National Health Service managers must manage design as well as people

Craig Thatcher is a branding consultant, director of www.frasers.eu.com, and is passionate about helping clients to use design and branding better. He is an author of Continuous Branding, a book for service-based organisations ambitious to grow. Here he talks about the importance of strategic design in the public sector.

The commonly held view is that branding and design is superficial, and the most visible and frivolous symptom is in an unhealthy preoccupation with just logos.

For all senior managers in control of considerable budgets in the public services, this type of thinking is not helpful or productive. Steve Jobs of Apple put it very well: “Design is a funny word. Some people think design means how it looks. But of course, if you dig deeper, it’s really how it works.

Some people think design means how it looks. But of course, if you dig deeper, it’s really how it works.

Steve Jobs, former CEO, Apple

The public sector can learn from the private sector about how to capitalise on the power of design and branding to help achieve more with less. In 2013, research conducted by Warwick Business School on behalf of the Design Council included interviews with 48 leaders of world class companies. The main findings were that design is customer-centric and greatest when intimately related to solving customer problems. It is most powerful when culturally embedded, and best when it has strong senior management support.

Design also transforms the way that organisations think and work, with research from the Design Council revealing that for every £1 invested in the design of innovative services, public sector clients have achieved more than £26 of social return.

Now let’s take the National Health Service (NHS) as an example. If it were a commercial company facing the same boom in the numbers of elderly people, it would have to grow significantly over the next 15 years to meet expected demand. By 2030 there will be 36% more people over the age of sixty in the UK, who will all be consuming more services.

In reality the NHS will have to be more efficient and I don’t mean by cutting jobs. With patients expecting higher quality and personalised healthcare services, removing staff from the system is the last thing I am suggesting. But they will definitely have to become more productive. So this is where design can really make a significant  contribution and I propose that spending money on design management and thinking is essential, despite the austere times we’re facing. One thing is for certain, an economic boom is not coming back any time soon and the pressure on the NHS system is only going to get worse.

Using design strategically

In 2003, to help assess the economic benefits of design in Denmark, the Design Ladder was developed by the Danish Design Centre. It was used to identify the different levels of design being used in organisations within the country. They found that the most successful companies use design strategically, making it integral to their continuous renewal of their business concepts. They use it as a means of encouraging innovation, fusing it with their key objectives and so it plays a role at every stage of their development.

This is what I call branding and in short it means that these organisations are continually evolving, adapting and improving rather than undertaking periodic, seismic and highly disruptive shifts in direction whenever there is a change in senior management or in the case of the NHS, a change in government.

Awareness of the importance of managing design in both the private and public sectors is growing through the efforts of the Bureau of European Design Associations and, with other European partners, it is enabling better design management by governments across Europe.

This is achieved by bringing design management training to the public sector using best practice from the private sector and adapting their set of successful design management tools. Despite the public sector commissioning billions of Euros in design services each year, the benefits of design management are still not widely understood, and design thinking is not properly harnessed.

Designed for well-being

Take the design of Huashan Hospital in China by Gresham Smith & Partners. It is patient-focused as soon as you enter the reception and throughout every other aspect of the building. It values Chinese cultural expectations and it clearly allows both nature and technology to feature in the healing process.

The building was designed with efficiency in mind in terms of delivering caregiving services, moving materials around and in the movement of inpatients, outpatients and visitors, with as little stress as possible. Increased privacy for them and their families along with natural light, clearly designated separate patient entrances and intuitive way finding also promotes a sense of well-being.

This thoughtful design approach means a more efficient and higher quality of service in a more pleasant environment. The south-facing glass façade, made with high-efficiency glass to control solar heat gain, incorporates exterior shading devices. As sustainability is such a key issue in China, green roofs have wide-ranging benefits, from energy efficiency and controlling water runoff to extending the life of the roof.

Successful UK examples of experience based design

Recently I came across a case study using an ebd (experience based design) approach from Airedale Hospital (on the now closed down NHS Institute for Innovation and Improvement website). Patients, carers, volunteers and staff were all involved in co-designing services. The aim was to understand what it feels like for patients receiving services and to then work with them to redesign the services to better meet patient needs. 

These improved services transformed their experience and their care at the same time. Redesigning the structure of therapy and dietetic services provided better co-ordination of patient care, increased flexibility, greater staff satisfaction and improved cost-effectiveness.

Another example of experienced based design in the NHS is that at South Tees Hospital Trust where the Chief Executive at the time was an advocate of ebd. Quite simply, they wanted to find out what patients liked and didn’t like about the Fractured Neck of Femur service. The techniques they used pointed out the difference in opinion between staff and patients.

It’s like looking at the service through a new set of eyes and it’s hard for anyone to ignore.

Nurse, South Tees Hospital Trust

As one nurse summed it up: “It’s like looking at the service through a new set of eyes and it’s hard for anyone to ignore.” And the great news is that, as the South Tees example shows, the things that mean the most to patients are not always expensive to implement - it could be re-arranging a ward for better social interaction or simply a nurse taking the time to hold a patient’s hand.

In the Walsall Hospitals Trust, an ebd project focused on the crucial, but overlooked, portering services. Visits to private sector service givers were run as part of the process which provided a fresh perspective to the NHS team. This project generated a staggering 286 ideas that were honed down to 9 for presentation to their board.

Designing better experiences is not all about resources, it is more about culture and approach

My final example is the Wigan Renal Unit, which has won national recognition and a top award after they used ebd to produce improvements in service. This project identified numerous ways that the patient experience could be changed for the better, ranging from a Wish Wall where patients could post their problems and issues, to buddying up with Salford University and Wigan and Leigh Colleges so that students on beauty therapy courses could provide complementary treatments.

Much of the experience of both staff and patients is determined by things within our control.

Dr Janet Hegarty, Consultant, Wigan Renal Unit

Consultant Dr Janet Hegarty sums it up beautifully: “Experienced based design taught us that much of the experience of both staff and patients is determined by things within our control, in our culture and approach and not, therefore, all about resource.”

Looking at the current crop of NHS websites, my concern is that experience based design appears to have been lost somewhere along the way. A shame, because when used, they’ve evidently had amazing results - delivering care pathways that leave patients feeling safer, happier and more valued, and making staff feel more positive, rewarded and empowered.

Given that design as a way of thinking and an approach to improving services adds such great value to the context of healthcare innovation, I was surprised and disappointed to learn that the NHS Institute for Innovation and Improvement died as an organisation in 2013 and is now administered by NHS Improving Quality.

This is a lost opportunity by senior managers who don’t appreciate the power and impact that branding and design can have on organisations, and on patients. Yet these very same people recognise what a great experience it is to use Apple products and interact with well trained and knowledgeable people at the Genius Bar.