GSAxNHS collaboration 2019

NHSXGSA a collaboration project

OCTOBER 2018 Joรฃo Lourenรงo

Introduction & Brief In collaboration with the Scottish National Health System (NHS) we were asked to explore the terrain of sexual health provision, education and experiences, and to communicate our understanding of these, as they stand at the moment and then develop new design opportunities and strategies by which the issues raised may be addressed.

This 6 week project looked at the new roles that are emerging for designers in as open design approaches are being used as ways of creating design & stimulating innovation. It involved working collaboratively with a range of stakeholders to develop new modes of working in design.

Hospital ward/clinic: Ayr Hospital – Gatehouse Sexual Health Clinical Core staff GSA: Ian Grout / Lorenz Herfurth / Rachael Sleight Core staff NHS: Karen Bell / Dr. Ruth Holman / Dr. Anja Guttinger October, 2018

Team

For this project we had the chance to collaborate with universities’s partners exchange students. We worked as a design consultancy agency and the team was formed by:

Alice Harper

gsa EXCHANGE

Breagh Baird

João Lourenço

Arianna Rapetti -Politecnico di Milano

Helena McDonald

Pier Rosa

Carrie Carter -Maryland Institute College of Art (MICA)

Jose Parrilla

Content, process and project time-line

DE

VER DISCO week1

week2

LIV

E DEV

E

week3

DE

LOP

FIN

week4

week5

week6

log-in & booking site visits

making sense of data

patient journeys

Defining final directions design opportunities

ER

logo

final presentation at clinic

chat bot

personal contributions

Redesigning

concepts, prototypes

tools

Outcome & Poster

reflection

DISCOVERING

The discovery process started with a presential introduction to the staff of the clinic at the school. We have clarified what were the expectations from both sides - NHS would employ us and provide with this opportunity of professional practice, giving us access to the backstage of the service, availability to answer our questions, and in exchange would expect us to look at their service from an outsider perspective, with fresh eyes, and potentially use our design skills to find opportunities for improvements.

With introductory informal open-end conversations, where we got to know each others. We then planned a couple of visits to the clinic in the following days.

the entrance might be hard to find because the clinic was built with privacy in mind: but people usually try to go in through the staff door

From bus stop to clinic’s entrance

SITE VISIT To understand everything working around the clinic we have started with staff interviews, site visits, photographic documenting, artefact collection, observation frameworks and sketching, social probes. For desk research we relied on data demographics and available reliable internet resources.

Before arrival we were cautioned with a curious advice “the entrance might be hard to find because the clinic was built with privacy in mind: but people usually try to go in through the staff door�. Privacy had a major role in the whole experience.

We went using the available public transportation lines, baring in mind that local users of the clinic could start their experience like this too.

INTERVIEWS At arrival, early before opening time, we were well received and shown around the building.

We met most of the core and auxiliary staff of doctors and nurses, as well as receptionist and cleaners. They knew what we were doing there, were willingly to tell us what issues they usually face in their routines, and what they would like to see addressed.

This staff interviews were invaluable to see how each individual perceives the service from their own perspective, and see a range of issues: For instance, the doctors would like to understand why people come back to the clinic if a contraception is self-administred, (1) nurses would like to see the delivery men come pick up the samples for laboratory more often, and auxiliary staff wished people would start looking at the signs to properly find the button that opens the door to exit the consulting ward.

(1)

The Sayana press is a self-administred contraceptive solution. It is injected through a needle.

Not only we were being proposed to answer questions but also a massive volume of information was being poured to us in very short amount of time.

Why has there been a drop at the turn-ins?

Why are people returning to the clinic if the contraceptive is self-administred?

All tests of the area are collected by the same delivery man to take it to the hospital laboratory - tests have to sit and wait for their turn to be picked up

Women come to the clinic for gynaecology consultations because they get it faster in here than in the hospital

some people don’t seem to know when to come to the clinic

SIGNAGE Although basic, it kept being mentioned by staff as an area we could intervene. There was something naive and humorous about this issues.

A paper solution implemented by the staff when faced with the comment that the clinic did not have gender neutral toilets.

