design in health care for the health foundry
TRANSCRIPT
We are SnookPeople by Default Sarah Drummond
Sharon was not involved in the design of her system
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“I no longer feel that I can deliver an adequate service even allowing for working a 70 + hour week. I have taken a support worker role in order to spend time with my family in an attempt to recover some quality of life. I wish you all well.”
The British Association of Social Workers and Social Workers Union
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“I spend most of my working day typing and inputting services plans, filing, etc., all admin tasks.”
The British Association of Social Workers and Social Workers Union
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“Social workers are spending too much time in the office and not enough time with clients. The very essence of social work is being eroded, which is a great, great shame.”
The British Association of Social Workers and Social Workers Union
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“Working in an out of hours team, we have no administration, we have to organise all assessments, visits and undertake reports. I spend most of my time on the computer”
The British Association of Social Workers and Social Workers Union
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We are SnookPeople by Default Sarah Drummond
ADMINISTRATION COSTS US PEOPLEWe have created systems that don’t solve problems. They create more work, cost us more to run and take us away from the frontline
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1. Manual processing use of paper and manual copying across systems
2. Unnecessary processing users completing the wrong transactions at the wrong time 3. User contact users trying use a service, complain or track something
4. Casework edge cases and ‘user-errors’ handled by humans
Louise Downe, Head of Design | Government Digital Service | @louisedowne
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“I cried down the phone because it was the 27th time I’d called the hospital. They direct transferred me through to a department that wasn’t even open that day. I was desperate to shift my appointment, they insisted on sending a letter each time to change the appointment”
NHS Service User
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We are SnookPeople by Default Sarah Drummond
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INDUSTRIAL MODELS OF THE PAST CONTINUE TO SHAPE OUR DESIGNS“Technology has locked us into ways of working, the design of services, even operating models of organisations”
Dave Briggs, Head of Digital and Design at Adur & Worthing Councils
We are SnookPeople by Default Sarah Drummond
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TECHNOLOGY WON’T SAVE US, WE ARE AUTOMATING THE WRONG PROCESSES
We must fundamentally understand the problems we have to solve, meet user needs and design services that work
We are SnookPeople by Default Sarah Drummond
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GOOD TECHNOLOGY {AND DESIGN} SHOULD BE INVISIBLEWe need insight into what works, what doesn’t and what jobs we want to help people do to improve our systems and services
We are SnookPeople by Default Sarah Drummond
Image courtesy of Flickr user makeworks | FUTURE OF DESIGN IN HEALTH
MORE PUBLIC FACING SERVICESWith automation and good service design comes more time to spend on the frontline. A fundamental rethink and opportunity on how we deliver
We are SnookPeople by Default Sarah Drummond
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AN UPHILL BATTLE
The touchpoint has grabbed our design attention
UX and digital has over shadowed the service and organisation play
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How does this process ffer if
- No immediate family- Has immediate family
Name: Helen Age: 92 Gender: FemaleOccupation: Retired
Background: Helen has been living at home until a recent fall resulting in a hip fracture led to her being admitted to hospital. She has no family and is quite socially isolated with only a neighbour looking in and helping out occasionally.
Personal details Journey
“Step Down Beds & Discharge/ End of life”Frail/elderly. Single Shared Assessment. “Bed Blockers”. End of life? Discharge to rehab hospital or care home?
• A&E;• Medical Admissions Ward;• Care of the Elderly Ward;• Occupational therapist;• Physiotherapist;• Social worker;• Rehab hospital ward;• Nursing home;• Dietician.
Services
User Journey #11: “Step Down Beds & Discharge/ End of life”
Journey step 3
Helen is placed on the Frail Elderly pathway and has the forget-me-not stickers on her wristband and notes.
Frail Elderly Person’s Pathway Assessment tool
Nursing staff
Image
Journey step 4
Helen is given Single Shared Assessment in Care of the Elderly Ward.
Copy of Single Shared Assessment doc here: www.gov.scot/Publications/2004/08/19652/40277
Social worker
Journey step 5
Social worker creates
care plan for Helen
but since she owns
her own home and has
significant savings, her
lawyer is involved in
discussing funding for
a care home place.
Isolated older people who have no family can get stuck in hospital while legal details of payment for care are agreed.
Social worker and lawyer
Journey step 7
Helen is put on waiting list for three care homes but no places are currently available.
Limited Care Home places can lead to people being stuck in hospital.
Phone calls
Social workerCare home admin staff
Journey step 6
Social worker enquires about nursing home places for Helen .
Social worker
Phone calls (lots of)
Journey step 8
Helen is reviewed by Consultant Geriatrician who recommends that she is seen by a Physiotherapist and Dietician.
Consultant Geriatrician Junior doctors
Journey step 12
Helen is in Rehab hospital for further six weeks.
Nursing staff Consultant PhysiotherapistSocial worker
Journey step 13
Helen is transferred to nursing home.
Nursing staffPortersPatient transport Care home staff
Journey step 9
Helen receives
physiotherapy while in
hospital and support
from a Dietician as she
is not eating well.
Older people deteriorate quickly when they are hospitalised.
Physiotherapist and dietician
Journey step 10
Helen waits four weeks for a step down bed in the Rehab hospital.
Phone calls (lots of)
Hospital bed managerRehab hospital bed manager
Journey step 11
Helen is transferred to Rehab hospital.
Paper notes and computer systems
PortersPatient transport
Journey step 2
Helen sees a Consultant Geriatrician who makes a frailty diagnosis.
