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Patient-centred care – how to make it a reality

How can a user-centred approach help make patient-centred healthcare in the NHS a reality? That was the key question that innovators in digital health, healthcare provision and service design sought to answer at Opencast’s TechNExt fringe event this summer. We take a look back.

The patient-centred event, hosted at Opencast’s Newcastle HQ and live-streamed online as part of the annual TechNExt festival, addressed the agenda and pain points faced by patients and people working in the NHS in and beyond the North East – particularly those involved in designing, improving and transforming healthcare services.

Our panel of expert speakers focused on the positive impact that patient-centred care can have, and how taking a user-centred approach can help in both the NHS and wider healthcare settings.

Moderator Andrew Besford brought perspective both as a non-executive director at Northumbria Healthcare NHS Foundation Trust and a former deputy director at the Government Digital Service – and framed the talk by asking what patient-centred care means and the role of design in that.

Murray Ellender, Jamie Whysall and Ute Schauberger

Our speakers

Dr Murray Ellender – Founder and Chief Executive, eConsult

Ute Schauberger – Service Design Practice Lead, Opencast

Jamie Whysall – Principal, Head of Healthcare, Netcompany

Andrew Besford – Non-Executive Director, Northumbria Healthcare NHS Foundation Trust (moderator).

Andrew Besford of Northumbria Healthcare

Why patient-centred care matters

Ute Schauberger, Opencast’s Service Design Practice Lead, who has also worked as a service designer at NHS England, said many of the challenges were about the NHS as a service: “the steps that repeat throughout the system…the boring parts like booking appointments, arranging things and repeating tasks that both patients and staff have to do to organise care and make sure people can see the clinicians they need to see.

“All these services are ones that designers and technology can help a lot with in handling repetitive tasks that currently have to be completed by a human being,” she explained.

“Patient-centred care matters and is about making sure that all these different systems, both on the data side and the front-end, work together so people can get the care they need and get in front of a clinician when they need to. In the UK this is a public service, so we need to make sure it works for everyone.”

Murray Ellender, Co-founder and Chief Executive at digital health business eConsult – and a practising London GP – said he founded his tech business “hugely frustrated by the patient’s challenges booking appointments. The driver for us was, how can we harness technology to make this better for our patients?”

He added: “We built a platform that allows patients to go online and have a lot of their health care needs addressed digitally, bringing patients into a building only when they need to. This technology has now been adopted by every practice in the country.”

Jamie Whysall, Principal and Head of Healthcare at Netcompany, a consultancy responsible for 60%  of public sector digitalisation across government, health and social care in Denmark, in central government, health and social care. “Providing the linkages around data is the key foundational stone to being able to be patient-centred,” he said.

“In the UK we are building out on those foundations, trying to take some of the lessons and the technology that we’ve deployed in Denmark and bringing that to the UK market.”

Opencast's Ute Schauberger

Backdrop of challenges

Ute pointed to a “culture clash” between design, technology, clinical practice and other healthcare professions – “but what often is also the case is that we have a common purpose, which is to make it better and make sure it is patient-centred, and that people get what they need.

“This can lead to a healthy tension between all these professions and how they work differently. Clinicians can be very risk averse, and that’s a good thing. But in design and technology we depend on a bit of risk. We need to experiment – we’re introducing new things. What is important to improve collaboration is that shared purpose and common definition of patient-centred care.”

Jamie said that in Denmark, user-centred design is referred to as ‘equity by design,’ understanding that all users aren’t the same. “Actually, it’s about designing services that work for individuals as opposed to an amorphous blob of the user, which is quite an interesting concept when you apply that to products, services, or end-to-end systems and pathways.”

Murray said that: “to get the right patient in front of the right clinician every time, there’s going to be an inherent efficiency in doing that using traditional systems. But we estimate about 30% of patients are sitting in the wrong queue for healthcare. They’re either waiting to see a GP when they could be seeing a pharmacist or waiting to see a dermatologist when they could be dealt with by a GP.”

