Introduction and Context
As a designer and researcher working in health and care, I see some consistent and persistent issues in how conventional service design tools – which typically originate from non-health and care contexts - are difficult to apply to health:
Citizens are not the only user.
While they should be placed at the centre of most services, health and care user journey approaches that only map the citizen as user miss much of what the intended design work will target. They render invisible everything clinicians are doing where their patient is not directly present. It is a missed opportunity for understanding and re-designing services and systems.
The limitations of linear thinking.
Too often I’ve seen health and care colleagues use linear service maps and think of patient experience as being an A-Z pathway when the reality is that the experience of care is always cyclical. NHS patients come back, maybe to a different service and maybe years later, but they always come back. While this can cause a lot of service design headaches, I think the NHS has a huge opportunity to learn about citizens and truly deliver patient centred care and as such represent the experience of NHS services accordingly.
Getting the most out of people quickly.
Clinicians at all levels and professions have huge amounts of valuable experience and different kinds of knowledge but little time to share it. When I bring clinicians together, I need a quick way to organise knowledge, to verify what I have learnt, to ask good questions, and to incorporate many different perspectives.
Getting the right level of information to be useful.
Exercises to map patient pathways often end up either so general that they became meaningless, or so detailed that they are impossible to finish or use. Health and care is complex - made up of buildings, technology, equipment, people, workflows, and countless decisions– so that attempting to map a pathway accurately means mapping a clinician’s mind. Each decision they make depends on many factors and determines what happens next, where it happens, and who is involved. In short, this is an impossible task. It is good to remember that a map is never an exact and accurate truth, it is a representative model of reality which serves a purpose. My maps need to help me to understand the service just enough to design a better one.
I developed the Experience Map in response to these issues. It can be used to explore and consider the experience of primary care and secondary care clinicians, as well as the people they care for. The tool is made up of three sections, which each fit into each other: one covering patient/citizen experience, one covering Primary Care and one covering Secondary Care. Workshop participants are invited to move along key steps from first symptoms to discharge or follow up, and consider what works well and what does not for each group. The map visually organises the journeys of all three groups, makes clear where they intersect, and places the citizen at the centre of all health and care services.
When to use it
This is a useful tool when a group of people from different parts of the system such as primary care, secondary care, lived experience, and third sector first come together. It gives space to different kinds of expertise, and allows the group to combine and visually organise what they know together as a collective. It also highlights gaps in knowledge or representation, which can then be addressed going forward.
The map works as a framework and prompts conversations around steps of a stakeholder journey that might have been overlooked. By focusing on how each step is experienced rather than carried out, there is no need to settle on what is the most correct or accurate version. While clearly positioning the citizen’s experience at the centre of all health and care services, this map gives space to clinician expertise and experience. Defining what works well and what causes frustrations for health care professionals is an important part of our work.
It is especially useful in the initial design phase, in a group with diverse sets of people, and when time with stakeholders is limited and the output can act as a compass for design research in the future. The completed map can highlight gaps of knowledge to be explored, and people to be included in future conversations. It can make visible areas where many issues cluster, areas which seem to be running smoothly, and allows to better define questions about underlying problems for the next phase of design.
Mapping a service can mean quickly diving into miniscule details, getting stuck with conflicting perspectives. This loses sight of the ultimate purpose of this activity: designing a better service. Using the Experience Map provides a framework for groups to work towards an overall model, include different voices, and consider other people’s experience.
How NES Digital Service has used it
NDS recently organised a kick-off workshop in the context of Endocrinology services with a range of different clinicians and the Experience Map was the main tool used, with this flow:
Step 1: Completing the three segments of the map in three groups
The attendees were split into three tables. At this stage of the process we only had clinicians and we invited them to join whichever group they felt most interested in. They filled in one journey and identified positive parts of the experience (marked with a green dot) and negative parts (marked with red). While you can do this with particular specialists e.g. only secondary care clinicians fill out the secondary care segment, I found it particularly useful to have each segment worked on by people from different professions, and different services which vary across Scotland.
Step 2: Bring the segments and the attendees together
I asked each group to bring their completed segment and we fit them all together. This is an especially nice moment since having worked on individual segments, most people have not realised how the three segments fit together to create a holistic view so it can be a fun reveal.
Step 3: Individual segments share highlights
The group then shared the key insights from their individual conversations. As the conversation flows, the map started to show interactions between primary care and secondary care, and where communication is difficult. And with the citizen at the centre of the Experience Map and Endocrinology services, it made clear how clinician experience matches or might influence citizen experience at each step.
Step 4: Have a holistic conversation
After going through the three segments, I invited observations based on everything we’d heard. This sparked productive conversations around key opportunities, what works well elsewhere, and where a change could make the most difference. It also highlighted whose perspectives the people in the room knew little about, and the urgent need to identify and include people with lived experience who currently use Endocrinology services.
Step 5: Use the Map as a reference for future work
As we’ve progressed the early design phase, we’ve referred back to the Experience Map from that initial session to ensure we’re aligned with the understanding and ambition it articulated.