Magazine

The future of healthcare: getting off to a good start

A good overall experience significantly influences positive health outcomes. People get better, faster if their whole being is cared for - emotional and practical support can be as important as the actual medical care. But what constitutes an experience and how does it have impact? At Livework we break experiences down into significant journeys. A journey starts with a clear need and ends with a clear outcome. A key journey in any experience across all service types is the beginning - the start journey. The start in healthcare can be a diagnosis, a treatment, a relationship with a provider or a new episode in life such as having a baby - and it is critical.

Moving from fixing to preventing

Livework looks at many sectors to understand the dynamics of the relationship between service providers and their usersWe find that a good start is invaluable across all sectors. Improving this boosts the outcomes and effectiveness of the service across the whole journey
The start is a change in someone’s health situation. The need is to adjust to the situation. The outcome of a good start is a successful adjustment, it is significant because it’s an opportunity to avert issues later in the service cycle. This is particularly important in healthcare, as prevention is always better than cure. Our health systems need to move from a fix’ to a prevent’ model to cope with the growing scale and cost of demand for healthcare. It’s not just our health that benefits from avoiding illness or complications in treatment, we also avoid wasting time, money and pain
What do we mean by a good start in healthcare? We have a few examples from our recent work and research that unpack a good start and how it’s applied.

MS – A good start to living with a disease

Living with Multiple Sclerosis is challenging and requires a combination of expert medical and social care. NHS trusts find it hard to deliver local support effectively as the UK population with MS is around 85,000 people too small to demand local specialist services.
Like all diseases, but especially degenerative ones like MS, the outcomes for people living with them can be improved by having a clear plan from the beginning, to maximise quality of life and ensure people get the help and advice they need up front. 

We learned that the ideal service would be personal and support the individual and their family when issues arose  not when the clinic was open.

Livework facilitated a team of medics, therapists and commissioners in the London borough of Ealing using a patient-centred service design approach. We learned that the ideal service would be personal and support the individual and their family when issues arose  not when the clinic was open.  From this key insight, the team created a multi-disciplinary team and a guide for patients on how to call the right team member at the right time. We ensured that patients were set-up with this team from the startUsing their awareness of the network of support, patients were able to prevent their issues from escalating and minimise expensive trips to the hospital.
An example of how this worked was that patients were given remote access to the specialist neurological hospital in central London, where they could speak to a specialist MS nurse.

In the majority of cases, the nurse was able to advise the patient to self-care. This reduced the number of in-hospital consultations by 60%.

ADHD - Managing change well to ensure a good start at school

The Centre for Child and Adolescent Mental Health in Norway felt that they could be helping children with Attention Deficit Hyperactivity Disorder better. There was a tendency for the process of diagnosis and treatment to take a long time, increasing stress for everyone involved. Kids who have a hard time settling at school get stigmatised and isolated quickly. One parent spoke of their child not being invited to birthday parties as soon as the first half term holiday at school. We realised that to get children and their parents help sooner, it makes sense to assess and monitor them in the areas they actually spend the most time in: their homes, their kindergarten, and then school. 

Finding out what motivates engagement is more useful for educators than a list of incidences of problem behaviour’.

We designed a programme called A good school start’, arranging a meeting between kindergarten staff, the school, the family, their GP and a specialist, 6 months before starting school. Parents and staff were given log-books to record  not the problems and upsets in the child’s day  but their strengths and successes. The moments where they were focused and full of curiosity. Finding out what motivates engagement is more useful for educators than a list of incidences of problem behaviour’. In the summer holidays prior to starting school, the specialist medical team would do some basic tests on the children and these results, together with the log-books from home and kindergarten were used at a meeting between the family and school to form an action plan for the start of school. 

Designing a good intervention early is transforming futures for these children.

One of the KPIs we were given was the referral rate  how many children ended up being referred to a specialist for psychiatric help. At the time of writing, this figure stands at zero for the children in the the local area we worked with. One of the subjects of our study who was unable to live with his mother at that time due to behavioural problems, is now living at home and doing well at school with no medical intervention needed. Designing a good intervention early is transforming futures for these children.

Teams gathered positive information about children in their care in order to plan the best transition between pre-school care and starting school

St.Nick's Hospice - A good beginning at the end of life

Even at the end of life  perhaps especially so the beginning of the journey is vitally important. In our work with St.Nicholas Hospice, we realised that a key problem for them and their users was the sheer breadth of their services. Most people think of a hospice as being a physical place. A building where people go to spend their last days. St.Nicks does have a residential ward, but it also has a day centre, with services ranging from manicures and massage to talking therapies. They also partner with many external services to provide night-care, transport or financial advice. 
Most people we spoke to only became aware of the kinds of help that were available to them much later in their journey often too late to make use of it. One of the key concepts we’re trialling with them is a journey planner’ given out at the first meeting, which will help them plan and get the support they and their carers need. 

When a patient is given a terminal diagnosis, they’re often asked if they have any questions, but the enormity of the news tends to paralyse rational thought.

The journey planner is designed to help people formulate questions when they can’t think. It does contain some information  lists of organisations they work with and services they provide.  But unlike the highly medicalised, sometimes intimidating leaflets they may have been given to explain their condition, it’s practical and concise.  
The main function it serves is to enable them to start thinking for themselves so they know what they don’t know’ and can ask. When they meet with a St.Nicks planner on their second visit they’re armed with this planner and can go through it with them to get the advice, support and services they need.  
A central part of the planner is the build your own care team’ section. This isn’t about assembling a medical team. It’s about identifying the people in your personal network who can help with your practical and emotional needs. The person who’s good with finances, or tech, the one who makes you laugh, the one you can call at 4 in the morning. Identifying who’s around you that can help and getting their buy-in is, in itself, a life-affirming process and capitalises on the desire people have to help somehow (there’s only so many casseroles you can take round to a sick person). 
cards helped people to formulate ideas about their needs and expectations when planning end of life care

Engage and empower people to take charge of their healthcare

Designing a good start like this ensures people are treated as individuals. It empowers them to make the plans they need to make, get the best care and ensure they’re having the best possible quality of life. 
The evolution of healthcare services is a huge challenge in a world with a growing, increasingly elderly population. Successive generations live longer and aspire to have a higher quality of life. As governments and health care providers struggle to cope with increased demand and expectations, it’s important to remember that designing with and for the people that use these services will ensure their needs are more likely to be met and they will be more self-sufficient. We believe that designing services that begin well engaging users so they feel listened to, supported and engaged in the decision-making process is key to maximising their quality of life, whether they’re just starting out in life or coming to the end of it.  

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