Healthcare Safari Report May 2016

Contents

3. Background 4. Participants, expectations and structure 5. Approach 6. Framework 7. What is design thinking? 8. Visualisation 9. Touchpoints 10.Empathy Mapping 11.Service Safari 12.Affinity Mapping 13.Journey Mapping 14.Idea Generation 15.Feedback 16.References 17.Downloads and contact details

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Background

The Hospital Service Safari was a one day taster workshop at Ninewells Hospital and Medical School in Dundee introducing design thinking and service design techniques to healthcare professionals.

The day was organised by Rod Mountain, Ear Nose and Throat surgeon from NHS Tayside and facilitated by Hazel White and Mike Press from Open Change.

We introduced a range of well tested service design methods to a range of healthcare professionals to demonstrate how a design-led approach supports constructive, creative approaches to developing new or improved services.

These methods support organisational change - putting patients at the heart of innovative solutions to complex problems and enabling staff and patients to collaborate around a shared vision.

The emphasis was on introducing participants to practical tools to: • understand the perspectives and journey of patients • generate ideas for possible new services/service improvements

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Structure The day was structured around quickly getting participants into a patient’s mindset and out into the morning clinics. This was followed by an introduction to ‘design thinking’ and hands-on use of a range of service design methods.

Expectations

ENT surgeon and design advocate, Rod Mountain set the scene for the day’s activities, outlining his experience of using a design thinking approach to understanding and tackling issues in a creative and collaborative way. We used check in sheets to gauge participants’ expectations and objectives. These suggested a very positive attitude and a strong desire to meet new colleagues and take away practical tools and methods.

Participants

Twenty eight participants from a range of backgrounds took part, including consultants and registrars and improvement staff from NHS Tayside, lecturers and staff in the School of Medicine, independent consultants and the Director of Public Health.

9.00 Welcome and introductions

9.10 Rod Mountain

9.20 Empathy Mapping - getting in to someone else’s shoes

9.45 Service Safari

10.45 Tales from the field - sharing insights from Safari

11.00 Design thinking

11.30 Journey Mapping and share

12.30 Lunch - find a healthy lunch around the Ninewells Campus

13.30 Affinity Mapping - theme finding

14.00 Rip and Mix - innovative thinking tool

14.45 Present back

15.15 Discussion and reflection

15.45 Check out

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Approach A Service Design approach helps understand patients’ needs and generate and test ideas for new services.

Service design uses methods from design, business and sociology to understand current experiences and design better future experiences. Service design is widely used by business and in the public sector to improve and design new services. For example in healthcare, service design has been used in large scale systems change to transform shift handovers between nursing staff (1) and in small scale interventions to enable new ways of thinking (2).

The information that we gather from service design research methods is qualitative - we are looking for insight, rather than numbers. Quantitative data is useful - such as the percentage of people who use or don’t use a particular service - but it doesn’t tell us why. To make any changes or improvements to services we need to understand people’s underlying motivations and needs.

Service Design methods for gathering and sharing experiences - such as service safaris, empathy and journey maps give us insights that quantitative data doesn’t capture - insights that can be used to develop design concepts.

Qualitative research is not ‘better’ than quantitative research, but it gives more useful insights that can be used as a basis for design. (3)

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In the one day taster workshop, we walked through the discover, define, develop and deliver framework. In practice the process is less linear than the model suggests - it is an iterative process, with the steps being revisited.

It is important to develop multiple ideas before making a decision on which ideas to test with users - otherwise one idea is championed - usually the one chosen by the most senior person or person with the loudest voice. Having lots of ideas allows some ideas to ‘fail’ - if there is only one idea - it will get pushed through, even when evidence suggests it will not work.

New services should undergo testing and refining in use, as the Nurse Knowledge Exchange (1) project demonstrates - rolling out a large scale system change without piloting, refinement and gaining buy-in is a costly process in terms of resources and trust.

Framework The Design Council’s Double Diamond framework of Discover, Define, Develop and Deliver underpins the design process with a range of service design methods introduced at appropriate stages.

