Engaging users in the design of systems means they are easier to use and achieve better outcomes

What is user centred design?

User centred design (UCD) is an approach that puts the end-user at the centre of the development process, ensuring that the design of a product or service remains focused on who will be using it. This not only makes technology support tasks easier to operate and adds direct value to users.  In healthcare these users are the patients, clinicians and wider workforce that keep the NHS (and social care) running.

Why now?

Covid-19 has exacerbated the profound stress and demand faced by the NHS and its staff. Waiting lists reached a 14-year record high in April 2021 of 5.1 million patients waiting for treatment and 2020 saw six million less referrals to elective care than 2019. Despite this, the NHS has responded swiftly, creating radical shifts in the way the service provides care to meet the needs of its users. Examples of this include a rapid shift to provide 550,000 video consultations in primary and secondary care, and 2.3 million online consultation submissions to primary care, as well as more than 500 GPs returning to work alongside 1,000 locums and other GPs to support the clinical assessments during the pandemic.

Alongside the demand in care and overwhelming waiting lists, the NHS faces a new challenge with governance. The release of the government’s whitepaper on the future of health and care poses new concerns about the powers bestowed on the Secretary of State to determine the NHS’s direction of travel. As Nick Timmins, Senior Fellow at the King’s Fund and the Institute for Government, has said, the white paper “largely removes the one bit of Andrew Lansley’s Health and Social Care Act 2012 that has worked, namely the statutory independence of NHS England”. The level of autonomy the NHS has benefitted from over the last decade has recently come into question.

What are the challenges that can be addressed through user centred design?

The pandemic shone a new light on the NHS, highlighting the challenges within the system, including:

• Recognising and supporting the critical role of the workforce and their well being
• Reassessing delivery of care and the structure of the health and social care system
• Moving away from traditional delivery of care to more proactive, citizen-led journeys
• The need for simple digital systems e.g. for data entry when wearing PPE
• A one-size-fits-all does not meet needs of the large and diverse population the NHS serves and employs. National strategy should consider evidence, build on best practice, and define principles and outline a framework, but actual design needs to be more local and driven by users.

Perhaps the most critical challenge that has been publicised is the wellbeing of the people who are working within the system and providing care to patients. Results from the ‘Covid-19: Are You OK?’ survey run by the Nursing Times reveal that, one third of the 3,500 nurses they surveyed rated their overall mental health and wellbeing as “bad” or “very bad”, with the NHS Confederation highlighting the risk of large numbers of staff leaving the NHS.

At the core of these challenges lies the need to move to a user centred approach in how problems are approached. “Evidence shows that co-producing services with communities can improve population health and tackle underlying inequalities”. In other words, “by bringing in the cultural contexts, experiences, personality traits and motivations of a diverse subset of users, we can understand problems in new ways and avoid the pitfalls of traditional business thinking”. Placing the people who use the service at the forefront ensures solutions serve the people, enables more effective adoption and creates a cultural shift towards collaboration and co-creation with the people who know the service the best – the workforce, patients and carers.

How does user centred design approach these challenges differently?

Looking at the current set of challenges and reframing them with a user-focused lens enables outcomes that go beyond solving a business or service challenge and encompass the human element. This approach allows you to “identify potential opportunities and test corresponding prototypes at a small scale quickly and efficiently, thereby reducing the amount of resources necessary to understand whether they will be successful”.

To get to this stage, we must ask ourselves ‘who are the people that are most impacted by this problem?’ and ‘who would benefit most if we were to solve this problem?’. Taking the challenges listed above as an example and re-examining them with a human lens, produces a different set of questions to think about: 

Current challenge	Reframing the challenge
Recognising and supporting the critical role of the workforce	How do we empower the people who deliver care in their day to day lives?
Reassessing delivery of care and the structure of the health and social care system	How do we enable different services to work together and provide the most valuable care to their patients?
Moving away from traditional delivery of care to more proactive, citizen-led journeys	How do we empower citizens to get the right level of care, at the right time?

People really matter. Adjusting traditional approaches to key public sector challenges involves placing the people at the heart of the solution and bringing them along the whole journey from the initial ideation to completion. 

Where to start on your user centred design journey

When laying the foundations for a user centred approach within teams and organisations, consider:

• Finding the change makers – programmes of work are led by teams with a human outlook. Who are the disruptors activating collaboration across departments and engaging different teams? Rather than relying on external ‘best practice’ models, organisations should embrace the crucial role of unleashing internal leaders to design practical, emotionally resonant strategies for organisational activation.
• Adopting tools to accelerate change – the internal tools and technologies which make a new way of work faster, smoother, and more collaborative, such as the Connected Experience Framework developed by Capgemini. From defining personas and indexing the employee experience this tool helps bring together all the touch points in a user’s journey and helps you measure the improvement rate after a transformation has completed.
• Demonstrating impact – working in agile ways to make fast, iterative changes with demonstrable value to people and processes.

What’s next?

User centred design facilitates the pathway to ensuring the right problem is being solved, considering needs from the outset and iterating along the way to provide useable solutions, faster. Understanding the users, their needs and bringing them along in the journey is crucial to the process.

The next blogs in this series will explore how user centred design can be applied to develop citizen journeys that meet the health and wellbeing needs of the future.

We would love to hear your views and experiences of using user based design. Do get in touch.

Tamanna Akther

Senior Researcher

Tamanna is Senior User Researcher at Capgemini with experience conducting user research in the NHS and government.

Dr Janak Gunatilleke

Senior Manager

Dr Janak, Senior Manager at Capgemini – a doctor with experience using technology and data to improve patient care delivery and healthcare operations

Matthew Cooke

Chief Clinical Officer

Professor Matthew, Chief Clinical Officer at Capgemini, having spent a career as an NHS emergency medicine consultant and having been the National Clinical Director for Emergency Care in England.  #EDdoUK