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© NHS Institute for Innovation and Improvement 2009
Dr Lynne MaherDirector for Innovation and Design
Session Plan
• Provide an overview of some of the things happening in the area of pregnancy and obesity within the UK
• Introduction to the ebd approach
• Illustrate the potential for using this approach for obese pregnant women through case studies
© NHS Institute for Innovation and Improvement 2009
The NHS is one of the largest organisations in the world
• £96,6 billion total spend 2009/10
• Over 1 million patients every 36hours
• Total Number of NHS Employees 1,368,693
The NHS Institute ......supports the NHS to transform healthcare for patients and the public by rapidly developing and spreading new ways of working, new technology and world class leadership.
Management of women with obesity in pregnancy-2010
• Royal Collage of Obstetricians and Gynaecologists and Centre for Maternal and Child Enquiries- Research & Guidelines (March 2010)
• Guidance on Obesity and Pregnancy from the National Institute for Clinical Excellence (NICE) (July 2010)
• RCOG + CMCE research provided evidence which supported a 2 year project resulting in Centre for Child and Maternal Enquiries- report & recommendations (December 2010)
Royal Collage of Obstetricians and Gynaecologists and Centre for Maternal and Child Enquiries
• Research – Obesity in Pregnancy -Is a growing problem:
rising from 9–10% in the early 1990s to16–19% in the 2000s
Centre for Child and Maternal Enquiries
• 2008-2010- National project on Maternal Obesity in the UK– Per annum- 38,478 (4.9%) BMI ≥35 (Class II
and Class III obesity)– 34% of pregnant women with a BMI ≥35 were
living in the most deprived areas– The majority of these women are from Black
and Minority Ethnic (BME) groups.
Centre for Child and Maternal Enquiries
• 58% of women with a BMI ≥35 stayed in hospital 7 days or longer
• www.cmace.org.uk
Reccomendations
• 11 ( including a call for further research)• All pregnant women with a booking BMI ≥30 should
be provided with accurate and accessible information
• Women should be given the opportunity to discuss this information with health professionals who have been trained in the management of maternal obesity
• Self-reported weights and heights should not be used as a substitute for accurate weight and BMI assessment.
Nice Guidance 2010
• 6-Recomendations framed as:– Who will benefit- the woman and baby– Who should take action – everyone but the
woman
• www.nice.org.uk/guidance/PH27
What is happening .........
• Provision of advice on nutrition is inconsistent• Even when it is given the quality of the advice is
highly variable• Most of the information is given at time of
booking and gets mixed up with everything else • Antenatal classes focus on the actual birth –
missed opportunity• No clear guidelines about level of physical
activity – fear of miscarriage so professionals skip over this
Every system is perfectly designed to get the results that it gets.............
If we want a change we need to do different things or do things differently
The ambition for change…
The NHS has made huge progress. But I want it to go from good to world-class, moving away from numbers and towards what matters most - the patient's experience.
Andy Burnham – Secretary of State for Health
…we require healthcare organisations and their staff to understand what matters to patients and to respond to this in new ways, making sure that every contact with a patient count towards delivering the highest-quality services.
Understanding What Matters (DoH 2009)
3 Ways to do service improvement
1. Don’t listen very much to our users and we do the designing
2. Listen to our users then go off and do the designing
3. Listen to our users and then go off with them to do the designing
(Professor Paul Bate 2007)
© NHS Institute for Innovation and Improvement 2009
The ebd approach is…
…about using experience to gain insights from which you can identify
opportunities for improvement
…about experiences not attitudes or opinions
The components of good design
Berkun, 2004 adapted by Bate
Performance Engineering The aesthetics of experience
How well it does the job /is fit for the
purpose
How safe, well engineered and
reliable it is
How the whole interaction with the
product/service ‘feels’/is experienced
Functionality Safety Usability
+ +
© NHS Institute for Innovation and Improvement 2009
Experience Based Design is about designing better experiences…
© NHS Institute for Innovation and Improvement 2009
Understanding the needs of people living with Multiple Sclerosis
Hospital Portering services286 ideas came from using this approach
Children’s mental health services
Combating Heart Disease in our Asian Communities
• Traditional methods of cooking handed down over decades
• Engaged local community advisor• Nutritional expert and local women talk to
advisors in Asia• Developed published and sold
new recipe book
Design Council-RED Project- diabetes
• Challenge- diabetic patients with poor control and anxiety about reporting back to the clinical teams.
