Realising Realistic Medicine Through Service Design

Scotland’s Chief Medical Officer launched her report Realising Realistic Medicine in February 2017, explaining how the vision presented in her first report in 2016 can be realised within a decade. One of the case studies in the report Realistic Medicine and Service Design focuses on the work we have done with NHS Tayside over the last eighteen months.

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Realising Realistic Medicine is a landmark report that shows how Scotland’s NHS will become more patient centred and innovative. Researching and producing the report has drawn upon a broad range of expertise in NHS Scotland, led by Dr Catherine Calderwood,  Chief Medical Officer. Open Change is working with NHS staff to explore how service design tools, methods and approaches can help healthcare professionals better understand the needs of patients, carers and communities and how they can work collaboratively with them to improve healthcare delivery.

In a recent seminar, Creating Care with the Chief Medical Officer, members of her team and healthcare professionals and creative practitioners, we talked about design as something beyond problem-solving – design as a strategic resource for the NHS. The research report Design for Public Good, a pan European survey of design’s role in the public sector, describes a three step process for leveraging ever greater value from design.

Step one is design for discrete problems

We gave the example of Dialogue Cards, which aim to improve communication and understanding between clinician and patient. Developed by staff at NHS Ayrshire & Arran with Open Change – prototypes are currently being trialled at University Hospital, Crosshouse to gather patient feedback. The UK Design Council has been very active in encouraging step one design innovation in healthcare in recent years. Examples include Design Bugs Out – creating hospital furniture and equipment to eliminate bugs and consequent infection. More recently their A&E Design Challenge explored how design thinking could reduce violence and aggression in accident and emergency is departments.

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Step two is design as capability

This is where design becomes part of the culture of public bodies and the way they operate and make decisions. In NHS Tayside, for example, teaching empathy mapping to dental practitioners as part of an Open Change workshop has enabled practitioners to add it to final year dental training. We have also run workshops for GPs on service design and ideation methods, and together with ENT surgeon, Rod Mountain facilitated a one-day workshop for 40 Clinicians, managers and medical students on service design. This not only enables healthcare professionals to make use of design thinking in their day-to-day practices, but also enables them to commission more complex design projects from service design specialists. For example, in Norway, Akershus University Hospital commissioned service design consultancy live|work to design and develop a 24-hour acute care centre, representing a new model for unified healthcare. Such an ambitious project could only be initiated because of the close working relationship between the client and the design team, and the understanding of the healthcare managers of how design could transform how care is structured and delivered.

Step three is design for policy

Here design thinking is used by senior managers and policy makers, and often focused on how services can be better joined up. This is also referred to as strategic design. A recent study by the RSA on the codesign of interventions to promote mental well-being is an example of this. Phillips is one company that now offers strategic design as a service to health care providers alongside its medical hardware, claiming to be “leveraging design thinking to create innovative healthcare environments”. IDEO and NESTA recently collaborated on developing a resource entitled Designing for Public Services. Spearheading strategic design at a government level has been Mindlab based in Copenhagen, a cross- governmental innovation unit that involves citizens and businesses in creating new solutions for society. In London, Policy Lab is allied to the Cabinet Office, creating an environment where policy teams can use design knowledge and skills to develop policy in more open, informed and user-centred ways. The Scottish Approach to Service Design being developed currently is very much part of design’s new strategic direction.

We need to be clear about what design does. When it comes to innovating healthcare it offers three particular strengths:

  • a range of methods and tools for understanding people;
  • processes for innovating systems;
  • by encouraging people to challenge assumptions and think hard about the nature of problems and opportunities, it changes mindsets.

Realising a design-led health strategy

This would help people and organisations find the things that are holding them back, providing a framework and a set of tools to explore the issues, and enable an exploration of possible ways forward. Our research published in Valuing Design examined the most important conditions required for design-led approaches to flourish in public sector projects:

  • leadership
  • community building
  • capacity

For a design-led health strategy to make a lasting impact we must be committed to building communities committed to developing new approaches to inclusive healthcare innovation, growing creative capacity amongst all healthcare professionals and developing and enabling visionary leadership.