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Case Study: Experience matters


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Case Study: Experience matters

  1. 1. experience matters how 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
  2. 2. A National Priority Improving the experience of people who ‘The compassion, dignity use the NHS is a national priority. The and respect with which Darzi Review identified understanding and patients are treated... learning from the patient experience as one can only be improved of three key steps towards the ultimate goal by analysing and of improving the quality of care offered by understanding patient the NHS. satisfaction with their own experiences.’ The case for improving patients’ Department of Health (2008) experiences is justified in three ways: High Quality Care for All (Darzi Review). 1. the moral imperative to protect people when they are at their most vulnerable ‘The goal of improving 2. the clinical case, which shows that experience is... justified patients who feel informed, relaxed and clinically and therefore in cared for heal faster terms of value for money.’ 3. the business case, as patient choice The Kings Fund (2008) Seeing the person in the patient begins to permeate through the NHS So far, policy-makers have sought to create ‘Being asked to choose from a “patient-led NHS” through surveying and a menu of options, none acting on patient opinion, through getting of which appear to reflect patients involved in formal accountability your needs... can be as structures within the NHS, and through disengaging and frustrating gradually introducing choice into NHS as a situation where there is services, mimicking the market in order to no choice at all.’ Demos (2006) allow patients to “vote with their feet”. But The Journey to the Interface thinkers at the vanguard of public service reform know this is not enough. These thinkers also point out that putting ‘The rhetoric of user-led patients at the heart of the NHS risks public services put forward further alienating frontline staff already by this government risks disempowered by a target-driven culture. As polarising professional and Sir Nigel Crisp stated in 2005, “a patient-led user empowerment as if it NHS is easy to say but hard to do”. were a zero-sum game.’ Demos (2006) The Journey to the Interface
  3. 3. 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. Over the course of twelve months, thinkpublic initiated thinkpublic needed everyone at the the UK’s first ever, Head and Neck Cancer Service to be co-produced, enthusiastic about experience-based “experience-based design. We feared that past “patient design” project in engagement” exercises could have left the NHS. 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.
  4. 4. 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.
  5. 5. What happened next The 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 “It surprised me how committed Improvement were really pleased they are. They are always at with the results, and thinkpublic were meetings, always on time. engaged to produce guidance and tools Their commitment has really for other NHS services who want to try blown me away because I know out experience-based design. normally when you have got patient groups, sometimes you’ll The NHS Institute’s Experience have four, next time you’ve got Based Design Approach toolkit was one and then it is a bit ad hoc officially launched in 2009. We hope but this time they have been that services across the UK will now really committed and I would take the opportunity to improve their praise them for that.” user experience by putting their most Support Staff member, valuable resource – the patients that Luton and Dunstable Head and Neck Cancer Service they serve – in control of driving service improvement.
  6. 6. find out more: To find out how thinkpublic can Download the Toolkit help you capture, understand Download the experience-based and use patient experience to design toolkit from the NHS improve health services contact: Institute website: thinkpublic 5 Calvert Avenue Read the Demos Case Study London E2 7JP Read a case study of this project, produced by the Demos think tank: 0207 033 9978 http://www.demos. thejourneytotheinterface