Health portrait Report

With many thanks to

All the amazing people at the Willow Bank Partnership

Harriet, Ben and the team at live|work

Th e NHS was formed to bring healthcare to every person in the UK regardless of fi nancial or social situation. Th is simple idea has dramatically improved the health of the nation but has also come with a great fi nancial cost, £108 billion per year in 2012. Since the beginning of the NHS, the service has proved to be extremely popular with demand constantly overwhelming supply. Th is has traditionally been met with increasing supply but with budgets reaching their limits the NHS must fi nd ways to provide the same level of service for the same money. On the frontline, GP surgeries are struggling fi rsthand to deal with this high demand and believe a source of the pressure is misuse of services by patients, specifi cally making appointments for minor ailments which could be treated at home or by visiting the pharmacist. Health Portrait is a service design project that looked at the high demand situation faced by the GP surgeries and dove into the problem to understand patient needs and experience. At the same, it was important to understand how the modern surgery works and what it takes to run it. Insights were made after primary research, including interviews and shadowing. Th ese insights led to the design of a new online service for GP practices to connect with their patients called Health Portrait. Th is service would be open between patients and professionals, allowing patients to share family, skills and information through a “portrait” with professionals. Th is “portrait” would provide a richer view of the patient allowing professionals to understand larger issues behind a minor ailment. Th e service would also provide a portal for patients to book consultations (online, email, phone and in person) through a system which suggests the appropriate professional for a person to see. Health Portrait aims to improve the relationship between patients and health professionals in the GP surgery while reducing the patient’s need for face to face consultations.

Summary

Problem Introduction 1

Health as a Concept 5 The History of GP Services 6 Demand Management of GPs 9 Over-Usage of GP Services 10 The Different Element of the NHS 11 Stakeholder Map 12

Patient Lifecycles 15 Patient Lifecycles Hotspots 17 Shadowing GP Surgeries 19 Shadowing Willow Bank Longton 21 Shadowing Willow Bank Meir 23 Findings from Shadowing 25 Shadowing a Health Visitor 27

Navigating the NHS 31 Personal Experience 32 Interview with a Willow Bank Patient 33 Interview Diffi culties 35 Personas 36 Current Service Solutions 39

Problem Introduction

ResearchBackground Information

Primary ResearchBehind the Reception Desk:The Surgery’s Perspective

Primary ResearchSitting in the Waiting Room: The Patient Perspective

Contents List

Insights 42

Initial Idea Generation 47 Short-Term Results Ideas 48 Long-Term Results Ideas 51 Selected Ideas for Development 52 First Co-Design Session 53 Leafl et and Token Concept Development 54 Second Co-Design Session 55 Patient Profi le Concept Development 56 Patient Profi le Concept Testing 57 Patient Profi le Website Testing 59

Health Portrait Overview 63 Storyboard 65 Touchpoint Details 69 Customer Service Journey 77 Consultation Type Journey Map 79 Emis Web 80 Conclusion 81

Insights

ConceptsIdeas, Design and Testing

Final DesignHealth Portrait

1

pro

blem

intr

oduc

tion

“Sometimes you can call at 10 minutes past 8am and the appointments have all gone... you can’t book ahead”

“Urgent appointments that aren’t that urgent, over exaggerated complaints that don’t turn out to be that bad (fl u, cold, rash)”

Problem from the Patient’s PerspectiveThe waiting room, specifi cally the waiting part, is the problem because the doctor has taken on too many patients to try and meet the huge demand. But these people feel lucky to wait as they were one of the few that could get past the busy signal and get an appointments after winning the “lottery” of 8 am rush. At the same time these people had little selection on when to come in.

Problem from the Surgery’s PerspectiveThe constant ringing phone is the problem. Receptionists have to sit on the phone for an hour straight in the morning dealing with the 8am rush and feel terrible turning patients down. Doctors and nurses have there time completely consumed and this leaves little time to get to know patients. Additionally, patients who are turned away may end up at the hospital for emergency care in order to be seen.

Problem Introduction Health Portrait is a project about the relationship between young families and GP practices. Th is relationship is the theme that runs throughout the entire project from initial problem, to research, to the fi nal design solution. Th is project began in collaboration with live|work, a service design consultancy, who had been approached by Willow Bank Surgery group with a problem. Th e problem was simple on the surface, Willow Bank, a partnership of two GP surgeries, were seeing a very high and costly use of GP services and A&E, especially by families with young children, and needed to understand how to shift these patients into a more aff ordable model that is still satisfactory to their health and support needs. Th is was a problem for the surgery but they also understood that their patients were not happy with the current situation either. Patients have to call the surgery between 8 am and 9 am in order to get an appointment or there would be none available. If they were lucky enough to get through the constant busy signal they had very little choice on the time of the appointment. In addition, the Willow Bank Surgery would prefer to be spending time on community health prevention but the professional’s time is being consumed by the health needs of their patients. Th e root of the problem, in the opinion of the people at the surgery, are health issues being brought in that were not that servere. As one professional put it “Urgent appointments that aren’t that urgent”, over exaggerated complaints that don’t turn out to be that bad (fl u, cold, rash). Th rough further research it was found that this problem is not exclusive to Willow Bank but found at surgeries across the UK. In fact, since the founding days of the british health care system there has always been very high demand for this free service from the public and it has always proved diffi cult for the government to budget in order meet this demand (Jones 78). Live|work is a service design consultancy based in the London with over 10 years experience having worked on a wide variety of projects ranging from private to public sector with clients including Orange, BBC, the NHS and many others. Live|work was approached by Willow Bank with their problem and I had the opportunity to come intern at live|work to take on this project. Th e area of public services and healthcare in particular always has been an interest of mine and I was grateful for the opportunity. Willow Bank Partnership is a social enterprise owned owned by the staff across the two surgeries in Stoke-on-Trent. Currently, they run the two GP surgeries with a patient base of 7000 people but would like to have more time to engage the public in proactive and preventative health issues. Th is project is an attempt to try something new at their surgeries in hopes of freeing time to achieve their wider social health goals.

2

prob

lem

intr

oduc

tion

Context ResearchBackground Information

In order to identify families health care needs and how these could be addressed it was important to understand the concept of health. Th e concept of health was explored as a base for this research in a general sense as it was not the major focus. Th e main question for this project was “What is health?” Th rough the research it was found that there are no right or wrong answers of what health is. It will vary from person to person and it is important to understand what health is to that people if you are looking to help them. Here are some defi nitions of health found:

A state of complete physical, mental and social well being and not merely the absence of disease and infi rmity (WHO 1946/84 cited Seedhouse 2001)

Health and disease cannot be defi ned merely in terms of anatomical, physiological or mental attributes. the real measure is the ability of the

individual to function in a manner acceptable to himself and to the group of which he/she is part (Dubos 1959 cited Seedhouse 2001)

By health I mean the power to live a full, adult, living, breathing life, in close contact with what I love … I want to be all that I am capable of becoming

(Mansfi eld 1997 cited Seedhouse 2001)

As these defi nitions demonstrate good health can interpret a variety of ways, from the absence of any disease to the ability to live one’s life in an acceptable manner to them regardless of illness. As good health means diff erent things to diff erent people this has implications for health professionals and healthcare should work with the patient’s priorities and perceptions of health. Perceptions of health may be relative to age, life situation, life experiences, cultural infl uences etc. (Seedhouse 1998) Health care can also be viewed outside of the person. Health does not exist only in the individual: there are elements outside the individual which also make up health. Th ey don’t just infl uence health, they are a part of health itself and they include aspects such as emotional, psychological, physical, sexual dimensions but also social, environmental, and spiritual dimensions. (Seedhouse 1998) Individuals put emphasis on diff erent aspects according to personal priorities. For example: a sense of well being may be the most important factor of health for one person. All of this has an important impact on whether a parent decides to bring a child into to receive healthcare from the surgery. If the parent believes that any illness is bad health and that only doctors should treat bad health then they might overuse the surgery’s services. A person’s defi nition of health has impacts on how and when the access the services available to them needs to be considered.

Context Reserch

Health as a Concept

5

res

earc

h

Th e general practice surgery is at the centre of the National Health Service, the NHS, in the UK. Th e government has shaped the GP surgery’s role in the health care system to be the primary supplier of healthcare and the main source to shape people use of the NHS. Th is position is unique in the NHS and comes as a result of the General Practitioner’s long tradition and place in society. Society has had people providing medical treatments for thousands of years but the GP, as we know it today, has its roots in the 1800’s.(Jones 68) If you were born 150 years ago in the UK, your relationship with the doctor or GP would depend a great deal on a variety of factors. Th e main factor infl uencing whether or not you saw a doctor for a medical problem was money. GPs were like any other profession, such as lawyers or accountants, and in order to access their services you had to pay. Since doctors ran their practices like businesses it made sense for them to set up their practices in wealthy neighbourhoods where more clients could aff ord their services.(Timmins 89) Th is lead to location, the other main factor which aff ected one’s access to a GP. Th ere might not be a doctor in the neighbourhood were a common worker in a larger city or town would live but these people could access one more easily than people in the country could. Medical access in the countryside, especially the poorer areas, was almost impossible and required traveling great distances. However, at this time there were other healthcare professionals available to people with less money. Midwives were commonly available for the diffi cult job of delivering babies and their specialized skills in this area meant a person would be in relatively good hands. At the same time, voluntary hospitals started opening to care for those people who could not aff ord to pay for medical treatment. Th ese hospitals mainly cared for the poor who had sustained injuries and could return to work if treated, excluding women, children, and disabled people. (Timmins 96)

The Royal Waterloo Hospital was founded in 1812 and was one of two hospitals in

London to care for women and children. It had just 80 beds.

Source: personal photo

As the tiling on the building shows, this hospital was supported by voluntary contributions from wealthy

donators. These voluntary hospitals were the only source of professional health care for many of London’s citizens.


Context Research

The History of the GP Services

6

rese

arch

Th e turn of the century saw the conditions improve slightly as better paying jobs saw more people being able to aff ord some primary care but it was still far from the majority. In 1911 the government realized the importance of keeping its workforce healthy and created the National Insurance Act. Th is act required workers to pay a portion of their salary into a fund in exchange for access to GPs and hospitals. Th is act excluded their spouses and children. As the decades progressed calls were made to make this scheme available for all and free of charge. (Jones 123) Th e voluntary hospitals supported this plan as they were fi nding it increasingly diffi cult to gather donations to keep up with the increasing costs of caring for the sick. On the other hand, the GP’s resisted this movement vigorously as they did not want to become civil servant and wanted to maintain their independence. (Timmins 99) After World War 2 the nation was feeling great unity and camaraderie and the GPs were on the wrong side of public opinion. Building upon the 1942 Beveridge report, which identifi ed a health service as one of fi ve “giants” of a social security system, Aneurin Bevan brought the National Health Service Act (1946) to government and it was passed, thus starting the NHS. In order to get the GPs support he allowed them to operate as independent contractors rather than salaried government workers, a condition which exists to this day. Th e NHS was set up as a universal health care system which is free of charge at point of use and available to every citizen in the country. Th e GPs were designed to the be the ‘gatekeepers’ to other services in the service such as the hospital thus people were required to register at a GP to access the NHS. Th e new service was a huge success and 90% of the population was registered at a GP within a month of starting. (Jones 133) Th e NHS has continued to evolve through the years most signifi cantly during the early 1970’s and the 1980’s under Th atcher. Th is service has made signifi cant advances in the health of the nation. Th e diagrams on the next page show life expectancy has increased by 15 years for the average UK citizen and infant mortality has declined by 85%. (DOH 2009) However, these changes have come at a fi nancial cost as the next diagram shows the cost to run the NHS has increased by 100 billion per year after being adjusted for infl ation.

