Sunday, September 16, 2012

Designing a better experience for patients

By Paola Pierri, Published: September 17, 2012

Shall we be optimistic? Despite the economic situation this could (and should) be really a good time for redesigning the health system in a way that could improve patients’ experience.

As the current system of delivering care for patients has proved not to be so effective and sustainable for the future, also because of the demographic change, the health sector is looking for different models of designing and delivering services, also learning at different disciplines to mutuate tools and approach.

Design is definitely one of those because of the common ethos that underpins the different professions: make things work well for the users.

As Bate and Robert have argued “‘good design’ of healthcare services (…) is essentially no different from good design in any sphere, be it a product or a service, this being a function of three things:

While the first two elements have clearly been the standard for health services, the interest around the patients’ experience has increased in the last years.

Research has shown that "patients care about their experience of care as much as clinical effectiveness and safety".

Service Users experience is, according to NICE guidelines, one of the 3 dimensions of high quality standards of care (together with clinical effectiveness and safety). Although improving patients experience of the NHS is now unanimously considered a quality standard of the care provided, the way to measure this experience and make sense of it are different and not all equally effective.

Experience Based Co-Design (EBCD) is one of these approaches. It is the result of an ‘expedition’ (Bate and Robert, 2007) took in 2004 into the field of design and design sciences to see what the health care system could learn from design professions and whether there were any frameworks and methods being used in these disciplines that could prove to add value in addressing some of the challenges facing the NHS.

It enables the health sector to engage patients “(…) with the goal of making user experience accessible to the designers, to allow them to conceive of designing experiences rather than designing services.” (Bate and Robert, 2007).

The main aspects of this approach are its focus on experience, as said, together with the shift of power from clinicians to patients and the new roles the different stakeholders will have in the spirit of co-designing and co-producing the service.

The importance of focusing on experience is based on the assumption that experience is sedimentary learning (Bate and Robert, 2007) is what people implicitly learn everyday in different contexts from their actions, feelings, interactions, judgments, reflections, reaction, success and mistakes.

Experience is as powerful as neglected in service improvement. Patients themselves, from my experience of working directly with them, tend to underestimate the importance of their feelings and their thoughts in the process of improving a specific service. They are more used to give you feedback or tell you what went wrong and what could have been done differently than just tell you the story of their experience with the service.

The Experience Based Co-design approach is being mainly used in the UK and Australia so far. In the UK, the King's Fund has developed a very useful and very comprehensive EBCD Toolkit that gives a step-by-step guide for professional who wants to implement an EBCD project.

Different evaluation reports measuring the impact and the progress of using EBCD with patients and staff are now available (Point of Care programme; Better Together Experience Based Design Cancer Pilots (PDF); Using Emotional Touchpoints to learn about the experience of receiving care (PDF); see also the Australian project mentioned above).

In times of budget constraints it could seem naïve to be so optimistic about the introduction of such an innovative approach. And there are some critics and concerns, for instance around the time needed to realise in-depth ethnographic research for capturing the experience in a meaningful way (see the Testing Accelerated EBCD project (PDF) for more information). But EBCD has a great potential in designing high quality care for patients and could also be cost-effective. Many of the things that have proved to have the biggest impact in improving patient’ experience in fact - such as emotional support, kindness, human empathy, dignity, co-ordination and integration and information and education - cost little or nothing at all and have sometimes reduce wasting of money on expensive service improvement projects that were not going in the right direction because of the lack of patients’ engagement.

About the author

Paola Pierri works with Mind to improve the co-production of local services for mental health together with the network of local Minds. She is also studying for her PhD with the King’s College on using Experience Based Co-Design for improving the care of patients with genetic rare diseases.

Also by Paola Pierri: Personalisation in the health sector: from ‘Mass Production’ to ‘Mass Co-production’


  1. Bate, P. and Robert, G., (2006) Experience-based design: from redesigning the system around the patient to co-designing services with the patient , in Qual Saf Health Care 2006;15:307–310
  2. Bate, P. and Robert, G., (2007) Bringing user experience to health care improvement: the concepts, methods and practices of experience-based design. Oxford; Radcliffe Publishing
  3. Buscher, M., Carr, V., Cooper, R. et al, (2009), Clinicians as service designers? Reflectionson current transformation in the UK health services, First Nordic Conference on Service Design and Service Innovation
  4. NHS Innovation Unit, The Experience Based Design Approach