Participatory Design Methodologies Used to Effect Change in a Healthcare Environment.

Abstract

The United Kingdom National Health Service (NHS) was introduced after the Second World War to provide healthcare free, at the point of delivery. Originally, the NHS was focused on treating acute conditions, but due to socio-economic changes over its 60-year lifespan the focus is changing from acute care, to care for chronic conditions. User Centred Healthcare Design (UCHD) is an interdisciplinary action research project involving designers, technologists and health professionals aiming to develop new participatory design methodologies, and promote design thinking in the way the NHS provides services to people with long term conditions. UCHD is exploring design through a series of design case studies at three distinct levels: Designing localised service improvements, designing service innovations, and designing for strategic change. Our first case study examined the current ‘state of the art’ of participatory design in the NHS. The NHS Institute for Improvement and Innovation has developed Experience-based design (EBD) as a method (and toolset) that is used within the NHS to assist service improvement initiatives. EBD is a participatory method that involves patients, carers, clinicians, managers and designers in a collaborative process of identifying problems, envisioning solutions and implementing change. UCHD worked with the Royal Hallamshire Hospital in Sheffield to develop Better Outpatient Services for Older People (BOSOP), using this project as an evaluation of the effectiveness of EBD. Our findings showed how using the Medical Outpatients service extends beyond the physical extent of the building, with many touchpoints before and after the appointment, such as confirmation letters, reminder telephone calls, and interactions with General Practitioners forming part of the interaction. Practical initiatives arising from the BOSOP case study include proposed revisions to the signage within the hospital; a revised drop off area outside at the entrance to the Outpatients department; a revised appointment letter; and a new handout map detailing prescribed routes around the hospital. One key finding from the case study has been the relationship between designing new ways of working, and motivating stakeholders. As the project progressed, staff have found it difficult to be released from their duties to engage in participatory exercises, and when they are released, this can sometimes result in extra work pressure being put on their colleagues. The project team have recognised the need to support the technical design activity, with broader communication initiatives to promote local support and good will towards the re-design effort. The ‘design problem’ is not simply to develop a new vision of the service, but also to develop the motivation of staff and managers to respond positively to the potential for change. A second finding was that although EBD provided strong support for the capture and understanding of patient experience, there was limited advice within the method to support creative ideation. In future work, we hope to address this limitation.