design in health care for the health foundry

Design in healthcare

wearesnook.com @wearesnook

| FUTURE OF DESIGN IN HEALTH

http://wearesnook.com

You design hospital interiors?


The whole system of healthcare


| FUTURE OF DESIGN IN HEALTH| FUTURE OF DESIGN IN HEALTH

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Why design is on the rise, and matters in health care.


We are SnookPeople by Default Sarah Drummond

Sharon was not involved in the design of her system


“I no longer feel that I can deliver an adequate service even allowing for working a 70 + hour week. I have taken a support worker role in order to spend time with my family in an attempt to recover some quality of life. I wish you all well.”

The British Association of Social Workers and Social Workers Union


“I spend most of my working day typing and inputting services plans, filing, etc., all admin tasks.”



“Social workers are spending too much time in the office and not enough time with clients. The very essence of social work is being eroded, which is a great, great shame.”



“Working in an out of hours team, we have no administration, we have to organise all assessments, visits and undertake reports. I spend most of my time on the computer”




ADMINISTRATION COSTS US PEOPLEWe have created systems that don’t solve problems. They create more work, cost us more to run and take us away from the frontline


1. Manual processing use of paper and manual copying across systems

2. Unnecessary processing users completing the wrong transactions at the wrong time 3. User contact users trying use a service, complain or track something

4. Casework edge cases and ‘user-errors’ handled by humans

Louise Downe, Head of Design | Government Digital Service | @louisedowne



Most services and systems have been accidentally designed.

“I cried down the phone because it was the 27th time I’d called the hospital. They direct transferred me through to a department that wasn’t even open that day. I was desperate to shift my appointment, they insisted on sending a letter each time to change the appointment”

NHS Service User




INDUSTRIAL MODELS OF THE PAST CONTINUE TO SHAPE OUR DESIGNS“Technology has locked us into ways of working, the design of services, even operating models of organisations”

Dave Briggs, Head of Digital and Design at Adur & Worthing Councils



TECHNOLOGY WON’T SAVE US, WE ARE AUTOMATING THE WRONG PROCESSES

We must fundamentally understand the problems we have to solve, meet user needs and design services that work



GOOD TECHNOLOGY {AND DESIGN} SHOULD BE INVISIBLEWe need insight into what works, what doesn’t and what jobs we want to help people do to improve our systems and services


End users are not just patients. Design for health professionals too.


Image courtesy of Flickr user makeworks | FUTURE OF DESIGN IN HEALTH

MORE PUBLIC FACING SERVICESWith automation and good service design comes more time to spend on the frontline. A fundamental rethink and opportunity on how we deliver



AN UPHILL BATTLE

The touchpoint has grabbed our design attention

UX and digital has over shadowed the service and organisation play


I promise only ‘one’ diagram


Double Diamond - Design Council 2007


Some thoughts on design…


End to end services and user journeys. Not just the ‘app’.

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How does this process ffer if

- No immediate family- Has immediate family

Name: Helen Age: 92 Gender: FemaleOccupation: Retired

Background: Helen has been living at home until a recent fall resulting in a hip fracture led to her being admitted to hospital. She has no family and is quite socially isolated with only a neighbour looking in and helping out occasionally.

Personal details Journey

“Step Down Beds & Discharge/ End of life”Frail/elderly. Single Shared Assessment. “Bed Blockers”. End of life? Discharge to rehab hospital or care home?

• A&E;• Medical Admissions Ward;• Care of the Elderly Ward;• Occupational therapist;• Physiotherapist;• Social worker;• Rehab hospital ward;• Nursing home;• Dietician.

Services

User Journey #11: “Step Down Beds & Discharge/ End of life”

Journey step 3

Helen is placed on the Frail Elderly pathway and has the forget-me-not stickers on her wristband and notes.

Frail Elderly Person’s Pathway Assessment tool

Nursing staff

Image

Journey step 4

Helen is given Single Shared Assessment in Care of the Elderly Ward.

Copy of Single Shared Assessment doc here: www.gov.scot/Publications/2004/08/19652/40277

Social worker

Journey step 5

Social worker creates

care plan for Helen

but since she owns

her own home and has

significant savings, her

lawyer is involved in

discussing funding for

a care home place.

Isolated older people who have no family can get stuck in hospital while legal details of payment for care are agreed.

Social worker and lawyer

Journey step 7

Helen is put on waiting list for three care homes but no places are currently available.

Limited Care Home places can lead to people being stuck in hospital.

Phone calls

Social workerCare home admin staff

Journey step 6

Social worker enquires about nursing home places for Helen .

Social worker

Phone calls (lots of)

Journey step 8

Helen is reviewed by Consultant Geriatrician who recommends that she is seen by a Physiotherapist and Dietician.

Consultant Geriatrician Junior doctors

Journey step 12

Helen is in Rehab hospital for further six weeks.

Nursing staff Consultant PhysiotherapistSocial worker

Journey step 13

Helen is transferred to nursing home.

Nursing staffPortersPatient transport Care home staff

Journey step 9

Helen receives

physiotherapy while in

hospital and support

from a Dietician as she

is not eating well.

Older people deteriorate quickly when they are hospitalised.

Physiotherapist and dietician

Journey step 10

Helen waits four weeks for a step down bed in the Rehab hospital.

Phone calls (lots of)

Hospital bed managerRehab hospital bed manager

Journey step 11

Helen is transferred to Rehab hospital.

Paper notes and computer systems

PortersPatient transport

Journey step 2

Helen sees a Consultant Geriatrician who makes a frailty diagnosis.

Consultant GeriatricianNursing staff

#11 User Journey previewGroup Tool

Journey steps

Challenges along the way

Opportunities for change

People

Patient

Touchpoints/Interactions

Journey connections

Participant comments

Rounded edges: Participant comments

Key

Think ‘home first’. Did Helen expect to never go home again when she was admitted with hip fracture?

