NHS Scotland

NHS x GSA Product and service design for Scotland’s National Health Service

Zoe Reifel Fall Semester 2019 Glasgow School of Art

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The Project The Team Crosshouse Hospital

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User Research

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Contents

Introduction

22 23 24

In the Field Making Sense Gyn Ward User Journey

Analysis & Opportunities Defining Opportunities Further Analysis Design Question

Concept Development The Concept Design Solution #1 Design Solution #2 Design Solution #3

Conclusion Final Reflection Credits

Introduction The Project The Team Crosshouse Hospital

2

3

The Project This project surrounds Scotland’s National Health Service (NHS) and the experience of women seeking gynecological services. Based our user research in Kilmarnock’s Crosshouse Hospital, we were asked to utilize design thinking to map and improve the patient’s journey.

4

The Team

Federica Bruschi

Calum Ferguson

Taylor Moffat-Kyle

Zoe Reifel (me!)

Holly Thomson

Andrew Thurston

Haili Wu

Alice Xiao

5

Crosshouse Hospital Crosshouse is a large general hospital located in Kilmarnock, Scotland. Kilmarnock is a mediumsized town with a population of about 50,000, but Crosshouse also serves its surrounding rural areas. It is managed by NHS Ayrshire & Arran.

Gynecology Their gynecology department offers both inpatient and outpatient services, ranging from regular checkups to major restorative surgeries. Between the ward and clinic, it has a staff of about 70, including doctors, nurses, trainees, and receptionists.

My time at the NHS revealed how different the UK’s healthcare system is from the US, which emphasized the importance of recognizing cultural differences in the field of design.

User Research In the Field Making Sense

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In the Field During the first week of the project, our group spent two days conducting user research in both the Gynecology Ward (outpatient) and MacDonald Suite (inpatient).

I spent a majority of my time in the Ward. To gain a sense of how it worked, I observed processes, shadowed staff, mapped space, and spoke to patients recovering from surgeries.

One of many process maps I made while at Crosshouse.

8

Making Sense After our time in the hospital, our group reconvened to put together our notes. In this process, we collaboratively created a large map outlining the journey of patients, their visitors, consultants, junior doctors, nurses, and receptionists.

This stage revealed the importance of collaboration. With the work of our classmates, we were able to fill invaluable gaps in individual knowledge.

9

Gynecology Ward User Journey To visualize the wall in a more succinct way, I created this user journey map. It went through several iterations as we collated notes and received feedback from the NHS staff.

This map made perfect sense to myself and my colleagues and was an valuable design tool. However, we received feedback that it might not be intuitive to our client. I learned to put myself in someone else’s shoes and created different materials for presentation.

Analysis & Opportunities 10

Defining Opportunities Next Steps Further Analysis Design Question

11

Defining Opportunities Next, we turned to an online resource, Care Opinion, which hosts reviews and stories by patients who have gone through the NHS. We sorted each post about Crosshouse Hospital’s gynecology department into two categories:

positive and negative. Then, we marked where these reviews occurred during the user journey, revealing the most and least satisfactory experiences. This method formed our design opportunities.

The experience of waiting for an appointment letter

Post-op at-home recovery

Patient-hospital information and communication

Finding and navigating the ward

12

Further Analysis With our opportunities, my group began to reexamine pre-operation actions. Based on our observations and data, we created an emotional journey of a patient before their surgery. From this

blueprint, we realized many of the highest points of stress correlated with a lack of frontstage action. Each of these stress points also happened to coincide with prolonged wait times.

This is the point of the process where our solution began to become obvious.

Previously, I felt nervous about finding concrete evidence to backup our ideas.

13

Design Question From our analysis, our main question arose: How can we improve the NHS’ communication of information to patients during waiting times?

Before attempting to answer this question, I did some research on healthcare design and communication.

Some of my most valuable insights came from the field of salutogenesis.