Staff nurses would point out minute frustration induced routines - such as the patients being stuck inside the clinic because they could not see the button as it was placed 2 meters behind them.

consultation room We looked at all the artefacts and tools involved in educating the incoming patient at the consulting room - scale models of reproduction system to aid a conversation and explain how a contraceptive installation procedure works (2), leaflets that get handed in, almost unreadable spreadsheets that showed the appropriate times of incubation for STI’s to be traceable (3) and contraceptive solutions (4), etc.

This later proved useful to inform better website educational tools.

(2)

(3)

(4)

Staff was committed to make us understand the service to the extent of role-playing interviews.

STI tracking STI tests are in big demand as it is the second biggest reason for attendance. The majority of them are self collection samples, where the patient heads to a dedicated W.C. to perform the act.

It was intriguing to see that in this space there was no platform or surface for people to put down the test components, apart from the sink and the toilet itself, which was unhygienic and a potential for cross contamination.

While describing the procedure of several tests, the doctor mentioned that there is a relevant number of people that do not know how to use the tests, although there are instructions provided.

After the collection of a sample, this room has a dedicated window on the wall, with a one way door opening system, that was designed to pass the sample to the nurse that is on the other side.

We had test instructions fixed on the toilet wall but people kept on stealing them!?

How could we make clearer to people that they shouldn’t go [urinate] before a collection?

People book STI tests when they haven’t waited the necessary time to be tested

waiting ROOM At the waiting room the first impact was a somewhat neutral environment in terms of furniture but with an overload of information on the walls. Leaflets from different institutions but with repeated information were found, and even leaflets from Scottish Power amongst the relevant sexual health ones.

There were two screens, one turned off and another on, duplicating again the information encountered on the walls and leaflets.

We have made our observations here, while sitting in the room as regular patients, for the next 3 hours.

Every group member had a different set of things to notice, from objects to patients movement. In the first day we were doing observations during “holistic drop-ins”, and on the second day the crowd changed substantially with the “young people appointments”

We can’t have toys and such because they would have to be disinfected everyday

patients

Due to the sensitive nature of the services of sexual health, we were limited in regards of gathering information from patients. Having had a previous workshop in ethnographic research methods, sketching and writing was used to for qualitative data and clinics statistics for quantitative. We produced forms to make up for the information we needed for a deeper understanding.

We have included these in the initial sign-in form.

Your feedback is important for improving our services.

Thank you!

Welcome to the clinic!

Please rate how you’re feeling about your visit

relaxed

anxious

embarrassed

We made initial forms with mostly non private statistical questions.

Your feedback is important for improving our services.

Thank you!

Later we have produced individual questionnaires to pry into what people were feeling throughout their experience, as social probes.

the website A website intervention was requested by the staff at a very early stage, but no reason was given why, apart from their perception of that “it was not very good”. We have started by looking at the desktop version. The first impression connected to the experience of the waiting room - information overload. Just on the homepage there was 4 instances for the “free condoms” option. Although colours were being used to divide categories, they were so many that the shades had to be repeated.

www.shayr.com

Sexual Health Ayrshire

GO TO REPORT

All Web Site Data Overview

Oct 26, 2017 - Oct 26, 2018

All Users

100.00% Users

Explorer Summary

Users 300

150

January 2018

April 2018

Acquisition

July 2018

Behavior

October 2018

Conversions

Device Category Users

33,327

3. tablet

59,586

Bounce Rate

60.33%

Pages / Session

2.24

Avg. Session Duration

00:01:47

Goal Conversion Rate

0.00%

Goal Completions

0

Goal Value

$0.00

% of Total:

% of Total:

Avg for View:

Avg for View:

Avg for View:

Avg for View:

% of Total:

% of Total:

(33,327)

(33,059)

(59,586)

(0.00%)

(0.00%)

(0.00%)

(0.00%)

(0)

($0.00)

51,001

61.63%

2.15

00:01:45

0.00%

6,788

52.81%

2.80

00:02:00

0.00%

1,797

51.86%

2.73

00:02:06

0.00%

26,667 (80.06%)

2. desktop

33,092

Sessions

% of Total:

100.00%

1. mobile

New Users

5,348

(16.06%)

1,293

(3.88%)

100.10%

26,521

(80.14%)

5,295

(16.00%)

1,276

(3.86%)

100.00%

(85.59%)

(11.39%)

(3.02%)

60.33%

2.24

00:01:47

0.00%

0.00%

0

(0.00%)

0

(0.00%)

0

(0.00%)

0.00%

$0.00

(0.00%)

$0.00

(0.00%)

$0.00

(0.00%)

Rows 1 - 3 of 3

© 2018 Google

We later have asked for the statistics of usage. The doctor immediately said that they have never requested them before and so never looked at them. Once we received it was clear that most of the usage was being made through mobile devices. Looking at the website through a smart-phone revealed another experience - the website was not scalable, and some essential functionalities, such as a search bar, was missing.