Consultant GeriatricianNursing staff
#11 User Journey previewGroup Tool
Journey steps
Challenges along the way
Opportunities for change
People
Patient
Touchpoints/Interactions
Journey connections
Participant comments
Rounded edges: Participant comments
Key
Think ‘home first’. Did Helen expect to never go home again when she was admitted with hip fracture?
How crazy is this process?!
Challenge - Money! Different parts of the system.Opportunity - Find a smooth route to the right future for Helen
Parking Lot
Social support
Power of attorney welfare should have been in place?
Where is the early assessment/early intervention to maintain independence and avoid fall
Risk assessment before fall and hip - to prevent
Why did Helen fall? Is this the first time? How could we prevent fall?
Pharmacist re meds prescribing and supply of appropriate medicines
Neighbour is part of services to support, and source of info
Really of e ve be mindful of
‘Signs of dementia’ Early intervention assessment opps in community to support Helen with GP/Churches/Community
How people/communicate support early diagnosis prevention at home
Journey step 1
Helen is in Care of
the Elderly Ward after
being admitted with a
hip fracture and signs
of dementia.
Nursing staff
Cognitive impairment propels people to 24hr care
Liaise with MDT community mental health team (elderly) to evaluate possibility of supporting at home
Needs review of medicines
Why is Helen not going home here?!
Why not transfer to rehab/reablement facility at this point?
Frailty assessment on admission - protocol. No Geriatrician needed. Frail elder path on admission
1. Waiting forassessment
2. Lack of3. Location of
comprehensiveneeds assessment
4. Who doesassessment?
Older people have no voice
Discharge planning should start here.
What does Helen want?
Added step
Why not rehab at home?
Assessment needs to be in own environment and community
Whose needs does this meet? Is it Helen’s or her family’s?
Is the ‘assessment’ truly multi disciplinary? Does Docs view on ‘risk’ colour all of the discussion
Is it fair to Helen to be assessed in an alien environment?
In frail elderly ward likely to be seen by OTs, Physios, MH liaison? Social workers, Pharmacy
Families collude with progress to care - Views of person of less importance
Whose needsWhose abilitiesWhose valuesWhose voice is heard (or not)You! the people impact
If no family members - who speaks for patient?
Care plan created for her! Who’s plan is it?
Patient? Her choice and voice?
No remit to discuss private live-in help? Autonomy issues
What temporary measures could be put in place to support Helen home while longer-term options considered
Could she have stayed at home with Social Care input?
Do we have a placement policy if the patient refuses three care homes?
Where is ongoing engagement around
Right medicine can be ‘life’ enhancing
Poly pharmacy is embalment in end of life. RIP.
Why is rehab reablement not much earlier in pathway?
Pharmacist reviews medicine
HCSW body?Is dietician necessary?
Lunch clubs - Community support - This could be avoided
Independence is everyone’s responsibility
Artificial barriers
- Current rehab bed structure
- MH rehab,Physical rehab
Need new type of rehab to allow peoples strengths
ixed H ‘people friendly’.Slow rehab - staff/community with right skills. Are decisions made ‘too early’ can go from living alone with no c e to nursing home ‘big leap’
Nursing home decisions
Why: - Cognitive- Physical- Choice- Risk- All/none
Early engagement with MDT to facilitate discharge home or step-down bed
Helen and HCP collaborate on MACP?
Who asks what Helen wants at end of life?
What does Helen want?
Why six weeks?
What is your definition of end-of-life care?
Help more people to be comfortable with the concept that life will end
Community support to keep Helen at home.Why nursing home?
Do we need to plan our own care - before we need it?
Does Helen want to go to a nursing home?
Do we need new concepts of care for frail elderly?
Are we risk-averse as a culture/nation?
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*insert image of mental health research and employment*
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We need to create platforms for a depth of expertise to come together with designers and technologists.
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“We need to redesign primary care and care in the community to offer a credible alternative to A+E’
[research participant]
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Hacks used not to build the solution but bring multiple perspectives and insight to a problem across a system.
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Here’s my top five IT fix requests:
1. Use standard usernames Each system appears to require its own type of login. My usernames include hoggda80645, david.hogg. dhogg, hoggd, hoggd80927, DHOGG, 80927hoggd and david. Add to that inconsistent passwords (some requiring uppercase, some not allowing uppercase, others needing punctuation).
Solution: we need this to be standardised. The NHSnet email address is a good place to start for a username or alternatively couldn’t we use the registration number - GMC, NMC, HPCC? The username ‘gmc123456’ makes a lot more sense.
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Build platforms for systems to talk to each other that work for people.
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You can’t design products and services unless you put them in the hands of people.
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We must build systems that allow us to continue to challenge, iterate and improve our designs.
This can be institutionally led and user led.
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Health care isn’t one departments problem.
This is a deep system problem
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“But a systems-oriented view of problems challenges the idea that healthcare, say, is the responsibility of a Department of Health. Health is directly affected by urban planning, transportation and other infrastructure, patterns of employment, food, education, industrial policy, retail policy and so on, most of which will sit outside of the neatly defined boundaries of one department.” - Dan Hill
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Design is not a panacea. It gives us the space to hold conversations about the system and it’s dynamics.
It’s the glue between research, user needs and technology that will bring form to the future
*(and hopefully a good one).
Focusing on function over form. Make things usable. Technology as an enabler.
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Thank you wearesnook.com
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