Improving pre & post operation communication
Service Design | User research

Developing from a series of projects previously realised, we were asked to revisit the way information is given to patients in advance to their Endoscopy procedure across the NHS Lothian hospitals. The result of this was the design of a new Appointment Guidebook, that replaces the current information booklet, and two supporting booklets aimed at the NHS staff.
Services
Team coordination;
Service design; User research; Product design
Client
NHS Lothian
Challenges
When introduced to the project, the NHS staff had a few quite clear challenges to tackle in mind. When we started our research on the field, we only found out more to add to the list.
1. There is no specific target audience for the Endoscopy unit
While it is true that many patients visiting the unit aren't exactly in the prime years of their lives, there are also many of them that are relatively young, seemingly healthy and with no clear complications or specific needs. Moreover, their background is educationally and financially as diverse ad society itself.
2. A high number of patients arrives at the unit unprepared for their procedure, despite the many communications received
3. Another high number of patients simply doesn't show up for procedure and wastes NHS time and resources
These last two points are probably better evidenced by the case we witnessed during the course of our field research in the unit: out of all the procedures scheduled for the day, only about half of them got actually through.
The rest of the patients either had not prepared properly or had failed to inform the structure about their absence, leaving nurses and doctors frustrated, Moreover, those absences and delays had an impact on the backlog of patients waiting for their scheduled procedure, who could, had they known of the planned absences, had the procedures in their place.
The main reason?
Patients do not read, do not understand, or in some cases do not receive, the information booklet given to them.

Approach
As mentioned, great part of our involvement with the Endoscopy unit was spent researching directly on the field and gaining first hand experience from doctors, nurses, patients and hospital administrative personnel of all levels to truly try and identify the main issues we faced.
Once that was clear and evident to all and the information booklet was identified as the main culprit, all our efforts were then put into understanding what was actually wring with it, what was good and what could we then change to solve the enpasse.
By conducting further interviews and testing sessions with patients, it emerged that an important issue with the booklet was with the tone and terms used in the communication.
Being written in a rather condescending and technical form, it wasn't really intelligible by an unexpectedly great amount of people, as it basically required an over the average familiarity with medical terms which cannot be expected from everyone.
Moreover, the information provided were not set out with a clear timetable of when to complete each and every step of the pre and post procedure preparation, thus the issues with patients that showed up unprepared.
What unexpectedly emerged from interviews were also issues with the visual layout of the booklet.
With the name of the procedure clearly printed on the front page of the booklet, it provided little privacy to the patients, who more often than not hid it in a remote corner of their drawer rather than having it readily at hand.


Results
The outcome of the research was thus the creation of the Appointment Guidebook: a 16 A5 pages long booklet divided into 4 sections, it follows the patient journey, from learning about the procedure to the patients' recovery.
Each section is colour coded and followed by a "Worksheet", where the patient can check if they have completed each required step of the preparation for the procedure, or read through every important bit of information.
Other important aspects that we considered were giving bits of responsibility back to the patients, by giving them ownership of their procedure - hence the Worksheets - and working on the tone, both verbally and visually, of the Guidebook, so that it would feel personal and familiar, whilst also conveying the correct information at the right time.
Alongside the Appointment Guidebook, we also designed two artefacts specifically for the NHS staff, the Instructions booklet and the Patient information manual. In these, the different members of the NHS staff can find information on how to interact with the Guidebook and all the information needed to replicate the booklets independently.
The final outcome was very well received by the NHS Lothian, which appreciated the innovative aspects of the Guidebook and its adaptability to a digital format.