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2
3
4
5
6
CONTEXT
DESIGN FOCUS
INSIGHTS
CONCEPTS
IDEATION
VALIDATION
PROTOTYPE
USER JOURNEYS
CLIENT'S FEEDBACK
INTERVIEWS
DESK RESEARCH
USERS' OPINIONS PAIN POINTS
CASE STUDIES
SECONDARY RESEARCH
DIRECTION
FUTURE SCENARIOS
CONCEPT DEVELOPMENT
ITERATION
STORY TELLING
p4
p8
p12
p16
p20
p25
p36
p42
p48
7 p31
8
Storyboarding
9 10
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01 WEEK
A Glance at NHS24
29/01--04/02
CONTEXT & DESK RESEARCH
From the presentation of NHS24 overview and its five-year strategy, we realized that NHS24 is aiming at releasing pressure on NHS's medical services such as GP and A&E by giving people additional access to solving their health problems in a digital way. Contacting 111 or other medical hotlines, for instance, could reduce waiting hours for seeing a practitioner. However, we also noticed the fact that with an increasing use of this service, NHS24 is also facing great pressure of handling endless emergent or non-emergent issues every day.
Meet New Team Members As it is the first time for some of us to work together, we ran a quick self-introduction with each member's backgrounds and skills. We also created a project plan on calendar to keep our progress organized.
Moreover, although the digital innovation has moved some of medical service from traditional face-to-face method to online platforms, the traditional patient-doctor relationship is yet to be changed: Patients seek for help when health issue occurs, wait in a queue, describe their symptoms and wait to be treated.
Discussion on NHS24's Presentation We then had a discussion over the presentation given by NHS24 staff and shared opinions on what aspects we may emphasis on later.
NHS24 Desk Research We started the first round of desk research which was done by each of us collaboratively. In this way we could make sure every one of us are familiar with the context and have an overview of current situation of NHS and its possible future trends. 4
AR/VR
AR/VR: Technology Trends Since our initial context was the application of augmented and virtual reality, we first tried to clarify the different concepts of AR and VR. Then we looked at the existing and emerging technologies and tried to find out what they can be used for especially in medical fields. We found that, since VR provides a highly immersive experience, the current medical applications are mostly in teaching and training of medical students and practitioners. For patients, the most popular use is in recovering from serious mental or physical illness.
AR adds digital elements to a live view often by using the camera on a smartphone; VR implies a complete immersion experience that shuts out the physical world.
TELECARE Image from: http://medicalfuturist.com/top-9-augmented-reality-companies-healthcare/
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AR, on the other hand, is of great help in accessing information and perform remote assistance. Cases have suggested AR glasses can add another layer of patient's information when a practitioner sees the patient. It also frees our hands from smart devices so that we can be doing while watching instructions.
Stakeholders Map
However, there are still many limitations restricting the widespread use of AR and VR in NHS24 services. Because it relies highly on the technological devices and some (such as VR glasses) are by no means portable and usually costly, it is hard to foresee that most people would be equipped with this gear in the near future. In addition, using VR and AR devices, although sounds exciting, requires time and efforts to learn, which increases its cost of popularizing to the mass.
Organization Academic Health Psychologist Personal
Patients; Family and friends;
Telehealth and Telecare To identify NHS24's position in current medical service market, we researched on the healthcare trends nowadays and found the new developments all direct to 'telecare', or 'remote-care'. It enables people to stay at a home-based environment while gaining access to medical consultants virtually. This actually gives more control to patients themselves as they would no longer follow the appointments and queues to get a 5 minutes' meeting with the practitioner. Instead, they can choose anytime and anywhere they would like to get access to the service. What's more, this is changing the relationship between patients and doctors, turning healthcare and medical treatment to a commodity which you can purchase as you like instead of a burden which consumes your time and energy.
Image from: http://imaginingcareanywhere.org/html/journey.html#page/6
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c Through the collaborative desk research, I had a general understanding of NHS24 and its comparable medical services worldwide. One prominent feature I noticed in the new trend of healthcare is that it becomes more user-centred, that is to say, more patient-centred and patient-led. New modes of healthcare emphasise on customizing patients' experiences and put more efforts in long-term health tracking and preventing the illnesses beforehand. Some of the medical companies have begun to provide their customers with an overall and omnipresent care. Nonetheless, I also found it hard for NHS24 to fully adopt such strategy. As NHS is not a commercial enterprise but a publicly funded health service, it is less likely that high-end technologies and services will be provided as long as customers pay for them. For NHS24, its ultimate goal should be giving people easier and quicker access to their services equally. 7
02 WEEK
05/02--11/02
DESIGN FOCUS & USER JOURNEYS
NHS24 Services 111
MSK
Breathing Space
Living Life
Care Info Scotland
Quit Your Way
Users Providers Access Service
NHS inform Workshop
Categorizing NHS24 Services
We attended a workshop--a part of the 'Fire Starter Festival'--held by NHS24 to improve the website experience of NHS inform, where we collaborated with NHS staffs and people from different disciplines.
Instead of the general research, we took a deep look into NHS24's services, tried to categorize them and identify their users, service providers and accessibility.
We found there are so many services within NHS24 that it seemed confusing at first glance. After sorting these services and distilling key information, we noticed there are overlaps between some services and all of them can be defined in three main themes: Mental wellbeing, physical issues and long-term care. One of the problems I noticed was that although some services are closely linked in content, the access channels and available times are slightly different, which undermines the integrity of NHS24 services. However, it is also interesting to note that 111's role is special as it acts as a node which can link to all other services, as the call handler can refer the caller to other branches according to the triage.
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Drafting User Journey
De ning Design Focus
By categorizing the services, we found that there exist two types of user journey: One is based on selfhelp, represented by NHS inform; The other is seeking help from other people, which is typical in the service of NHS 111.
In this week, according to a deeper research of NHS24 services, we decided to focus our design direction mainly on 111 and NHS inform by improving their communication issues.
What is also worth mentioning is that besides offering the channels to access human help, all these services also provide self-care information and guidance on their own websites. Following the links, we found all the information came from NHS inform, which acts as a comprehensive database backing up all these services.
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Services of NHS 24 Breathing Space
Listening to you
NHS INFORM USER JOURNEY
Providing information and advice Cognitive Behavioural Therapy
Living life
Services
Stakeholders
Appointment Supporting material
Mental wellbeing MSK helpline
NHS 24
6-9 sessions regular contact
Physical health
111
Quit your way
Care Care information Scotland
Self-help guides
Users' actions
Scottish Emergency Dental Service
Stages
Referring you to a physiotherapist or podiatrist Providing information and advice Medical advice out of hours Unscheduled care service
Proving advice and plans Free quit-packĘź Referring to free local NHS service
Providing care information
User Journey Mapping (1/3) In this first draft of user journey, we tried to consider not only the patients engagement, but also the experience of service providers and how they interact with patients in different stages. Because service design is not only designing for users but considering how to benefit all the stakeholders and all service system as a whole. So, we would better start from thinking of the big picture at first and then gradually narrow down our objects. NHS111 USER JOURNEY Stakeholders Users' actions Stages Service providers' actions
Service providers' actions
Stakeholders
c Among various aspects of NHS24 services, at this stage we concentrated our focus on 111 and NHS inform, as we realize these two are central junctions of all other services and bear a considerably large flow of users: one is the linking node and the other is the database. We would like to see a future where not only the experience of 111 is improved, but also the integration of 111 and inform is strengthened, with a further achievement of releasing the pressure of NHS24 staff, thus responding to the five-year-strategy proposed by NHS24. From the user journeys and tutorial feedback, our attention was drawn onto the communication aspects during the 111 service, which appears repeatedly in both users' and service providers' actions and constitutes the essential part of the user journey. To further identify the problems and potentials, it is important for us to hear from the users' opinions, understand their pain points and analyse these pain points within the user journey.