The diamonds represent the opening up divergent thinking processes to discover how things currently operate before using convergent thinking to define problems to be addressed. Thinking becomes divergent again when considering multiple solutions, before converging on solutions to be prototyped and tested. This staged process allows time for reflection and iteration - rather than scrambling towards a ‘solutioneering’ approach where surface issues are ‘solved’ but the underlying issues remain. (4)

DISCOVER DEFINE DEVELOP DELIVER

Seeing the world with fresh eyes

Understanding people’s behaviours and motivations

Innovation and creativity techniques, prototyping 

Refining and testing.

Service safari Empathy mapping Rip+Mix Present new concepts

Intro. to design thinking Tales from the field

Journey mapping

Affinity mapping

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RADICALcreate mission focussed passion optimist energy generating attract possibilities together

TROUBLEMAKERcomplain

me focussed anger

pessimist energy sapping

alienate problems

alone

What is Design Thinking? There’s a shift under way in large organizations, one that puts design much closer to the centre of the enterprise. But the shift isn’t about aesthetics. It’s about applying the principles of design to the way people work.

This new approach is in large part a response to the increasing complexity of modern technology and modern business. Sometimes the problem being tackled is itself multi-faceted: Think about how much tougher it is to reinvent a health care delivery system than to design a shoe. And sometimes the business environment is so volatile that a company must experiment with multiple paths in order to survive.

I could list a dozen other types of complexity that businesses grapple with every day. But here’s what they all have in common: People need help making sense of them. Specifically, people need their interactions with technologies and other complex systems to be simple, intuitive, and pleasurable.

A set of principles collectively known as design thinking—empathy with users, a discipline of prototyping, and tolerance for failure chief among them—is the best tool we have for creating those kinds of interactions and developing a responsive, flexible organizational culture.

Jon Kolko, Harvard Business Review, 2015

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Visualisation We use visuals as one of our primary ways of understanding the world - we are naturally good at imagining the future using images.

Visualising allows multiple perspectives to be input at the same time, giving a sense of ownership, enabling people to share stories and outcomes.

Based on a method developed by Ole Qvist-Sørensen - we had teams using visualisation techniques straight away.

We created safari kits containing instructions, pens, notepads and a safari destination to be distributed to pairs of participants.

The safari kits are a touchpoint of the workshop experience. When designing a service, all the elements that a user ‘touches’: an appointment letter, the clinic environment, information notices, staff name badges, webpages - are touchpoints. These need to be considered from users’ point of view as they affect their experience either positively or negatively.

18 destinations were identified: from clinics including Fracture, ENT and Dermatology to more general instructions e.g. “You are an hour early for an appointment, find somewhere to spend the time”. These were distributed ensuring that people explored somewhere that they were not familiar with.

It is useful to begin by visiting a service other than one which you deliver or use, so you can observe objectively.

As far as possible - put yourselves in the role of someone who uses this service.

Take photos, make notes and sketches to help you remember aspects of the service, which will help you compile a Customer Journey Map on your return.

Don’t take photographs of people.

• Different stages which make up the service

• People involved in delivering the service

and what they do

• What objects you use or interact with

• What spaces the service takes place in

• What information is available to people

• How people involved in delivering the

service contribute to the experience.

Service Safari guidelines

A service safari is a field trip to experience how a service is delivered from the ‘users’ point of view.

aware How does someone find to about it?

join What do they need to do to sign up?

use What sort of things do they do?

develop Are there other things they could do?

leave Can they continue to be involved?

chan

nel/s

cont

ext

satis

fact

ion

Date: CREATED BY: ORGANISATION:

ROLE:

journey map for:

A journey map focusses on a service from the user’s perspective, using text and visuals. It helps us see the big picture: both over time and in context. It can be used either to record how things are now, or to think through how things could work in the future.

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Touchpoints

Empathy Maps help you see the world from a patient’s point of view.

What do they see and hear?

What might motivate them or hold them back?

What are their hopes and fears?