Th is huge increase in cost has been a constant struggle for the NHS since its inception. In the fi rst year of operation the budget had to be doubled as demand was higher than expected. It was thought that once an initial rush of patients had been treated for existing untreated conditions the demand would fall but it never did and has actually increased ever since.(Jones 161) Th is problem which has existed since day one of the NHS is what this project investigated. How can you manage demand for a free service which is very popular? Currently, the NHS is the fi fth largest employer in the world with 1.8 million employees and is the oldest, largest public health service in the world. However, it is undergoing massive changes as it looks to serve the existing

“There is a sheer increase due to people getting things they need but could not afford before.” (Public Records Offi ce, 1948 cited Jones 2008)

7

res

earc

h

The NHS has improved the lives of millions of people. The health advances have brought more people into

this world and extended the lives of many others.

Source: Department of Health (2009)

However, during this same time the cost of running

the NHS has increase dramatically. These budgets

may have reached their peak and now the NHS must increase services

without increasing spending.

Source: Department of Health (2009)

Life Expectancy in UK

Infant Mortality in UK

Male

1948: 60 yearsToday: 75 years

(Deaths per 1,000 live births)

1948: 34

Today: 5

Female

1948: 65 yearsToday: 80 years

Health Care Budget in UK(Adjusted for inflation)

1948: £9 Billion Today: £106 Billion

population with less resources. Th e budget has been frozen fi ve years since 2011 eff ectively meaning it must fi nd £20 billion in savings over that time to continue to operate.(Butler 2012) Th is has led to changes in the way the whole service is going to be structured and run. However, at its core it still has the same problem since it began which is an issue of public demand. Th is project is an optimistic one. It looks at a system, formed from an idea that healthcare should be accessible for everyone regardless of fi nancial situation but is currently under great strain and says “this can and must work”.

8

rese

arch

Th e problem of high demand for the services provided by the GP surgery have led to a number of strategies and attempts to deal with the issue. Some techniques, such as the appointment system, have evolved over time and diff erent surgeries do these in their own unique way. Other ideas have centred around a marketing strategy to help educated the patients about eff ective use.

Appointment SystemsTh e early appointment systems in the 1800’s for the more wealthy patients required someone from the household to call for the GP when needed and the GP would visit the house of the patient the majority of the time. With the start of the NHS it became ineffi cient for the GP to visit the long list of patients and patients were mostly required to come to the offi ce.(Jones 111) Most acute illness was dealt with on a fi rst come, fi rst served basis and resulted in long waits. As the telephone became more pervasive GP surgeries began taking advanced bookings over the telephone. However this created its own issues as now it is not uncommon for every appointment to be gone within an hour of a surgery opening.(Martin, Dunbar-Rees 2012) Some practices have begun taking bookings over the internet but only for advanced booking for non-urgent reasons.

Additional HelpNurses have long been a part of the health care system and their role in whole NHS has been constantantly increasing. Th is is mainly due to it being cost eff ective to have nurses helping doctors with certain tasks thus allowing more patients to be seen. Th e nurses role in the GP surgery has grown signifi cantly over the years with many roles being created such as: Nurse Practitioner, Practice Nurse, and Health Care Support Worker. Th ese diff erent levels can take care of a wide variety of issues, by some estimate up to 70% of all cases in a GP surgery.(Seedhouse 2001) However, these nurses are not well understood by patients and can cause confusion. Th is will be explored further in a later chapter.

Self-Care PromotionTh e therory of self-care proposes that if patients had more ability to look after themselves during routine illnesses, such as coughs and colds, then the GP would have more time to care for more serious illnesses. Self care can have limited eff ect though, one study in 1967 half the patients in one practice who were given a self care book. About 60% of people felt that the book made them more able to deal with a problem themselves. However, the consultations rates for those who read the book and those who did not were nearly identical.(Platts, Mitton, Boniface et al. 2005) Th is study showed that promotion and education may have limited eff ect on patient’s use of health care services.

Th ese are a few of the major eff orts to deal with the demand of patients either through prevention or management. It is not a complete list, but gives a glimpse into kinds of eff orts that have been made and what can be learned.

Nurses have played an important role to increase

the capacity for patients in GP practices.

Source: nhs.co.uk

The fi rst come, fi rst serve wating room is an primative

demand management.Source: nhs.co.uk

Context Research

Demand Management by GPs

9

res

earc

h

Th e problem of patient misuse of services isn’t limited to Willow Bank, it is also occurring across the country. A recent IMS Health study was conducted that looked at the GP appointment data for issues that could be resolved at home. Th ese statistics show this is a national issue and represents at least 2% of NHS spending (Tisman 2008)

Context Research

Over-Usage of GP Services

51 MILLION

18%

which works out to ...

which works out to ...

common reasons for appointments...

10

res

earc

h

(Tisman 2008)

Th e NHS is an extremely large and complex organization. In order to understand the role of the GP it is important to have a little overview of the diff erent levels of services provided in the system. Th ese are important to understand as people have options when deciding on the healthcare they wish to receive and those decisions have consequences which will be expanded upon in a later section. Below are the major services:

Hospital As a patient you can’t just access the services of the hospital. You must either be referred by another professional for a reason or you may be admitted after being treated at the Accident & Emergency (A&E). Th e hospital handles the most serious and urgent cases.

Accident & EmergencyTh e A&E is a part of some hospitals and is designed to handle patients with urgent issues that may result in serious conditions or death. However, people tend to overuse this service with non-serious issues due to the 24 hour availability of the service and the fact that all patients there will be seen by a doctor.

Urgent Care CentresSimilar to A&E these centres are meant to handle urgent case but those that will not result in death, such as broken bones, cuts, and injuries. Th ere are not many of these centres and they are not well known.

Out of Hours Clinics and Walk In ClinicsTh ese clinics are meant to handle patients with illnesses that require the attention of a GP but operate at late night or when their GP surgery is out of appointments. Th ese facilities are relatively new to improve the burden on the A&E and people have yet to become accustomed to them.

GP SurgeryA great deal has be said about surgeries already but in short they are meant to be the gatekeepers to the NHS system. A patient is required to attend before seeking specialist services or hospital care. Th e GP surgery also has computer data on the usage and conditions of its patients allowing management of the patients usage.

SpecialistsTh ere are a wide variety of specialist available to look at every aspect of the human body. Generally a referral is needed for these specialist in order to ensure that they see only the patient who need the services.

All of the services described above have a few more sub-options resulting in dozens of types of health professionals that a patient can see. Th is has its advantages in allowing for very specialized work to be done in a cost eff ective way but it also can be challenging for people, including NHS staff , to navigate.

Context Research

The Different Elements of the NHS

11

res

earc

h

Context Research

Stakeholder Map

patients

general practitioners

health visitors

community

NHS

business managers

sure start centres

schoolnurses

nursery

primary

secondary

support groups

receptionistsnurses

12

res

earc

h

Primary ResearchBehind the Reception Desk: The Surgery’s Perspective

GP Visit Cycle

GP Relationship Cycle

General Young Family Cycle

ConfirmCheck at Home

Test at GP SurgeryEntered into system

GP

Check UpsGet due date

Scan at 12 weeks Scan at 20 weeks

Hospital

BirthBaby is born

Usually at hospital

Hospital / Midwife

First 8 WeeksChecks at 10 days

and 8 weeks

Health Visitor

RegisterGo to office

Fill out paperworkSubmit

EvaluateEvaluateInform

PreparePrepare Child

Get DocsTravel

PrepareEducation on birthParenting advice

MIdwife

New CaseMake appointment

TravelWait

EvaluateTreatment

2nd ConsultMake Appointment

Travel Wait

EvaluateAdjust

DecideCheck InformationMake Appointment

Plan

SelectionFind GPs in areaAssess Options

Choose GP

Primary Research

Patient Lifecycles

15

prim

ary

rese

arch

ResolutionIllness is resolvedStop going to GP

Ongoing ConsultCheck Appointment

TravelWait

EvaluateAdjust

DisagreementCheck other sources

Raise with doctorEvaluationTreatment

ReferralEvaluateReferral

Guidance

Second ChildPregnancy

BirthChecks

First 6 MonthsCheck at 6 months

Health Visitor

First YearCheck at 1 year

Health Visitor

Second YearCheck at 2 1/2 years

Health Visitor

SchoolChecks starting at 5

School Nurse

GP OfficeTell Reception

WaitDescribe Symptoms

EvaluationDiscuss Advice

Follow Up VisitDiscussEvaluateAdjust

After VisitPharmacyTreatment

ReflectCriticize

Patient lifecycles were produced in order to understand where to focus when researching and interviewing patients. These lifecycles were developed based on initial conversations with parents to identify the key stages and steps at each level.

16

prim

ary

rese

arch

Primary Research

Patient Lifecycle Hot Spots Th e lifecycle was printed out on sticky notes, to allow rearrangement, and brought to Willow Bank Surgery in Stoke-on-Trent. A brainstorming session was held working with some of the staff to identify key stages in a young family’s lifecycle along with problem areas in the general appointment service journey. Interesting points were raised regarding the relationship cycle which fi ts between the two. Additional issues that didn’t fi t on the lifecycles but needed further exploration were written on sticky notes and added to the wall.

Working with staff was useful as it allowed for areas of interest to come to surface quickly.Source: Personal Photo

Hot spots were identifi ed with sticky tags. Visually it became easy to see areas of interest to explore.Source: Personal Photo

17

prim

ary

rese

arch

Important Stages and Steps to Investigate

• First 8 weeks of child’s life is a very high use period• 50% of children do not come in for vaccines at fi rst• Between the 1st and 2nd year is an interesting time• Health Visitor and GP only interact over problems• Second child usually means double the appointments• Why do people register with Willow Bank?• There is a New Patient introduction to register patients • Long term conditions have big effect on usage• What are people’s skill set?• What are people’s social health care support?• Making appointments is fi lled with diffi culty• No options for people who get sick in the afternoon• Booking follow-up appointments can be confusing

18

prim

ary

rese

arch

Primary Research

Shadowing GP Surgeries Two days were spent shadowing the two Willow Bank surgeries in order to understand how service works and the challenges they face. Th e two surgeries are located in Longton and Meir which are boroughs of Stoke-on-Trent. Although they are roughly 2 miles apart they have dramatically diff erent client bases and challenges. It was extremely interesting spending time with the staff and seeing the diffi culties that they face. A great deal was learned during this time but another week could have been spent in the practices learning all the details. Th e interaction and requests from patients can be extremely complex with needs far beyond what the practices can off er.

2004

2005

2008

2006

2011

The PCT (local health authority) decides there is a need for a new GP practice in Longton and opens the practice itself. The PCT hires the doctors and runs the practice on its own.

Willow Bank History

After running the Longton branch for over a year, the PCT decides they shouldn’t be running the GP practices and puts the practice up for tender.

A small group of people working at Longton form a Community Interest Group to run Longton. The social enterprise wins the tender and Willow Bank Longton is formed.

The PCT decides there is a need for new GP practice in Meir and puts out a tender for the practice. Willow Bank bids for it and wins, setting up the new practice in portable buildings.

Willow Bank Meir moves into a brand new building which is a health centre with other health care services in it, such as blood work.

