experience mattershow you can mobilise the health service’s most valuable resource A patient-led NHS is easy to say but hard to do.thinkpublic adapt the best approaches from the design sector, and combine them with cutting-edge thinking in innovation to put the ideas and aspirations of policy-makers into practice at the frontline. The results are positive, even transformative. Read on to find out how we can help you improve your service too...

social innovation and design

A National PriorityImproving the experience of people who use the NHS is a national priority. The Darzi Review identified understanding and learning from the patient experience as one of three key steps towards the ultimate goal of improving the quality of care offered by the NHS.

The case for improving patients’ experiences is justified in three ways:1. the moral imperative to protect people when they are at their most vulnerable2. the clinical case, which shows that patients who feel informed, relaxed and cared for heal faster3. the business case, as patient choice begins to permeate through the NHS

So far, policy-makers have sought to create a “patient-led NHS” through surveying and acting on patient opinion, through getting patients involved in formal accountability structures within the NHS, and through gradually introducing choice into NHS services, mimicking the market in order to allow patients to “vote with their feet”. But thinkers at the vanguard of public service reform know this is not enough.

These thinkers also point out that putting patients at the heart of the NHS risks further alienating frontline staff already disempowered by a target-driven culture. As Sir Nigel Crisp stated in 2005, “a patient-led NHS is easy to say but hard to do”.

‘The compassion, dignity and respect with which patients are treated... can only be improved by analysing and understanding patient satisfaction with their own experiences.’Department of Health (2008)High Quality Care for All (Darzi Review).

‘The goal of improving experience is... justified clinically and therefore in terms of value for money.’The Kings Fund (2008)Seeing the person in the patient

‘Being asked to choose from a menu of options, none of which appear to reflect your needs... can be as disengaging and frustrating as a situation where there is no choice at all.’Demos (2006)The Journey to the Interface

‘The rhetoric of user-led public services put forward by this government risks polarising professional and user empowerment as if it were a zero-sum game.’Demos (2006)The Journey to the Interface

We understand that improving public service isn’t just about listening to service users, or asking them to sit on committees. It’s about empowering people to improve the services they use, and to act for themselves.

So we were delighted when the NHS Institute of Innovation and Improvement asked us to put our convictions to the test. The experiment took place at Luton and Dunstable Hospital with users and staff at the Head and Neck Cancer Service.

Over the course of twelve months, thinkpublic initiated the UK’s first ever, co-produced, “experience-based design” project in the NHS. Combining radical thinking in commercial and social innovation with seasoned techniques from the world of design, we put together a methodology that would get the best results from patients and staff. Then we stepped back and let people do the improving for themselves.

thinkpublic needed everyone at the Head and Neck Cancer Service to be enthusiastic about experience-based design. We feared that past “patient engagement” exercises could have left patients cynical about getting involved. And we wanted to reassure staff that the project would not simply be about blame and finger-pointing. The team branded the project in collaboration with patients and staff, then created posters and newspapers to enhance its presence in the clinic. We gave staff and patients tools to create photo and video journals showing their personal experience of the service. We ensured participation from senior clinicians and ward nurses, and reinforced the project’s ties within the management structure of the hospital.

Over the course of twelve months,

thinkpublic initiated the UK’s first ever,

co-produced, “experience-based design” project in

the NHS.

Next, thinkpublic filmed interviews with staff and patients, asking them to tell their story. Frontline staff initially feared the presence of cameras in the hospital, but when they saw how positively the patients reacted to being on camera, they relaxed. We gathered over 30 hours of footage of patients and staff telling their story, then edited this to create a 30 minute film. The film was shown to groups of patients and staff in two initial, separate meetings, designed to lay the groundwork for the next, and most important, stage in the process.

We brought staff and patients together, involving them in activities designed to give them a deep insight into each others’ experiences of the Head and Neck Cancer Service, and the confidence to work together. Using techniques developed in the design and branding industries, we asked patients to map, and then describe, emotional “touchpoints” along their journey through the service. This helped everybody to understand where priorities for improving the experience lay and gave everyone an opportunity to vote on priorities.

Staff and patients immediately felt ownership of the priorities for improvement because they had identified them themselves. They also felt confident that they could work together. Away from their everyday roles as carer and cared-for, they began to see each other as equals, with a shared goal of improving the Head and Neck Cancer Service, and unique insights that would help them achieve that goal. They organised themselves into working groups, each tasked with taking on one of the priorities. thinkpublic provided tools to help these working groups function productively, but it was here that we withdrew from direct involvement in the process. That’s because we knew change had been put into the hands of the experts.

What happened nextThe project resulted in 43 separate improvements to the Head and Neck Cancer Service, improvements affecting efficiency, patient safety, and the overall experience of the service. All of the improvements were low or zero-cost, despite the fact that no budget limits had been set. Many of the improvements have since been adopted by other services at Luton and Dunstable.

Most importantly, the project fostered a new, collaborative relationship between frontline staff and patients, one focussed on the individual human dignity of service users. Staff felt remotivated to do their jobs well, and patients felt empowered – some even spoke of the project’s therapeutic effect. This relationship stands in contrast to other attempts to empower and involve patients in a meaningful way.

The NHS Institute for Innovation and Improvement were really pleased with the results, and thinkpublic were engaged to produce guidance and tools for other NHS services who want to try out experience-based design.

The NHS Institute’s Experience Based Design Approach toolkit was officially launched in 2009. We hope that services across the UK will now take the opportunity to improve their user experience by putting their most valuable resource – the patients that they serve – in control of driving service improvement.

“It surprised me how committed they are. They are always at meetings, always on time. Their commitment has really blown me away because I know normally when you have got patient groups, sometimes you’ll have four, next time you’ve got one and then it is a bit ad hoc but this time they have been really committed and I would praise them for that.”Support Staff member, Luton and Dunstable Head and Neck Cancer Service

find out more:

To find out how thinkpublic can help you capture, understand and use patient experience to improve health services contact:

thinkpublic5 Calvert AvenueLondon E2 7JP

0207 033 9978deborah.szebeko@thinkpublic.comwww.thinkpublic.com

Download the ToolkitDownload the experience-based design toolkit from the NHS Institute website: http://tinyurl.com/nhsinstitute

Read the Demos Case StudyRead a case study of this project, produced by the Demos think tank: http://www.demos.co.uk/publications/ thejourneytotheinterface