Concept Development The Concept Health Communication Branding & Identity

14

15

The Concept Our goal was to create a series of informational touchpoints between the NHS and patient throughout their journey. The information would provide transparency in the system and knowledge of the patient’s upcoming experience. These touchpoints fell into three categories:

Print Pamphlets Booklets Letters

Conversation Discussions between staff/ patient

Digital Website Mobile app

16

The Concept This information would be placed into a folder over time.

The user journey is displayed on the folder through icons which correlate with the printed materials.

The aim of the folder is to keep the patient organized, informed, and connected to the process. By providing an object that is with them throughout the journey, they are more likely to form a connection with the materials.

The timeline of where and how to provide information to patients was tricky to coordinate with each member of the group’s work. It was important to be flexible and open to other ideas.

17

Design Solution #1 The Appointment Letter In the UK, appointments to see specialists or schedule surgeries are communicated via mail. In the case of gynecology, a typical patient who needs surgery would receive three of these letters: consultation, pre-assessment, and surgery. I received a copy of the appointment

Clear & specific communication

letter from the NHS (on the left) and found it overcomplicated, wordy, and visually confusing. With the principles below, I set out to redesign the letter.

Legibility & hierarchy

Scannability & chunking

18

Appointment Letter Redesigned This is the final of 11 iterations on the appointment letter. I followed guidelines from Abraham and Kools’ Writing Health Communication: An Evidence-Based Guide to create an accessible design specifically aimed at older patients. This involved layout changes as well as condensing and rewriting the language.

Clear title establishes what the document is

Eye is initially drawn to the most important pieces of information Communicates time sensitive next steps Bold black text is visually emphaiszed, grey text is deemphasized Chunked bulleted lists are easily scannable

Font size, vertical spacing, and margins recommended by Abraham & Kools Short sentences with active verbs

19

Evolution of the Appointment Letter

#FFFEF6

#003D6E

#B1E6D7

#B1D3E6

Design Solution #2

#FFE47A

20

Branding & Identity We also created and redesigned informational print materials for patients pre-operation. Before starting this, I wanted to revisit the NHS’ visual identity. My goal was to create a look that was warm and approachable but not patronizing.

Title Header — Stone Sans Bold

Welcome to the Crosshouse Hospital Gynaecology Ward!

Subheader — Stone Sans Bold

About your upcoming surgery Body Text — Stone Sans Regular

Our goal is to help you achieve the quickest recovery possible so you can return home comfortably.

After developing this visual language, I thought it would be valuable to also create our new materials in the existing NHS graphic brand. This gave our client options and would allow them to implement our ideas without worrying about inconsistency with the NHS. Blob 1

Blob 2

Blob 3

Icon Library

21

Design Solution #3 New Informational Materials Using our brand, we created several new materials, including a foldable that would be provided at the first step of the journey (GP’s office), checkable to-do lists, and a pamphlet with information about the gynaecology ward.

Conclusion Reflection Credits

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Final Reflection One of my biggest takeaways from the project was the importance of teamwork. Working in such a large team on such a subjective project is difficult, and people often clash. However, it’s valuable to recognize that everyone comes from different perspectives.

Point of view is such an important facet of design—empathizing with the user, no matter who they are or where they come from. In a way, this came through when simply working on our project together.

Overall, I’m proud of the work I did and the new skills I gained. I feel much more proficient in mapping user journeys, both in content and visual design. I also furthered my knowledge of working with clients, especially in asking lots of questions and iterating based on their feedback.

In the future, I would be interested in doing more experimentation. It’d be great to see how real patients reacted to our solutions and evolve from there.

All graphics, sketches, photographs, and data visualization by myself unless otherwise stated: 4 6 11 12 15 16

17 18 20 21 23

Illustrations by Alice Xiao Photograph by Federica Bruschi Data gathered by Holly Thomson, Haili Wu, and myself Journey map content gathered by Haili Wu, Alice Xiao, and myself Pamphlet illustrations by Alice Xiao Folder created by Haili Wu Pamphlets in right pocket by Holly Thomson and Federica Bruschi Appointment letter provided by Crosshouse NHS Book cover via Sage Publications Icons via flaticon.com Pamphlet illustrations by Alice Xiao Pamphlet by Federica Bruschi and Holly Thomson