Stakeholders 10
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03 WEEK
Voice from Users (1/2)
12/02--18/02
USERS' OPINIONS & PAIN POINTS
Users' Review of NHS24
Improving User Journey
Thanks to the rich information of feedbacks on websites such as 'Care Opinion' and 'NHS Choices', we could gain both quantitive and qualitative data.
With the pain points discovered from the users' reviews, we refined our user journey of 111 service to a more concise one highlighting the stages where future design may intervene.
“Twice I've been given what I feel to be poor/ inaccurate information with respect to treating my baby son.”
“I went through a series of questions with the advisor who then kept repeatedly asking... I was unsure of what they wanted or expected me to say!”
We focused our attention on the experience of NHS111 users. After gathering a large number of user's feedbacks through online research, we found what frustrated the patients during their communication with call handlers, nurses and clinicians could be concluded in three aspects:
“I called 111 again that evening saying that it was now more than 24 hours since I had originally contacted them.”
Delayed access to advice due to the long waiting hours caused by huge number of patients; Unnecessary repetition of basic information due to a lack of efficient info-sharing system;
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Street Survey
Peer Review
Meanwhile, we conducted a quick street survey trying to find out the emotional changes of the people around us when interacting with NHS111. Due to the limitation of time and people we could reach to, the result was not abundant but could verify the pain points we have found.
On Thursday, we had a pin-up and peer review in which we gathered many helpful advices from tutors and other students.
Misunderstanding of advice or not acting correctly on advice due to being in a high-pressured situation. It is interesting to note that although the frustration and confusion come from various reasons, in users' accounts, they would blame everything to NHS, which is quite similar to most customer reviews in online shopping. And it was with our findings from later researches and interviews that could we define the causes of these frustration points. This made me realize that although we are 'user-centred', as a service designer it is important to have a holistic view and carefully hear from all stakeholders, otherwise may easily lead to biases. 13
c
User Journey Mapping (2/3)
From the feedback in the peer review, we were encouraged to keep enquiring further about the consequences and impacts of the pain points described by users. Equally important was that we should also hear from NHS's side and find out if communication issues also occurred to them. With the voices from both sides, we could define the interaction between patients and NHS without prejudice.
In this user journey of NHS111 service, we added pain points from users' reviews and highlighted the stages where have an opportunity to make improvement. It is obviously shown that all the pain points mentioned by users happened in the stages after they called 111, which was actually not the starting point of the whole user journey. With the blankness of the part of 'self-diagnose' before making the call and the seemingly problematic phases after making the call, we could see there are two directions:
The advice on technology aspect was also very inspiring for us, as we were suggested AR and VR were not packaged tools to solve problems, but to create a new context leading with technology. I realized what we should emphasis is more of the qualities and values these technologies have brought to our lives. With these qualities and values, we could plan for new types of behaviours of people and new relationships with the service. As a result, instead of restraining ourselves in the question of 'How can we use AR/VR to tackle these problems', we decided to adopt a more holistic viewpoint and think of the possible improvements of the whole service system.
One is to clearly define each problem and find the corresponding way to tackle it. And in this case, we could refer to emerging technologies as the tools. However, it seems very discrete and lacking of holistic system and smooth experience. The other is to take a deeper look into the phase before users calling 111 as there should be more actions concerning self-diagnose and self-management which was hidden in users' account. If we could have a better understanding of patients' behaviours in this stage, we could possibly create a positive influence on the phases after calling by changing the experience before it. And this is the direction we were going to take in the following weeks. Long waiting time
Patients have difficulty to speak;
Unprofessional or wrong information;
Being asked piles of questions;
Useless or unproper im advice;
Bad attitude
Customer Journey starts here.
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Urgent medical health concerns occur.
Attempt to self-diagnose.
Call 111.
Placed on hold whilst waiting for an operator.
Introduced to an advisor.
Long waiting time
Lack of patients records
(Generally 1-3 hours, some may last over 24 hours)
Arranged for a professional to call back.
Unprofessional or wrong advice; Unuseful information;
Offered support/ diagnosis immediatley.
Describing symptoms.
'
Referred/directed to a pharmacy, GP or hospital.
Waiting for an appropriate professional to call you back.
Call returned from a medical professional.
Describing symptoms.
Diagnosis.
Self treatment and maintainance
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04 WEEK
19/02--25/02
CLIENT'S FEEDBACK & CASE STUDIES
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NHS24 Site Visit
GSA SimVis Visit
Two of our team members visited NHS24 on Monday and have gathered rich feedback on our project, which was shared and discussed within our team.
In order to gain more knowledge from the technological perspective, we have contacted Mathieu from School of Simulation and Visualisation weeks before and had an interview with him in this week.
Case Study
Context Mapping
Meanwhile, we began to learn from other innovative ideas and implementations and look for inspirations. We studied the cases thoroughly with a deep look into their outcomes and values.
After hearing from all perspectives, we could have a thorough understanding of the context. To clarify our knowledge and further narrow down our focuses, we mapped out what we have gained so far.
Voice from NHS24 The feedbacks on our project offered by NHS24 were mainly in three aspects: Patients' behaviours, 111's roles and values and technology developments. When talking about the misunderstandings in the communication, they mentioned that some patients do not act on the right way they were told or could not give the answers to the questions asked by call handlers. These issues, as NHS24 has analysed, are probably caused by patients' anxiety and irrationally high expectations. As a result, more time and assistance may be involved in such occasions. We also noticed that there are some limitations in the current 111 services. One of the call handlers' job, for example, is to search for information on NHS's Care Info website according to the symptoms described by patients, which is actually helping patients with self-help. Such works also lead to a very busy situation within 111. Another thing we have known is that call handlers cannot see all information about the callers and can only access the information shared by GP. This could well explain why some patients are asked repeated questions. As for the technology part, we were suggested to consider if patients do need expensive new devices to get access to health care when there are already many free websites or apps to offer equivalent help, and also to consider if we could tie up the new service with the existing technologies. Because 111 is not an everyday service to most of the people, and few would like to keep an app on their phone merely for emergencies. In general, we were encouraged to find solutions from a realistic and costeffective perspective.
Voice from SimVis Expert When we asked Mathieu from SimVis about technology issues, the suggestions were quite the same, emphasizing the importance of accessibility, affordability and easy interactions. 17
Case Studies on Communication AUGMEDIX Services: Hands free charting Real-time documentation Gear: Google glass Remote scribe
Values: - 80% Less Electronic Healthcare Record charting; - More time to focus on patient care; - Rehumanize healthcare and enhance the patient experience
IBM WATSON Services: Virtual agent chatbot Visual recognition Speech to text conversion Tone analyser Gear: Mobile phone
Values: - Allow more personalized customer experience; - Understand emotions and communication style in text. - Quick and easy to build for service providers;
RCS (RICH COMMUNICATION SERVICES) Services: Enable business messaging to send rich media messages Package delivery notifications via SMS Gear: Mobile phone (SMS) 18
Values: - The next generation of text messaging; - Build all services and businesses into one platform; - Integrate every messaging channel; - Faster and easier access.
