NHS eReferral service
Reducing clinical risk by making system experience improvements
Situation
Clinical systems are renowned for having poor usability and performance issues, but NHS Digital are leading the way in what good should look like.
I was a user centred designer at NHS Digital, working on staff and patient facing digital services. This means I was responsible for the end-to-end system experience of the e-Referral system, used by clinicians and admin staff.
The e-Referral service allows clinicians to offer patients a choice when booking appointments, giving them freedom, convenience and confidence at the point when care is needed, or even critical.
My team consisted of a lead BA, 2 user researchers, a junior designer, whom I coached, and a delivery manager.
We juggled policy intent with users needs in an area of the NHS where clinical input is critical to minimise risk to patient care, but also where usability is a clinical safety issue.
Task
My product team put user needs first, as they are key to getting services and systems right, and in the short time on the e-Referral programme, we changed how the team worked by focussing and prioritising on the tried and tested double diamond process, with discovery and alpha phases at the heart of the agile (little ‘a’) cadence we work within.
Team
As a product team, we diverged on separate but directly related areas of work as part of a single user flow, and both have risen from a process, still being experimented with but looks a bit like this:
- Story mapping
- Design sprint
- Problem statement / hypotheses generation
- Prototyping with the NHS prototyping kit
- Testing our hypotheses
- Iteration, metrics (SUS, SEQ)
- Show and tell (stakeholders and wider team/wider org)
Focussing on the problem
I challenged the team to move away from implementing suggested solutions and ideas, and instead to focus on the problem statement at hand. We did this by mapping out the existing steps of a flow, creating a story map of the digital service from the user’s perspective, and highlighting known pain points to focus on as part of the redesign.
As part of an empowered team, we looked at improving as well as removing things users don’t need or want in the system.
Designing with data
We used metrics and data to evidence decision making, analysing user feedback and analytics to feed into the confidence we have in a version of a design that were testing. This also helped us doing the show and tells, giving the rest of the team insight into how things are shaping.
Result
The scope and impact of what we did was massive and we worked with our own NHS Standards team, NHSBSA, Summary Care Records, different hospital trusts, not to mention GOV designers, collaborating, sharing, asking questions, and learning from each other.
Building the clinical standard
Alongside other NHS designers, I was an early adopter of the NHS service manual prototyping kit, using the kit as the baseline for patterns and components for our service. Where we diverged from the NHS service manual patterns, because sometimes the thing you work on isn’t a website, we documented how and why.
Our team was among the first to contribute back to the NHS service manual upon its inception, ensuring other teams could find what we do useful for their own service, and solve similar problems in a consistent way.
We delivered a simpler clinical system for booking patient appointments, more confident staff, and more time for doctors to focus on patients.
