Asking questions in hospital

Designing patient-centred consultations with Guy’s and St. Thomas’ NHS Foundation Trust

 
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Overview

The brief

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?

 

Solution

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

patients

reported improved understanding of their health

30 patients

tested a prototype

in six live hospital clinics

 

4 in 5

patients

were reported to be more engaged

4 in 5

patients

were noted as being more confident


Approach

Discovery

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

Methods included:

  • Contextual interviews

  • Card sorting

  • Co-creation workshops

  • Shadowing outpatient clinics and team meetings

  • User journey mapping

User journey map of the current consultation experience: identifying pain points and opportunity areas

User journey map of the current consultation experience: identifying pain points and opportunity areas

The working hypothesis: enabling people to ask questions will have positive outcomes for both the patient and the hospital

The working hypothesis: enabling people to ask questions will have positive outcomes for both the patient and the hospital

Key insights

  • 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?

User Needs

  • 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. 

 

The proposed platform: enabling patients to prepare a question list and send to their clinician in advance of an appointment

The proposed platform: enabling patients to prepare a question list and send to their clinician in advance of an appointment

Working with patients to populate the list of available questions

Working with patients to populate the list of available questions

Prototyping

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.

UX and UI design by    Mindwave Ventures

UX and UI design by Mindwave Ventures

Platform development

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.

The Ask Me Anything platform continues to be tested and iterated

The Ask Me Anything platform continues to be tested and iterated

Stakeholder engagement

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.