Using user centred design to improve citizen journeys

Introduction

We believe that placing users at the forefront of services and solutions is a step towards creating a more connected and responsive health and care sector. This will be a pressing need as financial resources look to recover on elective care delivery and for the social care sector will be a continuing challenge.

In our last blog post, we outlined the challenges faced by health and social care and the role of user-centred design in shaping their future. We identified why design solutions are needed to empower individuals within our health and social care systems. While clinical decision making has evolved and patients are more empowered to make decisions that are best for them, based on advice and support from clinicians, how care is organised has not progressed as much. The system was designed primarily for those with single conditions but there is an increasing proportion of patients with multiple conditions. For example, a patient with the common combination of diabetes, kidney failure and heart condition may get sent three separate clinic appointments to see three different teams and be given three different sets of advice. By re-examining challenges through a human lens, we can facilitate a design-led approach with people at the centre. Current challenges must be re-envisioned by framing them to focus on people, posing questions such as, ‘How do we empower citizens to get holistic treatment whilst enabling their autonomy to manage their own care?’

As the service landscape has evolved in response to changing needs, organisations face the challenge of understanding the impact of their adaptations. For example, how to place citizens at the forefront to achieve the right balance between human and digital. In practice, user-centred design has the capability to support services to focus on the human element and integrate this with business or policy decisions.

Identifying needs and opportunities to learn

In our experience, and for many who have run and attended health and social care services, gaps in citizen journeys can be found when transitioning between services. Primary, secondary, and tertiary care organisations may have different systems, technologies and procedures in place that create barriers to sharing information and knowledge that then create delays in care and potentially sub-optimal clinical decision making.

Using the example of a resident in a care home being admitted into a hospital: the information flow between the care setting and hospital is often disjointed. Hospitals will not always receive all the information and records they need for the resident on arrival onto a ward, thus leaving health care professionals with a limited picture of the resident’s care needs. Similarly, once a resident is discharged and taken back to their care setting, care home staff often find themselves without the necessary discharge information they need to update their care plans. Much of the information is in summary format and it can be challenging for carers to find the required detail.

These problems can be difficult to capture when viewed from a traditional care delivery model – people can become lost in the gap where responsibilities and duty of care are transferred. This is what we might label disjointed care pathways.

Care may be provided by different people and organisations in someone’s journey but to the citizen this may be part of a single larger goal such as to recover and receive ongoing support to maximise their quality of life. This goal is service agnostic.

If we were to re-examine the problem from the persons perspective, what kind of service might we look to design?

Connecting systems and aligning them to measure the citizen experience according to the citizen’s goals may provide the accountability organisations require to deliver outstanding care outcomes. Further to this, people seem to show a high level of demand for, and expectation of, control over their individual health record – the context of their care and who it is shared with needs to be patient-driven.

While citizens are a key user, they are not the only users to consider. Inefficient and ineffective services impact the numerous healthcare professionals, management and other operational staff involved across various organisations. For instance, remote care solutions which have focused solely on citizen needs have potentially alienated health care professionals. Novel solutions, from smart apps to emerging technologies, require training and have implementation costs for providers. Designing for people includes those who run our services, in addition to those it aims to help.

Opportunities moving forward

With the NHS and Social care introducing the integrated care system model (ICS), there is an exciting opportunity to move beyond disjointed models of care based on single organisations or formal referral and gate keeping between organisations to those designed around citizen needs and covering the journey from start to finish.

In reality, there will be constraints on how radical changes can be in terms of new models and service provide reconfigurations. Indeed, the proposed ‘ICS health and care partnership’ entity will look at how existing organisations can work together. Our experience suggests that organisations can challenge their current thinking by asking key questions such as:

• How well does the current service meet the needs of those involved? Above we discussed patients receiving multiple clinic appointments. Could they be empowered to follow-up with their clinician? Patient initiated follow-up suggests a model for achieving this.
• How does the system tackle the known inequalities in care? How will new systems reduce these inequalities?
• How does the service cater to diverse levels of digital confidence?
• What impact does the home environment, with privacy or cultural constraints, have on patient’s ability to engage?

As these user needs are identified, a vision can emerge of how organisations can connect to provide joined-up pathways. For instance, NHS Camden and Islington Foundation identified 20 users who were digitally excluded from receiving support from their Traumatic Stress Clinic. To solve this, they collaborated with specialist accessibility organisations, AbilityNet and Jangala to provide a low-cost tablet solution. Our experience suggests that one of the key questions to ask is ‘how [can] your service offering be improved by connecting with strategic partners?. Partnering with other organisations can provide the specialist insight required to understand and provide for identified user needs, such as provision of an omni-channel experience for users with low digital capability or accessibility requirements.

The ability of care providers to capitalise on improvements to the current challenges will depend on the capability to identify and join-up pathways. Human-centred design is a vehicle to design for people and integrate services.

Some of the considerations that may help your organisation implement user-centric services. In addition, to those discussed in our original article :

• Develop a culture that values user needs – organisational direction is defined by what success is measured against. What is driving your organisation and motivating programmes of work? Instead of solely relying on traditional key performance indicators of efficiency, organisations should look to measure how well they are meeting the needs of people they aim to serve.
• Research and design solutions for both those who provide the service and those it aims to help. Delivering value requires a holistic understanding of the current challenges to design effective solutions.
• Create frameworks that support collaboration – methods of sharing knowledge and innovations across organisations with shared goals. What is your organisations outlook to partnering to provide better services? Developing organisational relationships can expand your capabilities and oversight on the wider user journey, increasing effectiveness of outcomes.

We would love to hear about your experiences and your views, please get in touch.

Michael Lo

Public Sector Consultant

Michael Lo is a Public Sector Consultant at Capgemini Invent with experience conducting user research in NHS and Government.

Dr Janak Gunatilleke

Senior Manager

Dr Janak Gunatilleke, 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

Series Editor: Professor Matthew Cooke, 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.