Human-centred design to improve healthcare
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This document discusses human-centered design approaches to improve healthcare systems and patient experiences. It covers several topics: 1. The importance of considering human needs, feasibility, and economic viability when designing healthcare solutions through approaches like industrial design, service design, and interaction design. 2. Examples of applying design thinking to problems like asthma treatment to improve control and reduce hospital admissions, and improving cancer patient experiences through better navigation of screening and treatment pathways. 3. The use of design research methods like identifying "extreme" user profiles to fuel creative problem solving and better engagement of patients in their own pre-assessment and care.
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Human-centred design to improve healthcare
- 1. Human centred design to improve healthcare NHS Expo 8 September 2016
- 5. Mobile Data-driven Unparalleled access
- 9. Image: Wikipedia, public domain
- 10. Image: 23andMe
- 11. Image: 23andMe
- 13. INDUSTRIAL DESIGN VISUAL DESIGN SERVICE DESIGN DESIGN FOR BEHAVIOUR CHANGE INTERACTION DESIGN GRAPHIC DESIGN SYSTEMS/TECHNOLOGY DESIGN ENVIRONMENT DESIGN UX DESIGN
- 15. 9 / 10 of the lowest-rated cancer patient experiences are at large London NHS Trusts. 2011/12 National Cancer Patient Experience Survey
- 16. Initial assessment may be done over the phone About 1 in 20 women will be called back for further assessment. (technical recall, area of concern, Normal but symptoms warrant clinical + Lump in the breast or axilla + Ulceration + Skin nodule + Skin distortion + Eczematous-like changes to the nipple, not just the areola + Recent nipple retraction or distortion (less than 3 months) + Unilateral nipple discharge which stains clothes Patient Asked about: + Age (risk increases with age) + Lumps Other breast symptoms, such as: Ulceration, Skin nodules, Skin distortion, Nipple changes, Nipple discharge, pain, personal history of breast cancer Refer to breast clinic for triple assessment (urgently) Routine Screening 20%ofbreastcancerpatientsidentifiedthroughroutinescreeningprograms. Letter with appointment details No Review Medical History General advice - Breast Aware Discharge to primary care Is any additional information asked - when compared to visit to GP????? Clinical Examination Patient should be seen within 2 weeks PATIENT PROFILES Women identified as being at higher risk, should be offered the opportunity to have their risk formally assessed and, where appropriate, to discuss their risk management options. The National Health Service Breast Screening Programme offers three-yearly mammogra- phy. Screening happens between 47-73 years of age Around 1/ 3 of breast cancers are diagnosed through screening. PatienthasConcern 80%ofbreastcancerpatientsidentifiedaftervisittoGPwith Patient arrives at reception Gen eral Practiti oner Family History Review + Names and ages of all your family members who have had breast cancer (including men) + Any cancers your relatives have had + The age they were diagnosed Yes + Unknown family history (adopted) may seek testing for genetic mutation Gen etic Couns ellor + Breast cancer diagnosed before age 50 years + Cancer in both breasts + Both breast and ovarian cancers + Multiple breast cancers Two or more primary types of BRCA1- or BRCA2-related cancers in a single family member + Cases of male breast cancer + Ashkenazi Jewish ethnicity FAMILY HISTORY CLINIC GENETICS TEST (Tertiary Care) SECOND STAGE SCREENING Triple assessment - Clinical Examination + Imaging + Cytology Each examination given offered a different perspective Hospital or breast clinic (All scans + tests are normally done in one day) Undresses in changing room A paper gown may be offered to the patient Patient arrives for consultation ASSESSMENT (ROUTINE)Routine screening for women (usually) with no signs or symptoms of breast cancer. Screening may take as little 5 minuets, visit will last for 30 minuets or longer Patient arrives at reception. Patient is given a questionnaire to fill out Patient undresses in changing room A paper gown may be offered to the patient A female nurse feels for any enlarged lymph nodes under arms and base of neck and around the breasts Physical Examination in examination room During the mammogram each breast is placed in turn on the x-ray machine and gently but firmly compressed with a clear plate. The compression only lasts a few seconds and doesn't cause any harm. It's needed to keep the breast still and to get the clearest picture with the lowest amount of radiation possible. Mammography (x-ray) in examination room. Breast care nurse explained reason for recall and the tests (that may be required (patients expected pathway). Occasionally, the need for more tests is due to technical reasons; for example, if the mammogram picture was not clear enough. Around 2 women in every 100 (2%) are called back for technical reasons. Breast care nurse explains the need for test Patient book appointmentPatient receives referral letter Screening Leaflet Letter outlines what the patient can expect - Length of wait, result Be Breast Aware leaflet http://www.cancerscreen- ing.nhs.uk/breastscreen/publications/- breastaware.pdf Touch Look Check by breakthrough breakthrough.org.uk/tlc After your breast screening appointment - what happens next Info for patients relatives and carers Feedbac