NHS X GSA

A collaborative service design project between the Glasgow School of Art and NHS Scotland, this project explored, gained insight into and proposed design opportunities concerning patient journeys before, during and after endoscopy procedures. Divided into groups of four students, we were given access into the endoscopy units of four different hospitals, where we conducted extensive user research in the form of patient and staff 1:1 interviews, observing medical procudures and shadowing entire patient journeys throughout the hospital.

Some of the initial questions we seeked to answer:

• What are the current sticking points and issues within the provision of the endoscopy unit’s services and experiences?
• What are the existing good practices that may be worthy of adoption adaption and amplification?
• What is the current patient information in this arena, how and where is this disseminated and how effective is this?
• How are the current services managed, delivered and experienced – for whom and for why?
• How may we redesign these to the further mutually benefit of both the users of and staff within the NHS?


Synthesising field research

Endoscopy is both a procedure and an experience involving a wide range of interconnecting relationships and user journeys. One of our main focuses in the research stage of this project was to was to map out the varying experiences and touchpoints encountered by patients in the endoscopy ward. 

The development of a user journey map played a key role in the project, as we were able to collect all of our most important insights in one place. We referred back to the map throughout the project, in order to further understand what each stage of the endosopy process, how the patient felt and the touchpoints they encountered. We created two visual graphs for the map, one of which showed the emotional journey of the patient in correspondence to what they were experiencing. The other showed the relationship between the information received by the patient and the amount of agency they felt as a result of this.



Key insights + opportunities

Improving patient agency

A lack of patient agency was an important theme throughout the project, as many of the issues we observed during our time within the hospital were the result of a lack of information available to the patient about how the endoscopy unit operates. Without a clear mental of their procudure, the patient’s journey thoughout the ward seemed very fractured, with unexpected preparatory work, multiple different waiting bays and interactions with a number of different staff members. As a result of this, the nurses and consultants spent a great deal of their time explaining the procedure, answering questions and reassuring anxious patients, adding more strain to their already hectic workloads.

Cancelled and missed appointments 

Cancelled, missed and late appointments were one of the key issues causing friction within the Crosshouse endoscopy unit. This was partly due to the lack of option and flexibility in the current appointment system, but it was also due to patients not understanding the financial and operational implications of missing appointments.

Waiting time discrepancies

The nature of the procedures carried out in the endoscopy unit can vary a lot, making it difficult to predict waiting times. In Crosshouse Hospital, there were specific days which were busiest due to there being more consultants (and therefore appointments), which lead to larger waiting times. How could this information be made accessible to patients so they would A) know what to expect when arriving for their procedure? and B) know the reasons for any delays that might occur?




Outcomes

Digital appointment system

We prototpyed a digital appointment system that could also act as a platform to could give patients a mental model of their journey throughout the endoscopy unit. This system would give patients greater choice and flexibility in choosing their appointments and allow them to change/cancel appointments online, alongside data visualisations displaying average waiting times. The website has a section which explains how waiting times arise, and how they can be unpredictable due to the nature of endoscopy procedures. This would help to combat missed appointments, and give patients the tools to contextualise the pressures experienced by staff in the ward. As people are used to booking appointments using a number of different systems for other services outside healthcare, it is not unfeasible to imagine such a system for the NHS.



EndpoPass + onboarding

Flight boarding passes contain much of the key information required by the passenger throughout their journey, including the belongings they need take with them. Carrying this physical artefact throughout the journey also gives the passenger a sense of responsibility for their own journey - something which patient’s don’t experience within the NHS, where patients hand over responsibilty and agency to the staff involved in their treatment. 

This element of the flight on-boarding process would be easily transferrable to the endoscopy journey, and would help the patient to build a mental model before their procedure. The EndoPass would be created by the patient when they fill out their consent form online. This would remove the hassle of signing consent forms within the ward, which takes time and resources. Completing the consent form at home would also give patients more time to think and check over the questions with relatives. Currently patients are expected to remember aspects of their own medical history when filling out the consent form with a nurse; the pressure of this can lead to confusion and means that patients enter their procedure with uncertainties.