19

prim

ary

rese

arch

Willow Bank LongtonOverview• 8:30 - 17:00 Monday to Friday• Set up inside old garage• Day-of appointments fi lled by 12pm

Patients• 3000 Patients• Mainly South Asian• Some Czech• Practice has built up trust overtime

Issues• Fever can mean death in previous countries• Belief that british health care can fi x all• Friday afternoon busiest (weekend closed)

Willow Bank MeirOverview• 8:00 - 20:00 Monday to Saturday• New shared building• Day-of appointments fi lled by 9am

Patients• 4000 Patients• Mainly lower income white British people• Some drug users• More young parents

Issues• Parents are overly nervous • Issues of state dependance• Monday morning busiest

20

prim

ary

rese

arch

Willow Bank Longton’s building is an old automotive garage which makes it quite dark inside. The location is not very accessible by public transit and most patients walk or drive to the surgery.

The waiting room is tidy with lots of chairs. There are a fair amount of posters on the wall which make the room feel somewhat cluttered but that is not unusual for NHS surgeries.

The reception area is directly connected to the room and all three receptionist are able to see who is standing at the desk. This allows for some continuity for patients and reception staff.

Primary Research

Shadowing Willow Bank Longton

21

prim

ary

rese

arch

One of the receptionists at Longton is a Carer for her mother and learned about a number

of NHS programs for Carers from working at Willow Bank. In order to help other Carers

learn about these programs the receptionist created these badges that the staff wears.

These appointment cards are given out to patients. Willow Bank has a system were if a

patient misses 3 appointments they recieve a warning letter from the management. Willow

Bank also has the right to “fi re” a patient. However, missed appointments are not

common with an estimated 3 or 4 a week.

Like most GPs, Willow Bank runs a Patient Participation Group to get input from their

patients on what to improve. One obivious example was there was no sign outside

Willow Bank and the surgery was always looking for new patients. The patients

suggested this would be an obivious form of advertising and help people fi nd the location.

22

prim

ary

rese

arch

Willow Bank Meir has a brand new building which they share with a couple of other GP practices and other health services. The accessiblity is simlar to Longton with one bus so most patients drive or walk.

The waiting room is bright with lots of space and plenty of seating. The posters are restricted to one board and leave the space feeling clean.

The reception area is split between the front and the back. Only one receptionist is up front and it is not the same receptionist that books in appointments in the morning. Additionally, the patients check in with a machine meaning there is very little continuity for patients.

Primary Research

Shadowing Willow Bank Meir

23

prim

ary

rese

arch

Patient check in for their appointment at touch screen next to reception. Most people

seemed to navigate the screens quite well but there was some diffi culty. The screens mean some people rarely have face to face contact

with the receptionists.

The reception has this cheat sheet to help understand the different professional and

the illnesses they handle at the practice. The roles of the professionals are complicated

and its diffi cult to understand. Also, this cheat sheet barely helps as it is fi lled with technical

terms and shows the doctor only treating 4 conditions while the nurse can do dozens.

Screens let patients know what rooms they should go to in order to see the doctor. In between patients the screen show health

tips and advice.

24

prim

ary

rese

arch

Primary Research

Findings from Shadowing

The Pyramid of CareThis was one of the most important fi ndings from the trip to Willow Bank. It is a diagram that was drawn fi rst by a Nurse Practitioner that shows the 5 different levels of professionals available at Willow Bank. It is arranged like a pyramid because at the bottom is the person with the widest experience and training, the GP, and at the top is the person with the narrowest training, Health Care Support Worker. This shows that there is far more than just a GP at the GP surgery and each professional has their own area of expertise.

Responsiblity for NavigationThese different levels of care for different ailments can make it quite complicated to determine what patient should see what professional. Patients have little education on the suitability of different options. Reception staff have no training and must learn on the job which professional should handle different conditions. There is a disconnect between the front responsibility for bookings and back end knowledge of the appropriate professionals.

Patients PerceptionThe GP surgery has undergone great efforts to have a variety of people to share the workload. However, the patient perceives the GP surgery to be mainly a visit to the GP and nurses are a lesser option for most. In reality each of the professionals have their own roles and it is important to spread the workload effi ciently and effectively.

receptionists patients GPs nurses managers

knowledge of different levels of care available

responsiblity for booking appointments for care

high

low knowledge of different levels of care available

responsiblity for booking appointments for care

high

low

front end back end

GP

GP

nursepractitioner

practicenurse

clinic nurse

care support worker

nurses

patients perception practice reality

General Practitioner

Nurse Practitioner

Practice Nurse

Clinic RoomNurse

CareSupportWorker

higher level of training and experience

lower level of training and experience

Th e key fi ndings from the 2 days at Willow Bank are shown here. Th e major insight was that Willow Bank is a very complex and busy place. Everyday close to a dozen people handle around 70 appointments with patients, dozens of prescriptions, follow ups with hospitals, booking of appointments and a small mountain of paperwork. Another observation is that peoples health needs are quite numerous and complex with hundreds of diff erent codes to register peoples conditions. Finally, the practice has evolved to spread this workload but this design has led to a complexity that receptionist and patients can fi nd diffi cult to navigate and default to their habits of previous experiences.

25

prim

ary

rese

arch

Same Day Appointments OfferedNot all appointments are the same as previously mentioned. There are up to 7 different kinds of appointments available to patients. Starting at 8 am phone rang for close to 1 hour straight. The GP spots fi lled quickly and the receptionist had to resort to other options to try and meet demand. Spots with the nurse practitioner were offered and the phase “Is it something the Nurse Practitioner can help you with?” was used. This phrase didn’t put the patient on the spot or dig into their private life and was well received.

Advanced Appointment AvailablityThe advanced appointments are available up to 4 weeks ahead of time. However, there is great variety between when the earliest appointment is available. As the charts shows, at Longton you can see a doctor within a couple of days. However, if you want to see Dr. Gregon at Meir you could have to wait a couple of weeks.

Appointment Types per SessionAppointments are broken down into 3 rough categories. There are advanced booking which patients can request for non-urgent things such as check ups or help to quit smoking. Then there are the same day appointments which are for more urgent matters, mainly acute illnesses. The same day appointment are locked until 8am when the open for reception to book them. Finally, one appointment is saved for an urgent patient who might phone in the afternoon. This urgent spot is usually saved for a child.

General Practitioner

8:00 am

9:30 am

General PractitionerNurse Practitioner

Phone TriageNurse Practitioner

3 appointments for advanced booking

12 same day appointments unlock at 8:30 am on day(Doctor can request for spots to be unlocked)

1 urgent end of day saved

1 week 2 weeks 3 weeks 4 weeks

Earliest atLongtonEarliest atMeir (any doctor)Earliest atMeir (Dr Gregon)Advanced atAppointments can be booked 4 weeks ahead

26

prim

ary

rese

arch

Primary Research

Shadowing a Health Visitor A day was spent with Lynn, a health visitor in Meir, Stoke-on-Trent in order to understand other perspectives in family health care. A health visitor is responsible for the monitoring of the development of the new born babies in their area and visits with the children at age milestones. Typical visits occur a couple weeks after birth, 6 months, 1 year and 2 years. After this the child’s development is shifted to the school nurse. I went on two house visits with Lynn as she met with families. Th e major takeaway from these visits was that the health visitor is responsible for the full development of the child not just the health aspect as with the GP. Th is means check for physical development, mental development and ensuring that the environment they are being raised in is acceptable. Lynn said she wants to ensure that these children have the opportunity to reach their full potential. Th e most interesting part of this was the gentle way Lynn would check on the environment the child is being raised in. A question she always asks is “Who is living in the home with you?”. She explained that if the home environment is stable over time it is a good sign of positive parenting. Lynn would also ask about the other children and check on how they are doing. She later explained that every question helps you paint a picture of that person and determine if that person needs more attention. All this information means Lynn knows these families extremely well and this knowledge helps her do her job of ensuring these children have the most opportunity available to them.

health visitors

developmentenvironment

health

The health visitor is responsible for the full development of the child. This includes health, mental development and the environment they are raised in.

27

prim

ary

rese

arch

28

prim

ary

rese

arch

Primary Research

Navigating the NHS An important issue that came forward from talking with people and researching the NHS, it was simply, “Where do you go when you get sick?”. Th is straightforward question was actually anything but simple. As explained in the context section there are at least 6 diff erent places people can go to for help and then further options inside each of those. Most people talked to have their own way of dealing with being sick and there was no universal system. Some would wait any illness for three days but after that an appointment would be made. Other would get appointments quickly as they don’t have time to be sick. Still other would resist the doctor completely. And this was just for a cold or fl u. When things become more complicated it becomes diffi cult to determine what would should be seen at the A&E and what could go to pharmacist. For example, NHS has a game to play to see what service a patient should go to. One question was about diffi culty breathing during the day. I picked the GP in a couple days and the correct answer was the A&E. Something I perceived to be harmless could be very serious. (www.miltonkeynesccg.nhs.uk/choosewellgame/) To deal with this there has been a few attempts to help people through this process. Below are a couple of examples. For both it is actually quite diffi cult to judge the eff ectiveness because of the variability of the each case but they are interesting to review.

Choose Well is a campaign to communicate the different levels of care using a graphical

treatment. The campaign has been well received in the for its graphic design but the

effect on the public is unknown currently.Source: choosewell.org.uk

NHS Direct is 24 hour phone line and website that provides health advice and reassurance. Users have the opportunity to talk to nurses

for health advice and navigation. However, the effectiveness has been questioned and recently reduced its staff numbers by 50%

Source: nhs.co.uk

31

prim

ary

rese

arch

I joined my local surgery to go through the process of registration. My NHS card

came with this letter explaining the different services available and when to use the

services. The information was useful but I failed to notice it upon receiving the letter.

Source: nhs.co.uk

Primary Research

Personal Experience In order to understand the NHS better I signed up at my local GP surgery. Th is helped me see the experience through the patients eyes and to relate to certain aspects they are talking about. I started by searching on NHS Choices, this is a website which lets you see the practices around you and provides reviews from other patients to help you decide. I picked one based on proximity and generally favorable reviews from other patients. After picking, I walked to the surgery and asked to register. Th e receptionist handed me a sheet to fi ll out and sent me to the waiting room to fi ll it out. Th e room was quite dark and fi lled with posters and leafl ets. Th e form was easy to fi ll out and asked standard questions along with my medical history. After handing in the form, I asked about the appointment system. Th e receptionist explained that I would have to phone in the morning for an urgent problem and I could call ahead for advanced appointments. Th ey gave me a card with basic information about the practice like opening hours. After a month I received my NHS card which let me access other services. Along with the card came a letter which explained the diff erent services provided by the NHS and when to use them. Overall the experience was good but there was certainly room for improvement, especially introducing the services provided by the surgery along with basic information.

32

prim

ary

rese

arch

Primary Research

Interview with Willow Bank Patient

An interview was conducted with Steph, a Willow Bank patient, in order to get the patient viewpoint of the services along with their health care usage. Th e interview was very interesting and provided real insights into what its like to care for children’s health as well as adults. Th e interview followed a guide which can be found in the appendix and lasted approximately an hour and a half. Conducting the interview was the business manager at Willow Bank and myself. Steph and her family have recently moved to Stoke after life on an army base in Germany. Her past experiences on the army base and from her childhood upbringing form the bases for her health knowledge, which she feels quite confi dent about. She will usually wait out any illness for 24 hours as she doesn’t want to “waste people’s time”, including her own and uses old wives tales to treat issues. However, once she has (self ) diagnosed the problem and has decided it needs addressing she “keeps on and on to get the outcome you want”. She has adistrust of the doctors and likes it when they “tell it how it is” Sonya visits Willow Bank most as it is the closest and only resorts to the walk-in clinic if she can’t get an appointment at Willow Bank. She lacks information about the appointment booking system and has never been off ered an advanced appointment, even though most of her personal appointments are non-urgent and preventative. Karen has been seeing an Outreach Worker for speech and behavioural issues and Steph really appreciates the support, “She’s been a lifesaver”. It is a part of a Positive Parenting Programme. Steph is seen by her friends as a health “resource” and receives texts from her friends asking about their children’s health. In conclusion, Karen is a confi dent user of health services and tends to diagnose the problem herself and views the GP as a gatekeeper to the treatment she wants. Th is interview was the major source for one of the personas shown.

