Asking questions in hospital

Designing a new digital service to encourage self-management in healthcare for Guy's & 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 create a list of topics to discuss and send it to their clinician, thereby setting an agenda for the consultation. It is anticipated 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 with long-term health conditions
  • Barriers to self-management
  • The needs of medical professionals
  • The competing pressures of working in a hospital environment

User research methods included:

  • Semi-structured contextual interviews
  • Card sorting activities
  • Shadowing outpatient clinics and team meetings
  • User journey mapping - identifying pain points and opportunities
  User journey map of the current consultation experience: identifying pain point and opportunities for improvement

User journey map of the current consultation experience: identifying pain point and opportunities for improvement

  The main hypothesis: supporting people to ask questions has a positive outcomes for both patient and the hospital

The main hypothesis: supporting people to ask questions has a positive outcomes for both patient and the hospital

Key insights

  • The power imbalance between medical professionals and patients 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 activation’, a measure of someone’s confidence, knowledge and skills to manage their condition
  • Effective interactions between patient and clinician can lead to knowledge sharing and consequently 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?

 

The concept

An online platform was conceptualised that would enable patients to create shortlists of questions and share these with their clinician, in order to set an agenda for consultations.

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

A paper prototype of the platform was developed to test the concept.

Patients were mailed a form that enabled them to build a list of questions to ask, which was shared with their clinician before the consultation.

This paper prototype was piloted in six hospital clinics and yielded encouraging results:

  • 65% of patients said they learned more about how their condition affects their life
  • 76% of patients were reported as being more engaged than usual
  • 76% of patients were noted as being more confident

There were encouraging 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 during the prototype testing.

  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 needs 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.

 

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.

An extensive 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.