19 July 2019, written by Sophie Dennis, Lead Service Designer at NHS Digital
We’ve had an intense few weeks pulling together insights from interviews with patients, staff and commissioners. Plus, visits to health services around the country, as well as data analysis and secondary research. Weekly week notes writing fell off our list, so these are more like month notes than week notes.
The result of this activity is an extensive set of artefacts, describing the current state of urgent and emergency care: from the patient perspective and staff perspective, the service delivery and technology landscape. These now grace an entire wall of our offices in both Leeds and London. I discovered the hard way that it takes one person 45 minutes to get it all up on the walls and 20 minutes to take it all down again. Note to self: next time get help and buy more Blu Tack.
We’ve shared a digital version with a number of people, but the volume of work means it’s best viewed in person. So this week, we’ve been hosting drop-in sessions for people to come by and view the work. We’ve had brilliant chats with colleagues from NHS Digital, NHS England and NHSx, all of which are helping further shape our thinking. We’re particularly grateful to those who travelled some distance to see us and give feedback.
Identifying and prioritising opportunities
For three days we locked several of the team in a room, to see them emerge with an exciting, and often challenging, set of problem statements summarising everything we learned from all the visits and interviews with potential digital solutions and interventions. This output summarises where we believe digital could make the most impact, whether improving patient care, increasing staff productivity, or increasing patients’ trust and confidence in our services.
We’ve prioritised opportunities by the:
- Spread of the impact: is this problem impacting many people?
- Depth of the impact: is this problem playing a key role in improving health outcomes, improving patients’ sense of trust and reassurance, increasing staff and system-wide productivity, reducing cost and mitigating system pressure, improving convenience for patients?
- The level of improvement: by addressing this problem, will we significantly improve the situation?
We’ve also categorised opportunities by the type of change required to change the problem. Does it require:
- system-level change to how multiple services and organisations work within the UEC system
- service-level change to how particular services are designed, orchestrated or delivered
- patient-level change to individual patient’s behaviour and perception
In identifying where we can make the most difference with digital efforts from “the centre”, we’ll be focusing mostly on the first two: system and service-level change.
We’re constantly iterating these to get to the clearest expression of the problems and opportunities. And we’ve started sketching possible solutions. Literally drawing what’s in our heads. It’s always incredibly powerful to move from describing things with words to describing things with pictures (even really bad, really rough pictures).
Sketches help us align on what our view is and express ideas more clearly. They range from screens and flows for digital products to a storyboard of how a remote, distributed urgent care workforce might triage and treat a patient in future. And, the digital tools, data and technology needed to do this.
Strategy is about making choices; deciding what you will and won’t do out of equally valid but ultimately incompatible options. So, our sketches include deliberately bold and provocative concepts. Shining a light on the extremes ensures we have the hard conversations about which of those valid but incompatible futures we will pursue.
We’ll be doing a similar exercise with different groups of stakeholders from both national and local teams in a series of workshops over the summer, piloting with smaller groups at the end of July. We’ll be sharing more of that in our next Show and Tell on 23 July.
Our work with FutureGov wraps up on 13 August. Over the final few weeks we’ll be:
- mapping our findings against the policy and strategic intent of the Long Term Plan
- refining our sketches and target state of how the patient, staff or service experience of unscheduled care might be transformed through digital
- piloting workshops, bringing together national teams and local commissioners, staff and patients to build consensus on that future state
The work won’t end in August. There’s still lots to do to reach consensus on what the future of urgent care might look like and the digital tools, data and services we’ll need to support that. The NHS Digital team will be taking that forwards over the coming months.