When it came to the access data, the stats showed that the average session lasted 2 minutes and the average number of browsed pages per session were just two. This raised our curiosity and since we could not make a survey for this time we went with consented hunches: People use the website for quick info (phone number/ address) and take a while to find it, or just give up.

Moreover, was the existence of a website necessary at all?

DeFINING

MAKING SENSE OF DATA After the clinic visits we have returned to the studio to make sense of the gatherings, which meant compiling everything in a digestible way.

We have produced a rough layout of the service on a post-it wall, and received orientations to follow the process of translation over the next days that produced service blueprints, user journeys and experience mappings helping us reach an understanding of all the clinic’s processes and also identifying design opportunities.

Graphic creation of quantitative data We have produced graphics to quickly communicate the uses of the clinic: What are the services and who are the people using them.

Service usage

Demographics:

Stakeholders On identifying the relevant actors of the service, we built two stakeholders maps. These are the pieces that put together the service and that without them the clinic would not work.

ICE V R

UCATIO ED

N

OL

ISTS

MANA GERS

FAMI LY DOCT ORS

COUN

CELL ORS

NURS

ES

LO G

PUB TRAN LIC SPOR T

I

ST

IC A

L

E

SCHO

PTION

GPs HE

A LT H C A R E

FRIEN

L IONA SUPPO OT M

RECE

DS

RT

SE

1) Direct

/ORGANIZ L A TA

L ONA TI

NHS

DELIVERY MEN

S

CY PHARMA

ITAL

P AYR HOS

LAB TECHs

C NI

CL I

ALTHCARE E H

CHARITIE

LABS

ROYAL MAIL

G LO

ARE HEALTHC S R O IS V D A MAINTAIN PEOPLE

HO

L

H SCOTTIS ENT M N R E V GO

IC A

RS TAX PAYE

ST

VERNME N GO

2) Indirect

ANCE

S P ITA L

I

Patient journeys We began by de-configuring all the information by mapping user journeys. On a paper model and using colour coding we tracked the physical journeys patients were taken on according to the service they require. This also gave us a general sense of the use of the space.

We have also created a time-line to track the emotional journeys users go through during the several stages of the services.

After producing a series of user personas consistent with the data and observations, we have used colour coding to show the physical journeys patients are taken on according to the service they require.

Consulting Room 1

Consulting Room 2

Main

Entrance

Reception

STAFF area

Staff Bathroom

Laboratory

Sample Room

Interview Room 1

Waiting Room

Interview Room 2

Sample Room

Cytology/Exam Room 5

Consultation/Exam Room 4

Consultation/Exam Room 3

Bathroom Bathroom

Service blueprinting We have tried several ways of compiling all the service into one map.

Stages

Concern

Physical Evidence

- Website

Suspects Sexual Health Problem

User Actions

Arrive

Booking

Look for a clinic

Call clinic and book appointment

Receive reminder text two days before appt

Wait....

Follow Up

Be Seen

- Outdoor Signage - Posters - Leaflets

- Phone number - Reminder text message

Find front door

Arrive at clinic

- Consultation Chair - Posters

- Reception Desk - New Patient Form - Waiting Room Chairs

Greet reception

Fill out paperwork if a new patient

Greet and sign in patients

Instruct new patients to fill out paperwork

Sit in waiting room

- Call Card

Called by nurse and guided to consulting room

Wait in consultation room

Evaluated by doctor, test or procedure performed

Given call card

Doctor conducts evaluations and tests

Fill out patient info on call card

Leave clinic

Wait 2-6 weeks

Call automated line for test results

Schedule follow-up appointment if results are positive

Line of Interaction Answer phone and guide patients through booking process

Front Stage

Send text reminder

Show patient to consulting rooom

Call patient if they haven’t called within a reasonable amount of time

Line of visibility Set up automated reminder text

Log patient info and appointment time into calendar

Backstage

Process appointment sign-ins and new patient forms

Prepare consulting room

Check medication inventory: order new medications and dispose of expired ones

Print new patient forms when low

Internal Interaction

- High no show rate - Clinical/Unwelcoming waiting area - Long wait times, both to book an appt and to be seen - Forms are difficult to understand