Mapping Out Everything At this stage of our project, we came to a point where we almost have gained everything in the context from research and engagement. This is the reason why I found it important to map everything out and share with each other to keep everyone on the same page and ensure everyone has the knowledge up to date. Through mapping, we found the current challenges, obstacles and pain points all came around users' high expectations and relative frustrations.
c One of the valuable insights from this week is that AR and VR may not be the solution to the existing problems in the 111 service. At least seen from the current trend, they are still far from mature in technology, expensive to the mass and require time to learn. Thus, I found it a relief that we could keep exploring without the constrain in this field. And I hoped we could probe into the fundamental causes and solutions to the problems. After hearing from different stakeholders, our next step is to further clarify the relationship between users and NHS111 and identify the 'expectation' and 'frustration' in detailed statement. As this would help us to narrow down our focuses from loads of information we have already had. The case studies were also inspiring to us as we realized due to the future trends of humanized and cost-effective technologies, our design should also follow this principle and give solutions in a way as easy to implement as possible. 19
05 WEEK
26/02--04/03
INTERVIEWS & SECONDARY RESEARCH
User Interviews
Desk Research
One of our team members was able to conduct some informal interviews with her friends who had used 111 service before, which were then shared with us.
In this week, we run a secondary desk research individually, with the aim of looking for literature review of users' expectations and frustrations as well as current technological trends in tacking such issues.
Voice from Users (2/2) “I waited a long time before deciding to call the 111 service. I thought that the symptoms would go away, but they started increasing. I was waiting for the situation to worsen.”
Megan 22 years old 20
We found there is a delay in taking action to call 111 because there will usually be a period of time before the symptom getting worse, and some patients also need to assure if they really need help. Amrin 24 years old
I donʼt know if I can trust the accuracy (of an online directory). I prefer to have a phone conversation with a medical professional rather than ll out an online form.
Patients have a desire for a formal professional opinion, which NHS definitely has an advantage over other information resources. What patients expect is also reassurance and empathy, which online directories cannot offer. This suggests the reason why users make the call, and also implies they need trust-worthy and humanized services.
“I called three hours ago and they still hadnʼt called me back - There was no follow up. I was looking for an indication that my call hadnʼt gone into the ether.
We also found users need to be kept informed on the progress of assessment. Their anxiety during the waiting comes not from the long waiting time but the unawareness of how long they are going to wait. The transparency of the backstage and the sharing information between users and service providers seem to be important. 21
Expectation Gap "Expectation Gap"
"Chanel Sweet Spots"
Pick-up of the call
We found the cases of customer service in commercial field was comparable with 111 service as both services include human interaction which mainly based on phone calls and question-answer process. The latest trends of the customer service are making use of digital platforms. Many companies have adopted the chatbot to assist their customer service business to let users engage with a chatbot before interact with human call handlers so that they 'no longer have to wait on hold for the next available association'1. Some articles also suggest a multiple-channel and multiple-touchpoint trend in customer service, mentioning different 'channel sweet spots' of different customer demands. While simple tasks can be completed by self-service, complex ones need the involvement of human help through phoning or face-to-face communication2.
Returning of the call
30 seconds.
20 minutes.
60 seconds.
1 - 3 hours.
Through the research we could find there exists an expectation gap in 111 service, and the waiting time is the most obvious. Users expect the call would be picked up within 30 seconds, while the reality takes usually 1 minute. This led someone to hang up the phone before it was answered. Same thing happens when the call is returned to users. While they expected to wait 20minutes, they usually have to wait 1-3 hours to get the call from 1111. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605546/ https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2015/08/Monthly-performance-statistics-summary-Mar-17-FINAL-1.pdf
One of the reasons lead to such high expectations can be the increasing convenience in today's world dominated by the Internet and advanced technologies. The fast speed of services such as online banking, smartphone apps and social network is raising people's expectations about the access to medical and healthcare information2.
"User Initiative" We found that people are looking forward to an improvement in the patient-clinician relationship today3. Patients are becoming less passive and want more knowledge and control over their health conditions4. Such demands require a more patient-led healthcare in the future which not only provide treatment to patients, but also give them access to their own health data and a better understanding of how they could manage their own health issues. 1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605546/ https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2015/08/ Monthly-performance-statistics-summary-Mar-17-FINAL-1.pdf 2 https://www.salesforce.com/blog/2017/07/customers-expectations-in-age-ofthe-customer.html 3 https://www.kingsfund.org.uk/projects/time-think-differently/trends-publicattitudes-expectations-services 4 https://www.economist.com/news/leaders/21736138-welcome-doctor-yourevolution-health-care-coming
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"Built-in Technologies" As mentioned above, there is a trend of using chatbots in customer services and this is for various reasons. It is interesting to note that the public is showing an 'app fatigue' nowadays3 which we also heard from the NHS staffs (p.16). Compared to an app, the chatbot does not require users to learn to use as it is built in the existing platforms4. Similarly, it is also easier for the service providers to develop and iterate. There are many online communication platforms working to support the chatbots. The 'Rich Communication Services' which is mentioned in the case studies (p.17) is a representative example. By enabling rich media sources and interactions in the traditional text messages5, it provides a great opportunity to open up new channels for users to access services. 1 https://bdtechtalks.com/2017/06/13/the-business-case-for-customerservicechatbots/ 2 https://medium.com/@gerrymcgovern/business-case-for-digital-self-service72a030cd4772 3 https://venturebeat.com/2016/10/01/how-customer-service-chatbots-arethe-newblack/ 4 https://bdtechtalks.com/2017/01/28/the-chatbot-approach-to-appdevelopment/ 5 https://techcrunch.com/2018/02/22/more-than-40-carriers-now-support-rcs-thenext-generation-of-sms/
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USERS' EXPECTATIONS TOWARDS MEDICAL CARE
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SERVICES & VALUES OF EXISTING TECHNOLOGIES
WEEK
DATA
USER-CONTROL
05/03--11/03
INSIGHTS & DIRECTION
RELATIONSHIP
INFORMATION
EXPECTATION
Gaining Insights
Future Direction
From the themes we defined last week, we could distil them into five insights describing what we have learned from people.
We learned from a series of selfmanagement case studies which can inspire the future direction and scenarios of 111 service.
Improved User Journey
Current Self-management Pathways
c After running the research individually, I suggested we come back together to share the insights and categorize them. In this process we could further narrow down our focuses into several main themes as shown above. The interviews and literature reviews are of great value to our project as we were able to specifically define the expectations and frustrations of the users. When contacting 111, they expect a quick reaction, a better understanding and a sense of reassurance. Additionally, they also look forward to be able to track the process of their contacting process and their health conditions. They would like to gain more control over their health issues. The technological trends also help us to think of how we might change the experience of 111 based on a future scenario. 24
We mapped out the final version of current 111 user journey with more detailed users' actions, thoughts and feelings.
Then we mapped out the current relationship between patients and 111, addressing the problems in the existing self-management pathways.
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Insights
Future of Self-management 1. Expectation People have higher expectations on 111 than reality in many aspects.
