How small changes can help us support more people

Sometimes the biggest, most revolutionary changes are achieved by changing just one small thing at a time.

Late last year, we redesigned our talking therapies services to support more people to access help. Over an intensive, two week design sprint with design agency Snook we reviewed how people engaged with the service, what was working well and what we needed to improve.

As a result, in just six weeks we fundamentally changed how people access our services. We simplified our website, our phone systems and the text we were using to communicate with clients. We stripped away a lot of the obstacles for people trying to register for our service by making sure our online form was user friendly, and only asked the questions we really needed to know.

We did this using simple, free or low cost software (e.g. google forms), with no complex bespoke solutions.

But however slick we made the registration form, booking an appointment was still a complicated task. We needed people to answer their phones to book an appointment. To make this more difficult, we were calling from a withheld number, during working hours, and didn’t leave a voicemail. If we couldn’t get through we wrote a letter asking them to call us, which the clients would do, but more often than not couldn’t get through to anyone on our very busy phone lines. And so the cycle would go on. Too often, clients would simply give up.

If we were really going to support more people to access mental health services, we needed to fundamentally change our ways of working. We needed to do this quickly, simply, and without additional investment in complex solutions.

From pipe dream to real possibility

People had already told us that the most challenging part of their experience was booking an initial appointment. They told us they needed a sense of control, reassurance and confidentiality. This is particularly important for people getting in touch with a mental health service, where fears about stigma, shame and anxiety are already likely to be affecting someone’s emotional state.

When was the last time you called someone to book an appointment? When was the last time you booked a table at a restaurant over the phone? As clients of the restaurant, we often make the conscious decision to book online rather than calling. We can see all availability and select from that what suits us best: we may go onto the site wanting a table at 7.30pm, but we can immediately see there are no bookings available then, so we make an immediate, informed decision to take the table at either 7pm or 8pm. It’s quick, it’s easy, and we feel like we’re controlling the experience to meet our own needs. In the space of only a few minutes, our evening is organised and confirmed.

Allowing clients to view all available appointments online and immediately book the one that works best for them seemed like a pipedream. But with some quick testing, google searching and input from the wider organisation, we found a simple way to make it a reality.

Radical, incremental changes

We tested two software as a service booking systems that we could get ‘off the shelf’ (Simply BookMe and Calendly — but there are lots of other alternatives available). We did some quick testing with our staff and our clients.

Throughout the design process, we were clear that our priority was improving the client experience. We needed to introduce a process that put our clients in control, but was quick and intuitive for them to use. We didn’t want to create an additional burden for staff. And we wanted to implement changes quickly and keep control of how it worked. We knew we were going to take an iterative approach where we would test, gather feedback, and improve. This approach gave us the freedom to innovate, but didn’t need to get it perfect first time.

What was the impact?

We’ve piloted our online booking system in our services for four months. Over that time, we’ve changed how we use it by building on the things that work, and discarding things that don’t. It isn’t perfect. It requires our staff to run their diaries differently, and needs us to run an effective data-entry team to keep on top of appointments. Our IT systems have had to adapt and our managers have had to invest time in training and monitoring. But it’s fundamentally changed how our clients access the service, and their experience of us as a service provider.

Making these changes has increased the number of people entering treatment with our service following making a referral by 20%. The percentage of people who are discharged and never book an appointment with us has decreased from 43% to 18%.

We’re not finished and there’s a lot more we need to do. But this process has taught us that sometimes the biggest, most revolutionary changes are achieved by altering just one small thing at a time.