“If you can use technology to support and fix that, then it’s undoubtedly going to be helpful.

“You know clearly as a clinician that the patient sitting in front of you is at the centre of what you’re trying to do. But there’s a tension which we’ve got to deal with as a technology supplier, which is this: the clinician is a user as well. When you’re thinking about technology, you can’t just put the patient at the centre.

“If you go back to the example of GP appointment booking, that’s not patient-centred design. Historically, we made it very hard for a patient to come in and see us, if we’re honest. Waiting four weeks to go and see a GP for something is not a great user experience.

“What the patient would like is the ability to interact with their GP, either in person, on the phone or online at any time. And we’ve got to ask ourselves, is that achievable within the NHS today?”

Netcompany's Jamie Whysall

What good looks like

Asked what good looks like on this balance, Jamie said Netcompany was working with NHS England on creating a new system, “taking the GP registration system from a disparate set of paper forms to a consistent national service. That is improving the system for patients.”

He said that nearly half of registrations Netcompany sees through that system “happen outside of GP working hours so available to the patient when they need it. In contrast, it’s saving typically 15 minutes within a GP surgery on administering what was a paper form. There’s a win-win there.” 

Ute said small improvements like this can help move the whole system towards a more patient-centred model. “The reality on the ground is once you start, and you take a corner of it and improve it, it ripples through the system and it opens up new opportunities for technology, for designers to work with clinicians and make it better for patients and staff.”

Murray said that healthcare was one of the last industries to properly embrace technology. “The NHS spends something in the region of 2% of its total budget on tech, compared to ten per cent in an industry like banking. Ultimately, we need to shift some of the investment away from hospitals and staff into technology.”

Jamie agreed and described point solutions in parts of the system which were needed to make healthcare into a coherent whole. “In most cases, the data to solve the problem already exists within the NHS, it’s simply a question of leveraging it to shift the system forward,” he said.

eConsult's Murray Ellender

Patient at the centre of the debate

Ute said service design had been described as being like a piece of embroidery. “At first sight you should have a beautiful service that appears to be really straightforward and easy to navigate. But when you flip it over, you may find that on the back it’s much more chaotic – there might be 10 organisations involved in delivery with really complex relationships between them.

“Sometimes, when designing new services, we focus more on the back end and ensuring that internal stakeholders are happy, whereas in fact we should focus on making sure that the front end is straightforward, accessible and easy to navigate for patients. Services that are designed with a focus on the back end can actually end up causing more chaos, as patients struggle to access them and end up losing trust in the system.”

Jamie agreed. “We're talking about patient-centred care, in any other industry we're talking about customer experience. Actually, that customer experience isn’t always considered because a patient hasn't got the ability to walk away for the most part.”

Murray outlined some of the difficulties that have emerged as the tech sector has taken on a larger role in healthcare. The first products for GP triage were available 24/7, which patients liked as they were able to log their symptoms at any time that was convenient for them.

“However, competitor products emerged that GPs could switch off at will, which the GPs preferred as it allowed them to manage their workload,” he explained. “Over time, more and more GPs switched to products which gave them control, but this arguably moved us further away from patient-centred design. What’s needed is designers bringing patients and clinicians on a journey together, but that takes time.”

Jamie added that in Denmark citizen health records have been put in the hands of patients, which has driven significant improvements in the perception of care: “Patients suddenly have access to all the information they need, in one place, and they can share it with others if necessary. Patients also have a clearer sense of the journey they’re on, and what comes next for them.”

Opencast's patient-centred care talk took place on 18 June at our Newcastle HQ as part of TechNExt 2024. Watch a full video of the session.

The talk was part of the TechNExt 2024 festival

Clinicians can be very risk averse...but in design and technology we depend on a bit of risk...what is important to improve collaboration is a shared purpose and common definition of patient-centred care

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