Care Design 2016 – A guest blog

One of my projects within the Horizons team is Care Design 2016, which has been to take the well researched design principles developed by Nigel Edwards CEO of  The Nuffield Trust and collaborate with an international expert group to fine tune these principles.  What makes this project different is that the Horizons team have gone one step further and crowdsourced the principles via a change platform by Crowdicity.

The results were fascinating  and one of the key points I would raise at this stage is that when we asked for the wisdom of the crowd, we considered all of the data received and incorporated important citizens concerns that resulted in enhanced design principles.  What we have now is rich data and terminology that resonates with everyone involved in the project.  I have written before about collaboration and how you may not receive the answer you expect when asking citizens to respond.  A point illustrated well by the BoatyMcBoatface story and the recent  EU referendum.

Citizen engagement is complex because of the multiple layers and thought processes, yet rewarding.  My colleague Sasha Karakusevic’s blog below illustrates through case study exemplars how excellence in healthcare can be achieved by design thinking.

Care Design 2016

We all know great service when we receive it.  But how often do we stop and think about how that magic moment was produced?  Was it a one off or if I return again next week, next month or next year will I still receive an outstanding experience?

Often, the difference between exceptional and merely good enough is a combination of small and subtle differences in approach.  Exceptional requires a little bit of magic and is often dependent on having the right people with the right training.  But that is often just the tip of the iceberg:  Designing, delivering and maintaining excellence is really hard.  As well as getting the design right in the first place there is a need to build in sufficient agility to change as knowledge, customs and fashion change.  This is one of the biggest challenges in health with the published literature increasing by at least 40,000 papers per month!

Exceptional goes well beyond delivering services safely or efficiently and is a judgement that people make in their heart or gut – its essence is about feeling and not analysis.  That is not to say analysis is not important, however unless that analysis leads to an insight that unlocks passion, excitement and understanding the resulting service is likely to be just good.

Over the last decade there has been increasing recognition that design thinking can contribute to improved health and care delivery.  However, in reality delivering this is tough.  Recent work by the NHS Horizons team and Nuffield Trust has identified eleven principles that people think are most important to consider.

Care Design Principles 2016

Understand who needs care and what they need – identify common needs across the population and design services to meet those needs

Design care so people can flourish

From supply side (service led) improvement to demand side (citizen-driven) change

Design care so that when people need it they flow effortlessly through the system

It’s a complex world: plan for emergent not just certainty

Technology enabled

Networks/sharing spaces and organisations

Measure outcomes that matter

Mobilising and valuing people and assets in the local place

Continuous improvement and attention to detail.  Standardise where you can, customise when needed.

Ensure environmental sustainability

For the most part these principles are about people and the environment they operate in.  Interestingly, the principles do not differentiate between people as patients, carers or care givers.  In healthcare each group needs to flourish to get the best results for communities and wider society.

How can this be achieved at an organisational level?  For boards the answer must be about creating the right environment in which excellence can emerge. The performance indicators for this look very different to those required to assess short term delivery and need to consider learning, innovation and team performance.

It is very difficult to introduce design thinking across a whole organisation or system. Therefore focussing on a few themes that matter locally is likely to be more successful.   Aligning these themes to mission critical challenges will help to ensure senior leadership interest and involvement.  Involving people with design expertise to build capacity and capability is also likely to be achievable at this level.

There are a growing number of examples emerging and I have been lucky enough to meet and talk through a number of approaches with people who are leading the design movement around the world and what follows are a few examples of what is possible:

Western Diabetes Institute

The team designed care around the needs of patients:  Recognising that patients can only deal with a number of issues at one time the team enable the patient to identify what their key issues are and address them. By working in a multidisciplinary way they can respond flexibly to the changing needs of their patients providing greater integration and better outcomes than previously achieved.

The team are collaborating with Newcastle University as documented here.


North Devon pathology optimisation

The pathology team recognised that by working with local GP’s and the CCG there was scope to improve the care of patients.  The team started work with individual stories to understand the patient experience of tests and how to improve this.  Their detailed approach involves looking at the complete patient experience.  As well as improving care the team are also saving money!

More details are available here 

Both of these case studies illustrate adoption of the design principles and delivery of high quality care for patients.  One of the challenges is how best to organise teams to provide care at the same time as supporting innovation and learning.  The Buurtzog example is very interesting.

Buurtzog Nursing

Buurtzog have developed a very successful care organisation by being very clear about what the patient needs and how teams design can be optimised.  The result is a very flat organisation that provides high levels of professional autonomy, builds on experience and is scale-able.  Read more here

These examples show that by being clear about the design principles, enabling teams to progress and keeping to a small number of rules the rate of improvement can be accelerated.

Think about changes in your own organisation.  Have the design principles been applied and what difference did they make?  In these examples teams started small and built up capacity and confidence as they developed and improved care.

If you want to apply the design principles in your work have a look at our resources for advice and guidance and if you need more help please get in touch.


Sasha Karakusevic

Project Director – Horizons NHS England

Twitter @Karas01









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