We’re having a baby!

Helsinki Livework © 2015 9 March 2016

We’re having a baby! March 2016

SD IN GOV

CASE STUDY

Alice Ainsworth

Head of Digital Strategy

Department of Health

@aliceainsworth

Alex Nisbett

Senior dervice designer

Livework

@alexnisbett

#SDinGov

TODAY

Context & background

Project story

Stakeholder engagement

Project story

Project conclusions

Next steps

Livework © 2015 2

Livework © 2015 3

DH

Digital services as

things – Alice has

slides

Livework © 2015 4

TODAY

2. Project story

Livework © 2015 5 5

The DH would like to adopt a user needs approach, to a major life transition, as the basis for service improvement

THE PROJECT

The digital team at the DH, working with GDS, want to develop a ’user needs

platform’ based around a key life transition, as a resource to inform service re-design.

The project includes:

1.  Understand needs mapped to the current experience of a transition - having a

baby - and interacting with government and health services

2.  Develop a target ‘better’ user experience that responds to users needs and

supports government goals

3.  Develop prototypes for ‘quick win’ improvements, with a focus on digital.

Livework © 2015 6

Project overview and timeline

Prepare Understand Imagine Design Present

Field research

Kick-off

Generative workshop

Analysis

Review and validate

Develop and refine concepts

Test and validate

Prototype

9 June 13 July

Research review

17 September 27 October 19 August

Final presentation

Livework © 2015 7

How to get going…

Become an expert in the subject area

Get to know your stakeholders

Identify the do-ers

Understand the decision points

Keep it simple

Go to where the people are

Commit to your project objectives publicly

8

What is the experience for families interacting with the health system and government as a whole, before, during and after their child's birth?

RESEARCH QUESTION

The question we’re looking to answer:

6

What do they need and value during this life-changing experience?

Also…

Livework © 2014

Qualitative, empathic, design research

RESEARCH APPROACH

Livework © 2014

Qualitative research Aspect Quantitative research

Discovery,

understanding and

inspiration - ‘why’

Purpose Specific questions, test,

validate ‘what’

Empathic Approach Measurement

Free-form or

semi-structured using

design tools and probes

Data collection Rigid structure,

pre-categorised

Researcher intimately

involved, results

subjective

Researcher Researcher detached,

results are objective

Small samples,

in natural setting

Sample size Large samples to

produce generalised

results

FAMILY STORIES

Victoria and Nic Gemma, HV, London Angela, MW, Leicestershire Victoria, MW, Cambridgeshire

Julie (R), MW, Cambridge Diane and colleague, MW, Wigan

Joanne, HV, Hounslow Anne, MV, Carolyn & colleague Anne, HV, Sidcup

Onye, HV, Hackney

Livework © 2015 12

Livework © 2014

1. Search For The Truth

2. Grey Boundaries

3. Milestones

4. Continuity of Care

5. Bureaucracy

Insights from HCPs

1. Search for the truth

FROM HEALTHCARE PROFESSIONALS

“It’s like being a detective!”

On the part of the midwife, there is a need for a continuous effort in building the trust of mum to allow her ‘real’ story to reveal itself.

EXAMPLE INSIGHT

Livework © 2015 14

Livework © 2014

FAMILY STORIES Victoria & Nick An established long term couple who have

been together 10 years and married 6. They

have come to realise that life cannot be

controlled so it is better to be relaxed and

pragmatic. They already have a 2 year old son.

Key Challenge: An awful pregnancy

overshadowed by morning sickness.

Needs

Learning the sex of the baby as soon as

possible allows you to buy the right clothes,

toys and appropriate colour scheme. A private

4D scan cost £500 – money that was not easy

to find. They are very keen to buy their house.

Values

What will be, will be. She has not made a birth

plan or lists for this pregnancy as they “never

go right.”

Information and support

The Bounty Bag came too early. It was stored

away then later opened too late and some

products were out of date. Some of the offers

are irrelevant to them.

Belief

“Nothing is more rewarding than carrying your

own child.”

“Don’t be hero… take all the drugs you can”.

project.

15

Livework © 2014

FAMILY STORIES Nadia A rare medical condition meant that there was

a very high risk that Nadia may not conceive or

be able to carry the baby to full term.

Key Challenge: Managing expectations and

emotions of self and others.

Needs

The risk of their pregnancy failing was so high

that they struggled to enjoy or celebrate it in

case their hopes were destroyed. They waited

until week 30 to inform their broader social

network.

Values

It’s important to protect yourself from

disappointment and sorrow.

Information and support

Her husband, an engineer, was presented by

work colleagues with a folder of leaflets and

printouts other fathers had collected during

their own pregnancies. It had become a ‘man’s

bible’ passed down over the years, with each

new father adding along the way.

Beliefs

You can not assume the future.

16

Livework © 2014

1. Past & future drivers

2. Counterbalancing

3. Taking control

4. Transitions in identity

5. Points of reality

6. Information

7. The savvy consumer

8. Reaching out

9. Trust

INSIGHTS

Insights from families

3. Taking control

18

“We don’t really know how it’s supposed to work”

Many families feel they lack

control, they need support

and information to help make

the right decisions now, to

better prepare them for later.