Empathy mapping enables people commissioning and designing services to walk in the shoes of potential service users, and also consider those excluded from current service provision.

Participants were tasked with creating an empathy map for a person who was attending their safari destination. In the example above ‘Sam’ is attending a Dental clinic as he needs his wisdom teeth extracted - he is concerned about recovery time and having to take time off work.

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Empathy Mapping

A service safari lets you see the world with fresh eyes. You experience how another service is delivered and observe where this is working well and where there are opportunities for improvement. A safari takes you out of the role of service provider into the role of service user.

We started the safari by circumnavigating the exterior of the hospital, discovering the community garden and other green spaces. We entered the building by the main entrance on Level 7 where each participant team set off to find their destination.

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Service Safari

This technique helps sort large volumes of unstructured information, identifying themes and developing consensus on priorities.

On our return to the Improvement Academy, we debriefed and captured a variety of stories from uplifting experiences with staff to daunting trips to confusing clinic waiting areas.

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Affinity Mapping

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Customer Journey Maps show services/experiences visually from the clients’ point of view. They highlight weaknesses in current services and areas where opportunities exist for improvements. Journey maps can also be used to plan future services.

In the example above, ‘Brian’ (a persona created in the empathy map exercise) is apprehensive and confused when he visits the diabetes clinic and overwhelmed by the visual information in the clinic, which doesn’t offer concrete facts. He is reassured after meeting others at the clinic - suggesting there may be opportunities for outpatients to buddy/interact whilst they are waiting for tests to be done.

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Journey Mapping

Idea Generation There are many tools available to generate ideas, helping put aside the issues that constrain thinking - from brainstorming to Six Hats Thinking.

In the workshop we used Rip + Mix an idea generation method developed with Deutsche Telekom to bring non-designers into the design process. This method helps you and your team think creatively about how existing products or services can be transformed or new ones developed by applying lateral thinking to ‘pain points’ in your business.

Ideas generated in the workshop included:

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Planning Together Medical Ed Patient Friend Garden

Appointments

Health and social care board room meetings held in the community. Working together in the environments where the challenges are. Local people, workers and organisational decision makers having meaningful and productive conversations locally, e.g community halls, and trying out ideas in real settings together.

An App for student evaluation of the medical education curriculum: identifying what to remove and what to add.

A digital service to help patients through their healthcare experience from guiding them around the hospital to accessing medical records and test results.

Garden Appointments: bookable appointments for a volunteer to take patients or relatives to Ninewells Community garden - either self referred or referred by occupational health etc. with the aim of increasing wellbeing and social interaction.

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Feedback

I liked

• The rip and mix technique for idea generation. It was fun!

• Being able to think differently and inspiration.

• Good mix of people, new ideas, good tools.

• Safari. Getting to observe. • Good course for beginners. • The Safari and having a task for it. • Networking. • Empathy Map. • Constructive discontent. • Rip and mix. • I liked everything! Really useful

going forward! • Make service design fun and

interesting. • Productivity. Relevancy. • How informative today was. Very

useful! • Refreshing :) • The enthusiasm in the room :) • Interactive and inspiring! • Working with strangers. • Looking for a healthy lunch in

Ninewells. • The whole day :) • Variety of people attending and

modes of delivery. • The network sites • Mapping journey • Creating new ideas and

networking • Stepping out of usual • Rip and mix tool • Rip and mix. Useful tool. • Enjoyed meeting a range of

colleagues. • Enjoy visiting clinic followed by

the exercises • Time to have ideas.