2 3 4 5

The Project The Team Crosshouse Hospital

6

User Research

7 8 9

10 11 12 13

14 15 17 20 21

Contents

Introduction

22 23 24

In the Field Making Sense Gyn Ward User Journey

Analysis & Opportunities Defining Opportunities Further Analysis Design Question

Concept Development The Concept Design Solution #1 Design Solution #2 Design Solution #3

Conclusion Final Reflection Credits

Introduction The Project The Team Crosshouse Hospital

2

3

The Project This project surrounds Scotland’s National Health Service (NHS) and the experience of women seeking gynecological services. Based our user research in Kilmarnock’s Crosshouse Hospital, we were asked to utilize design thinking to map and improve the patient’s journey.

4

The Team

Federica Bruschi

Calum Ferguson

Taylor Moffat-Kyle

Zoe Reifel (me!)

Holly Thomson

Andrew Thurston

Haili Wu

Alice Xiao

5

Crosshouse Hospital Crosshouse is a large general hospital located in Kilmarnock, Scotland. Kilmarnock is a mediumsized town with a population of about 50,000, but Crosshouse also serves its surrounding rural areas. It is managed by NHS Ayrshire & Arran.

Gynecology Their gynecology department offers both inpatient and outpatient services, ranging from regular checkups to major restorative surgeries. Between the ward and clinic, it has a staff of about 70, including doctors, nurses, trainees, and receptionists.

My time at the NHS revealed how different the UK’s healthcare system is from the US, which emphasized the importance of recognizing cultural differences in the field of design.

User Research In the Field Making Sense

6

7

In the Field During the first week of the project, our group spent two days conducting user research in both the Gynecology Ward (outpatient) and MacDonald Suite (inpatient).

I spent a majority of my time in the Ward. To gain a sense of how it worked, I observed processes, shadowed staff, mapped space, and spoke to patients recovering from surgeries.

One of many process maps I made while at Crosshouse.

8

Making Sense After our time in the hospital, our group reconvened to put together our notes. In this process, we collaboratively created a large map outlining the journey of patients, their visitors, consultants, junior doctors, nurses, and receptionists.

This stage revealed the importance of collaboration. With the work of our classmates, we were able to fill invaluable gaps in individual knowledge.

9

Gynecology Ward User Journey To visualize the wall in a more succinct way, I created this user journey map. It went through several iterations as we collated notes and received feedback from the NHS staff.

This map made perfect sense to myself and my colleagues and was an valuable design tool. However, we received feedback that it might not be intuitive to our client. I learned to put myself in someone else’s shoes and created different materials for presentation.

Analysis & Opportunities 10

Defining Opportunities Next Steps Further Analysis Design Question

11

Defining Opportunities Next, we turned to an online resource, Care Opinion, which hosts reviews and stories by patients who have gone through the NHS. We sorted each post about Crosshouse Hospital’s gynecology department into two categories:

positive and negative. Then, we marked where these reviews occurred during the user journey, revealing the most and least satisfactory experiences. This method formed our design opportunities.

The experience of waiting for an appointment letter

Post-op at-home recovery

Patient-hospital information and communication

Finding and navigating the ward

12

Further Analysis With our opportunities, my group began to reexamine pre-operation actions. Based on our observations and data, we created an emotional journey of a patient before their surgery. From this

blueprint, we realized many of the highest points of stress correlated with a lack of frontstage action. Each of these stress points also happened to coincide with prolonged wait times.

This is the point of the process where our solution began to become obvious.

Previously, I felt nervous about finding concrete evidence to backup our ideas.

13

Design Question From our analysis, our main question arose: How can we improve the NHS’ communication of information to patients during waiting times?

Before attempting to answer this question, I did some research on healthcare design and communication.

Some of my most valuable insights came from the field of salutogenesis.

Concept Development The Concept Health Communication Branding & Identity

14

15

The Concept Our goal was to create a series of informational touchpoints between the NHS and patient throughout their journey. The information would provide transparency in the system and knowledge of the patient’s upcoming experience. These touchpoints fell into three categories:

Print Pamphlets Booklets Letters

Conversation Discussions between staff/ patient

Digital Website Mobile app

16

The Concept This information would be placed into a folder over time.

