Week 14
Appointments, agencies, and sensitively asking about pregnancy.
- I was struck recently by an experience I had accompanying someone to a doctors appointment. The difference between a bad consultation a good one is enormous — I’m not sure it can be overstated. A bad one — nothing resolved, problems made worse, stress and unanswered questions. A good one — immediate relief, a way forward and improvement in mood and outlook. How do those designing health services close this gap? Can we?
- Linked to that, I had a great meeting this week learning about the Realistic Medicine movement in Scotland. It’s absolutely fascinating, and is, I think, an answer to some big problems in medicine. Perhaps even the one I mentioned above. For example, I learnt that in NHS Lanarkshire in every appointment letter sent to patients they include a leaflet suggesting 5 questions to ask at the appointment.
- Our project re-building our advance decision service has become challenging in a few ways.
- Partly there is a question of agency fit — do we have the right partners, and do we work in a way which lends itself to agile delivery? For example, we have very good in-house capability in content design and user research. Less so service design and tech. So how do you procure a partner effectively in this situation to re-build a mission critical digital service? I think this is actually VERY difficult to do.
- I am starting to reflect that perhaps our size and setup lends itself better to working with skilled freelancers/contractors rather than agencies — however that doesn’t quite work when you need to find a technology partner to build, host and support a live service. Tricky business.
- Another big part is that our service (and the policy space it sits within) is just very complicated. I’ve talked before about us being experts, and I’ve always worried how well any external supplier, freelancer can understand the problem space quickly enough.
- Let me give you a specific example…
- When completing an advance decision to refuse treatment, we need to ask people whether they are (or are intending to become) pregnant…
- This is because if you are pregnant, in your advance decision it is a good idea to make clear whether your refusals of treatment will apply during the pregnancy.
- The NHS service manual rightly advises designers to ‘consider the sensitivities around your questions’. Asking whether someone is, or intends to become pregnant is a sensitive topic. Also given years of experience running this service we also don’t want to annoy people for whom this question simply isn’t relevant. So, we’ve been thinking about how to better frame this question. The service manual also suggests using filter questions to help users move quickly through a form by routing them to the questions that apply to them.
- We might for example try a filter question like this:
- This is just one example I think showing 2 things — firstly the complexities in our service. This is just one of 100’s of design problems to address. How do you design a process to make sure you’re delivering enough attention to each part of a service?
- …and secondly how much the NHS digital service manual and GOV.UK design system can help us improve our service.
