The art of medicine: designers in the NHS

Maja Kecman is part of a small team of designers from the RCA charged with re-inventing and improving services in Imperial College London’s St Mary’s Hospital. The Helix Centre, set up by Lord Darzi as part of his Institute for Global Health Innovation is tucked away in a building overlooking Paddington station. I visited the team at their workspace, to see one of the ways the NHS is taking a new approach to improving its services.

Institute for global health innovation

Helix Centre at the Institute for Global Health Innovation

Based permanently at the hospital the team get a daily insight into the problems each service faces. One of their projects involved improving patient experience of breast cancer care programmes. The team mapped out the full breast cancer pathway in a complex map that spanned a 4m by 2m table in the centre of the room. It reminded me of our new dean of the medical school’s opening words to the final year students: ‘if you find the nightmarish systems of the NHS hard to navigate, spare a thought for your patients.’

Map of breast cancer care pathway

Map of breast cancer care pathway at Imperial College London

The team simplified the diagram as a memory aid for themselves, but when they showed it to the medical staff and patients there was huge interest. No one had yet created a clear educational tool to help clinicians and patients understand these pathways, and now the team plan to place them all around the cancer centre.

Some particular problems with the patient experience they were trying to solve included:

  • How can we follow up after a consultation and see if the patient has understood everything? The shock of a cancer diagnosis wipes all memory of any important information the doctor might give in the consultation.
  • Could the consultation be separated out into diagnosis, and then a day or two later, the key information?
  • How might we measure the patient experience at different points in the pathway?
  • How might we change waiting rooms and reduce waiting times?
  • How might we support shared decision making for doctors and patients? (The NHS already has a great one)
  • Could we create a NHS trust based buddy system for cancer patients, much like Macmillan?
Brainstorming at the Helix Centre

Brainstorming at the Helix Centre

As well as improving the patient experience, the team is charged with reducing costs to the NHS – one of their key metrics of success. Its a weighty burden, and a challenging role to play in an organisation that is generally rigid towards new ideas. But the hope is that small innovative improvements to the system at St Mary’s will be reproducible in hospitals across the country.