NHS 111: Award winning user-centred design to reduce urgent care footfall

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In response to winter pressures on urgent care due to Covid-19, the NHS needed to reduce the risk of infection in busy waiting rooms. Health systems were asked to divert demand towards telephone and online triage (111) to prevent overcrowding and manage demand. 

To test and refine ways people might access urgent care using 111, Healthier Together worked with Healthia to develop, test and refine the changes. The team wanted to quickly understand how users would react to contacting 111 for a time to arrive, and how they might adapt to the new behavioural pathways. 

This project won the Global Award for Excellence in the Quirks Healthcare Awards competing against projects by Glaxo Smith Kline, Nutricia, Unanimous AI and Qualie.
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Outcomes

• The project identified problems and possible solutions faster than ever before, we worked at pace to prioritise issues, agree and implement change, saving money and increasing effectiveness
• The insight led to a pilot scheme where 111 calls were triaged by clinicians rather than algorithms resulting in a 70% reduction in the number of people visiting urgent care after calling 111
• We gathered evidence for a business case to recruit people to work as NHS representatives in local communities helping people to access healthcare
• The work inspired cultural change and investment in an internal user experience capability / lab
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Working as one team

Testing anything conceptual relating to health is difficult. To immerse participants in realistic use cases, we designed a series of scenarios and used the storyboards to walk people through the process. We used mood boards to capture feelings, thoughts and likely behaviours.

Our research and service design team collaborated with stakeholders and frontline staff throughout and worked as one team to create a prototype made up of annotated storyboards and realistic scenarios to communicate the new ‘call NHS 111 first’ concept.

Researchers conducted depth-interviews with participants and walked through the storyboards exploring reactions. They captured thoughts, feelings and typical behaviours at each step. They also tested reactions to campaign messaging to be used in posters and social media.

We went on to run co-design workshops with clinical, operational and reception staff involved in urgent care to conceive ways of addressing the pain-points, barriers and opportunities identified.
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Next steps for 111

Based on the project, the design of 111 pathways became more ‘people-centred’; following our work, a pilot scheme was introduced which changed the way patient calls were managed, from one led by algorithm to one which included clinician assessment.  This pilot scheme reduced the volume of patients presenting in emergency departments after calling 111 by over 70%.

New behavioural interventions were developed - insights from the project fed into a business case for recruiting a team of navigators; representatives to work as champions for the NHS within local communities, helping people to access the most appropriate healthcare.

The project also inspired significant cultural change - it demonstrated the value of taking a people-centred approach to service design and delivery across the board. Following this initial project, the organisation has begun developing a user experience lab, to develop common user-centred-design approaches and guidance and share best practice across the South West.
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Amplifying the voice of the patient

Alex Ward-Booth, Head of Insight & Engagement, BNSSG CCG ICS said: “This project has enabled us to bring the voice of patients and service users to life and demonstrate the value of running early design sessions with patients and the public. The findings have been taken on board at all levels in the organisation and the recommendations have fed into the way we approach communications, messaging and long-term plans for the service.”

Our work is all about experience, so we worked hard to understand the emotional and practical impact of the proposed changes on patients. Using service design techniques such as storyboarding, prototyping and qualitative research we were able to understand why people were behaving in certain ways as well as how they might react.

Integrating with the NHS team allowed us to share skills, knowledge and mindsets and really highlighted the value of understanding the patient experience. Everyone involved in the project was super-motivated to improve things and create change, which led to a great outcome.