Patients’ opinions of the care they received are informing better service design choices, writes Jennifer Taylor

Healthcare service design revolves around performance, engineering and the aesthetic experience. Much work has focused on the first two elements. The experience based design approach, developed by the NHS Institute for Innovation and Improvement, addresses the third - how interactions with the service are felt or experienced.

It’s about understanding what’s causing positive and negative emotions, because experience is based on emotion

EBD is about bringing patients, staff and carers together to improve care and redesign services. The approach draws out the subjective, personal feelings that patients and carers experience, rather than just their views on speed and efficiency.

There are four steps to the EBD approach: capture, understand, improve and measure.

Capture is about collecting information in patient, staff and carer experiences by getting people to tell their stories, then observing what actually happens in practice.

The next step is to pull together all of the information and try to understand it. Different mapping tools, such as emotional mapping, can be used at this point.

“It’s about understanding what’s causing positive and negative emotions, because experience is based on emotion,” says Helen Baxter, lead associate in the NHS Institute design and innovation team.

Since various methodologies can be used to implement improvements, Ms Baxter recommends that trusts continue to use the ones they already have in place. What will be different is that staff won’t do the improvement work on their own. Because staff, patients and carers have identified the priorities together, they will also come up with joint solutions.

Measured progress

The final step is to measure the improvements - again using familiar methods - and look at how they can be sustained.

A suite of products on the EBD approach are freely available from the NHS Institute website. An introductory booklet explains the approach and includes a DVD that can be used to engage people in the process.

The “guide and tools” book covers the four steps of the approach in detail, while “concepts and case studies” provides some theoretical background and examples of the technique being used in practice.

The most recent addition is the “facilitator’s pack”, which came about following numerous requests for Ms Baxter to lead sessions on the EBD approach in England and elsewhere.

An invitation to do a one hour presentation at a conference in the US kick-started the development of a guide that people can use to present the idea of EBD and, if time allows, take their group through some practical exercises.

The pack was used by a presenter during the conference in the US and the feedback has been very positive.

The ideal culmination of the EBD approach is to work towards experience based co-design. That involves working to understand patient, staff and carer experiences, identify priorities for improvement and then working together to develop solutions.

Ms Baxter says: “It’s very much about non hierarchical partnership working.”

Experience based design: the benefits

  • Patients feel safer, happier and more valued
  • Staff feel more positive, rewarded and empowered
  • Reduction in waiting times and overcrowding
  • Creation of a safer environment
  • Preservation of patient dignity

Case study

Ealing Primary Care Trust used experience based design to improve services for patients with multiple sclerosis.

A team from the service design company Livework interviewed nine patients and their families. Patients spoke about their work, social life, what it was like to live with MS and their experiences of services. The team observed interactions between a number of MS patients and social services by shadowing a community therapist.

Commissioners, clinicians and managers from health and social care met with the team to identify opportunities for improvement. They discussed what makes a good experience and what makes a bad one. Most negative experiences were associated with a feeling of not being in control and not knowing what was going on. Good experiences were used to identify ways to improve the service. Sessions were held with patients and their families to discuss and refine the ideas.

A community service called Enable was developed for people with long term neurological conditions, which consists of access to a multidisciplinary team in the community, a single point of contact for self referral, telephone advice and weekly outpatient physiotherapy.

Chris Walecki, team manager for the service, says: “The most important thing for any service design or redesign [is] to involve patients at the centre of things.”


Patient Experience Tracker results in November/December 2009 from 45 patients. Highlights the quality of the service 18 months after the EBD approach was implemented.

Did your healthcare professional know enough about your condition?4041
Did your healthcare professional treat you with respect and dignity?4401
Do you have trust and confidence in your healthcare professional?4311
Did you receive clear answers to any questions you asked?4221
Were you involved as much as you wanted in decisions about your care and treatment?4221