Care at Home: A Systemic Exploration in the NHS and UK
Cross-published on the Livework Studio Blog
Given new possibilities enabled by digital technologies and evolving policies, the role of hospitals is changing and the barriers between medical facilities and people’s homes have become more permeable.
As the popularity of hospital level care at home services rise, so too does their potential to create value for patients, clinicians, providers, and payers — but realizing that potential requires that they are comprehensively designed, with an eye on the big picture, and with humans at the heart. Our project takes a deep dive into patient and staff journeys while simultaneously exploring the broader dynamics of a health system that’s evolving towards more home — and patient — centric.
The Approach
→ A systems exploration
We are going broad, interviewing and engaging with a wide range of stakeholders in and adjacent to the NHS to understand how the system of care is evolving, how care at home fits in, and how design interventions can best position virtual health services to generate positive impact. This involves mapping, connecting dots, identifying patterns, and finding leverage points.
Key questions:
- How are key elements of virtual health services connected to patient health outcomes, patient safety, psychological wellbeing, clinician satisfaction, cost savings, system benefits, and other outcomes?
- How might virtual health services act as an element of a system that produces valued outcomes for patients, clinicians, providers, and payers?
- Which dynamics might generate ripple effects in the system if leveraged?
→ A deep dive
We are going narrow, to tease out the factors in one particular virtual health service that might enable successful referrals and treatment at home. This involves qualitative interviews, process observations, and contextual inquiry.
Key questions:
- How do patients, clinicians, and carers currently understand what virtual health services are, who they’re for, and how they work?
- How do relationships between patients, clinicians and carers change when care is provided at home?
- What are the key social determinants that affect patient outcomes in home-based care and what can we do to address the challenges surrounding them?
What have we learned so far?
The following are some of the key insights from our initial conversations with partners, trusts, and other stakeholders, as well as the questions we believe design can help to address.
Clinician Confidence
Virtual health feasibility is contingent on clinicians’ buy-in to, and appropriate use, of referral pathways.
Design question: How can we increase confidence in virtual health services?
Virtual Health Inclusion Criteria
As virtual health services evolve, many organizations are refining referral pathways, and some are making the shift from condition-based to acuity and capability based inclusion.
Design question: How might we design virtual health eligibility criteria around patient safety, needs, and circumstances, rather than their diagnoses?
Evidence Building
For the growth and sustainment of virtual health services across the UK, understanding and demonstrating their impact on patients, staff, and systems is key.
Design question: How can we design metrics that best represent these stakeholders’ priorities?
Care for Carers
Care at home shifts more responsibility to patients and their carers.
Design question: What physical and emotional implications does this have and how can we design for carers?
Social Determinants of Health
Successful treatment at home hinges on patient and family skills, confidence, and environment.
Design question: How should we account for these factors in virtual health referrals and service delivery?
What’s Next?
As part of the project, we are hosting a three month working group with NHS trusts who are working on developing or expanding a virtual health services (e.g. a Virtual Ward or Hospital at Home). Each month, we are into some of the topics above, sharing new insights as our project progresses, and encouraging participants to connect and learn from one another. As the work evolves, we look forward to sharing more. Thanks for following along!
Contributors
This project is being co-led by Sylvie Abookire and Anath Hojman, in collaboration with Livework Studio, the NHS, and their partners.