2. Accessibility People want increased access to their health information so that they can make more informed choices.
From the insights we found the most important demand of the users is an increasing involvement and control, which could be achieved and supported through self-management as suggested in the literature reviews. So, we set out direction of imagining how can NHS 24 give people the tools to self-manage their healthcare needs beyond a phone call. Following by this, we looked for more self-management cases in various areas in our daily lives. This self-management method could not only simplify the users' efforts of seeking help, but also greatly reduce the large quantity of phone calls and release the pressure of 111 to promote a better quality of services.
3. Relationship People want to see an improvement in the patient and clinician relationship with more understanding of their conditions.
4. Consistency People need more continuity of health care and consistent guidance over a period of time.
5. Self-management People want to be more involved in the healthcare process in order to have more control over their own health outcomes.
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McDonald's Amazon Go IKEA warehouse Amazon Locker Online FAQ Airline check-in
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Self-management Journey
User Journey Mapping (3/3)
Internet
Having decided the future direction, we took a look back at the current 111 user journey. We mapped out the users' actions before making the phone call in detail and through referring to the interviews, we found that their attempts to self-management are mostly with negative feelings such as self-doubt and entangled.
Google it
Phone Call 111
Followed by the user journey, we also mapped out the existing pathways patients follow to self-management (shown on the right page). As is shown in this diagram, online searching and personal consultant all tend to advice the patients to call 111. And when patients feel they cannot tackle the problem immediately, they would also make the phone call. As a result, all the pathways lead back to calling 111.
Personal
friends/family
111 user journey
STAGES
SELF-CARE
AWARNESS
REGULARLY VISIT GP
MEDICAL EMERGENCY OCCURS OUT OF HOURS
SEARCHING THE SYMPTOM ONLINE
HOME FIRST AID KIT
HELP SEEKING
ASKING FAMILY/FRIENDS FOR HELP
NHS self-help guides
PHONING 111
CONNECTED TO A CALL HANDLER
ACTIONS
CALL HANDLER ASSESSES ACCOUNT OF SYMPTOMS.
NHS Inform
NHS 24 website
Call 999 (in accident and emergency)
Feel calm
Book GP
Feel anxious and call 111
Feel nervous
Suggest calling 111
CLINICAL QUEUE
TRIAGE
CALL HANDLER ASKS A VARIETY OF QUESTIONS.
Feel confused and call 111
or diagnosis immediately
CALL RETURNED FROM A MEDICAL PROFESSIONAL
DESCRIBING SYMPTOMS
“I don’t care
“Is my illness
“What’s wrong
them know this
“Why does it take
“Finally, c c
“Why I have to answer so many
“I’m gonna be
DIAGNOSIS
CALL RETURNED FROM GP
Referred/directed to a pharmacy, GP or hospital
Arranged and waiting for call back ...
THINKING
DISPOSITION
“Am I identifying my symptom c c
“Why hasn’t anybody call me c
“This is really
“Another waiting c c
SATISFIED
+
ESAY UNSTRESSFUL HAPPY
FEELING
_
NOT CUSTOMIZED HEALTH INFO.
PAIN POINTS
TOUCHPOINTS
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GP,
IMPATIENT
SELF-DOUBTED NERVOUS ENTANGLED
SCARED HELPLESS
WEBSITES APPS
ANXIOUS
INFORMATION GIVEN BY NON-CLINICAL STAFF.
WAITING TIME.
FAMILY/FRIENDS
CALL HANDLERS
AVAILABILITY OF GENERAL PRACTITIONER.
TIRED WORRIED
REPEATING ACCOUNT OF SYMPTOMS UNDER STRESS.
LIMITATIONS OF CDSS PATHWAYS SYSTEM.
A&E
WAITING TIME.
PROFESSIONALS
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07 WEEK
c The existing pathways for self-management helped us to have a better understanding of the current relationship between patients and 111. The self-care information provided online is often dead-end. Even in some medical apps for self-care, the final step of the whole process is the result of a diagnose. If patients want to take further actions, they are still advised to call 111. Other phone calls are results of failure in self-management due to the inevitable weakness of the current online directories. When patients feel confused or anxious, they would turn to professionals to help, which leads them to make the phone call. In conclusion, the current access to medical services is highly dependent on 111. All health issues, no matter urgent or not urgent, have to go through the call handlers to be distributed to other branches. What we have to consider at this stage is how self-management could fit into this current relationship. From my perspective, instead of letting users to go to different online directories or search engines, 111 itself can take the responsibility to provide users with tools and paths of self-management. Since people have already built up a trust of 111 because of its authority on medical service and have already accustomed to the notion of seeking help from 111, we could add on its value without changing its existing functions. Although it is obvious that nowadays people have an increasing demand of self-management, I feel it is particularly challenging to achieve this in medical care field. For health issues, it is difficult to define its level of seriousness by a non-professional and the effect might be life-threaten. This is the reason why people need more reassurance from others and are not as confident as they are managing themselves in other aspects of life. Such reality requires the preservation of the phone call service and the enhancement of links among different channels. Referring to the 'channel sweet spots' in the literature review (p.22), we could imagine in the future there will be multiple channels and touchpoints to suit users with different demands, that is to say, patients with different levels of health issues.
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12/03--18/03
CONCEPTS & FUTURE SCENARIOS
Omni-channel Study
Mapping Channel Shift
To inform our concepts, we had a study on 'omni-channel' -- a concept of business method. As we found the channel shift in 111 can learn from it.
We mapped out the current channels through 111, and the new channels of self-management, to have an overview of the future scenarios.
Outcome in Data We also referred to 111's triage distribution data as a way of foreseeing the possible outcomes through the channel shift.
Questionnaire on Self-management We asked some people of their behaviours and habits on selfmanage their health.
31
Current channel Current Channel
"Omni-channel" Although it is originally defined as “Omni-channel experience a sales approach, omni-channel is a multi-channel approach is inspiring for the redesign of NHS111 channels. Currently, to marketing, selling, and the access to NHS's medical serving customers in a way services is a 'cross-channel' that creates an integrated and approach where users have to go through 111 to be distributed. cohesive customer experience Concurrently, what most business today invest in is a 'multi-channel' no matter how or where a method where users can choose customer reaches out." 1 from multiple platforms to engage with the service but the channels are still not well integrated. However, with 'omni-channel', these multiple channels will work together to create a seamless experience and consistent service for users.
DEPENDANCE
EMERGENCY DEPARTMENT
MINOR INJURIES UNIT
AMBULANCE DISPATCH PHARMACY
HEALTH CONCERN
MENTAL HEALTH SUPPORT
PHONING
OCCURS
OUT OF HOURS GP
DENTAL
HEALTH INFORMATION SELF-CARE ADVICE
New channel New Channel Cross-channel (current 111 channels)
Multi-channel
SELF-MANAGEMENT
Omni-channel
PHARMACY
DEPENDANCE
DENTAL
HEALTH INFORMATION
Channel Shift In the new channel, in the case of non-emergency issues, users can be referred to different medical services through a system according to the levels of the seriousness of their concerns. Only the really urgent cases where patients need a human's assistance will go to 111 call handlers.