I suggest

• Rolling out these concepts throughout healthcare • Coming to NES • Bringing teams of people MDT to improve their own

areas • Signposting to the online certificate Mike alluded to (5) • Deliver the workshop again to IPC groups and students

(nursing, medicine, etc) • Like the idea of having events like this in more unusual

spaces • Clear instructions / more staff for facilitation • Communicate the outcomes and photos from the day

to others is not here • Larger scale events / cross department • Others in the service need to experience this • Do more of this! Enjoyable! • NHST look at these methods at a high-level • Having some design teaching as part of healthcare

curriculum

I didn’t like

• Nothing I didn't like • Felt rushed at times • Nothing I didn't like • An hour for lunch • Dining options were a little last-minute / imposed • Sometimes confused on what to do • Specific clarity over the use of various tools e.g. affinity

mapping etc • Room that is a little bigger would be better

References

(1) Service Design and Change of Systems: Human-Centered Approaches to Implementing and Spreading Service Design Mike C. Lin, Bobby L. Hughes, Mary K. Katica ,Christi Dining-Zuber and Paul E. Plsek International Journal Of Design Vol 5, No 2 (2011) http://www.ijdesign.org/ojs/index.php/IJDesign/article/view/928/348

In this paper the authors outline the importance of staff input in a human-centred design process. Kaiser Permanente - one of the largest healthcare providers in the US developed and implemented the Nurse Knowledge Exchange (NKE) - shift handovers at the patient’s bedside. The new system had limited success as nurses were reluctant to implement a change which appeared to be imposed. The design team worked with staff to develop NKEplus, a new system which enabled nurses to design elements of the bedside handover themselves, substantially improving acceptance.

(2) The Goldilocks Conundrum: The ‘Just Right’ Conditions for Design to Achieve Impact in Public and Third Sector Projects. Joyce S. R. Yee and Hazel White International Journal Of Design Vol. 10(1) April 2016 http://www.ijdesign.org/ojs/index.php/IJDesign/article/viewFile/2381/724

In this paper the authors outline the ingredients required for a design-led approach to gain traction in public and not for profit sector projects. The three key factors are: leadership, capacity and community - the most important being building a community who champion and have skills in people-centred design. Kathleen McGuire, LTC & Community Ward Manager, NHS Ayrshire and Arran describes the change of thinking when working with other services at a design-led workshop on the integration of health and social care:

“We were thinking around anticipatory care, I was coming at it thinking about GPs and district nurses and how it would look in five years’ time. However we also had to consider views from the ambulance service and others, and what we ended up creating was quite different and something that I had never actually thought of.” You can download the (more easily digested) report here: http://valuingdesign.org/ValuingDesign_Report_2015.pdf

(3) Polaine, Lovlie and Reason, (2013) Service Design : From Insight to Implementation, Rosenfield Media.

This book provides a good balance of theory and practice with a great range of case studies to illustrate how the theory has been put into practice and the resulting difference that makes. This book is not to be missed for those with a passing interest in service design, new students of design, and old hands who can rebase their knowledge. This book takes the reader through the why, what, and how of service design. It illustrates the importance of people and their relationship with services, and showcases the collaborative approach of co-production and the value that it brings. Dr. Lynne Maher, Director for Innovation and Design, NHS Institute for Innovation and Improvement

(4) http://www.designcouncil.org.uk/news-opinion/design-process-what-double-diamond

(5) The School for Health and Social Care Radicals Run by NHS Horizons Group, the School is entirely online, free and is a platform for radicals to learn together, using powerful, guided learning which also qualifies for Continuing Professional Development points. http://theedge.nhsiq.nhs.uk/school/

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The Healthcare Safari was initiated by Rod Mountain, NHS ENT surgeon and Associate Postgraduate Dean, University of Dundee and member of the Academic Health Science Partnership (AHSP) in Tayside, Scotland. Rod is co-founder of Healthcare - Designed in Dundee an initiative which brings together transdisciplinary teams to work on complex healthcare problems.

The workshop was designed and facilitated by Mike Press and Hazel White from service design agency, Open Change, who provide training and service design expertise to healthcare, government, not for profits and business.

Mike Press, Hazel White, Rod Mountain

Download

workshop slides, completed worksheets and digital version of this report at www.openchange.co.uk click on ‘client zone’ on menu at enter code HS1

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Contact us

rodney.mountain@nhs.net @RodneyMountain http://medicine.dundee.ac.uk/rodney-mountain

hazel@openchange.co.uk @hazelonewhite

mike@openchange.co.uk @mikepressuk

www.openchange.co.uk