- no online booking option

- Poor website

Design

Opportunities

Complete lab tests and log results into

Process tests and send to the lab

Gather medications, equipment and necessary materials

Log when patients dont call

Lab tests pickup logistics

- Low visibility of important info while waiting - visual overload of unreadable info

First version, based on linear steps and procedures.

managers

admin

lab technician receptionist doctor/nurse

takes calls & make appts.

stock check

admin

welcome patient

checks system

explain & give patient form

update system

takes calls & make appts.

make coffee

log in

check emails

go to reception

collect patient form

service user arrive

travel

go to office

drop off belongings

call patient

show patient to room

consultation

user journey

research clinic NHS website

make appt.

sex ed. at school

travel

find buiding

arrive

public transport

google maps

staff entrance

sign posts

front door

phone

clinic website

car

in clinic

walk

go to reception

(reg. user)

register

(1st time user)

wait... wait...

called by number

called by name

initial interview

ask staff

go to dr’s office

consulation

advised by dr test results card

swab

medication

urine sample

follow up appt.

smear test

friends leaflets & posters

pregnancy test procedure contraception vaccines HIV deterrant referrals

physical evidence registry fom

posters & leaflets

good

ok

poor

Chris

Lauren

John

Louise

Tim

Dr/nurse

Second version, with added emotional journeys.

show patient out

blood test

discharge sample

phone

give advice/ prescription

perform test

family

GP’s

process/ package

update system

lunch

admin

wait...

call results line

prep meds

sign in

drop-in

prescribe medication contraception

check name&DOB

carry out tests

swab, urine test, medication, syringe

shown out

go home

log off

travel

arrive home

before

after

clinic experience

user journey drop-in

go to reception

make appt. search clinic

search clinic

drop-in

! search clinic

appointment

search clinic

!

arrive

find building

arrive

go to reception

!

hard to find the clinic after getting dropped off by the taxi

go to reception

arrive

find building

travel

wait

register

wait

(1st time user)

! !

anxious: gives a fake name

register

initial interview

called by number

stressed out by upbeat music and visual overload of the surroundings

travel

wait

consultation

procedure

initial interview

!

shown out

go home

referral

shown out

go home

referral

shown out

go home

shown out

go home

John Annie

initial interview

called by number

sign in

called by number

wait

called by name

wait

initial interview

! !

(reg. user)

Lauren

Dr/nurse called by number

wait

(reg. user)

waiting period

interview room is very clinical and doesn’t make her feel good

!

sign in

go to reception

arrive

find building

go to dr’s office

has to wait a lot because it’s busy wait

(1st time user)

go to reception

arrive

find building

pass from reception

doesn’t cancel appointment

drop-in

!

finds the website really confusing

find building

travel

travel

drop in

!

travel

called by name

called by number

thinks he is getting seen but goes back to the waiting room

!

consultation

perform test

discharge sample

!

lets his frustrations out on the receptionist

advised by dr

given test result card

wait

!

gets asked for a urine test but has recently peed

call results line

loses test-result card

his child, Chris gets very bored so he tries to show him cartoons but wifi doesn’t work called by name

wait

initial interview

go to dr’s office

doesn’t fall within test window

go to dr’s office

consultation

!

can’t book online

prescribe medication

procedure

consultation without her mother

!

given medication

shown out

go home

informed of the different options by one of the doctors

touch points people people

artefacts

posters and leaflets

receptionist

GP

website

phone

receptionist

staff

public transport

car

walk

google maps

sign posts

registry form

Ayrshire Hospital

spaces

front door

nurse

phone

radio

posters and leaflets

nurse

doctor

blood sample

phone

radio

doctor

nurse

swab

posters and leaflets

receptionist

doctor

prescriptions

blood/urine sample

test result card medication

phone

staff

staff entrance

reception

waiting room

interview room

waiting room

consulting room

consulting room

toilet

mood map

Third, improving on the last and developing the information about the services.