The user journey is displayed on the folder through icons which correlate with the printed materials.

The aim of the folder is to keep the patient organized, informed, and connected to the process. By providing an object that is with them throughout the journey, they are more likely to form a connection with the materials.

The timeline of where and how to provide information to patients was tricky to coordinate with each member of the group’s work. It was important to be flexible and open to other ideas.

17

Design Solution #1 The Appointment Letter In the UK, appointments to see specialists or schedule surgeries are communicated via mail. In the case of gynecology, a typical patient who needs surgery would receive three of these letters: consultation, pre-assessment, and surgery. I received a copy of the appointment

Clear & specific communication

letter from the NHS (on the left) and found it overcomplicated, wordy, and visually confusing. With the principles below, I set out to redesign the letter.

Legibility & hierarchy

Scannability & chunking

18

Appointment Letter Redesigned This is the final of 11 iterations on the appointment letter. I followed guidelines from Abraham and Kools’ Writing Health Communication: An Evidence-Based Guide to create an accessible design specifically aimed at older patients. This involved layout changes as well as condensing and rewriting the language.

Clear title establishes what the document is

Eye is initially drawn to the most important pieces of information Communicates time sensitive next steps Bold black text is visually emphaiszed, grey text is deemphasized Chunked bulleted lists are easily scannable

Font size, vertical spacing, and margins recommended by Abraham & Kools Short sentences with active verbs

19

Evolution of the Appointment Letter

#FFFEF6

#003D6E

#B1E6D7

#B1D3E6

Design Solution #2

#FFE47A

20

Branding & Identity We also created and redesigned informational print materials for patients pre-operation. Before starting this, I wanted to revisit the NHS’ visual identity. My goal was to create a look that was warm and approachable but not patronizing.

Title Header — Stone Sans Bold

Welcome to the Crosshouse Hospital Gynaecology Ward!

Subheader — Stone Sans Bold

About your upcoming surgery Body Text — Stone Sans Regular

Our goal is to help you achieve the quickest recovery possible so you can return home comfortably.

After developing this visual language, I thought it would be valuable to also create our new materials in the existing NHS graphic brand. This gave our client options and would allow them to implement our ideas without worrying about inconsistency with the NHS. Blob 1

Blob 2

Blob 3

Icon Library

21

Design Solution #3 New Informational Materials Using our brand, we created several new materials, including a foldable that would be provided at the first step of the journey (GP’s office), checkable to-do lists, and a pamphlet with information about the gynaecology ward.

Conclusion Reflection Credits

22

23

Final Reflection One of my biggest takeaways from the project was the importance of teamwork. Working in such a large team on such a subjective project is difficult, and people often clash. However, it’s valuable to recognize that everyone comes from different perspectives.

Point of view is such an important facet of design—empathizing with the user, no matter who they are or where they come from. In a way, this came through when simply working on our project together.

Overall, I’m proud of the work I did and the new skills I gained. I feel much more proficient in mapping user journeys, both in content and visual design. I also furthered my knowledge of working with clients, especially in asking lots of questions and iterating based on their feedback.

In the future, I would be interested in doing more experimentation. It’d be great to see how real patients reacted to our solutions and evolve from there.

All graphics, sketches, photographs, and data visualization by myself unless otherwise stated: 4 6 11 12 15 16

17 18 20 21 23

Illustrations by Alice Xiao Photograph by Federica Bruschi Data gathered by Holly Thomson, Haili Wu, and myself Journey map content gathered by Haili Wu, Alice Xiao, and myself Pamphlet illustrations by Alice Xiao Folder created by Haili Wu Pamphlets in right pocket by Holly Thomson and Federica Bruschi Appointment letter provided by Crosshouse NHS Book cover via Sage Publications Icons via flaticon.com Pamphlet illustrations by Alice Xiao Pamphlet by Federica Bruschi and Holly Thomson