AMBULANCE DISPATCH
MINOR INJURIES UNIT HEALTH CONCERN
SYSTEM
OCCURS
SELF-CARE ADVICE MENTAL HEALTH SUPPORT
OUT OF HOURS GP
EMERGENCY DEPARTMENT
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1 https://blog.hubspot.com/service/omni-channel-experience
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c
An Expected Outcome The data suggests in the past year of 2017 -- 2018, only 20% of the callers were triaged as serious conditions with despatch to ambulance and A&E. While most of the users' concerns were not as much urgent and can be addressed by recommending to other services or self-management. And among all the answered calls, only 13.9% were offered a call-back. We could imagine if these patients can manage their own health issues through other channels, the pressure of 111 will be greatly released. This will allow 111's call handlers to concentrate on real urgent or troublesome issues and thus promoting better qualitied services with a much higher efficiency.
NHS111 Triage Distribution 1 GIVEN HEALTH INFO HOME CARE NON-CLINICAL ADVICE
NOT RECOMMENDED TO ANOTHER SERVICE
13.96%
AMBULANCE DISPATCH
12.78%
RECOMMENDED TO A&E
8.64%
PERCENTAGE OF THE ANSWERED CALLS
In our interpretation, the concept of 'Omni-channel' in this project is two-folds: Firstly, users will have more than one channel to access different medical help. They can be led to pharmacy, out-of-hour GP or given self-care advice directly without all heading for the call centre. Secondly, all these channels will work together by sharing information on time to provide the users with a seamless care without leaving them in the dark. And the concept of 'Self-management' does not mean merely leave all the tasks to the users or patients themselves. In our project, it means a tool to assist people going through the self-care process and contacting the proper human help if necessary. It should be like a permanent companion instead of a one-off service. What I found interesting is to consider in what occasions should the patients be advised to contact 111 for human assistance. In us discussion, we thought it was in some emergency conditions such as bleeding or severe pain. However, I think it may not only depend on the seriousness of the symptom, but whether the patients are able to clearly identify what is wrong with them and get a specific triage result. If they fail to reach a convincing conclusion of their health concerns, they are more likely to seek answers from humans no matter the condition is life-threatened or not. On the contrary, if they are fully aware of their condition, they can take actions to deal with it by themselves without hesitation.
RECOMMENDED TO ANOTHER SERVICE
4.76%
CALL BACK OFFERED
13.90%
RECOMMENDED TO PRIMARY AND COMMUNITY CARE
59.86%
PHARMACY DENTAL OTHERS...
1 https://www.england.nhs.uk/statistics/statistical-work-areas/nhs-111-minimum-data-set/
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35
08 WEEK
Generating Concepts
19/03--25/03
IDEATION & CONCEPT DEVELOPMENT
INSIGHTS
IDEAS
36
Brainstorming Ideas
Ideas Sharing
Based on the insights and an object of channel shift, each of us writing whatever we could think out roughly on sticky notes.
Then we talked through each idea within the group and gave suggestions to each other before we sketched them in details.
Voting for Final Concept
Developing Concept
Coming back with detailed sketches of ideas, we ran through them again and voted for the ones with the greatest potential for implementation.
We combined the selected ideas into one concept and used storyboarding to map out the possible new user journey.
We did not rush to draw on the concept sheet separately. Instead, I suggested we once again affirmed our insights and objects as a group, and then quickly write down all the possibilities which are in accordance with these insights. By doing so we could make sure everyone is aware of our knowledge so far and stick to the ultimate goal. Since each one of us could read others' ideas, we could raise opinions or suggestions on them and if there were some ideas digressing from the subject, we were able to pull it back in time.
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The voting process afterwards was also proved to be valuable to us. By voting for the most potential ideas, we could also find that our minds thought alike and many ideas share the similar essential. We identified these similarities and found our ideas fell mainly in the following areas:
BUILD UP DATABASE
Go to website to register
Fill in your basic info and health data
Choose which data you Add NHS111 to your agree to share contact on your phone
HEALTH CONCERN ARISES
1. An omni-channel access to service. Users can reach the service from the most applicable device they could reach. And they would be receiving care seamlessly from all relevant departments of the service provider. 2. A system which is able to package the patients' information and forward to the proper human help (e.g. call handler/clinician...) for the next steps. A cloud database of health information could be shared between the patients and the clinicians.
Open the SMS on your phone
Start chatting about your symptom
The backstage system will package your information and forward to a clinician
Get a call back from a clinician
The clinician will give you instructions and prescription
The backstage system will forward your prescription to the pharmacy
3. It will be able to interact with you and keep tracking down your condition in a period of time. This can be supported by the A.I. technology which is able to learn from you and develop humanized and customized service.
Storyboarding (1/2) GET INVITATION
Receive a digital or physical invitation from 111
38
Get the guidance to the Get your medicine pharmacy
Receive a message from 111 asking feedbacks
39
The way users interact with the new service will still be in conversations. As 111 users have been used to talking to someone about their symptoms, we would not like to change their behaviours or make it complex. If the conversations could be as close to the tone and emotion of a human as possible, it would give the users more sense of assurance.
The invitation acts as users' first mode of encounter of the new 111 service, and it will reach the users in both physical and digital form. The next step would be the users registering their 111 accounts where they could choose which information they want to share with clinicians or call handlers in case of emergency. Then we imagined that the SMS will be the future platform of this service and will be able to forward information to different departments.
However, due to its nature of medical care, there are inevitably loads of notices, terms and conditions to make sure every user is informed the basic information they need to know. How do these long sentences or even paragraphs fit into the conversations naturally is something we have to consider.
Conversational Interactions
NAL
Hi 111
ATIONAL ON
Hi 111
Hello Emma, are you seeking help for yourself? Hello Emma, are you seeking help for yourself? Yes
Yes
Read the database of Emma from 111 account
It sounds serious. I think you need to talk to a clinician. Do you want the clinicianIttosounds call you back?I think you need to serious. talk to a clinician. Do you want the clinician to call you back? No No
Read the database of Emma from 111 account hatʼs wrong with you, Emma?
Yes Yes Yes
Package the information and send to the clinician
hatʼs wrong with you, Emma? I have a lower back pain I have a lower back pain here do you feel the pain?
c
Yes
Package the information and send to the clinician e have sent your information to a clinician who will call you in 1.5 hours. In the meantime, youinformation can e have sent your to a follow these suggestions release clinician who willtocall you in 1.5 your pain: hours. In the meantime, you can follow these suggestions to release your pain:
here do you feel the pain?
…… …… …… …… …… ……
The ideation was a very productive phase and we were glad to see that everyone's mind came together when generating concepts. Based on the same insights and goals, we could come up with different functions of this 'system' we are going to design. Because its function of forwarding information and form of conversational interactions, we thought the chatbot could be the best solution. Here we could apply what was used in commercial customer service to the new medical service. The case studies and desk research in the previous weeks could also provide rich guidance for us to further develop this concept. What we should consider in the next stage is to clarify the final outcome of this service including a consideration of visual consistency with the NHS services, define its platform and map out new user journeys in real circumstances.
…… ……
Thanks Thanks
Triage Triage
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09 WEEK
Competitive Analysis
16/04--22/04
VALIDATION & ITERATION
Competitive Analysis
Chatbot Study
We did some case studies of the existing alternative medical services to identify their strengths and weaknesses.
We researched into the application of chatbot to understand its potentials and limitations and how we can make use of it.
BABYLON HEALTH
ASK NHS
If the project is going to be implemented, it will not be the first time of NHS to adopt a chatbot strategy. There are already some NHS apps using this technology to provide self-diagnose tools for people. After trying to use them, I found Babylon Health and Ask NHS are the most up-to-date apps with a satisfying experience. However, I also found several drawbacks of them.