before

clinic experience

after REFLECTION

GO HOME

COUNSELLING

ABORTION HOSPITAL VASECTOMY

JAG

VACCINES

GO HOME IUD

DROP-IN

WAITING

SMEAR

INITIAL INTERVIEW PROCEDURE

TRAVEL SYMPTOMS ARISE

RESEARCH CLINIC

BOOK APPOINTMENT

REMINDER TEXT

FIND BUILDING

ARRIVE

REGISTER

WAITING

SIGN IN

CALLED BY NUMBER

CONSULTATION COUNSELLING

PERFORM TEST DISCHARGE TEST

URINE TEST GO HOME

WAIT

CALL FOR RESULTS

SWAB TEST

BLOOD TEST

PRESCRIBE MEDICATION

GO HOME

A version we would end up using more often, as a map, to talk about the service as a whole, as it was easier to identify given stages at given points.

design opportunities A map with all friction points across the service. was produced and later applied to the service time-line while also adding the personas emotional journey.

opportunity cards The sum up of this frictions where transferred to producing these cards to facilitate discussion and choosing them for the final direction.

Defining final directions The group was excited with several opportunities to tackle that have come from the research work.

When leaning towards child entertainment solutions in the waiting room we were appropriately advised to focus on a sexual health related opportunity - after all this is the theme and would be a shame to not use the opportunity.

We then had a discussion and decided that we were going to address 3 areas, deemed of major importance, and consequently dividing the team into sub-teams: -Website; instructions.

Waiting

Room,

and

Testing

I was appointed to the website team, along with Pier and Jose.

Developing

website Seeing potential on improving the website as it was on a point of the service that was living before the user getting to the clinic, and so with a good chance to be an informational tool that we thought it could be better used for patients triage - if it was an efficient and fast way to deliver crucial information, it may prove useful in reducing the amount of people turning in for drop-ins without the need to do so.

In terms of graphics and communication, we idealised a service that would use a lighter tone, as if one had was chatting to a confidant.

Lastly, converting the website into a useful patient tool that could be accessed through the privacy of a phone, seemed coherent with discretion values when dealing with a culture of shame when it comes to sexuality.

ideating

En

Hiya!

Which one do you have?

Concept 1 Communication tone, using humour in order to lighten up the theme, while still being accurate provide serious and trustworthy content.

shayr.com

Concept 2 Identify the most important information that patients who come to the clinic are missing and make that information easy to read and access. (i.e. STI incubation time windows).

Concept 3 Create Sexual Health related tools that are actually useful and are used by people - for instance, a period calendar tracker, a contraception comparison tool, etc.

Concept 4

Create customised access for personalised navigation. With the enormous amount of content around the theme of Sexual Health this option would show only relevant content and could be used for other customisations such as language or other basic bur important accessibility options.

Concept 5

Education is the first line of defence against sexual health issues, so to strengthen that front the website could provide a rating/score system of knowledge on this theme. Pushing this concept further, this score could even be linked and displayed in social dating profiles.

redesigning Approach (tone), Need and Efficiency were the main points to address in our redesign. We have started working on the website by mapping its structure and see how we could produce an hierarchy of content. We have used the statistics of the most used services to inform this decisions.

Some of the content was merged into more broad categories to reduce their number and simplify browsing. From the initial 12 categories accessible from the homepage (and most multiplied at least twice) we have made 4 main.

We have looked at other clinics websites to see how the navigation was, and pinpoint what was working or not. We have also looked for medical websites that had been awarded design prizes for navigation, such as Mayoclinic.org.

Different layouts were tried to seeking for an efficient navigation.

We then looked at how brands that deal with intimate subjects communicate in a contemporary and pleasant way. A brand that stood out was Shethinx, and we got inspired by its simple but fun vector shapes, pastel colours and readable type.

chat bot For triage and main communication, a chat bot was proposed, at is a today a commonly accepted feature as per customer service based websites and brings a more personalised interaction with the user.

Hypothetical dialogue pathways. In one example we show how the dialogue could pop-up in the process of booking to make sure a patient wanting to book an STI test was within the appropriate testing window, and, if not the case, relief the clinic of said patient.

log-in & booking After the tutorial with Mafalda Moreira we were advised not to go forward with the personalisation tool, as the idea of capturing sensitive information could be dissuasive.

