Last month’s ombudsman report didn’t just highlight the gap between the NHS’s values and the reality for older people; it suggested that the health service needs to reshape ways of working that start putting patients back at the heart of care, argues thinkpublic’s design project lead Ella Britton.
The recent report from the health service ombudsman describe the appalling experiences of 10 older patients within the NHS. Many of these cases describe feelings of neglect, abandonment and suffering, and half of the cases include examples where patients are left malnourished and dehydrated.
The cases, the ombudsman concluded, reflect “an attitude – both personal and institutional – which fails to recognise the humanity and individuality of the people concerned”.
Reading the report, what struck me most was not simply the gap between the values of the NHS and the reality being experienced by older people, but also the fact that these are not new issues. In the past decade since the Victoria Climbie tragedy we’ve seen a steady stream of reports cataloguing personal and institutional failures, each recommending fundamental overhauls of how we address complex social challenges.
If we are to make lasting improvements to the way we address complex social challenges I think we need to actively explore new ways of working that connect with, and value, the humanity and individuality of the people who use and those who deliver public services.
In my view, design research and approaches such as experience-based design (EBD) offers a powerful means of placing humanity and individuality at the heart of our public services.
EBD is an approach used to capture and understand how individuals, both public and staff, experience using and delivering health services. These insights are then transformed into design opportunities and used to inform the innovation and improvement of our public services. With EBD, the user is integral to how a service is designed.
At thinkpublic, we use experience-based design and a wide range of other design and social research approaches to understand, co-design and prototyping to put people at the heart of change. In the context of improving how we value and care for older people, these approaches offer the following benefits:
Engagement: a criticism of change programmes arising from reports such as Care and Compassion is that they can feel remote and externally imposed. This can produce a lack of local ownership of the change process, limiting its impact. With a co-design approach both service users and staff are brought together in an open way to explore their experiences of a service and how it relates to their lives.
For example during a recent EBD project with NHS Lothian thinkpublic trained willing staff to capture the experience of the patients and staff from the head and neck cancer ward. Patients and staff then worked together to turn these experiences into ideas for change. This process ensures that all parties with a stake in change are engaged and focused on the priorities and solutions that matter to them.
Adaptability: as well as the challenge of engagement, another challenge of major change programmes is that they can result in a standardised set of improvements. Not always addressing specific local needs. By using co-design methodology to enable people to collaboratively design solutions, a prototyping approach can then be used to get those same people testing their ideas with real people in real places.
For example, during a recent project with Barnet council we co-designed a new community life coaching service with the aim of building the confidence and resilience of local families. We then involved one community in Barnet in the testing of this service by training volunteers to work with families over a period of time to try out the idea.
By involving the community in active and meaningful ways we believe that the resulting change reflects the needs and wants of local people. It also increases people’s buy-in to change and builds a collaborative commitment to producing and delivering new services.
Sustainability: the Care and Compassion report focuses heavily on bringing about cultural change, both in individuals and institutions. I really believe that this process of change can be supported in a number of important ways by using creative tools such as visual journey mapping and film to capture and communicate experiences, giving a voice to older people and their families. Healthcare professionals, having listened to and worked closely with older people and their families, are then motivated to exercise the leadership needed to bring about lasting improvement.
When I spoke to Sarah Moxon, a trained nurse from London, about what needs to happen internally to make the necessary change, she said; “When I have worked in wards that are providing good quality care to older people there tended to be a central leadership and central energy on the ward. The charge nurse would set the standards of care and would not let those standards slip. They would humanise the care by ensuring that everyone was treated with respect and dignity… That is what makes you do your best when the leadership is positive and the moral is high”.
Much of the recent coverage of NHS reforms has focused on institutions – abolition of PCTs and the new role of GP commissioners. The Care and Compassion report is a timely reminder of the need to recognise and value the human within public services.
With ever greater pressure on public sector finances, now more than ever we need change programmes to be effective at delivering lasting solutions that meet local needs. It is neither feasible nor desirable to continue to deliver change in traditional ways. Within this context, a patient-centred approach to managing change offers the best way of delivering services that place humanity and individuality at the core.