• Interview with Steph, 25 • Lives with husband, 29• They have two children• Karen is two and half• Samuel is 18 months• Registered early 2011• Vaccinations up to date• Medium users

33

prim

ary

rese

arch

“My friend always text with photo’s of whatever’s wrong with their kids.”

“I think I just picked it (health knowledge) up from my Gran to be honest, old wives tales. I think thats how her mother did it.”

“I only go to the doctors when I know what I want. There is no point in going otherwise or

you’re just wasting peoples time.”

“A few times we have debated bringing my youngest to A&E but we decided we will phone the doctors tomorrow

because its not really, really bad and we don’t want to waste peoples time... in the end we ended up going to the Walk In Clinic in Hanley because we couldn’t get the appointment”

“If you phone up at 8 o’clock they don’t have appointments till 11 or 12 o’clock and it’s like “eh?”, I phoned dead-on 8

o’clock so I should get it around that time”

“They say “sorry we don’t have appointments with the doctor can you take the nurse.” I’ll have to won’t I”

“Doctors get sick of me, believe me... you have to keep on and on and on and on and then you get the outcome that you want. I eventually

get, not so much get my own way, but the outcome that I wanted to”

“Sometimes you can be 10 minutes past 8 am and they (appointments) have all gone... you can’t book

ahead, I’ve never been able to book ahead.”

34

prim

ary

rese

arch

Primary Research

Interview Diffi culties Th e one interview was very insightful for the development of the project and it was planned to have at least 4 in order to get a balanced view perspectives. However, this proved to more diffi cult than predicted as patients didn’t answer phones and a couple patients that did accept an interview backed out at the last minute. It was felt that a cash incentive would have increased the number of uptakes but the surgery was not comfortable with this and time ran out. Th is was a disappointment as a lot of time was spent designing the interview and paper based task which are seen below. Th e interview was done in three main sections which were: • What is your relationship with Willow Bank?• How do you decide you need some medical assistance?• Where do you go when you decide you need that assistance? Th ese questions would have helped to understand the patients thought process before, during and after a service encounter with the GP surgery. Th e lack of interviews did provide some insights though. First, it was interesting that people demanded a great deal from the surgery but when the surgery ask for something the patients were not willing to share. It shows a patient belief that the practice being something to be used and not a mutual relationship. At the same time, the view into the patient’s life was very interesting for everyone at the practice and a question was raised “what if the practice could know this much about every patient?

An interview guide was designed to be used for the meetings with patients. It included a discussion guide

along with paper based tasks: “Your Family Health History”, “Your Health support resources” and “Your last

visit to... “ see the appendix for copies of these.

35

prim

ary

rese

arch

Primary Research

Personas Personas were developed based on the interview along with interesting stories about patients lives learned from time with the health visitor. Th ese pesonas help paint a picture of the diff erent reasons people might be coming into the practice. It became clear from just a few stories people usage has more to do with their beliefs and personal situation rather than any physical problem.

The Self-Confi dent Parent• young mother with working husband• high self-confi dence• low stress

Background StoryPoor past experiences have eroded her confi dence in health care professionals. She feels her life experience to this point has given her enough health knowledge to handle certain conditions. Sometimes this results in repeat visits with health care professionals in order to get the outcomes she desires.

ExampleHer son has a cough which rattles when she listens. She has decided this is an infection and only will clear with the use of antibiotics and books an urgent appointment with the GP. Current health thinking is that the use of antibiotics should be avoided if possible however the GP doesn’t communicate this to her and sends her away without alternative treatment. Unsatisfi ed, she returns 3 more times to until she gets the drugs she believes will remedy the situation. Feeling vindicated, her confi dence in professionals is further eroded.

36

prim

ary

rese

arch

The Dependant Parent• young single mother • low self-confi dence• medium stress

Background StoryThe dependant parent had a diffi cult childhood. Going to public school with dyslexia has destroyed her self-confi dence as she routinely failed tests and was mocked by her classmates. She doesn’t believe she is capable of handling any challenge put her way.

ExampleOur parent wakes in the morning to fi nd her 2 year old is not feeling well and is warm to touch. Unsure of what to do she phones the practice to book an urgent appointment, knowing if she doesn’t exaggerate she won’t get an appointment. Upon seeing the GP, she is given a diagnosis of the fl u and is given instructions to hydrate and monitor temperature. Later that night her child wakes from the fever and is unwell but generally alert. Having no faith in her ability to handle the situation she goes to straight to the A&E as it is the only service she knows that is open at this time. The doctor at the A&E sees the child and give her the same instructions within 18 hours of seeing GP.

37

prim

ary

rese

arch

The Anxious Parent• young father with working wife• rattled self-confi dence• high stress

Background StoryThe anxious parent has had his life turned upside down by a layoff 8 months ago from his job of 9 years. Future economic uncertainty has made him unsure of everything as his life decisions up to this point are now in question. How can he trust himself with the lives of his children?

Example of Appointment MakingWhile spending the morning at the park with his children he notices his son has rash on his arm. He takes a look thinks it is probably nothing and they continue with their day. By the afternoon he has checked it many times and it doesn’t seem to be going away. He goes to the internet to look for reassurance but instead the opposite happens. He calls the surgery demanding an emergency appointment as he is convinced it is meningitis. The surgery makes room for the child and squeezes him in at the end of the day only to determine it is a simple reaction to a plant in the park.

38

prim

ary

rese

arch

Sherpa This service is based in New York City and acknowledges the health care system is complicated to navigate. As a member of their service, you call them fi rst when you have a health care issue and they guide you to correct level of care, saving you time. They can also get users to do steps before a trip to the doctor, such as blood work, to save steps in the journey. Healthcare is private in the USA so cost effi ciency is at play here for the service provider.

Sky Customer Service Similar to the GP practice, customer service centres can get huge volumes of phones calls for information available on the website already. To try and reduce the calls, the website asks you to put in the reason for your call before they give you the phone number. Once you enter the reason, links to articles which may help your situation are displayed. This may let some users solve the issue on their own.

Primary Research

Current Service Solutions Here is some examples of other services or parts of services which were researched. Th e examples provided insights into the range of options and techinques being used both in the private and the public sectors.

39

prim

ary

rese

arch

care 4 care This service allows people to bank time they spend helping elderly people and use that time to receive care when they are older. The service allows elderly peoples needs to be met outside the traditional model of public care. The function of this service does not inform this project directly but the idea that needs can be met outside the traditional setting is useful.

NHS Parents This text message service sends new mothers a text message every week from the day their child is born. It gives timely advice on the stages of a child development and signs to look out for. It also gives advice on the mothers health care preventing complications which could then impact the babies care.

40

prim

ary

rese

arch

Research

Insights

Evaluate Arrive at GPAppointment Check In

43

ins

ight

s

Patients and reception staff have diffi culty navigating the many levels of nurses and GPs.

Supporting Evidence:Shadowing the surgery and talking with patients led to this insight. Talking with reception staff it became clear that they recieve no training on what each professional can handle.

Appointments are percieved to be most valuable when with the GP, nurses are seen as secondary.

Supporting Evidence:This insight was fi rst considered after talking with reception and confi rmed from talking with patients. Patients had little knowledge about the ablities of the nurses and nurse practitioners.

Patients varying histories and situations affect their usage of services provided by the surgery.

Supporting Evidence:Patient interview and talking with the health visitor provided this insight. In particular, the health visitor knew a great deal about the patients in the area and the issues affecting them.

SymptomsReview History Action Self Care

44

insi

ghts

The time presure on appointments makes it diffi cult for professionals learn about patients background.

Supporting Evidence:Appointments are 10 minutes and there is constant pressure to be quicker. This leaves little time to discuss anything outside the reason specifi cally mentioned regardless of best intentions.

It is diffi cult to deliver treatment advice and prevention information to patients.

Supporting Evidence:Patients expressed diffi culty remembering diagnosis and treatment advice after leaving the offi ce. Professionals will print out information for some patients but no patient accessible record is available.

Concepts

Initial Idea Generation Th e insights from the conclusion of the research phase generated plenty of inspiration for ideas. Th ere was enough of concrete information in order to improve small aspects of the service on a day to day basis with “quick fi xes”. Th ere was less evidence, due to the lack of interviews, to support larger, long term ideas which would really change the levels of demand so it was decided to work with what was available and test ideas in the practice. Th e ideas were also ran against a framework to see if they were managing the demand or reducing it.

1. Manage the demandImprove the way in which demand for services is managed through improved systems and/or better understanding of the systems by staff or by patients.

2. Reduce the DemandDesign ways to reduce the need for families to want the doctor appointment as their fi rst port of call when they have a medical issue.

Th ese distinctions were useful in understanding the potential of the idea as in the end it was much more desirable to reduce the demand rather than manage it. Th e ideas came from everyone who was involved in the project and went through some quick development before being drawn up and present back to the surgery to get feedback on the feasibility and the possible impact. As mentioned, diff erent ideas were clustered into short term results and longer term results solutions. Generally short term results ideas were quicker to develop and test but generally managed demand rather than reduce it. Longer term ideas required more time to see the eff ect and required more development to test. Th e hope was that these ideas could be tested in Willow Bank surgeries and the eff ectiveness could be validated before major investments. Th ere was great value in working with the surgery to see which ideas could work as they know what has been tried before and what could make a real impact to the problem they were seeing. Th is also allowed for aspects of one idea to be blended with another which was interesting process to be apart of.

47

con

epts

Concepts

Short-Term Results IdeasReferral Card

A referral card to help the receptionists know when a doctor has requested a follow up and when it should be scheduled.

One of the receptionist mentioned that one of doctors used to do this but has stopped. She found it very useful to have the confi rmation as she doesn’t want to confront patients over this.Could be a printed card that is fi lled in or a token system that could be reused, saving paper and printing costs.

Sell the Nurse Practitioners

Promote the advantages of the Nurse Practitioners, such as extra time and prescriptions, not just what ailments they can treat.

Currently the NPs are viewed as a last resort by patients but NPs are able (and extremely willing) to handle a wide variety of issues. They also have more time for the patients, can prescribe, help patients with education and have quick access to the doctors. Patients are currently unaware of these services which could free up doctors time.

Review Appointment Order

Offer more than just a doctors appointment to the fi rst people that get through on phone in the morning.

Currently, the fi rst patients are given doctors appointments without question. Once doctors appointments are gone the patients are offered nurses and fi nally callbacks from a doctor. These are not being given out in a way that matches patient needs.

Come back to:Dr. BensonIn a couple daysIn a weekIn a month

Meet our Nurse Practitioners

They have to offer:

More Time Prescriptions Education

Book with them for:

ColdsFlu

RashesBumps and Bruises

Call back first... Nurse second... Doctor third.

48

con

cept

s

Texts/e-mails to GP for advice

Providing patients with a way to access a doctor using alternative ways such as texting and emails.

