Design-Led Service Improvement for Older People

In the UK outpatient services are a major element of the health service for older people and large numbers are requested to attend hospital-based outpatient clinics. However, it has been reported that outpatient clinics have fallen behind improvements in inpatient and primary care and they are seldom the focus of the patient-centred quality agenda that promotes personalised care. Significant proportions of older people fail to attend their appointments and there are few studies into the experience of older patients using outpatient services. In this paper we report on a design-led service improvement project that involved older people using a medical outpatient service and its staff. The project was facilitated by an interdisciplinary user-centred healthcare design team consisting of designers, technologists and health professionals formed to develop new participatory design methodologies and translate design thinking and practices into health services. A significant finding of the project is that an outpatient service extends beyond both the clinical encounter and the physical extent of the building, with many touchpoints before and after an appointment, such as confirmation letters, journeys and wayfinding, and staff interactions. These significant interfaces and interactions constitute critical factors in the experience of patients and staff and impact upon the ability of the service to perform its clinical role. We argue that through the deep engagement, achieved by capturing the lived experience of patients and staff, the clinic can be reconceived and reconstructed from a user perspective and thus improve its clinical effectiveness and enhance the quality of its service. We discuss the benefits and practicalities of using an experience-based approach to service improvement in health care, and we describe the improvements and changes co-produced with the users of this outpatient system.