NHS: Design for Social Innovation
This trimester, as a part of the Design Studies 1 module at Edinburgh Napier University I participated in a project ‘NHS: Design for Social Innovation’ conducted in a collaboration with nurses from the Community Children’s Nursing Service at Firrhill House in Edinburgh. The research held between 15th February and 12th April 2019 concerned the influence of chosen disposable plastic items on the young people’s perception of the Community Children’s Nursing Service during home visits.
According to The Guardian [6], social innovation is a practice aimed at resolving the most significant challenges that society troubles nowadays. Designing for social innovation has an interactive nature based on an understanding of systems and communities it might have an impact on [8]. It is based on communication between designers and users, users and designs, and the designs as solutions to society’s everyday problems. The aim of this mutual understanding is to create products that meet people’s actual needs by introducing innovative solutions supporting their everyday activities [11]. In case of the mentioned above project for NHS, social innovation concerned the children’s perception of the Community Children’s Nursing Service, a lack of media that help with transport of supplies and excessive utilization of plastic items. All these issues were related to the negative appearance of disposable aprons and bags and an environmental impact of plastic that is used in their production. In this situation, being governed by IDEO.org suggestions [7], we should understand all parties that the innovation is going to serve: patients, nurses, but also the NHS. To introduce a product that would replace the faulty polyethylene items, it is essential to explore NHS regulations and guidelines on infection prevention, the use of Personal Protective Equipment, and waste management.
According to data collected by NHS Boards in years 2012–2013 and submitted in the Waste Prevention and Re-use Guide [1] only Scotland produced approximately 25,100 tonnes of domestic waste. The plastic film constitutes as much as 12,5% of this number and is situated right below food waste and paper hand towels. There is also noticeable 1.2% of clinical waste what brings a suggestion that a significant part of it was misclassified and should have been disposed of as domestic waste that is a subject to recycling.
A considerable number of produced plastic and clinical waste constitutes Personal Protective Equipment, including gloves, masks, headwear, footwear, gowns, and aprons. The PPE helps to reduce the risk of transmission of microorganisms to patients and healthcare practitioners, preventing contamination of a uniform by patients’ blood and body fluids [4]. The guide draws attention to the benefits of wearing disposable plastic aprons that cover the front of a body — the part that is a subject to constant direct contact with patients and the increased risk of catching an infection. It is recommended by both Cleanliness Champions: Promoting the Prevention & Control of Infection [4] and Standard Infection Control Precautions Literature Review: Personal Protective Equipment (PPE) Aprons/Gowns [3] to use single-use disposable plastic aprons, as they reduce the risk of transferring microorganisms from one patient to another. The apron should be changed right after completion of every episode of patient care following strict instructions that prevent the contamination of the uniform below. Then, according to previously mentioned PPE Aprons/Gowns guide submitted by NHS in August 2015, used disposable aprons should follow the healthcare (including clinical) waste stream. However, it is essential to notice that there are not any legislative requirements for the utilization of disposable aprons as for infection control purposes [3]. The guides do not strictly specify a material that should be used in the production of disposable aprons either. The choice of plastic and the form of disposal is based merely on recommendations. Opinions differ depending on a guide. Waste Prevention and Re-use Guide that provides guidance on executing waste management improvements within NHS claim that aprons not contaminated with blood and body fluids should be qualified as domestic waste and therefore recycled [1].
NHS Scotland should put more energy into the improvement of the waste segregation and spreading good practices in its classifying, especially in the face of challenges set by Climate Change (Scotland) Act 2009, Waste (Scotland) Regulations 2012 and Making Things Last strategy. They settled a plan of goals to be achieved before 2050 that concern reducing waste and greenhouse gas emissions and increasing the recycling rate. It might be especially hard as there seems to be quite a lot of confusion regarding some products constituting as the Personal Protective Equipment. On the other hand, it might be the right moment to introduce some new materials that would not only accelerate reaching the goals but also bring long-term change to the way we perceive NHS products. Even though the NHS Scotland supply chain consists of plenty of suppliers, they distribute solely aprons made of low-density polyethylene. LDPE as a material offers fairly satisfactory properties. It is semi-rigid and very tough, presents good chemical and water resistance and, what is significant about disposable items, is manufacturable at low costs [9]. The polyethylene that undergoes the process of recycling does not have a significant impact on the environment. However, according to the nurses from the Firhill House, the disposable plastic aprons usually end in general waste bins, thereby accumulate at landfills. In the meantime, there is a growing market of compostable plastics, made in 100% from biomass, including corn starch. Plant-based aprons could be disposed in food waste stream and instead of emitting greenhouse gases, enrich the soil.