Using these technologies would allow the use of photos and video to be added thus providing additional diagnosis information. Doctor could decide if and when an appointment would be necessary.

New Patient Check - “What We Offer”

An explanation of the the services offered by Willow Bank and how to book them during the new patient check.

New patients checks are great time to introduce the different levels of health care available at Willow Bank and how to book appointments for them. The “Nurse Pyramid” was shown to us by one of Nurse Practitioners and it was helpful to visually understand the different levels of care provided. Something similar could be designed for a leafl et.

Reception to be “Health Navigators”

Reception trained to help navigate patients through making the right choice of Willow Bank’s services, and even for the NHS at large.

Reception currently gets no medical training whatsoever and has to learn on the job about different medical conditions and who treats them. It is the fi rst point of contact for patients and if reception understood more about the services offered they could help patient get the correct treatment.

Doctor. I have a rash I’m concerned about. Can you take a look?

Sure! Send a picture over so I can get an idea. Thanks.

What Willow Bank Offers

Different services to keep you healthy

1. Health Care Support for ongoing2. Nurses for blood work and checks

3. Nurse Practitioners for minor illness4. GP for major or complicated illness

49

con

cept

s

Nurse Practitioner for New Mums

Each family would be assigned to a Nurse Practitioner and they would be able to contact the nurse directly if they had any questions.

This would give parents direct contact with a consistent professional that could help assess and guide them through health care situations. This would start with pregnancy so a relationship would be in place when the child is born.

Specialized teams for patient groups

Teams made up of staff from different roles would work together each focusing on a specifi c patient group.

These teams would focus on a specifi c target, such as families, to learn about the patients in this group and their needs. Then they could come up with ideas on how to better serve these patients.

Scripts for Follow Up Appointments

A phrase doctors and nurses can use at the end of appointments to get patients to come back only when they need to.

Some patients get confused on whether to come back after a check and this could help clear things up while reducing unnecessary appointments.

OAPTeam

FamilyTeam

Frequent Flyer Team

Please come back next week IF....

50

con

cept

s

Customer Relationship Management Approach

Integrate patient interviews into the doctor appointments and gather knowledge through them.

Get to know the parents better and treat them as the subject. eg. frequency of visits, categorise needs and understand parent capabilities. Invest in parents earlier to reduce the need later. Willow Bank can then respond to the parents needs and support them better. Only practice would see this.

Online Patient Profi les

Allow patients to access Willow Bank through an online platform with profi les and messaging. From here they could passively ask non-urgent questions, get reassurance from the team at Willow Bank.

After doing some research, a website is currently running called How Are You? which looks to manage long term conditions through a similar interface. Testing with this existing system to see if helps patients and reduces their need for appointments.

Health advocates in the community

Socially connected patients would be specially trained to help other patients in the community deal with their health care needs and Willow Bank.

The health advocates would be trained with a professional recognition, such as First Aid training, and would also be trained to understand Willow Bank’s services. Knowledge of the NHS at large would also help provide navigation assistance for the community.

The JonesCall - Message - Book -

Interview Notes

Need help with health education

Nervous about parenting

Ask condititions

Stats

8 visits in the past 3 months

3 requests for anti-biotics

4 visits for rashes

Concepts

Long-Term Results Ideas

51

con

cept

s

Selling the Nurse Practitioner Leafl et

Promote the advantages of the Nurse Practitioners, such as extra time and prescriptions, not just what ailments they can treat.

This idea was well received and would be easy to develop for testing. Picture of the NPs would introduce the patients. Icons would show the users the advantages of seeing the nurse practitioner. A list of conditions presented in everyday terms would educate users on what can be treated.

Follow Up Tokens and Phrasing

A follow up token to help the receptionists know when a doctor has requested a follow up and when it should be scheduled.

The token part of the idea was very well received and thought to be something different. There was also a possibility of it being a reminder token. The GP would also have to have a new phrase for patients they thought was ok but might need to return if get worse.

Understanding the Patient better through a Shared Profi le

Integrate patient interviews into the doctor appointments and gather knowledge through them. Profi les would be open for patient to see.

The practice could work to get to know the patients and this information would be open for the patient to access and update. This information would be accessed by the professional at the start of a consultation in order to get a quick refresher of the patients history and ability.

The JonesCall - Message - Book -

Interview Notes

Need help with health education

Nervous about parenting

Ask condititions

Stats

8 visits in the past 3 months

3 requests for anti-biotics

4 visits for rashes

Meet our Nurse Practitioners

They have to offer:

More Time Prescriptions Education

Book with them for:

ColdsFlu

RashesBumps and Bruises

Concepts

Selected Ideas for Development

Please come back next week IF....

What Willow Bank Offers

Different services to keep you healthy

1. Health Care Support for ongoing2. Nurses for blood work and checks

3. Nurse Practitioners for minor illness4. GP for major or complicated illness

After a discussion and some refl ection, Willow Bank proposed that these three ideas could have the most impact while being the most feasible. Th ey selected two very quick fi xes that could have an impact on the surgery and one longer term idea to develop.

52

con

cept

s

Concepts

First Co-Design Session A co-design session was held with the staff at Willow Bank to develop the three ideas for maximum potential for success in a working practice. Doing this with the staff was essential as their knowledge of the day-to-day workings are an asset which could not be gathered without a great deal of research. Th is process also help bring the team together and increased enthusiasm for the project in general. By contributing towards the ideas there was a sense of shared ownership. Th e leafl et was straightforward and the information to be presented was agree upon. As for the tokens, quick samples of were made from laser cut plastic sheet and brought up to so everyone had an understanding of the possible outcome. With these tokens in everyones hands diff erent scenarios were played out and thought through. In the end, it was decided that the tokens would stay inside in the surgery and travel, via patient, between the GP and the receptionist. Th e token would communicate the professional and the time until the next appointment. With these quick ideas sorted, the longer term idea was explored. Th e patient profi le idea was very loosely defi ned at the beginning of the session but slowly a clearer picture was defi ned as the discussion continued. It was important that anything designed should be open between the patient and the practice, this is a trend in health care. Also, the profi le needed to quickly communicate the patients information or it would be no use to already pressured professionals. Th e session fi nished with a consensus on what the overall framework would be and a plan with what to be done next.

A co-design session with staff at Willow Bank was very useful to quickly develop the ideas to level that could work

in the practice. The staff`s knowledge of the day-to-day operations at the practice was an asset that could not be

replicated without dozens of days spent shadowing.Source: personal photo

Tokens were quickly prototyped with the

laser cutter to show the possible outcome.


53

con

cept

s

Concepts

Leafl et and Token Concept Development

A storyboard was created to explain the system to the staff memeber

unfamilar with the project.Source: personal photo

The tokens and leafl ets were quickly designed

to deal with demand in the short term while the patient profi le concept is

developed and tested.Source: personal photo

The tokens are made from laser cut plastic and can

be reused. There are three lengths of time and three

professionals to choose from for making bookings.


ir*

nt*

NEXT WEEK

1. A child and parent comes to an appointment for a new issue...

2. You decide the child should be seen again for this issue...

The TokensIf you decide the child needs a follow up appointment...

3. Pick when they should be seen again and with whom, then select the appropriate tokens...

4. Give the child the tokens and tell them to hand them in at reception for an appointment. That’s it!

amount of time professional

*WillowBa

nkMeir*

*Appo

intm

ent*

OF WEEKS

**

GEN

ER

ALPRACTITIO

NER

WillowBa

nkMeir*

Appoi

ntment*

NURSE

*Willow

Bank

Meir*

*Appoi

ntment*

ACTITIONER

54

con

cept

s

Concepts

Second Co-Design Session A second co-design session was run to get as many staff members and patients inputs as possible for the patient profi le concept. Th e information needed to be what patients felt comfortable sharing with their health care professionals and also the information that would be most useful in helping the health care professional understand the patient. In order to get the right information a set of graphical cards were drawn up with diff erent options for the information that could be represented. Th ese cards were present to people along with an A4 sheet and people were asked to place the cards they wanted. However, the challenge was to pick the most necessary cards as there was not enough room to fi t them all. Th is forced people to make decision about the most vital information. Th e task was designed this way as there is a limit to how much people can take in and overloading the sheet would be ineff ective. Th e design challenge proved to be successful and 15 diff erent patients and staff members contributed their designs. Th e task also proved to be a good talking point as it gave people something tangible to talk about and ideas to add their own. A count was performed to fi nd the popular cards for patients and staff to determine the fi nal design.

55

con

cept

s

Concepts

Patient Profi le Concept Development Th e cards that people felt most strongly about were compiled onto one sheet. Th is blueprint was then worked up on the computer to get a better feel for what the fi nal concept could look like and test readability. After receiving feedback a prototype of a website was built to support the profi le allowing patients to view previous appointments, book appointments and manage conditions. Th is fi lled out the service proposal for a more complete experience.

David Taylor

male

David TaylorME

Sandra LesliePartner

Debbie LesliePartners Mother

Barry TaylorSon

Dee TaylorDaughter

past 3 months

about

who lives with me my mood my rating of my skills

lots of health knowledge

little health knowledge

gp visits a&e visits

what I want my health care professional to know about me

born in Stockport, UK

born on August 7th 1983

goes to school at LCC

lives at 23 Trentham Road past 12 months

past 3 months

past 12 months

“I get very nervous about visiting the doctor’s office”“I have trouble remembering what the doctor tells me to do”

“I wish I could get more explanation and eduction about my health issues”

today2 weeks ago

6 weeks ago

lots of health confidence

little health confidence

The profi le was then developed further on

the computer. This is an early version showing the

different elements.Source: personal photo

The fi nal selection of cards that would make up the

patient profi le. Source: personal photo

56

con

cept

s

Concepts

Patient Profi le Concept Testing A test was designed to see the usefulness of the patient profi le in a setting as realistic as possible. Th e prototyping worked by getting patients to fi ll out a paper version of the online patient profi le and hand it into the health professional they were going to see. Th e health care professional could then look at the profi le and see if it helped in understanding the patient. Th e patients were generally very open to the idea and willing to fi ll in the form. Most of it was straight forward however the section entitled ``What I want my doctor to know about me`` section was diffi cult for people to think of something to write. It was felt that this question would require some more refl ective time to think about and it proved diffi cult to come up with something on the spot. When the health care professional received the paper they were supposed to review it quickly and determine the impact it had on the consultation. However, the nurse ran behind quickly and didn’t have time really look through the paper. Although this was disappointing it reinforced the need for the profi le to extremely easy to understand as appointments are short and time is very precious. However, the nurse did say she thinks it would useful and she could see it becoming a habit. Th e feedback on the profi le in general was extremely positive with everyone saying it would be useful. Requirements being that it would be the fi rst thing pulled up when searching for a patient and it is extremely quick to read.

Patients were ask to fi ll out a paper based profi le sheet and hand it in to the Nurse Practitioner to test the effectiveness of the profi le.

57

con

cept

s

David Taylor

male

David TaylorME


Debbie LesliePartners Mother

Barry TaylorSon

Dee TaylorDaughter

past 3 months

about

who lives with me my mood my rating of my skills



gp visits a&e visits


born in Stockport, UK


goes to school at LCC


past 3 months

past 12 months

“I get very nervous about visiting the doctor’s office”“I have trouble remembering what the doctor tells me to do”


today2 weeks ago

6 weeks ago



This is the digital version of the profi le. The profi le is designed to share personal

details of a patients life to help staff with patients.Source: personal photo

The paper based form version of the profi le allowed

for easy prototyping of the interaction at very low cost.