42
De ning alues
Iteration
Then we could come up with the values of our design with advantages over the existing services.
We iterated our design concept to make it simpler and more applicable.
Firstly, it took quite a long time for the app to load and react when I opened the app, which made me lose my patience in the waiting time. Although just a few seconds, it did not meet my expectation of the response rate of a digital technology. Next, the Babylon Health requires users to register before the first time they start using the app. However, imagine if you are feeling unwell at the moment but have to fill in a series of characters and create passwords before gaining access to medical care, the experience would not be very pleasant. 43
One further problem is that neither the apps will preserve your chat history. In Babylon Health, you will receive your triage summary, but once you click 'go back', the summary will be lost and all your previous chats will be cleared up. There is no way to review your own records. Moreover, after getting the triage result, the service seems to come to an end. Although the app has the function of booking a GP for you afterwards, it will not be tracking down to your conditions. In other words, the GP and the health care app are two separate channels and the connections in between is weak.
To discover the advantages and limitations of the chatbot, I referred to some existing researched of this technology. As shown in the chart, it is estimated to be most suitable for answering urgent questions and forwarding information to the proper human, which is in accordance with the functions of the new omni-channel 111 service. The researches also back up our assumption that chatbot is an excellent blend of A.I. and human assistant, allowing users to shift between different channels according to their needs.
Nevertheless, there are some successful aspects in these apps that we can learn from. For example, the Babylon chatbot communicates in a very natural way which sounds like a human. And the popup sheet allows for a quick answer to the questions. Both of them enable users to choose voice interaction. Although I am not fully convinced that hearing someone reading through the questions is a pleasant experience, it still made me realize that we should consider different scenarios and try to make it usable for all users.
Also interesting is the finding that the benefits of chatbot are perceived by not only millennials, but also the generation of baby boomers, which means we do not have to refine our target group to the younger generation but can aim for people of all ages. This was a surprising result for all of us as we assumed selfmanagement was more suitable for millennials, but with the help of the chatbot, it would be easier for all to self-manage through this technology. Barriers to Chat Bot Usage
Chatbot Study
WonĘźt understand questions
1
Nothing to stop bot usage Would prefer a human
Chat Bots Perceived Benefits by Audience
Quick emergency answers
Quick answers to simple questions
Friendliness
70
Quick answers to complex questions
24-hour service
Baby Boomers
Forwarding to appropriate human
46
70
Millennials
Incapable of friendly chatĘź
40
50
Facebook-only access
64 Good customer service
13 10 13 13
21 24
33
23
8
24
30
Predicted uses for Chat Bots
29
17
21 24
58
33
Instant responses
33
58
Ease of communication
Convenience
Detailed answers
Easily register complaints Timely complaint resolution
App consolidation (e.g. all social apps in one place)
4
44
Complaint resolution
24 5
Expensive purchases (cars) Purchase inspiration
Page 15 _
26
Booking or purchase error concerns
Buy basic items (clothes, food)
Prefer normal website
16
19
24 20
Bookings or reservations
To pay a bill To get detailed answers or explanations
1 All charts and data in this section are from: https://www.mycleveragency.com/ whitepapers/messenger-chat-bots-research
Mailing list or service subscription
The limitation of the chatbot, as we found, was that people are worried about the bot would not understand their questions, and some would prefer a human help. This requires us to think about how we might design the chatbot in a more humanized and intelligent way, as well as how we ensure these people with doubts can receive the same level of care as those who use chatbots. 45
Why Chatbot? CONNECTION Unlike other technology, a chatbot allows you to forward your health concern to the appropriate person. Rather than waiting for their health concern to escalate, that person can address the situation head on. When the call is returned, they will not have to repeat their conditions.
SEAMLESS While waiting for 111 to call back, the users will have an overview of the triage results and access to self-care advice. This will provide a continuity of care to people who are not sure how to manage their own health concern and are left in the dark about how long they will be waiting or where they are in the queue. This will also release the stress and anxiety of the current 111 users.
Further Development In order to exploit the advantages of the chatbot -- quick and simple -- to the full, we revised our concepts again and get rid of the unnecessary ones to avoid making it over complicated. We discarded the idea of using any physical objects such as invitation letters in the service process as we found too much intersection between digital and physical touchpoints is not a pleasant way of leading users to engage with the service. We believe it is better to send users invitations where they can access to the service by just one click. We also found that as 111 is a short-term and seldom-used service while the database is more suitable for long-term care, the speediness is perceived to be more important than a long-lasting database. We thought that we could only store users' records of their enquiries during their engagement with this service. This will avoid letting users changing their channels from the chat app to website all the time and improve the easiness of use.
INSTANT The chatbot allows an instant reply to urgent request. Its response rate is expected to be just below face to face communication, which means users do not need to wait for the call to be picked up or spend time to log-in to an app. And it will keep online even if you exit the chat app.
USABILITY Users do not need to learn how to use it because they are already familiar with the interactions in a chatting process. Research has shown chatbot is welcomed by both millennials and baby boomers, which means this technology is highly accessible for the public. 46
When defining which platform this chatbot will be working on, we agreed not to design new apps but to build it on existing chatting platforms. We thought about SMS first but we found currently its functions are still limited and the time before the prevalent use of RCS service is still unknown. So, we decided to implement it on chat apps such as WhatsApp, Telegram and Facebook Messenger. These platforms have already allowed chatbot to be built and allowed for a variety of functions. We could imagine that the 111 chatbot will start from one of the platforms and expand its service to others throughout time, and users will be able to choose their preferred platform to access this service.
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10 WEEK
Divergent Scenarios START
23/04--29/04
PROTOTYPE & STORY TELLING
ASK ABOUT SYMPTOM
EXPLORE
Hi FOR OTHERS
FOR MYSELF I have a headache
Hello Emma. How can I help you?
My friend has a headache Book a call from 111 May I know his or her gender and age?
OK. Iʼm going to ask you some questions to find out about your symptom. Q1:……………………?
call 111
Ask about health concern Go to my health archive
Female, 24 years old OK. Tell me your symptom.
…… ……
Hereʼs the archive of your past summaries.
……
Divergent Scenarios
Service Blueprint
We tried to consider all possible user journeys with specific scenarios and broke down the conversations.
Then we mapped out the service blueprint by bringing together all stakeholders and their roles in a typical user journey.
Thereʼs 70% chance that you have a Migraine. However, to get an accurate result, you can talk to a clinitian. Do you want a clinitian to call you back? Yes, I want to book a call No, I can self-manage Are you sure you are have an urgent health concern and want a clinitian to call you back?
Yes, I want to book a call 12:00
Do you want the clinitian to call her number or call yours?
I have arranged for a clinitian to call you back. If you want to cancel the booking, just tell me at anytime.
Yes, I want to book a call No, I can self-manage
Call her number Call mine
You are now the 10th contact in the queque. In the meantime, you can follow these suggestions to release your pain.
No problem. Please tell me her phone number.
07236892903 I have arranged for a clinitian to call her back. She will receive the queue number and updates through SMS on her phone.
Yes, I want to book a call I have arranged for a clinitian to call you back. If you want to cancel the booking, just tell me at anytime. You are now the 10th contact in the queque. In order to have a quicker triage with the clinitian, can you tell me your symptom?
