Redesigning a Clinical System

David Evans
Jun 27, 2019 · 4 min read

Clinical systems are renowned for having poor usability and performance issues, but NHS Digital are leading the way in what good should look like.

I’m a user centred designer at NHS Digital, working on staff and patient facing digital services. This means also I’m responsible for the end-to-end system experience of the e-Referral system, used by clinicians and admin staff.

The e-Referral service allows clinicians to offer patients a choice when booking appointments, giving them freedom, convenience and confidence at the point when care is needed, or even critical.

My team and I juggle policy intent with users needs in an area of the NHS where clinical input is critical to minimise risk to patient care, but also where usability is a clinical safety issue.

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“Usability is a clinical safety issue” stickers, produced by our Lead Designer Dean Vipond

A process

My product team put user needs first, as they are key to getting services and systems right, and in the short time I’ve been on the e-Referral programme, we’ve changed how the team work by focussing and prioritising on the tried and tested double diamond process, with discovery and alpha phases at the heart of the agile (little ‘a’) cadence we work within.

Double/triple diamond approach

As a product team, we diverged on separate but directly related areas of work as part of a single user flow, and both have risen from a process, still being experimented with but looks a bit like this:

  1. Story mapping
  2. Design sprint
  3. Problem statement / hypotheses generation
  4. Prototyping with the NHS prototyping kit
  5. Testing our hypotheses
  6. Iteration, metrics (SUS, SEQ)
  7. Show and tell (stakeholders and wider team/wider org)

Focussing on the problem

I’ve challenged the team to move away from implementing suggested solutions and ideas, and instead to focus on the problem statement at hand. We did this by mapping out the existing steps of a flow, creating a story map of the digital service from the user’s perspective, and highlighting known pain points to focus on as part of the redesign.

As part of an empowered team, we look at improving as well as removing things users don’t need or want in the system.

Designing with data

We use metrics and data to evidence decision making, analysing user feedback and analytics to feed into the confidence we have in a version of a design that were testing. This also helps us doing the show and tells, giving the rest of the team insight into how things are shaping.

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Research posters in the office courtesy of the brilliant Simon Davis

Working across team and organisations

The scope and impact of what we do is massive and we’ve been working with our own NHS Standards team, NHSBSA, Summary Care Records, different hospital trusts, not to mention GOV designers, collaborating, sharing, asking questions, and learning from each other as we go.

Building the clinical standard

Alongside other NHS designers, I’ve been an early adopter of the NHS service manual prototyping kit, using the kit as the baseline for patterns and components for our service. Where we have diverged from the NHS service manual patterns, because sometimes the thing you work on isn’t a website, we are documenting how and why.

Our team will hopefully be amongst the first to contribute back to the NHS service manual, ensuring other teams can find what we do useful for their own service.

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What I’ve learned

That its important to to stay focussed on the things that matter and not worry about other stuff outside of your control. That change takes time, and you need to grab the opportunities to make things better with both hands. That bringing people with you on that journey is really important. That its OK to be wrong about something. That testing your assumptions has to be a team sport. That celebrating positive feedback from users is important for your team.

Whats next

We keep going, keep putting people at the heart of everything we do, keep iterating and keep making things better for NHS staff and ultimately all users of our service.

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