Asking questions in hospital
Designing patient-centred consultations with Guy’s and St. Thomas’ NHS Foundation Trust
With more people living with long-term health conditions than ever before, equipping people with the confidence, knowledge and skills to manage their health is essential to reduce pressure on the health service. In collaboration with Guy’s & St. Thomas’ NHS Foundation Trust, this project set out to identify opportunities to personalise and streamline outpatient appointments to use face-to-face time most effectively.
How might we make the most of time-limited hospital appointments to give people the confidence, knowledge and skills to manage their health?
Ask Me Anything is a digital platform that encourages patients to ask questions in hospital appointments.
Patients can share a list of topics to discuss with their clinician, thereby setting an agenda for the consultation. Results from prototyping anticipate that this will result in confident, informed and engaged patients who are proactive in managing their health for the future.
2 in 3
reported improved understanding of their health
tested a prototype
in six live hospital clinics
4 in 5
were reported to be more engaged
4 in 5
were noted as being more confident
A discovery phase was conducted to understand:
The needs of patients
Barriers to self-management
The needs of medical professionals
The competing pressures of working in a hospital environment
Shadowing outpatient clinics and team meetings
User journey mapping
The power imbalance between patients and clinicians is not conducive of enabling people to manage their own health
Clinicians are extremely time poor and are resistant to the introduction of new tools and processes
Asking questions in consultations can improve patient confidence, knowledge and skills
Effective interactions between patient and clinician can lead to knowledge sharing and better health outcomes
Following a synthesis of insights, the project brief was refined:
How might we encourage patients to ask questions in face-to-face hospital appointments?
As a patient I need to prepare for appointments so I can get the most out of my consultation
As a patient I need to create a list of questions to ask so I set the agenda for the consultation
As a patient I need to lead the conversation in appointments so I feel in control of my health
As a clinician I need to see the questions before an appointment so I have time to prepare
As a clinician I need new tools to fit with my existing processes so I don’t lose any more time
An ideation session resulted in the concept for an online platform that addressed these user needs.
The USP of the online platform was the link with the hospital’s IT system; clinicians would see a patient’s question shortlist as they reviewed their medical record before an appointment. In turn, this would give the patient confidence to lead the conversation.
Hypotheses to test:
Preparing a question list will improve patient activation (knowledge, skills and confidence)
Preparing a question list will improve patients’ relationship with their clinician
Patients would be more likely to turn up at their appointment
This experiment tested these hypotheses using:
A paper prototype of the service - mailing them a form to choose or write questions
‘Wizard-of-Oz’ service prototype - using people and processes to simulate the digital platform
Pre- and post-appointment questionnaires - to capture user feedback
Th service prototype was tested in six hospital clinics with 30 patients.
65% of patients said they learned more about how their condition affects their life
76% of patients were noted as being more engaged
76% of patients were noted as being more confident
There were early signs that encouraging patients to prepare for their consultation could reduce the ‘did not attend’ rate at appointments. This ‘DNA’ rate was lower than expected for the duration of the service prototype.
Backed by user research and user testing, a backlog of user stories was created to prioritise features for development.
Working closely with Mindwave Ventures, a design and development company specialising in healthcare, the platform was built using agile methodology.
Regular user testing was conducted with the hospital team to ensure the platform responded to the needs of this complex environment.
Supported with Bright Ideas Funding from Guy’s & St. Thomas’ Charity, the Ask Me Anything platform continues to be built, tested and iterated upon.
A process of stakeholder engagement is underway to gain widespread support internally:
Presenting the project to different hospital departments
Liaising with the hospital IT and information governance teams
Building support of senior management
It is the work of these internal champions and supporters that will enable Ask Me Anything to be integrated into the hospital service in a sustainable way.