12:03
Prototyping Following the existing examples on NHS inform, we developed the conversations into precise and detailed ones and made prototypes based on one of the chat apps. 48
Storyboarding By storyboarding, we visualized one of the user journeys step by step combining the prototypes.
You are now the 9th contact in the queue. 12:05
How do you feel now? Please tell me if the condition goes better or worse.
…… …… ……
Here I took different user journey of people with different needs into consideration and mapped out the dialogues that would happen under these circumstances. In the following blueprint and storyboard, we chose to present the most common as well as the longest journey -- assessing symptoms for myself and schedule a call from 111. 49
Service Blueprint STAGES
PHYSICAL EVIDENCE
SELF-MANAGE
BEFORE HEALTH CONCERN OCCURS
SMS
HEALTH CONCERNS
Chat app (e.g:Messenger)
Facebook Ads
HELP OFFERED
Chat app
Phone call
In-app link/media
MAINTENANCE
Chat app
Pharmacy
In-app link/media
Wait for call back from 111
USER ACTIONS
Receive invitation from 111
Search for 111 on chat app
Add 111 to contact
Message 111 about health concern
Answer questions to describe symptom
Receive triage result
Book a call from 111
Receive call back from 111
Receive a summary
Receive the prescription
Go to the pharmacy
111 call handler or clinician
Link to the summary
Map and opening hours of the nearest pharmacy
Pharmacy staff
Archive the summary
Forward prescription to pharmacy
Get the right medicine
Pharmacy prepare the medicine
Pharmacy storage
Describe the development of conditions
Greeting message
FRONT STAGE
Brief introduction of the new 111 service
Questions with answers to select from
Triage result and suggestion
Ask for confirmation to call 111
Self-management guidance
Push-up messages (queue tracker; ask conditions)
User guidance and settings
BACK STAGE
Contact users by phone numbers
Search engine
Settings
Identify the patient’s information
Add patient to the queue and keep tracking Triage process
Forward information to clinician
SUPPORT
Mobile operators Facebook
50
Record the conversation
Medical database (e.g: NHS inform)
Clinician receive and analyse the information
Convert conversation to text
Voice-text converter
51
Prototype and Storyboard Different chatting platforms may have different functions and rules. Here we just use Facebook Messenger as an example of how the service will be used. The details of interactions may vary according to different platforms but the user journey will follow the same sequences.
Sketch
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NHS24 Scotland
Search Messages
Active
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…
Chat 111 Sponsored
Welcome to the NHS Chat 111 service! Add me to your contact and manage your health at anytime…See more
Today 9:20AM
Welcome to the NHS Chat 111 service! Search “Chat111” on your favourite messaging apps! If you have any urgent medical concern, you can chat with me to assess your symptoms, receive self-care advice, and schedule a call with a healthcare professional. We are currently available on Messenger, WhatsApp, Telegram and Skype.
ess
Connect in Messenger
e Let's
Send Message
Elon Musk
Q W E
22/11/15
Text me tomorrow for more inf…
Margot Robbie
2
08M33
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Пропущеный видео звонок Home
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Calls
People
Games
s
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STAGE 1: Invitation and Branding As the first mode of encounter, we designed a poster at pharmacies and GPs as a physical touchpoint. The digital touchpoints are advertisements on chat apps and social media, as well as text messages sent by NHS24 to all the phone numbers in Scotland.
et
We assume that people do not need to set up an account but can just use their phone numbers as their identity. And the new 111 service will also send invitations based on phone numbers. 53
STAGE 2: During the emergency Sketch
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chat111 People
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@chat111 168K people like this Medical/service
Welcome to the NHS Chat 111! If you have any urgent medical concern, you can chat with me to I your symptoms, You s assess recieveetselfcare advice, and schedule a call with Q W E R T Y U I O P a healthcare professional. We are currently available on Messenger, A S D F G H J K L Whatsapp, Telegram and Skype.
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Chat111
Active Now
Chat111
168K people like this Medical/service
Hello, Emma! Welcome to the NHS 111 Chatbot. I can help you assess and manage your urgent medical concerns.
Chat111
Z
Sketch
return
If you want to assess your symptoms, I will ask you a series of questions. These questions will assess your symptoms and the advice I give you will be based on your answers. If you're asking on behalf of someone else, please make sure the person is: - conscious and alert - responding normally to you If not, phone 999 and ask for an ambulance.
100%
When the health concern occurs, the users can type or say anything to the chatbot and it will reply with a menu. When assessing their symptoms, they will be asked some questions, get the triage result and whether they are advised to schedule for a call. If they want to schedule a phone call, they will be informed of their number in the queue and also be given self-care instructions during the waiting time. Of course, they can cancel the scheduled call at any time if they no longer feel they need help.
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Chat111
Active Now
We can start now, what can I help you with? Schedule a call from 111 Assess my symptoms Assess symptoms on behalf of someone else View personal historical summaries 00:10 AM
Assess my symptoms No problem. Now tell me what’s your problem. Headache How long have you had these symptoms? About 2 hours
Aa
Following the instructions on advertisements, users can search for this account and add it to their contact list. The chatbot will send you a welcome message and tell you all the important notice, terms and conditions before you start chatting with it. This also avoids letting the users go through the same long paragraphs of such information again when they are in an urgent health situation.
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Sketch
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Chat111
Active Now
Does any of the followings apply to you? Recent head injury Viral or flu-like illness Skin problem or hair loss Just headache Just headache Could you attach an image of where do you feel the pain to help me to assess your symptom?
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0:15 AM
Chat111
Active Now
00:15 AM
9 out of 10 people with these symptoms are likely to have Migrane. However, I recommend that you schedule a call with NHS 111 about your symptoms, as they may require further investigation.
Your position in the queue is #12. The estimated number of minutes before a medical professional will contact you is approximately 20 minutes.
Are you happy for a clinician to contact you on the number associated with your account?
In the meantime, I will give you a Headache self-help guide for you to manage your symptoms.
No, let’s try self-manage
0:15 AM
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Chat111
Home
Active Now
How to relieve headache
Migraine 9 out of 10 people with these symptoms are likely to have this condition (disorder causing severe headaches with nausea, vomiting or sensory changes. This usually requires seeing a GP but if this is not possible here are some resources that you can use to self manage the pain: There's no cure for migraines, but a number of treatments are available to help reduce the symptoms. These include: Painkillers – including over-the-counter medications such as paracetamol and ibuprofen Triptans – medications that can help reverse the changes in the brain that may cause migraines Anti-emetics – medications often used to reduce nausea and vomiting
Yes, please contact me Yes, please contact me A fully trained advisor will review your digital assessment and schedule a call from an appropriate medical professional for you. You may cancel your call at any time by going typing ‘cancel’.
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How to relieve headache
During an attack, many people find that sleeping or lying in a darkened room can also help.
Relieve migrains with this simple self-massage
Tap here to read
Aa
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Hi Emma, your position in the queue is now #5. The estimated number of minutes before a medical professional will contact you is approximately 8 minutes.
When the call is returned, the clinician can read the report while talking to the patient. They will be addressing the problem directly or asking more specific questions, which makes the communication more efficient.
00:25 AM
During the waiting time, the users can try to self-manage following the instructions. At the same time, they will receive updates of their position in the queue as well as further questions asking if their symptom has developed every 10 minutes. The answers will also be packaged to the clinician for assessing their problems.