How crazy is this process?!

Challenge - Money! Different parts of the system.Opportunity - Find a smooth route to the right future for Helen

Parking Lot

Social support

Power of attorney welfare should have been in place?

Where is the early assessment/early intervention to maintain independence and avoid fall

Risk assessment before fall and hip - to prevent

Why did Helen fall? Is this the first time? How could we prevent fall?

Pharmacist re meds prescribing and supply of appropriate medicines

Neighbour is part of services to support, and source of info

Really of e ve be mindful of

‘Signs of dementia’ Early intervention assessment opps in community to support Helen with GP/Churches/Community

How people/communicate support early diagnosis prevention at home

Journey step 1

Helen is in Care of

the Elderly Ward after

being admitted with a

hip fracture and signs

of dementia.

Nursing staff

Cognitive impairment propels people to 24hr care

Liaise with MDT community mental health team (elderly) to evaluate possibility of supporting at home

Needs review of medicines

Why is Helen not going home here?!

Why not transfer to rehab/reablement facility at this point?

Frailty assessment on admission - protocol. No Geriatrician needed. Frail elder path on admission

1. Waiting forassessment

2. Lack of3. Location of

comprehensiveneeds assessment

4. Who doesassessment?

Older people have no voice

Discharge planning should start here.

What does Helen want?

Added step

Why not rehab at home?

Assessment needs to be in own environment and community

Whose needs does this meet? Is it Helen’s or her family’s?

Is the ‘assessment’ truly multi disciplinary? Does Docs view on ‘risk’ colour all of the discussion

Is it fair to Helen to be assessed in an alien environment?

In frail elderly ward likely to be seen by OTs, Physios, MH liaison? Social workers, Pharmacy

Families collude with progress to care - Views of person of less importance

Whose needsWhose abilitiesWhose valuesWhose voice is heard (or not)You! the people impact

If no family members - who speaks for patient?

Care plan created for her! Who’s plan is it?

Patient? Her choice and voice?

No remit to discuss private live-in help? Autonomy issues

What temporary measures could be put in place to support Helen home while longer-term options considered

Could she have stayed at home with Social Care input?

Do we have a placement policy if the patient refuses three care homes?

Where is ongoing engagement around

Right medicine can be ‘life’ enhancing

Poly pharmacy is embalment in end of life. RIP.

Why is rehab reablement not much earlier in pathway?

Pharmacist reviews medicine

HCSW body?Is dietician necessary?

Lunch clubs - Community support - This could be avoided

Independence is everyone’s responsibility

Artificial barriers

- Current rehab bed structure

- MH rehab,Physical rehab

Need new type of rehab to allow peoples strengths

ixed H ‘people friendly’.Slow rehab - staff/community with right skills. Are decisions made ‘too early’ can go from living alone with no c e to nursing home ‘big leap’

Nursing home decisions

Why: - Cognitive- Physical- Choice- Risk- All/none

Early engagement with MDT to facilitate discharge home or step-down bed

Helen and HCP collaborate on MACP?

Who asks what Helen wants at end of life?

What does Helen want?

Why six weeks?

What is your definition of end-of-life care?

Help more people to be comfortable with the concept that life will end

Community support to keep Helen at home.Why nursing home?

Do we need to plan our own care - before we need it?

Does Helen want to go to a nursing home?

Do we need new concepts of care for frail elderly?

Are we risk-averse as a culture/nation?



We co-design with the people who will use and deliver services.


Products driven by user needs and problems, not technology

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*insert image of mental health research and employment*


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We need to create platforms for a depth of expertise to come together with designers and technologists.


“We need to redesign primary care and care in the community to offer a credible alternative to A+E’

[research participant]


*insert image of care hack*



Hacks used not to build the solution but bring multiple perspectives and insight to a problem across a system.


Innovation is fixing the problems.


Here’s my top five IT fix requests:

1. Use standard usernames Each system appears to require its own type of login. My usernames include hoggda80645, david.hogg. dhogg, hoggd, hoggd80927, DHOGG, 80927hoggd and david. Add to that inconsistent passwords (some requiring uppercase, some not allowing uppercase, others needing punctuation).

Solution: we need this to be standardised. The NHSnet email address is a good place to start for a username or alternatively couldn’t we use the registration number - GMC, NMC, HPCC? The username ‘gmc123456’ makes a lot more sense.


Design is everything. The function, the language, the service name.


Test everything. Put it in user hands early.

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Prototypes are a way of asking more questions.

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Build platforms for systems to talk to each other that work for people.


We are in a treatment economy. Design for prevention.


This is a cultural journey. Not just a design or technology journey.


The research can be brilliant, the design solution must be tested.


Design for sustainability


You can’t design products and services unless you put them in the hands of people.


We must build systems that allow us to continue to challenge, iterate and improve our designs.

This can be institutionally led and user led.


Health care isn’t one departments problem.

This is a deep system problem


“But a systems-oriented view of problems challenges the idea that healthcare, say, is the responsibility of a Department of Health. Health is directly affected by urban planning, transportation and other infrastructure, patterns of employment, food, education, industrial policy, retail policy and so on, most of which will sit outside of the neatly defined boundaries of one department.” - Dan Hill


Design is not a panacea. It gives us the space to hold conversations about the system and it’s dynamics.

It’s the glue between research, user needs and technology that will bring form to the future

*(and hopefully a good one).

Focusing on function over form. Make things usable. Technology as an enabler.


| OUR WORK

Thank you wearesnook.com

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We are an award winning design agency based in Glasgow & London, helping organisations produce great services by putting people first

http://wearesnook.com