• Understanding experience- ethnographic study
• Needs Cards.......”I am addicted to sugar”
“I’m frightened”
Design Council- RED Project- diabetes
“There needs to be a shift away from teaching patients what they should do, and instead find out from individuals what they can do, identifying what barriers there are to change, overcoming them and supporting that change into the long term”
Experience Based Design is about designing better experiences…
© NHS Institute for Innovation and Improvement 2009
The story of the toilet roll holder
Action: Toilet roll holders now on both sides to help the patient feel more independent and be safe.
© NHS Institute for Innovation and Improvement 2009
Language
Blisters/Lumps/Ulcers/Polyp/WartyThings/Necrosis/
Lesions/NaughtyTumour/Aggressive/Progressing/
Precancerous
Action: awareness has resulted in change
Experience Based Design is about designing better experiences…
© NHS Institute for Innovation and Improvement 2009
Experience questionnaire
© NHS Institute for Innovation and Improvement 2009
Patient story and a process map…
It took ages to find a car parking space and then I found it was a 15
minute walk to the outpatients clinic. How frustrating! The room was cluttered with out of
date magazines and notices on the walls and I was already feeling
really nervous
I wasn’t sure where to go – the signs were difficult to
follow
Patient waits to
sees consultant
Patient goes to different
department for investigations
(X-Ray/Pathology
Patient sees
consultant
Patient arrives at
clinic
Patient registers
with reception
How do I find out where to go...I think I am lost. I am worried that I
will be lateI seem to be waiting a long time, have I been forgotten or missed
my name being called out? Feeling anxious
Consultant was really helpful
Patient waits to
sees consultant
Patient goes to different
department for investigations
(X-Ray/Pathology
Patient sees
consultant
Patient arrives at car park
Patient navigates to clinic
Patient arrives at
clinic
Patient registers
with reception
Patient navigates
to department
+ve
-ve
frustrated
relieved
anxious
informed
nervous
worried
unsure
pleased
upset
It took ages to find a car parking space and then I found it was a 15
minute walk to the outpatients clinic. How frustrating!
The room was cluttered with out of date magazines and notices on the
walls and I was already feeling really nervous
I wasn’t sure where to go – the signs were difficult to
follow
Emotional mapping
Experience Based Design is about designing better experiences…
© NHS Institute for Innovation and Improvement 2009
Action Planning
A personal responsibility…
• Hugh McGrath-Patient
• Julie - Clinic Receptionist
• John Pickles-Consultant
Experience Based Design is about designing better experiences…
© NHS Institute for Innovation and Improvement 2009
• Reduction in weight/BMI• Reduction in Morbidity and Mortality• Reduction in Length of stay• and so on..............................
Measure the improvement
Measure improvement
• Collect stories
• Observe
• Use mapping techniques
• Before and after – from and to
Measuring
“what matters more than raw data is our ability to place these facts in context and deliver them with emotional
impact”Daniel Pink –A whole new mind 2008
“the point is to emphasize that each of the cases involved an actual human being. Describing them as a percentage would dehumanize the physical impact on a real person,
someone's mother, father, sister, or brother”Paul Levy CEO 2008
© NHS Institute for Innovation and Improvement 2008
Emerging work
• Southampton- really trying to understand experience- what are the high level principles that influence eating choice for women in similar socio economic circumstances ( some chose well and some don’t)
• Kings Collage – research starting this year on the practical aspects of behavioural change in obese pregnant women
• Cardiff have partnered with Slimming World• Chichester- developed their own in house weight
management programme
We need to start a shift.....
Move from
• Responsibility of professionals
• Information giving- predominantly ‘telling’
• Only working with individuals
• Domain of health services
Move to
• Professionals and women working together
• Meaningful dialogue- include listening
• Also working in groups
• Inclusion of other experts in weight management
“The ebd approach is about sharing and understanding the experiences of patients, carers
and staff together to design better services.”
© NHS Institute for Innovation and Improvement 2010. All rights reserved.