According to Manzini [10], “design for social innovation is everything that expert design can do to activate, sustain, and orient processes of social change towards sustainability”. However, because of the complexity of the process and the sensitivity of the subject, it is crucial to trigger off a social conversation that would engage experts from different occupational and social backgrounds. Starting with listening to people directly concerned, the debate should engage all people interested in consolidating their creativity to achieve social change. This exchange of ideas could be held in many ways, including the use of dedicated digital platforms and social media, but the most direct and straightforward way seems to be live conversation conducted by a group of people who desire to talk openly about social problems and innovative ways of resolving them. The good opportunity to execute the social conversation might be the annual NHS Scotland meeting. Every year it gathers people interested in working together to improve the quality of healthcare [5]. The aim of the meeting is the exchange of experience about challenges concerning the development of systems and sustainability within NHS. During the sessions with speakers, they address the problems that Scottish patients struggle with, including health inequalities, the increase of life expectancy or financial challenges.
However, this initiative is only seemingly great. The NHS Scotland Event advertises itself on the website as sustainable [5]. Indeed, the reduced use of printed paper is important while hosting a gathering of this scale. However, it would be much more significant to include at least one talk about the improvement of sustainable practices within NHS in this year’s programme. Moreover, the website says that the event can be only attended by those working in and with the NHS in Scotland, what currently disqualifies the designers and the patients from the participation in the discussions on social innovations. Meanwhile, it should be based on a calm and sincere dialogue between the representatives of all interested groups and mutual formative feedback. To design for social innovation we have to leave trite ways of thinking and doing things behind and circle the wagons to achieve the goals set by the modern world.
To sum up, design for social innovation within the NHS regarding the reduction of plastic waste is a highly complex task. It must be conducted through a detailed analysis of the needs of a final user and the detailed research of the NHS updated restrictions and materials variability. It should concern the complex sustainability issues that impact the modern world, meet the expectations of the nurses who are potential users and analyze the perception of the underage patients who are going to be the receivers of the design. It requires engagement from specialists of different brands of design and healthcare departments. It can be done only with mutual communication and a discussion the core of which are people’s needs, during which designers can introduce “a new way of looking at the world and at what design can do with and for people living in it” [10].
[1]: Resource Efficient Scotland. NHS Scotland: Waste Prevention and Re-use Guide https://www.resourceefficientscotland.com/sites/default/files/NHSScotland%20Waste%20Prevention%20and%20Re-use%20Guide.pdf
[2]: Health Facilities Scotland. (December 2016). NHS Scotland: Waste Management Action Plan 2016–2020 http://www.hfs.scot.nhs.uk/publications/1491320965-Waste%20Management%20Action%20Plan%20(SHTN%2003-00).pdf
[3]: Health Protection Scotland. (August 2015). Standard Infection Control Precautions Literature Review: Personal Protective Equipment (PPE) Aprons/Gowns http://www.nipcm.hps.scot.nhs.uk/documents/sicp-ppe-apronsgowns/
[4]: Cleanliness Champions: Promoting the Prevention & Control of Infection. Unit 4: Personal Protective Equipment https://www.nes.scot.nhs.uk/media/4011312/ccp_unit_4.pdf
[5]: NHS Scotland Event https://nhsscotlandevent.com/event-programme
[6]: The Guardian. (December 2012). Bringing social innovation to life through design https://www.theguardian.com/sustainable-business/blog/design-for-social-innovation
[7]: IDEO.org. The Field Guide to Human-Centred Design http://www.designkit.org/resources/1
[8]: Unreasonable. (January 2015). Interview: What is Design for Social Innovation? https://unreasonable.is/interview-design-social-innovation/
[9]: British Plastic Federation. Polymers https://www.bpf.co.uk/plastipedia/polymers/polymer-bio-based-degradables.aspx
[10]: Manzini, E. (2015) Design, When Everybody Designs. Cambridge; London: The MIT Press
[11]: Tonkinwise, C. (2015) Is social design a thing?.
