Overview
Chronic disease and conditions related to an unhealthy lifestyle have reached epidemic proportions and are rising still. This presents a momentous challenge for our current healthcare system.
Improving existing services is not the answer. Preventative approaches to health mean radical changes in our individual lifestyles - eating well, exercising more, self-managing chronic conditions. These changes can't be delivered through hospitals and GPs surgeries alone. We need to design new types of services that tap into people's motivations and relate to their daily lives.
Working with the Bolton Diabetes Network and Kent County Council over nine months in 2004/5, RED designed and prototyped two new health services. Me 2 supports people to live well with Type 2 diabetes, and activmobs helps people to stay active. These services are designed to be co-created by people and professionals. They represent a shift in thinking in the way we approach preventative healthcare, and demonstrate how design can be used to put patient centred thinking into practice.
activmobs: new services for active lifestyles
With Kent County Council we worked with people in one of the most deprived wards. We prototyped 'activmobs"' - a platform that supports people to get active and stay active in a way that fits with their lifestyle, interests and abilities. Groups of friends choose an activity and gain access to support from a personal trainer. It's an economical way to enable people to be active in a context that is comfortable and social.
The diabetes agenda: new services for type 2 diabetes
In Bolton we worked with the Bolton Diabetes Network to enable people to live well with type 2 diabetes. Here we developed 'Agenda cards' - a simple tool that reframes the interaction between patients and professionals. We also prototyped the Me2 coach service - a new and powerful support role, like a life coach but for people with diabetes.
The Agenda cards allow patients to set the agenda for their consultation; getting to the heart of the problem in the first few minutes of a typical diabetes check-up and freeing up valuable consultation time to work on solutions.
The design process
Design at its best involves the collaboration of people, organisations and experts in devising new solutions. Our design team included people with diabetes and their families, local residents, nurses, doctors, podiatrists, dieticians, health managers, local council officials, psychologists, sports scientists, personal trainers, economists, statisticians, health policy experts and social scientists, alongside service designers, interaction designers and communication designers. The design process acted as a conduit for these different perspectives.
The process we use starts from the point of view of the individual, not the system. We use design research techniques to understand people's needs and aspirations and co-design methods to develop and prototype concepts. People, patients and front-line workers collaborated on this project by brainstorming ideas, critiquing concepts, testing things out in context and suggesting improvements.
Read more about the design process and the development of the two prototypes here
Read more about the design process and the development of the two prototypes here
Impact
Current status as of November 2006:
Kent County Council is setting up activmobs as an independent social enterprise. The Bolton Diabetes Network is trialling elements of the new service with GPs in the local area. The work is being evaluated by Leeds University.
Kent County Council is setting up activmobs as an independent social enterprise. The Bolton Diabetes Network is trialling elements of the new service with GPs in the local area. The work is being evaluated by Leeds University.
RED Report 01: Open Health
The Wanless report advocates a shift in emphasis to a system that enables the full engagement of people in the maintenance of their own health. This engagement cannot be delivered by institutions - a new model is required. These prototypes point towards a radical new model of healthcare organisation:
Co-creation
Open Health shifts the focus from delivering treatment to engaging people in their own healthcare, supporting self-management and enabling healthy lifestyles. This means that the biggest untapped resource in the NHS is people themselves: how can we harness the power and expertise of patients and their families to co-create better health outcomes?
Systems like ebay, wikipedia, the Grameen Bank and youtube rely on ordinary people generating the content themselves. Their participation shapes the nature of the service: it is co-created. We set out to see whether we could apply the principles behind these 'open' systems - distributed tools, collaboration between people and professionals - to healthcare systems in order to engage people in their own healthcare. We call this approach co-creation, and seeds of it can already be seen in the health sector. Read more about communities of co-creation, and how they could create health services that are strengthened by participation rather than burdened by demand,
What we learnt
Through the course of this project we learnt some useful things about designing for 'behaviour change':
- It's all about motivation, not medicine: design the service to tap into people's existing motivations.
- Build services around people, not diseases: starting from the perspective of the individual creates radically different solutions.
- Create meaningful metrics: the measures of the system should be just as useful to the users themselves.
- Make it aspirational: people must 'opt-in' to these services so it's important to make it desirable to take part.
- Make progress visible to people: use visual forms and lay terms rather than medical jargon.
- Give people the tools to do things themselves: this helps them to take responsibility for their own healthcare.
- Create shared interfaces: tools, like the Agenda cards or the diabetes blog, are good ways of breaking down patient/professional hierarchies and putting the rhetoric of 'patient participation' into practice.
- Support roles are important: these may not always be medical roles.
- Build services around people, not diseases: starting from the perspective of the individual creates radically different solutions.
- Create meaningful metrics: the measures of the system should be just as useful to the users themselves.
- Make it aspirational: people must 'opt-in' to these services so it's important to make it desirable to take part.
- Make progress visible to people: use visual forms and lay terms rather than medical jargon.
- Give people the tools to do things themselves: this helps them to take responsibility for their own healthcare.
- Create shared interfaces: tools, like the Agenda cards or the diabetes blog, are good ways of breaking down patient/professional hierarchies and putting the rhetoric of 'patient participation' into practice.
- Support roles are important: these may not always be medical roles.
-Distribute tools and services into people's daily lives: health services should exist where lifestyle decisions are made - in supermarkets, not just surgeries, for example.
- Make use of social networks: design services to work with the economics and social dynamics of groups (like the 'mobs' in activmobs) to create more sustainable activities.
- Let people themselves own the system: designing services that allow people to set their own agendas and goals, and self-assess their progress, creates greater engagement.
- Make use of social networks: design services to work with the economics and social dynamics of groups (like the 'mobs' in activmobs) to create more sustainable activities.
- Let people themselves own the system: designing services that allow people to set their own agendas and goals, and self-assess their progress, creates greater engagement.
We also learnt some things about designing co-created systems:
- Co-created systems cannot be fully designed from the outset - there must be room for people to contribute and shape the service themselves. We think this can be done by designing platforms, tools, rules and roles.
- Co-created systems cannot be fully designed from the outset - there must be room for people to contribute and shape the service themselves. We think this can be done by designing platforms, tools, rules and roles.