Questionnaire Personal information, Past medical history, Current medical history, Ethnic Origin Touch Look Check breakthrough.org.uk/tlc by breakthrough Be Breast Aware leaflet http://www.cancerscreen- ing.nhs.uk/breastscreen/publica- tions/breastaware.pdf CLINICAL BREAST EXAMINATION (PRIMARY CARE)Assessment by primary care to - Check for - lumps & physical changes Goal - Early detection Patient - Male ??????? Refer to family history clinic (Genetics)Yes No No No Could the abnormality have been caused by by the menstrual period Yes Notes added to patients record / file Scans reviewed by two radiologists.Radiologists Radiologists Bre ast Care N urse Patent finds a sign of breast cancer Patient arrives / enters assessment room Personal details + Past + current medical history. Bre ast Care N urse Other literature - Breast implants and breast screening leaflet Patient gets dressed / leaves clinic Scans 1 Patient follows signs to ward / checks in with reception Patient fills out questionnaire Personal details + Past + current medical history Patient may be approached by a research nurse and asked if she would like to take part in a study? Patient will be asked to prepare some information for appointment / to discuss their family history with relatives General advice - Breast Awareness Wait in waiting room Patent has concern based on family history, age or medication Patient follows signs to ward / checks in with reception Results Letter Referral to triple assess- ment clinic Further investigation required DischargeResults clear Outcome communicated to Patient and GP 2 - 4 weeks Wait for results letter Patients get confused about where screening room is / who to approach on entering the clinic (Charing cross - Mammogra- phy) Re sults lett er Discharge Return for re-examination in 2 weeks Same day / Same week Patient is asked if there is a personal / Family history of breast cancer? No longer than three weeks between the mammogram and the breast clinic appointment. Examination - Are symptoms suggestive of breast cancer? Patient book appointment with GP / Goes to a drop in clinic. Patie nt - Personal h istory Scheduled for screening ever 6 months - 1 - 3 years Patient finds symptom of possible breast cancer P atient - Over 7 0 Entitled to routine screening (every 3 years) on request. Scedualed for screening ever 3 years Patient (47+) Patient finds symptom of possible breast cancer Patien t - Found Earl ySign Family History Patient finds out that a member of their family has or had breast cancer. Women - 1 in 8 Men - 1 in every 1000 Patients follow lines painted on floor to guide them to appointment room. Lines are only 1 cm wide and hard to see Letter sent to patient “Thank you for attending your breast screening appointment,. our screening images have been looked at and require further assessment as part of routine (or second stage) screening. the majority of women recalled for assessment are found to have normal breasts” Direction leaflet Cancer Research letter leaflet “Your appointment at the breast assessment clinic” The waiting area can cause frustrating , Patients from different wards can appear to jump the queue - DC (A plasma screen is being considered to show patient's position in the queue) Patients must have a moderate or strong family history of breast cancer to be referred - (High risk group) In some situations the GP may ask you to go back again in a couple of weeks time. This is because some non cancerous breast tissue changes naturally disappear after a menstrual period. Yes Changes to look out for - + Appearance. + Feelings. + Lumps. + Nipple change. Lifestyle advice + Alcohol + Smoking, + Weight, + Hormone Replacement + Therapy + Breastfeeding + Hormonal Contraceptives Info delivered in verbal & written form NHS Genetics Testing Network http://ukgtn.nhs.uk (not confirmed as supplied to patients) GPs don't always follow referral guidelines, causes unnecessary anxiety Scre ening le tter Breast Cancer Patient Pathways
- 17. Imaging and assessment Diagnosis MDT Therapy KEY Clinic If further surgery needed MDT Multi-disciplinary team meeting (patients do not attend) Results / treatment plan Holistic needs assessment Clinical reviewNeo adjuvant therapy Chemotherapy Radiotherapy Hormone therapy Pre-surgery assessment Surgery / reconstruction MDT Post-op results Adjuvant therapy Chemotherapy Radiotherapy Hormone therapy Reconstruction if not done in original surgery Hospital follow-up Imaging / clinical check-up Six months after surgery, then yearly for five years
- 18. PATHWAY PLANNER A VISUAL GUIDE TO YOUR CARE BREAST PATHWAY PLANNER A VISUAL GUIDE TO YOUR CARE BOWEL PATHWAY PLANNER A VISUAL GUIDE TO YOUR CARE BRAIN PATHWAY PLANNER A VISUAL GUIDE TO YOUR CARE PROSTATE
- 26. 5.5m Asthma sufferers in the UK 75% Asthma hospital admissions are avoidable 90% Deaths due to asthma are avoidable £1bn Cost to NHS for asthma treatment
- 28. 2/3 people do not fill in their Asthma Action Plan
- 32. 32 Floot
- 33. Problem Solution
- 34. Design research ≠ focus group
- 36. JANE! VIDUR & SABITA! RICK! Participates religiously Never heard of bowel cancer JANE! VID ROBIN! AL Physically difficult to do the task alone
- 37. Extreme use cases fuel creative thinking
- 42. 1. Problem 2. Hunt statement 3. Super users Referral to treatment times need improvement We are going to research patient involvement in pre-assessment so that we can better engage them before a procedure – Carer turned patient – Heavy drinker – Flight attendant