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Hi Emma, 10 minutes ago you described the severity of your pain as moderate. Can you please confirm if your pain is better, worse, or the same? Better Worse The same Better
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Chat111
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STAGE 3: After the emergency
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Choose a pharmacy
00:35 AM
Thank you for calling NHS 111. I have packaged a summary for you based on your triage result and suggested treatments. I have also archived it in your personalised health care information. You can review or delete it at any time.
i
200 Sauchiehall Street Opening 9:00A.M-17:00P.M
Tap here to read
0.1 mi
Emma’s prescription Medicine: Ibuprofen 29-04-2018
Lloyds Pharmacy 127-135 Great Western Road Opening 9:00A.M-17:00P.M
I found that the clinician has given you a prescription, would you like me to forward the prescription to one of the pharmacies around you? Health concern: headache 29-04-2018
Opening now
Boots The Chemist Ltd
Tap here to read
Emma’s summarised health report
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Woodside H C Pharmacy Woodside Health Centre Opening 9:00A.M-17:00P.M
0.3 mi
Reach Pharmacy
No, thanks
1094 Argyle Street
Yes, please
Opening 9:00A.M-17:00P.M
Yes, please
0.5 mi
LG Pharmacy 476 St Vincent Street Opening 9:00A.M-17:00P.M
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After the call with the clinician, the users will get a summary including their final result of triage and key information stressed by the clinician (which can be converted from voice to text). If they are provided with a prescription they can also get it on the phone and choose whether to forward it to a pharmacy. If they do so, the pharmacy will prepare the medicine for them in advance and make sure they can pick up the right medicine without waiting.
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Alternative scene 1: Schedule an urgent call
Alternative scene 2: Voice interactions
Alternative scene 3: Assess symptoms for others
Alternative scene 4: View historical summaries
If the users/patients feel they need to speak to someone directly, they can schedule a call from 111 at the beginning, when they are waiting in the queue, the chatbot will ask them to describe their symptoms to help with the triage.
If the users do not feel like typing and reading, they can send voice messages to the chatbot, and the bot will recognize their description. Once a voice message is sent, they have the option of converting their voice to text, as well as listening to the reply of the bot.
If the users want to assess symptoms on behalf of someone else, you will be asked about that person's sex and age before going through the assessment.
If the users want to review their summaries of previous assessments and calls, they can select from the menu and receive the links of historical summaries. All of these will be stored in cloud for them and can be sent to their emails or shared with others.
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Chat111
Home We can start Active now,Now what can I help you with?
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Assess symptoms on behalf of someone else
Schedule a call from 111
I hear that you have a headache. How long have you had these symptoms?
I have sheculed a call from our call hadlers for you. You may cancel your call at any time by going typing ‘cancel’. Meanwhile, could you tell me more about your symptom so I can forward your conditions to the call handler to assess head on.
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Chat111
Home We can start Active now,Now what can I help you with?
Schedule a call from 111
Schedule a call from 111
Assess my symptoms
Assess my symptoms
Assess symptoms on behalf of someone else
Assess symptoms on behalf of someone else
View personal historical summaries
View personal historical summaries
Assess symptoms on behalf of someone else
View personal historical summaries
Is this person male or female? Male Female
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Female May I know her age?
Headache
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View personal historical summaries
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Schedule a call from 111 Assess my symptoms
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29/04/2018 health report
02/12/2017 health report
Health concern: headache Triage result: migraine
Health concern: toothache Triage result: dental caries
Tap here to read
Tap here to read
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SUMMARY
REFERENCE Agius, A. (2018). 7 Outstanding Examples of Omni-Channel Experience. [online] Blog.hubspot. com. Available at: https://blog.hubspot.com/ service/omni-channel-experience [Accessed 1 May 2018].
In conclusion, the insights and process of this project is of great value to my learning experience. We were able to design a new 111 service which is not replacing the existing one, but enhancing its quality, efficiency and user experience. The omni-channel feature of this new service will link the current phoning service with the future online chatbot service and provide more continuous care to the patients. With such self-management tool which is highly accessible and easy to use, we hope to reduce the unnecessary dependence on phoning 111 and thus, reducing a series of problems causing by this over-volume of dependence. Before the final presentation with NHS24, I am glad to see we have a concrete design and narrative. However, there are still limitations in it. Although having considered different possible scenarios, it is better that we conduct some user tests or asking people if they really prefer this alternative experience, and then we can further tailor the experiences for different individuals and contexts. Thanks for reading!
Campbell, J., Roland, M., Richards, S., Dickens, A., Greco, M. and Bower, P. (2009). Users' reports and evaluations of out-of-hours health care and the UK national quality requirements: a cross sectional study. British Journal of General Practice, 59(558), pp.8-15. England.nhs.uk. (2018). Statistics » NHS 111 Minimum Data Set. [online] Available at: https:// www.england.nhs.uk/statistics/statistical-workareas/nhs-111-minimum-data-set/ [Accessed 1 May 2018]. The Economist. (2018). A revolution in health care is coming. [online] Available at: https:// www.economist.com/news/leaders/21736138welcome-doctor-you-revolution-health-care-coming [Accessed 1 May 2018]. Imaginingcareanywhere.org. (2018). Imagining Care Anywhere Stories. [online] Available at: http://imaginingcareanywhere.org/html/ journey.html#page/6 [Accessed 1 May 2018]. Katherine, K., Skinner, G., Duffy, B. and Watling, C. (2018). Great Expectations: Are service expectations really rising?. [online] Available at: https://www.ipsos.com/sites/default/files/ ct/publication/documents/2017-11/greatexpectations-are-service-expectations-reallyrising-2017_0.pdf [Accessed 1 May 2018]. The King's Fund. (2018). Public expectations and experience of services. [online] Available at: https://www.kingsfund.org.uk/projects/ time-think-differently/trends-public-attitudesexpectations-services [Accessed 1 May 2018].
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McGovern, G. (2018). Business Case for Digital Self-Service – Gerry McGovern – Medium. [online] Medium. Available at: https://medium. com/@gerrymcgovern/business-case-for-digitalself-service-72a030cd4772 [Accessed 1 May 2018]. mycleveragency - Full Service Social. (2018). Chat Bots, A Consumer Research Study. [online] Available at: https://www.mycleveragency. com/whitepapers/messenger-chat-bots-research [Accessed 1 May 2018]. The Medical Futurist. (2018). The Top 9 Augmented Reality Companies in Healthcare - The Medical Futurist. [online] Available at: http://medicalfuturist.com/top-9-augmentedreality-companies-healthcare/ [Accessed 1 May 2018]. Performance Statistics For March 2017 Were Released At 9.30Am On Thursday 11 May, Following:, 2., Service;, T. and Indicators;, A. (2018). Monthly performance statistics, March 2017. [online] Available at: https://www. england.nhs.uk/statistics/wp-content/uploads/ sites/2/2015/08/Monthly-performancestatistics-summary-Mar-17-FINAL-1.pdf [Accessed 1 May 2018]. Salesforce Blog. (2018). How Your Customers' Expectations Have Changed in the Age of the Customer. [online] Available at: https://www. salesforce.com/blog/2017/07/customersexpectations-in-age-of-the-customer.html [Accessed 1 May 2018]. TechCrunch. (2018). More than 40 carriers now support RCS, the next generation of SMS. [online] Available at: https://techcrunch. com/2018/02/22/more-than-40-carriers-nowsupport-rcs-the-next-generation-of-sms/ [Accessed 1 May 2018].
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