How service design can help solve the NHS crisis

“Keep Calm and Carry On”, the famous British motivational poster first espoused in 1939. Such messaging was thought up by the UK government to keep us proud of our stiff upper lip as we dealt with the drudgery of daily life. And we do. But the lives of those living in the UK have changed immeasurably since the advent of the famous poster, and the recent mid-winter NHS crises is reason to shake our Keep Calm attitude and start taking action in healthcare innovation.

In 1942, we saw the birth of the National Health Service, a public institution framed as “medical treatment covering all requirements [that] will be provided for all citizens” by Sir William Beveridge. As honourable as his sentiment was, Beveridge’s intentions have not carried through to today. For an individual attempting to navigate this complexity and use NHS services, the experience can seem a bewildering and frustrating one. Extracts of a leaked government taskforce report published in the Guardian (though later claimed by NHS England to not be a final version of the report), starkly set out some of the challenges faced by those seeking help from England’s mental health services, often considered to be less important than physical health within the NHS. The task force’s study revealed that medical needs are not being attended to early enough. Ten percent of young children, it found, are having their appointments cancelled as a result of staff shortages. The study also reported that more a quarter of people with severe mental health problems need more support than is currently on offer, and many are at serious risk of self-neglect.

Keep Calm Graphic

Further, these issues are not one-sided. This sense of frustration sits not only at the level of the service user — the patient — but also with the service provider: the highly trained, incredibly proud teams of medical professionals who staff our primary and secondary healthcare services. But “NHS staff just get their heads down and get on with it,” said Molly Case, a cardiac nurse at King’s College hospital, London, in response to the leaked government task report. Said more than half a century on since government inspired motivation messaging exemplified above, yet the parallels of conviction and sentiment are alarmingly striking.

Inspired and highly motivated professionals no doubt provide a frontline service that administers desperately needed care. But a burgeoning older population, with its ever-increasing set of complex clinical conditions, brings with it a need to think beyond a solution underpinned by efforts of human toil alone. As Sir David Nicholson wrote in the 2011 report Innovation Health and Wealth: Accelerating Adoption and Diffusion in the NHS, “Simply doing more of what we have always done is no longer an option. We need to do things differently. Innovation is the way — the only way — we can meet these challenges.”

But to what extent can these words be translated into an everyday reality for health practitioners and patients alike? How might we innovate to better the experiences of patients and medical professionals? In what way could a consideration of needs be met at the level of the engaged individual, from an empathic standpoint, reflecting on a holistic experience and underpinned by evidence-based learning?

The service design approach

The task of identifying what’s wrong with a service is a comparatively easy one. But when it comes to finding ways in which the healthcare service can make a step change, so as to transform its delivery into the kind we all hope for — that we all deserve — the answers are less forthcoming.

The field of primary and secondary care has always been, and continues to be, a mosaic of interrelated services. With new treatment approaches, clinical protocols, and technology-dependent interventions, the system is increasingly more complex in both context and practice. But what is undoubtedly clear is that the provision and receipt of healthcare are fundamentally human experiences. Human moments that we experience in our most vulnerable and compassionate states. Surely, then, when thinking about what changes can be made within a national healthcare system at the level of primary and secondary care, we must first think about the people that navigate these both very public and private worlds: the caregivers and the care ‘consumers’. Yet government-led programmes and initiatives appear to fly in the face of such consideration, often resulting in hasty programme rollouts that fail to consult with those they will most affect.

The core of service design is people. It’s not simply about designing systems for people, but rather designing them with people. Service design offers an empathic approach, one that focuses on real user needs and values instead of aesthetics and form. Ultimately, service design can help the healthcare system make the shift from repeatedly alleviating recurrent symptoms to solving the chronic issues at the core. How would this work? In the case of the cancelled children’s mental health appointments mentioned above, a symptom-focussed solution would be a temporary increase in staff members. But a deeper, more deliberate look into this issue might instead reveal the potential to optimise a fragmented communication channel between the GP and the mental health specialist. The solution to the chronic problem would be sustainable.

At a broader level, service design has the capacity to transform and break down information silos that exist between primary and secondary care management systems. The experience of transferring information across these two levels can be a jarring one, as paper-based secondary care records need to be manually coded into electronic formats in order to integrate with the digital record system of primary care providers. At the moment, every written clinic letter, every diagnosis, every record of procedures undertaken needs to be transferred and systematised by receptionists, leaving space for error and costing taxpayer dollars.

But it doesn’t have to be this way. Taken together, these examples shine a light on the opportunity for service design to facilitate the discovery, definition, development and delivery of new healthcare approaches, through three common methods:

Professional empathy

By offering insight into how both the patient and provider experiences are underpinned by the interactions and communication that take place across the different domains, professional empathy practices can help to break down the barriers that currently create information and sub-culture silos within healthcare systems.

Co-creation

Co-creation in healthcare would mean the systematic involvement and participation of healthcare providers and patients in an iterative generation of ideas and designs towards what ideal healthcare solutions might look like.

Implementation

As humans, we have the capacity to make problems for ourselves. As a smart species, we can create environments that are hugely complicated, so much so as that they can become too complicated for us to even understand how we created them. As Yale Psychology Professor Laurie Santos points out, sometimes our errors are systematic and predictable even in the face of bad consequences. And the result of this? We end up in environments we can’t deal with; and so, it’s no surprise then that at times we mess things up. Implementation allows us to deliver and capture the response to new service propositions and mechanisms through feedback loops as they become part of a wider service ecosystem.

While there is no doubt our “Keep Calm and Carry On” attitude has served us well as a people — through times of adversity and hardship — a prescient glimpse towards the future of healthcare reveals a stark need for change: to not accept the status quo, but instead look to a step change in the way we deliver this vital service. Service design offers a systematic approach that allows both patients and providers to discover and make sense of existing practices, in order to transform them into innovative patient-practitioner solutions that put people at the heart of the service.

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