58

con

cept

s

A prototype of the patient profi le website was also built to be tested with staff and patients at Willow Bank. Th is prototype was to test the functionality and usability of the proposed design. Th e key features being sought for feedback was an online appointment booking system, consultation history, other services, messaging and long term condition management. Th e feedback of the website was very promising. Improvement were suggested for the basic design and functions. Comments surrounded adding more information about professionals along with a couple additional features. Th ere was a lot of commentis regarding the appointment system with patients saying they felt more comfortable giving a reason for a consult to a computer rather than the receptionist. All the feedback was taken into consideration for the fi nal design.

Concepts

Patient Profi le Website Testing

Many different Willow Bank staff members were ask to navigate through the website prototype. Patients were also asked to use the prototype to get feedback on the

functionality and the usability. Most people welcomed the idea of booking online and the options for consultations.


59

con

cept

s

David Taylorabout


lives at 23 Trentham Road

October 30th, 2012Lung InfectionRequired anit-biotics

January 12th, 2012Rash Required cream

May 8th, 2012Rash Reoccurance

Feburary 30th, 2012Blood and DietCheck Up

August 10th, 2012Blood and DietCheck Up

December, 2012eBlood and DietaCheck UpU

Diabetesa

today- November 12012 2013

March 10th, 2012ConjunctivitisAdvice given

March 10th, 2012Back PainAdvice given

book a new appointment

text message

email

print out

March 10th, 2012

Case: Conjunctivitis NHS Choices Information

Sympotyms:Pink right eye, Puss, Swelling

Advice:Rinse twice a day with fresh waterApply cold cloth if bothered.

Medication:None

send information as:

profile appointments medications other services messages diabetes new page

David Taylorabout



October 30th, 2012Lung Infection Required anit-biotics

January 12th, 2012Rash Required cream

May 8th, 2012Rash Reoccurance

Feburary 30th, 2012Blood and Diet Check Up

August 10th, 2012Blood and Diet Check Up

December, 2012Blood and Diet Check Up

Diabetes

today- November 12012 2013

March 10th, 2012ConjunctivitisAdvice given

March 10th, 2012Back PainAdvice given

book a new appointment


David Taylorabout



add this appointment

cancel this appointment

new

existing Start typing here...

Lung Infection

DebbiePractice Nurse

DawnNurse Practitioner

Dr. SmithGeneral Practitioner

step 1 - appointment type step 2 - reason for appointment step 3 - appointment preference

Search our list:

Write your own:

Date:

Time:

oror

Select a professional:

Given your selection we suggest:

Also available:

November 18th 2012

Follow UpFollow DownFollow

Follow

10:00 am


The case page shows the history of the patients

visits to the practice. After testing this was expanded to

include phone and email.Source: personal photo

Any consultation could be expanded to show

details on that visit for later reference. From feedback,

the professionals picture and more info was included.Source: personal photo

Users found booking new appointments to be easy.

Input from staff suggested providing more information

on the ailment perhaps could prevent the consultation.

Source: personal photo 60

con

cept

s

Jones

Paula JonesME Sam Le

Partne

Debbie LeslieMother

Barry JonesSon

Dan JonesDaughter

past 3 months

m


th e

gp a&e

care professional to know about me

Liverpool, UKAugust 7th 1980

Paul’s Auto

23 Trentham Roadpast 12 months

ng the doctor’s surgery”he doctor tells me to do”uction about my health issues”


about

visits

adjust your ratings if you feel they chang

+ more to say

1245

0111

ices willow bankdiabetes

Final Design

Health Portrait Overview

Health Portrait is a service that connects patients and health professionals while adding depth to healthcare consultations. Patients create a “portrait” which captures specifi c aspects of their lives which are useful to health professionals when consulting with patients. Health Portrait also keep records of consultations allowing them to be referenced by the patient for previous diagnoses and advice. Patients can also book new variety of consultations types to fi t their lives, such as email, phone, online or in person.

63

fi n

al d

esig

n

clockwise from top left: 1. patients meet with a health care support worker to get introduced to the surgery and

Health Portrait 2. After creating the profi le users get a personalized information sheet on Health Portrait 3. Cards

are printed with a summary of the consultation for the patient to review at a later time. 4. Staff at the surgery

see the same screen as the patient for total transparency

64

fi na

l des

ign

Final Design

Storyboard

Paula checks NHS Choices to find the surgeries in her area and chooses one.

2 Paula and her 2 sons move into a new neighbourhood in Stoke-On-Trent.

1

Paula fills out a form for the Health Portrait online service. She fills out forms for the boys as well.

4Paula contacts the surgery and attends a New Patient Introduction to learn about the practice for her and her boys.

3

my name is

born onday month year

about


1.

2.

3.

who lives with me

name born (DD/MM/YY) relation






gaurdian / carer

gaurdian / carer

gaurdian / carer

gaurdian / carer

gaurdian / carer

gaurdian / carer

65

fi n

al d

esig

n

Online profiles for Health Portrait are created for the family members. A sheet is printed out with the profile and instructions.

5 At home, Paula logs in to update profiles, book appointments, view messages and manage conditions for the family.

6

A few weeks later Paula’s son, Barry, has a rash. Feeling stressed and with no one to social support for advice with she decides to visit the surgery.

7 She goes on to Health Portrait and books an in person consultation for the next day.

8

66

fi na

l des

ign

Paula checks Barry in at the sur-gery and confirms the reason for the visit.

10At the practice the staff can review the request and ensure that Barry visits the right person.

9

The doctor visits with Barry know-ing more information about him. He gives Paula a leaflet on rashes and info for a single young mothers play group.

12The doctor can check Barry’s profile before the appointment to learn more about his family and sees that they are new to the area.

11

67

fi n

al d

esig

n

At home, Jenny can review all her past appointments and message the doctor if she has a question.

14 The doctor adds the appointmentto Barry’s profile with his diagnosis and treatment advice.

13

A few weeks later, Paula’s family meets up with the play group the doctor suggested and Paula meets with young mums in the area.

15

68

fi na

l des

ign

Final Design

Touchpoint Details

Paula Jonesfemale

Paula JonesME

Sam LesliePartner

Debbie LeslieMother

Barry JonesSon

Dan JonesDaughter

past 3 months

who lives with memy mood my rating of my skills



gp a&e


born in Liverpool, UK


works at Paul’s Auto


appointment next week

message from Sue

“I get very nervous about visiting the doctor’s surgery”“I have trouble remembering what the doctor tells me to do”


today2 weeks ago

6 weeks ago



about visits notices

edit

slide to your mood

adjust your ratings if you feel they change.

+ more to say

1245

0111

portrait cases medications other services willow bank diabetes new condition

Paula Jones log out

The portrait tab paints a picture of the patients life, history, skills and current situation. This information creates the patient’s story and brings it to modern health care.

“my mood” is for patients to track their mood overtime. This information is useful for the patient and the health professional to see visualized . Feedback showed a lot of enthusiasm for this.

“what I want my health care professional to know about me” is a place for patients to share a personal message which is important to the patient.

“my rating of my skills” let the practice understand the patients knowledge and confi dence in order determine how much to education to provide you with and how to deliver it.

Patients can see number of visits to the surgery and a comparison to the average. This gentle reminder hints at the normal amount of visits.

Knowing “who lives with me” provides the practice with an understanding of what the patients social support network is like and if get to know the family as a unit.

69

fi n

al d

esig

n

portrait cases

Paula Jonesabout



todaynovember 1

2012 2013

start a new case

March 10th, 2012

TypeProblemAction

Online ConsultationBack PainAdvice Given

Consultation with:Dr. SmithGeneral Practitioner

medications other services willow bank diabetes new condition

Paula Jones log out

Diabetes

September 10th, 2012

TypeProblemAction

In Person ConsultationCheck UpBlood Test

Consultation with:DebbiePratice Nurse

r 10th, 2011


ion with:bbietice Nurse

March 10th, 2012

TypeProblemAction

In Person ConsultationRashRequired Cream

Consultation with:DawnNurse Practitioner

June 24th, 2012

TypeProblemAction

In Person ConsultationLung InfectionAnti-Biotics


The cases tab is a record the patients consultations with the surgery. This is not a full medical record but provides the useful parts of the vists for patients.

A case is an condition or problem raised and a consultation is a discussion about that case. A case can have multiple consultations but each consultation can only have one case.

Individual consultations are contained in boxes and can be expanded for more information. This consultations are stored for later referral if needed.

Consultations that are related by the same issue are connected by a line.

The consultations are organized by time allowing users to easily fi nd a case and view it.

The start a new case button is used to book a new consultation. This change in terms is an attempt to get away from in person appointments.

70

fi na

l des

ign

about



cancel new case

step 1 - what step 2 - who

portrait cases medications other services diabetes new condition

log out

start a new case

next next

Online ConsultationDecribe your problem in more detail and you will get a message back by the end of the day

Email ConsultationDecribe your problem in more detail and you will get an email back by the end of the day

step 3 - how

Phone ConsultationYou will be called back for a consultation at the time you select. Confirm this number is correct:07565 424051

Time: 10:00 am

Date:

November 8th 2012

Time: 10:00 am

In Person ConsultationFace to face appointments are available with Dawn below

Select a professional:

next

Type your reason for visiting: Select how and when to talk:

and

Headache

TodayIt’s quite urgent to talk with someone. (In Person Appoinments

may not be available)

When would you like to talk with a health professional?

AnytimeIt’s not urgent and can be anytime.

(All options should be available)

next

willow bank


Also available

Dr. Smith has been with Willow Bank for 3 years and specializes in treating complex long term conditions.more info


Given your selection we suggest

Dawn is a specially trained nurse able to handle a wide variety of conditions. She is also able to give perscriptionsmore info

Paula Jones

Paula Jones

This is the fi nal screen of the “start a new case” screen. Patients go through steps which guides the options for them and gives advice on how to treat at home.

In step 1 patients give a reason for wanting a consultation and the urgency of the issue. This helps fi nd the most appropriate person for the patient to talk with about the issue.

In step 2 the patient can select the health care professional to have the consultation with. A professional will be suggested based on the reason allowing nurses to be promoted when appropriate, giving GPs more time.

The patient adds the case to their health timeline and can be sent a text reminder before the appointment. They are provided with information about the ailment to try and resolve the issue themselves.

Finally, step 3 is where the patient selects the type of consultation and when it happens. There are four options for the patient: online, email, phone and in person. These options have different advantages for patients depending on the need.

71

fi n

al d

esig

n

diabetescases

about



blood suger levels weight

information my goals

post message

messages

Dr. Smith - General PractitionerHey. I heard the local leisure centre is having aquafit on Tuesday nights.

Start typing here...

PaulThanks for the advice at the appointment yesterday. I think swimming will work well for me.

Oct 18th

Oct 10th

Dr. Smith - General PractitionerThere is no medical reason for changes. Maybe you should come in soon for a check.

PaulMy levels are being a little less stable since I started taking this prescription. Side effect?

Sept 2th

Sept 1st

24

2

12

10 11 12 13 14 15 16 17

90

60

75

42 43 44 45 46 47 48

Diabetes UKhttp://www.diabetes.org.uk/

NHS Choiceshttp://www.nhs.uk/Conditions/Diabetes/Pages/Diabetes.aspx

What Do I Eat Now? - BookLibrary Link

The Diabetes Cooking BookLibrary Link

“Keep a better watch on my levels in the morning”

“Manage my weight better through better eating”

“Discover more foods that can help my condition”

portrait medications other services new condition

log out

willow bank

Paula Jones

Paula Jones

This screen is setup for diabetes but similar ones could be designed for any number of conditions with easy modules.

