Applying design thinking to drive transformation
Siobhán Manning, service innovation and design lead at the Mater Misericordiae University 
Hospital, explores how collaborating with designers is improving medical processes and patient outcomes.
In 2013, the Mater Transformation unit was established to work with frontline staff to codesign solutions. The unit has driven transformational change across multiple service areas.
In 2016, the unit collaborated with masters students from the National College of Art and Design (NCAD) to introduce a new approach to problem-solving. Manning says this collaboration “has grown exponentially” since then.
StrokeLINK
A project called StrokeLINK emerged from this collaboration. It aims to educate stroke patients and provide them with personalised support tools as they recover.
Explaining the rationale of the project, Manning says patients are provided with “loads of information” when they are discharged, such as how to prevent a second stroke. Patients are likely to forget this information as they have limited processing capacity at the point of discharge. This leads to patients later stating that they were not provided with the necessary information, despite stroke ward staff doing so.
“But of course that was the point when we were running up to them and telling them 50 million important things to remember,” says Manning.
To address this weakness in the system, the Mater Transformation unit employed a designer to “flip the whole lens on the problem”. The designer collected data on what information patients sought at various stages of their care journey. Two nurse specialists were employed to redesign the service based on this data. This was done in close collaboration with the designer.
Under the new service, patients were not overloaded with information at the point of discharge. Staff only connected with them to inform them of immediate steps they must take and to arrange a call the following day. A week later, staff would meet with the patient to “begin the education process” and provide them with a book containing necessary information.
“Our patients hold that book like a bible. It has become a critical asset,” says Manning. “In the last couple of years, we have been developing a website that is more targeted at the wider family.”
Demonstrating the project’s success, Manning says the proportion of people satisfied with the service at the point of discharge improved from 63 per cent to 98 per cent. The proportion of those who felt they had been provided with enough information rose from 70 per cent to 96 per cent. Those who felt they knew which danger signals to look out for grew from 28 per cent to 89 per cent.
Additionally, the proportion of people monitoring their blood pressure increased from 8 per cent to 98 per cent. The proportion of those that stopped smoking rose from 14 to per cent to 64 per cent. Those that improved their diet rose from 43 per cent to 93 per cent.
Before the project, one in 10 patients were visiting A&E with problems that “could have been prevented”, with one in 25 being admitted. Manning asserts that StrokeLINK succeeded in reducing both of these figures to 0.
Further solutions
Another project to emerge from the collaboration was Skinnovate which sought to create a potential solution to reduce the 54,000 people on waiting lists for dermatologists throughout the State. To develop the solution, Skinnovate targeted the Mater’s dermatologist waiting list of 4,000.
Using ‘lean’ thinking, Mater Transformation’s research found that a lack of a centralised referral system contributed to the lengthy waiting lists. Lean thinking is an approach that aims to optimise value for customers while cultivating an efficient workplace built on respect and teamwork. When referrals were addressed to specific consultants, they were placed on that consultant’s wait list. This created disparity in the length of the different consultants’ lists and some patients were “waiting way longer for an urgent appointment” than others.
“One of the things that we found was that there were duplicate referrals on the list,” adds Manning.
Working with the Mater Transformation unit, the dermatology team achieved a 40 per cent reduction in waiting lists. A key part of this was gaining consultant support to move to centralising the referrals. However, the rate of referrals continued increasing. “We were going to be back where we started in a few years. We knew we needed to think wider,” says Manning.
Patients must sit on waiting lists when their doctor refers them to a consultant if they are unable to find the root cause of their ailment. “The doctor’s hands are tied because they have run the course of what they can think of,” says Manning.
To address this, they are currently testing the use of Siilo, which Manning describes as an “encrypted safe version of WhatsApp”. If GPs are unsure of how to treat a patient, they describe the symptoms with an accompanying picture in the group, and consultants outline what steps they should take.
The Mater Transformation unit also introduced an active discharge letter to be provided by consultants to GPs. It includes details on the medication patients are on, and instructions for potential next steps.
Furthermore, the unit employed an NCAD student to interview patients about their experience on a waiting list. The interviews found that patients attempted to track their symptoms but felt “fuzzy and rushed” when outlining them to consultants. This led to consultants being provided with vague symptoms. To address this, the unit developed an app called DermaDiary which enables patients to track their symptoms.
“When you go into the peer-first consultation, you are two steps ahead. You are brining much better information and you are bringing pictures,” says Manning.
Projects such as StrokeLINK, Skinnovate, and DermaDiary demonstrate the potential for collaboration and design thinking to improve health outcomes. Concluding, Manning says: “This is now commonly the way we work. No matter what methodology we are using, we are problem-solving with staff.”