It was a sensible point, and we went forward with an optimistic take and only the benefit in mind - we propose it as an optional feature, where the data is safe, encrypted, and can be deleted at any time.

The benefits would be great, as it could be a direct line between user and service, work as a notification centre, prescription manager, and even appointment booking system.

We went ahead and added all this options in the UI.

toolS The STI informative sheet got its digital version where in as much simplified as possible table of details was produced.

Based on simple comparison tools of e-shopping, the contraception tool is equally simplified, with extra options stored on dropdowns. Words to rate options such as “reliable, not much reliable� were replaced with 1, 2 or 3 stars for easy reading.

Logo The logo had a quick intervention, since the original was composed of the male and female gender symbols engaged, in blue and pink respectively, we thought it would be a positive change to add a third element and colour, to favour diversity.

DELIVERING

We thought that making a short video could of an hypothetical website experience would be good to show at final presentation. Although after a tutorial it was put apart to use the time left on creating a functional prototype.

A close to final version was produced by creating links between the pages to simulate a finalised website, in order to show the experience to our audience.

Outcome & Poster The poster uses a common way of marketing a website, showing the full website pages and with added text to point out the features or main changes from the previous model. What I have to do next is add the human componente and value to it, representing someone using it.

Final presentation at the clinic

Our last presentation was at the clinic itself, where we presented our outcomes to not only the clinics’ staff but to other invited guests from various wards of the hospital, which showed interest in participating in this project next year, as everyone responded very well to our delivery.

As we have develop a working prototype we were able to pass a phone around for people to have the feel how it would be to browse the proposed website.

After the project have finished, we were still asked if we could produce a print of the map service for the waiting room, so that the patients would be aware of where they were in the grand-scheme.

Sexual Health

PATIENT JOURNEY

Ayrshire

Welcome to the Gatehouse sexual health clinic, we have laid out this patient journey to reassure you where you are and what is possibly going to happen next, according to the nature of each individuals’ case.

HERE YOU ARE!

Reflection Learning outcomes: Although the feedback was great, I don’t feel that I have learnt much about service design itself or built confidence towards it. Most of my work was around website design and the weblog, something I had done professionally in the past, and the new part learnt was taking research informed decisions in order to design around user needs.

I think I have lost an opportunity to learn something new and strengthen weaknesses (like physical prototyping or 3D modelling) but I did do a better job in terms of documenting and refining an outcome. It was the first time having a project with a team of this size and that was challenging, as my motivation is too affected by team dynamics for my own good, it was great to have everything going well in that department.

What I think it went well: I feel that I have committed to this project, mainly in the outcome of the prototype. This was the first project I felt this towards the end of the project and not at the beginning., maybe because I had some experience in it. But, although not my strength, I was also able to document work in order to keep the team blog updated. weekly.

What I would change: If I could do this project again I would like to work designing the tests, as It seems like a huge thematic to dive in (there seems to be potential in postal tests to alleviate clinic, but there are money limitations ad accuracy is an issue) and would be out of my comfort zone. I wish we had gotten qualitative data about the user experience related to the website but I understand the limitations of it. Ideally a smaller team.

To improve: PPJ: In terms of showing more about the thinking behind the concepts and the development process. As a 3rd year I already know that this is my weakest point, and by comparing to last years work I can see improvement, but still not up to a self-satisfactory level.

website designinghealthcare.co.uk/gatehouse pass: nhsxgsa2018

personal contributions Gladly anticipating the chaotic amount of information we would be dealing with and the organisation needed, I have introduced to the team the chat program Slack and preached the use of other open access tools for organisation and as a way to divert people from using social networks for group communication.

I have taken the initiative in early setting up the GSAXNHS website/ blog templates, for the whole class, making it ready for every group to only drop content, and I was responsible to write the daily work development for our group (which was later assessed by a couple of other members at the end of the project) Illustration, profiles and narratives for user personas; website concepts and presentations structures; prototype interactivity.

The main user-centred features development were defended and well appreciated by NHS staff. I did the main documentation of the site visits, taking pictures, recording sound and filming, and addressing the social probes to complement the insights we needed.

I have contributed to the Waiting Room team by scouting my local clinic to compare the layout of the space and brainstorm with them.

I have helped the Test team by doing some personal research on mail ordered tests and then brainstorming with them.