Monitors could get results from smart devices like blood sugar readers. The space could also be used for setting goals and educational materal.

Long term conditions are another major feature of the Health Portrait. This allows for patients to have ongoing dialogue of the condition with their professional.

Messages could be sent to the patients condition manager about non-urgent issues or concerns.

72

fi na

l des

ign

cases medications

about



medications

Name Dose Conditions Breakfast Lunch Dinner Evening

Potassuim 1 x 200 mg tablets Eat with food

Anti-Biotic 2 x 300 mg tablets Take with liquid

Paracetamol 2 x 500 mg tablets Take with liquid

New Medicine

Long Acting Isulin 30 Units Take before bed

portrait other services diabetes new condition

log out

willow bank

Paula Jones

Paula Jones

cases other services

about



services currently accessed

Health VisitorLynn

Contact: Phone 07673 918347email: [email protected]

Triple P Heather


Housing Assistance John


what I need help with

Sure Start - Classes Recommended by Lynnwww.surestart.co.uk

What to Expect in the First Year - Book Recommended by Jakiewww.whattoexpect.com

Parenting Guide - Website Recommended by Dr. Smithhttp://www.nhs.uk/Tools/Pages/Parentingselfassessment

Parenting and Food

post topic here

I would like some help with:

enter topic here to get advice from your service providers

I would like some help with:

portrait medications diabetes new condition

log out

willow bank

Paula Jones

Paula Jones

cases

about



Phone

0300 123 5002

Hours

Monday-Friday 8am - 8pmSaturday 8am - 12md

Services Offered

The team offer the full range of primary care medical services. These include:

General medical advice - led by our doctors

Childhood vaccination and immunisation - led by our nurse practitioners

Adult acute and chronic conditions led by our Nurse Practitioners

post message

questions for the practice

Sue - ReceptionYes, Paul. Deb is available this evening. She still has 5 spots available.


PaulWill there be a nurse available this evening for flu shots?

5:45 pmOct 26th

4:55 pmOct 26th

Sue - ReceptionI had a look and the pharmacy will drop it off around 2pm. Anytime after that!

PaulDo you know if my perscription will be available today?

11:39 amOct 7th

10:15 amOct 7th

portrait medications other services diabetes new condition

log out

willow bank

Paula Jones

Paula Jones

The medication tab shows the patients perscriptions and relevant information on those drugs for the patient.

The other services tab shows the help that the patient is recieving from other agencies. Also its a space to ask for help on any subject and get suggestions from the surgery.

The surgery tab provides basic information on the surgery. There is also space to ask general questions the reception staff could answer, such as if a perscription is ready for pick up.73

fi

nal

des

ign

todaynovember 1

2012 2013

March 10th, 2012

TypeProblemAction



Diabetes


TypeProblemAction



r 10th, 2011



March 10th, 2012

TypeProblemAction



June 24th, 2012

TypeProblemAction



start anew case

about



about



book follow up consultation

Consultation Record

text message

email

print out

send information as:

March 10th, 2012Consultation with:

TypeProblem

Symptoms

Action

Medication

Online ConsultationBack PainLinks: NHS Choices Information Patient.co.uk

Lower back stiffness. Especially noticable in morning.

Stretching before bed and warm compress in morning. Contact again after 1 month if still present.

None


post message

online consultation


PaulaNow you mention it, I did get a new car. I’ll adjust the settings and try stretching. Thanks!

Dr. Smith - General PractitionerNothing to be worried about. Try stretching of an evening. Any new chairs or funiture your sitting in?

PaulaMy back is very stiff and especially hurts in the morning. Is there anything I need to be worried about?

March 10th


log out

willow bank

Paula Jones

Paula Jones

about




log out

todaynovember 1

2012 2013

start a new case

March 10th, 2012

TypeProblemAction



Diabetes


TypeProblemAction



r 10th, 2011



March 10th, 2012

TypeProblemAction



June 24th, 2012

TypeProblemAction



November 1st, 2012

TypeProblemAction

Online ConsultationHeadachewaiting for message


willow bank

confirm consultation

Comfirmation of ConsultationNovember 8th, 2012Consultation with:

Type

Problem

Online Consultation

Headache

Before your consultation you might find the information on these websites useful. If you feel you can handle the problem on your own please cancel your appointment. Thank You.

Links: Headache - NHS Choices Headache - Patient.co.uk


post message

online consultation


PaulaI’ve been have this headache for the past couple days. I’ve tried pain killers but it comes back. Should I be worried? When should I come in?

Dawn is a specially trained nurse able to handle a wide variety of conditions. She is also able to give perscriptions

Paula Jones

Paula Jones

Barry Jonesmale

Paula JonesFather

Sam LesliePartner

Debbie LeslieMother

Barry JonesME

Dan JonesDaughter

past 3 months

who lives with memy mood my carers rating of their skills



gp a&e

what my carers want my health care professional to know about me

born in Stoke-on-Trent, UK

born on April 7th 2006

goes to Sure Start Nursery



message from Sue

“I have been getting stressed over Barry’s coughing at night. It really difficult in the middle of the night”

“I wish the doctor would listen when I want anti-biotics”

today2 weeks ago

6 weeks ago




edit

slide to your mood


2284

0121

portrait medications other services new condition

log out

cases willow bank

Paula Jones

When the patient clicks on any consultation more information becomes available. This is useful to see what action was recommended for similar previous cases.

Once the patient has selected their consultation options a confi rmation screen is shown. On this screen, links to relevant information is shown with the hope the patient is able to resolve the problem.

If the patient is a parent, gaurdian or carer then they will have the rights to access the person under their care, as well to book consultations and share information about them. 74

fi

nal d

esig

n

Consultation RecordMarch 10th, 2012Consultation with:

Type

Problem

Symptoms

Action

Medication

Online Consultation

Back PainLinks:http://www.nhs.uk/conditions/headachehttp://www.patient.co.uk/health/Headache-Chronic-Tension-Type.htm

Lower back stiffness. Especially noticable in morning.

Stretching before bed and warm compress in morning. Contact again after 1 month if still present.

None


online consultation

PaulaNow you mention it, I did get a new car. I’ll adjust the settings and try stretching. Thanks!

Dr. Smith - General PractitionerNothing to be worried about. Try stretching of an evening. Any new chairs or funiture your sitting in?

PaulaMy back is very stiff and especially hurts in the morning. Is there anything I need to be worried about?

March 10th

my self-rating





my name is

born onday month year

about


1.

2.

3.

who lives with me







Welcome to Willow Bank! In order to provide the best service we are looking to better understand you and your health. To provide that service we would like you to share some information with us, fill out as much as you feel comfortable. Thank you!

Please shade in the level of health knowledge and confidence you feel you have. This will help us to know what health information we should provide you with during your appointments.

In this section you can tell the doctor or nurse something you would like them to know. Could be something like: “I get nervous when visiting the Doctor’s office”“I worry a lot about my child’s health and would like more explanation”“I have a chronic condition that is a big part of my life”

Seeing who you live with can help us get to know your social health care support and see if any health issues are related. Let us know if you need another sheet for more than one household or more space.

gaurdian / carer

gaurdian / carer

gaurdian / carer

gaurdian / carer

gaurdian / carer

gaurdian / carer

This is the form for new patients to fi ll out when fi rst meeting with the surgery. The information patients give over during this form is used to create a online portrait. The form is designed to be more interesting to fi ll out than traditional forms. In the future, a laptop could be used for the patient to input the information directly.

The consultation record can be given to the patient for reference at home. This came from a fi nding that patients fi nd it diffi cult to remember what the health professional has told them.75

fi

nal

des

ign

Paula Jonesfemale

Paula JonesME


Debbie LeslieMother

Barry JonesSon

Dan JonesSon

past 3 months

who lives with memy mood my rating of my skills



gp a&e


born in Liverpool, UK


works at Paul’s Auto



message from Sue

“I get very nervous about visiting the doctor’s surgery”“I have trouble remembering what the doctor tells me to do”


today2 weeks ago

6 weeks ago




edit

slide to your mood


+ more to say

1245

0111

portrait cases medications other services willow bank diabetes new condition

Paul Jones log out

sharing some key un-asked information with the practice allows you to bring to attention something which is important to your life.

Welcome to Health Portrait! This online service helps you share more information with your medical professional. This information will help the medical professional understand you on a deeper level and provide better insights in your health issues. Health Portrait also lets you book consultations with all the medical professionals through a bunch of a different methods, such as email, phone or online messages. Log in at home and explore the website!

the about section shows your basic information and your employment could be changed at anytime.

visits let the practice see if you usage has increased and inquire the reason for this.

my mood is for you to track you mood overtime. this information could be useful for you and your doctor to see.

my health knowledge and confidence let the practice understand your skills better and determine how much to education to provide you with.

knowing who you live with can provide the practice with an understanding of what your social support network is like.

Login using your name and birthday.

Your password is:

After the patient’s information has been entered and a portrait has been created, a personalized introduction sheet is printed and mailed to the patient. This sheet introduces and explains the service while inviting the patient to go online and fi nish creating their account.

76

fi na

l des

ign

Health Portrait personalized

welcome sheet is given

Refers to previous

consultations online

Starts new consultation on Health Portrait

Call to reception to make new

consultation

Go to reception to make new

consultation

Refers to previous

consultations cards received

Refers other websites such

as patient.co.uk

Find RegisterNew Patient Introduction

Pre-service Service Encounter

Evaluateat Home

Make Appointment

Search websites like NHS Choices

Call surgery to ask questions

Portrait profile form is given and filled out

Care Support Worker intros Health Portrait

Final Design

Customer Service Journey

77

fi n

al d

esig

n

Professional reviews reason

and offers advice over

Health Portrait

Recommended action is

recorded on website

Recommended action is printed

for access at home

Recommended action is given in verbal form

Recommended action is given in verbal form

Recommended action is

emailed to patient

Recommended action sent to patient as text

message

Paper record can be refered to for advice

Website record can be refered to for advice

Can add reflective notes

to own “Portrait”

email record can be refered to for advice

Action record can be refered to for advice

Professional reviews reason and calls patient

to consult

Professional reviews reason

and emails advice to patient

“Portrait” acts as prompt for

deeper discussion

Symptoms are explained,

observed and recorded

Symptoms are explained and

recorded

Reminder to go to consultation

Check in with reception if problem or

more requests

Check in with computer

Reminder to go to consultation

Refers other websites such

as patient.co.uk

Service Encounter Post-service

Prepare Check In SymptomsProfessional Reviews

Action ReflectSelf Care

78

fi na

l des

ign

Consultation Type (for GP and NP)

User Selection

Staff Notification

Det

ails

Act

ions

Consultation In Clinic

Consultation Not In Clinic

Back Up

Easy

10

Non Urgent

Within 1 Day

ComputerSmart Phone

Easy

5

Non Urgent

Within 1 Day

ComputerSmart Phone

Moderate

8

Urgent

Within 4 Hours

Phone

Limited

12

Both

On Day/Advance

In Person

Consult Access

Consults per Day (projected)

Urgency

Time Frame

Method

Selects online consult and adds more

information / question

Message appears to

prompt reply. Notification

before shift end.

Time is alotted at the begining, middle and end

of clinical sessions.

Message will appear at

begining of next clinical session.

If not replied to within 1 work

day then patient is asked to send to new person.

Selects email consult and adds more

information / question

email is sent to staffs inbox. Normal email notification.

Time is alotted at the begining, middle and end

of clinical sessions.

email will wait until the start of

next clinical session.

