Raw, unfinished, and messy: applying design thinking to the patient experience at the John Radcliffe Hospital

13 / 06 / 17

The CCC cohort took part in a new exercise during which they visited the John Radcliffe Hospital (known as the JR) in Oxford to investigate how they could recommend improvements to the patient experience in radiology and cancer diagnosis.

The day started with a coach ride from Egrove to the JR, where participants were decanted into the bright, spacious, newly refurbished main reception. They were then taken into what seemed to be the back offices of the hospital, through a network of progressively shabbier corridors until they were finally squeezed into a meeting room to meet members of the JR’s radiology team.

A complex system

As Radiology Operational Services Manager Toni MacKay gave her introductory presentation, the full nature of the challenge started to reveal itself. For a start, cancer diagnosis is not a self-contained process: it takes place within a complex system. Radiology at the JR, for example, has multiple physical sites and encompasses several different types of scan. It serves all specialisms within the hospital, with the exception of obstetrics. The number of scans is increasing, and the machines involved are ageing, leading to more downtime. There is also a shortage of staff at all levels. Any form of medical intervention involves bringing together many people with different types of expertise, with referrals from GP (General Practitioner – usually the first point of contact with the patient) to consultant and then to consultant radiologist, with the additional involvement of managers and technicians, and other clinical staff.

Some of the early questions from the CCC participants may have seemed rather obvious to the hospital team: Why are the machines offline so much? Is that over-use or just age? Are the scans triaged? Why can scanning and reporting not be done together? What can you do to build in some additional ‘slack’ to respond to high demand? They also threw something of a sensitive spanner into the works as it gradually became clear that at least one of the participants had experience of the wrong – i.e. the patient – side of a cancer investigation. The questions became more emotionally charged and almost accusatory: ‘So patients are living under a death sentence for 59 days until there is a confirmed diagnosis?’ asked one participant.

Emotional impact on patients and staff

However, as participants worked with hospital staff to map out the key phases of the process from first referral by the GP to diagnosis, they began to uncover even more complexity and understand why it might take so long. And that was when they were told that the Government had imposed a seemingly arbitrary target of being able to give the patient a yes or no diagnosis within 28 days. (‘Is that based on research?’ asked Marc Thompson, hopefully; ‘No, as far as we know it’s just a figure that someone plucked out of the air,’ replied a member of the hospital staff.) To add insult to injury, they learned that the Trust (the NHS organisation that runs the hospital) would be penalised financially whenever the 28-day target was missed for any patient: they would receive no funding for any further treatment – although, of course, this would not stop them providing it.

All this must have an impact on the staff, too. ‘Do you get stressed? How much do you work?’ a participant suddenly asked the consultant radiologist. ‘I’m paid to work 48 hours a week but in practice I work between 70 and 80,’ he said. ‘Do you have any support? I mean, not necessarily sitting down and talking to someone but exercise facilities perhaps?’ There was a pause. ‘There used to be a tennis court, but that’s now built on. There used to be a bar but we don’t have that any more either… No, we don’t have any support.’ There are at least two sides to any user journey.

Developing proposals and prototypes

After this briefing, participants returned to Egrove to work on how to improve the patient experience, guided by tutor Christian Bason. They split into groups and approached the task in sections, each group focusing on one problem or stumbling block on the whole journey. The discipline was always to be user-centric and focus on the human actors – who are they and what are they doing? They played with concepts and ideas, and developed ‘prototypes’ – models and storyboards of how their proposals would work in practice.

The groups addressed problems including the parking system (which they rightly identified as causing needless anxiety and stress), scheduling of appointments and machine maintenance. Among the solutions were a free shuttle bus and the delightfully named HOPI app (Hopeful, Open, Patient-centric Information), which would be a vehicle for communication and information, as well as positive stories, throughout the whole patient journey.

A catalyst for further conversations

Bason called the proposals raw and unfinished – and indeed they were. But as they were presented to MacKay at the end of the day, it seemed that their unfinished nature was a benefit. She could see how the proposals would fit in to what the JR was doing already and identify the parts of the proposal that would be ‘even better if …’ All the materials were given to her to take away, and participants hoped they would act as a catalyst to generate further conversations.

As programme co-director Marc Thompson summed up the experience: ‘It was a small-scale intervention. The JR were helping us, but we hoped to be able to produce something that was of value to them in return. Our advantages were the diversity that we had in the room and also the fact that our participants did not have a vested interest. They could bring a different, external lens to the problem.’

Co-director Mathis Schulte agreed: ‘The case visit provided a great deal to think about in terms of engaging with a client organisation, group dynamics, working with a new intervention, and learning in real time. It was a really useful experience and helped to integrate much of the learning on the programme. We are building in more of these live cases as the programme design develops over the next few years.