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Experienced Based Design
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Abstract
Understanding how patients interact and respond to the care environment and healthcare providers is critical if you want to improve facilities, systems and processes.
Peter Rogers suggests healthcare providers should look to the commercial world for inspiration. In particular the emerging 'experience design movement' has valuable lessons for making patient and public involvement in service transformation work.
Context of Public and Patient Involvement
The vision of creating a Patient-led NHS (DH 2005) means responding to the needs and wishes of individuals as well as delivering care. Inevitably, this means transforming services and practice and is a challenge the health service still struggles to meet.
Angela Coulter, Chief Executive of the Picker Institute, recently described public and patient involvement in the NHS as a 'sham' (HSJ 8 June). She attributes this situation to a failure to manage the cultural change necessary both in the service and in government.
Experience Based Design
Realising the vision of an NHS that works with patients requires a new approach to service transformation in which patient and public involvement is taken to a new level. This means patient experience needs to be given the same sort of attention as service efficacy, reliability and governance.
This is the foundation of experience design, an emergent movement that crosses industry boundaries (Jacobsen, 2000). The experience of consumers has always influenced commercial designers to a greater or lesser extent; however this new design paradigm emphasises the importance of a holistic approach. Experience design starts and finishes with the experiences of those using a product or facility or service, as opposed to the more familiar product or service process centric design models (Forlizzi & Battarbee, 2004).
Experience Design in Action: Ambient Experience
Diagnostic procedures like MRI and CT scans can be scary and uncomfortable. Anxious patients quickly forget instructions and will often move about during the scan. Invariably this means a repeat examination creating more apprehension for the patient, costing more time and money, as well as potentially creating delays for others.
The Philips corporation combined its experience in healthcare, lighting technology and design with the aim of helping patients to relax during scans.
The result was hotel room styled waiting areas with direct access to the examination room where patients and family can be together. Patients entering the examination area are helped to feel at ease by an atmosphere they have chosen. Projectors show images and lighting effects selected by the patient.
For example, children might choose cartoon characters. This partial control over the environment helps to reduce anxiety by distracting patients from the investigation and its possible implications.
Clinicians using the facility report positive outcomes for patients of all ages and a reduction in the number of children needing to be sedated before examination.
www.newscentre.philips.com/about/article-15114.html
Fear of Patient Control
Some find the prospect of placing patient experience at the centre of service design, development and delivery threatening. So perhaps at this stage it is worth saying what experience design does not mean.
Experience design does not mean:
- devaluing the knowledge and expertise of healthcare professionals;
- constraining governance or efficacy requirements; or
- giving patients a veto over service redesign options.
It does however require a fundamental change in the nature of the relationship between patients and healthcare service providers.
As has happened in other industry sectors, health service providers have to acknowledge that patients are not passive recipients of products and services. They are active participants in their own health care who have an important contribution to make in shaping treatment processes and influencing service development.
Moving to a model of co-production requires sustained relationships between improvement leaders; front-line staff and patients rather than the short lived listening and consultation exercises more typical of PPI in the NHS.
Experience Design in Action: Information Prescriptions
In today's information age many patients have access to a wealth of data about their condition and treatment options. Doctors increasingly have to contend with patients who, having been given a diagnosis, return to see them with reports and papers gathered from around the world which they want to discuss.
Often patients' lack of knowledge and understanding creates unnecessary fear and anxiety about their prognosis and possible complications. Information from poor quality sources can misinform, leading to false hope or unrealistic expectations and results in lengthy and difficult consultations.
Information prescriptions, given directly to patients by health professionals at the time of diagnosis or specialist assessment can help to overcome these problems, and at the same time improve the effectiveness of future consultations.
By signposting people to reputable sources of further information and support that are relevant to their conditions and circumstances, we can meet patients' demands for more and better information, and enable them to become involved in decisions about their treatment.
Information prescriptions will also help to reduce the time doctors and others spend in correcting and explaining misleading and unsafe information.
User Expectations and Power
Whether we move to a model of cooperation because we want to provide services that work for people, or for competitive advantage in a market dominated by patient choice, distributed commissioning and plurality of provision is a moot point. The fact remains that the NHS service user now has greater expectations over their care than ever before AND a more powerful voice when their expectations are not met.
Disregarding this reality will ultimately affect services, either by becoming out of sync with user demands and therefore inefficient; or by users exercising choice and voting with their feet. Either way, it is bad news for the NHS.
Experience Design in Action: Safe Text - Sex Information by Phone
Reaching young people with important health messages is notoriously difficult. All the more so when the subject is as intimate and as potentially embarrassing as sex.
The anonymity of mobile phone SMS services, combined with the very high level of mobile phone ownership amongst teenagers has been exploited to offer young people a number of more acceptable ways and to interact with the providers of sexual health services.
In Birmingham 15 to 25 year olds receive text reminders to take oral contraceptives (Nursing Times, 2004)
A pilot study at Chelsea and Westminster Hospital found that the results of sexual health checks sent by text were received at least three days faster than usual, and resulted in patients commencing treatment approximately 6 days quicker. See news.bbc.co.uk/1/hi/health/4665418.stm
Northamptonshire Heartlands Primary Care Trust has piloted a service aimed at helping teenagers and young people access confidential health advice. Questions sent by text receive an immediate automated response. The messages are then read at regular intervals by health professionals who respond back with a text message. See www.egovmonitor.com/node/3869
Experience Design - a New Option for the NHS
What is clear is that delivering the vision set out in 'Creating a Patient-led NHS' (DH 2005) does require new approaches. Experience based design has yet to prove its worth in a UK healthcare setting, nonetheless the approach builds on what is best about PPI currently and uses tools and techniques already familiar to many NHS staff. It also offers a potential double win by supporting the transformation of health care services and at the same time managing service user expectations.
Even where modelling services to user experience proves difficult or takes considerable time, engaging patients in the design initiative will highlight where conflicts could occur. As a result the organisation is better able to respond should they actually occur. As a means of delivering sustainable and recognised patient centred services it's an approach you cannot afford to ignore.
If you have any questions about the subjects covered in this white paper or you would like to find out more about how Oakleigh Consulting could help your organisation, please contact us on 0161 835 4100 or email us.
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