Patient is told before hand

that emails for non-urgent.

Selects phone consult and

selects date/time

Consult is added to

appointment schedule of professional.

Professional phones

patient when appointment time arrives.

Phone consultation

can’t be booked

If running late, patient is called

by reception and consult is moved to last.

Selects in person consult

and selects date/time

Consult is added to

appointment schedule of professional.

Professional meets with

patient when appointment time arrives.

In person consultation

can’t be booked

If running late, patient waits in waiting room

until seen.

Final Design

Consultation Type Journey Map

79

fi n

al d

esig

n

Final Design

Emis Web Th e online part of the service concept has been designed with emis web in mind throughout the entire process. emis is the software system currently used Willow Bank and thousands of other practices across the UK. emis is used for keeping patient records, tracking QOF, booking appointments and internal communication. Recently, they have added online appointment for patients to access but the functionality is limited to advanced bookings and has no personal information. Technically, many of the functions of the proposed could integrate easily into emis without requiring additional work for the health professional or reception. For example, the consult records for Health Portrait could pull data from the patient full medical records which already include reason, symptoms, recommendations, action and medication. Currently the system recommends a professional for certain ailments when the reception is booking appointments, this could be expanded and developed for when the patient books consultations. Th e acceptance of the new service should be high in practices through ensuring it works with well with emis and integrates into the way practices work.

80

fi na

l des

ign

Final Design

Conclusion Health Portrait aims to improve the relationship between patients and health professionals in the GP surgery in order to reduce the need for face to face consultations for ailments that are treatable at home. Th is project started with a GP surgery listening to its patients who were having to call repeatedly fi rst thing in the morning to try and get an appointment. Basically, high demand was outstripping the supply of appointments. Th e surgery felt it was being burdened by patients requesting appointments with minor ailments which could be treated at home. Th e high demand for these minor issues were having negative impacts on the GP surgery staff and on a national level, huge fi nancial costs across the NHS. Research looked at the context of the larger health system, health history and demand management to understand the how this issue has evolved and its impact. Understanding what the GP surgery provides and how it operates was vital to making any designed solution be appropriate for the staff . At the same time, learning the patient’s stories was the key to seeing that people were visiting the GP for reasons hidden beneath the surface of the minor ailment. Th ese reasons are so varied that there is no one solution for every patient and health professionals need tools to understand each patient’s personal situation. Th e idea to allow better sharing of information between patient and professional is at the heart of Health Portrait. At the same time the new service looks to solve other problems for the patient such as navigation, options for consultations and open information. Th e concept of Health Portrait was developed and tested in a GP practice with the patients and professionals. Th e test, which asked patients to fi ll out a paper version of the portrait and hand it over to the nurse, proved the concept had merit and could be useful in a practice for both patient and professional. People who used the Health Portrait prototype website found it easy to navigate and said it was far better than any online appointment system they have used yet. All the feedback was taken into consideration and most was included into the fi nal design. Th e positive results from testing show the idea has a solid foundation and could be carried forward for further testing. Th e main recommendation is for another test of the “portrait” to make sure the information is useful for the professionals and is quick to read. Th is test would have to happen over a long period with dozens of “high use” patients fi lling out the form and it being added to their fi le. Th is way the test could happen over weeks and the ability for professionals to help curb the patients use would be a clear indication success. Additionally, a test of the new appointment would have to be 81

fi

nal

des

ign

designed to see what the usage of diff erent appointments would be like and plan appropriately. Th e best method for this test would be to put a nurse on the phone during the rush and get patients to give the reason for the visit. Th e nurse could then sort the appointments to the appropriate professional in an effi cient manner, including calls and emails. Th ese two tests would confi rm if the new service could really function successfully but would take time to achieve. Health Portrait is a new service for GP surgeries which aims to improve their relationship with patients. Th e modern medical system has improved the health of millions but in the quest for effi ciency there are now many diff erent professionals for patients to see and the time for appointments is limited. Th e eff ect of this effi ciency is a reduction in the amount any one professional can possibly know about a patient. Fragments of the patients story are scattered across the surgery with diff erent people. Health Portrait allows patients to create their whole story in one place and share it with the people who care for them.

82

fi na

l des

ign

Butler, P. (2012) History of NHS reforms: A state of permanent revolution. Guardian, [online] Friday 9 July 2010. Available at: http://www.guardian.co.uk/society/2010/jul/09/nhs-history-reforms-health-policy [Accessed: July 13 2012].

Choosewell.org.uk (2012) NHS :: Choose well. [online] Available at: http://www.choosewell.org.uk/ [Accessed: 21 Nov 2012].

Department of Health. (2009) Healthy lives, brighter futures – The strategy for children and young people’s health.

Department of Health. (2010) World class commissioning for GP services: Improving GP Access and Responsiveness.

Designcouncil.org.uk (2010) Design Council - Lewisham Council. [online] Available at: http://www.designcouncil.org.uk/our-work/leadership/Public-Services-by-Design/Case-studies/Case-Study-Lewisham-Council/ [Accessed: 13 Jul 2012].

GP Patient Survey (2011). ‘Practice report’. GP Patient Survey website. Available at: www.gp-patient.co.uk/results/weighted/practicereport/ (accessed on 18 March 2011).

Hunter, M. (2012) Redesigning public services: happier customers cost us less. Guardian, Tuesday 10 July 2012.

Jaimie, K. (2012) GP ‘cottage industry’ not fi t for purpose, says Kind’s Fund. Pulse, 6 September.

Jones, T. (1997). The structure of the National Health Service. Beckenham, Pub. Initiatives.

Murkoff, H. E., Eisenburg, A., Mazel, S., Hathaway, S. E., & Eisenburg, A. (2003). What to expect the fi rst year. New York, Workman Pub.

Martin, S. and Dunbar-Rees, R. (2012) Why GP surgeries need crowd control. BBC News, [online] 13 April 2012. Available at: http://www.bbc.co.uk/news/health-17548240 [Accessed: 13 July 2012].

Meroni, A. and Sangiorgi, D. (2011) Design for services. London: Gower.

Nhs.uk (1948) NHS history. [online] Available at: http://www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory1948.aspx [Accessed: 13 Jul 2012].

Parker, S. and Heapy, J. (2006) The Journey to the Interface: How Public Service Design Can Connect Users to Reform. Demos, 26 July 2006.

References

Platts A, Mitton R, Boniface D et al. Can self-care health books affect amount of contact with the primary health care team? Scandinavian Journal of Primary Health Care. 2005; 23: 142–8.

Improving the quality of care in general practice: The future of general practice. (2011) . The King’s Fund. http://www.kingsfund.org.uk/publications/gp_inquiry_report.htmlGood, M, Cara, J and Good, B (2005). The Blackwell companion to social inequalities. Chapter 17: The Culture of Medicine and Racial, Ethnic, and Class Disparities in Healthcare. Malden, MA, Blackwell.

Seedhouse, D. (2001). Health: the foundations for achievement. Chichester, UK, Wiley.

Seedhouse, D. (1998). Ethics: the heart of health care. Chichester, John Wiley.

Silvester, K. and Lendon, R. (2004) Reducing waiting times in the NHS: is lack of capacity the problem?. Clinician in Management, 12.

Stickdorn, M., & Schneider, J. (2011). This is service design thinking: basics, tools, cases. Hoboken, Wiley.

Timmins, N. (1995). The fi ve giants: a biography of the welfare state. London, HarperCollins.

Tisman, A. Driving the self care agenda (2008) [online] Available at: http://www.pagb.co.uk/information/PDFs/AndyTismanarticle.pdf [Accessed: 21 Nov 2012].

Ward, J. (2012) There is a good reason why GP receptionists are so grumpy. Daily Mail, 3 January 2012.

2

Insigh

ts

Tool

s:

1. F

am

ily

He

alt

hca

re T

ime

lin

e

Fil

l ou

t a

ll t

he

ma

jor

po

ints

in y

ou

r fa

mil

ies

life

so

fa

r. S

tart

fro

m

wh

en

yo

u fi

rst

fou

nd

ou

t y

ou

we

re p

reg

na

nt

wit

h y

ou

r fi

rst

chil

d

an

d m

ark

ho

w m

an

y y

ea

rs a

go

th

at

wa

s.

Ma

rk e

ve

nts

su

ch a

s: c

lass

es,

gp

ap

po

intm

en

ts, b

irth

, he

alt

h

issu

es,

pe

rio

ds

of

hig

h G

P u

se, p

eri

od

s o

f lo

we

r G

P u

se, s

cho

ol,

etc

.

Ma

rk t

he

se s

tep

s fo

r a

ll y

ou

r ch

ild

ren

.

Yo

uOft

en

Le

ss O

fte

nP

eo

ple

Pla

ces

Re

sou

rce

sO

the

r

Use

th

is s

he

et

to id

en

tify

all

pe

op

le a

nd

re

sou

rce

s

yo

u t

urn

to

fo

r h

ea

lth

info

rma

tio

n c

on

cern

ing

yo

ur

chil

dre

n.

So

me

ex

am

ple

s a

re:

- M

um

- N

eig

hb

ou

rs

- F

rie

nd

s

- D

oct

or

- G

oo

gle

- N

HS

Dir

ect

- B

oo

ks

- C

lass

- E

xp

eri

en

ce

- O

the

r

Insigh

ts

Tool

s:

2. H

ea

lth

Ca

re In

form

ati

on

Insigh

ts

Tool

s:

3. H

ea

lth

Vis

its

Tim

eli

ne

s

La

st G

P V

isit

La

st A

&E

Vis

it

La

st O

ut

of

Ho

urs

/ M

ino

r In

juri

es

Vis

it

La

st H

om

e C

are

Ex

pe

rie

nce

Try

to

th

ink

of

ea

ch s

tep

in y

ou

r la

st v

isit

to

ea

ch o

f th

e li

ste

d h

ea

lth

ca

re s

ett

ing

s. S

tart

wit

h t

he

firs

t sy

mp

tom

an

d g

o r

igh

t th

rou

gh

to t

he

re

solu

tio

n.

Th

ink

ab

ou

t:

Wh

at

we

re t

he

firs

t sy

mp

tom

s?

Did

yo

u s

ee

k e

xtr

a in

form

ati

on

?

Ho

w d

id y

ou

de

cid

e w

he

re t

o g

o?

Did

yo

u m

ak

e a

n a

pp

oin

tme

nt?

Ho

w d

id y

ou

ge

t to

ge

t to

th

e f

aci

lity

?

Wh

at

ha

pp

en

ed

du

rin

g t

he

co

nsu

lta

tio

n?

Did

yo

u r

ece

ive

tre

atm

en

t a

dv

ice

?

Did

yo

u g

et

me

dic

ati

on

?

Did

yo

u h

av

e a

fo

llo

w u

p v

isit

?

Firs

t Sym

ptom

sD

ecisi

onTr

ansp

ort

Cons

ulta

tion

Afte

r Visi

tFo

llow

Up

Firs

t Sym

ptom

sD

ecisi

onTr

ansp

ort

Cons

ulta

tion

Afte

r Visi

tFo

llow

Up

Firs

t Sym

ptom

sD

ecisi

onTr

ansp

ort

Cons

ulta

tion

Afte

r Visi

tFo

llow

Up

Firs

t Sym

ptom

sD

ecisi

onTr

ansp

ort

Cons

ulta

tion

Afte

r Visi

tFo

llow

Up

Health portrait Report

Documents

patient profi

health professionals

willow bank patient

shadowing gp surgeries

th e service

patient needs

health portrait overview

gp surgery