FROM FAMILIES

EXAMPLE INSIGHT

Livework © 2015

7. Savvy consumer

19

“If Amazon & O2 can do online chat, so should the NHS”

Today, a high precedent is

being set by other service

organisations we interact

with day-to-day. Families

expect a 24/7 on-demand

experience that allows them

to be high performing

individuals.

FROM FAMILIES

EXAMPLE INSIGHT

Livework © 2015

Livework © 2015

Mapping information

20

Livework © 2015

Mapping information

21

Livework © 2015

Mapping information

22

Livework © 2015

Health Visitor info packs

23

Livework © 2015

Health Visitor info packs

24

Livework © 2014

Research conclusions

TODAY

1. Trust

Trust is integral to the success of every interaction along the

lifecycle, the journey, of having a child. It is the foundation

upon which a smooth experience is based.

The opportunity

Make this a core mission of the service. Allow it to become the

driving force and principle for how decisions are made.

If trust can become a product of all activities in this transition, it

will provide a solid base from which everything else can grow.

CONCLUSIONS

28

2. The lifecycle

There is a discrepancy between health professionals and

families view of what the lifecycle ‘is’ in terms having a

baby and in terms of the services provided.

The opportunity

Align these differing perspectives, so that there is a

shared view of the process, the timeliness, what and

how is provided.

CONCLUSIONS

29

3. High-performing families The health service is based on a legacy of excellence, but which

now exists within a fast moving world where behaviours and

expectations of families have evolved hugely as they engage with

increasingly sophisticated service organisations, and come to

pregnancy with a wide range of personal histories and contexts.

The opportunity

To acknowledge and support the myriad of family values, needs

and behaviours to create both a better experience for them, and

in turn higher performing families for the health service.

CONCLUSIONS

30

Livework © 2015

Concept generation

31

Livework © 2015

Concept generation

32

28 ideas

33

Livework © 2015

Concept development

34

7. HOLISTIC ACTIVITIES

10. BABY JAMBOREE

2. 1001 DAYS

9. CHARACTERISTICS CARDS

1. PREGNANCY OVERVIEW 3. ALL-IN-ONE PREGNANCY GUIDE 4. DIVIDE & CONQUER

11. MENTORS LIKE ME

8. DIGITAL MATERNITY RECORD / LIFE STORY

5. FINANCIAL DECISION-MAKING TOOL 6. NHS ENDORSEMENT

PROJECT PLAN 12 Concepts

The Baby Box is an idea borrowed directly from Finland, where it was established as a gift from the government for all expectatant mothers with the objective of reducing infant mortality.

The box is essentially a starter kit containing everything a mum needs for her newborn baby, and the box itself is used as a first crib.

Mothers have a choice between taking the box, or a cash grant, currently set at 140 euros, but 95% opt for the box as it’s worth much more.

In the UK, instead of giving this to all mums, no matter their situation, mums in particular need of support, or facing paticular circumstances, could be targeted first.

PREGNANCY TO EARLY YEARS CONCEPTS

12. Baby Box

Pregnancy journey

• The box is used as a crib

• Bedding

• Clothing

• Books and guides

• Nappies

• Socks

• Mittens, hat

• Bra pads and condoms

• Picture book and teething toy

• Cuddly toy

• Hooded bath towel

• Nail sciissors

• Hair brush, bath thermometer

• Nappy cream and washcloth

Key features

Challenge it addresses

The baby box gift signifies for many Finns that the government, the state, cares about giving all citizens an equal start in life.

At 75 years old, the box is now an established part of the Finnish rite of passage towards motherhood, uniting generations of women.

Knowledge that the state will look after them, also helps reduce mum’s stress towards the end of pregnancy.

1 2 3 4 5 6 7 8 9Insights

Planning / conception Pregnancy Labour, birth, and

first days First weeks

12. BABY BOX

Livework © 2015 35

Livework © 2015

A visual timeline that provides a simple overview of the entire pregnancy journey featuring what happens when, where and why (e.g. appointments, scans, tell your employer you’re pregnant), and with who.Takes both a physical and a digital form. The physical, e.g. a large

fridge magnet (or paper poster), gives you an overview of the 40 weeks and beyond, and serves as a visual reminder for the entire family of your pregnancy and what takes place when. The digital is more interactive, links to timely information, and syncs with your (and potentially also your MWs and HVs) calendar. Will also contain contact information for your MW/HV team, and a guide to who to contact when. Links with the NHS Alpha project.

Planning / conception Pregnancy

Labour, birth, and first days First weeks

PREGNANCY TO EARLY YEARS CONCEPTS1. Pregnancy overview

Challenge it addressesMany families, particularly early on in the pregnancy, struggle to gain an overview and keep track of what should/will happen when, where and with who.

Essential information and contact details are either often forgotten, lost or drowned in the plethora of information available.

Pregnancy journey

• Timeline overview ◦ Key appointments, scans etc. ◦ “When to prepare what”• Synchronisable calendar

• Reminders• Linking to time-based information

• “My MW/HV team” contact information• List of prioritised tasks

◦ Filterable by type ◦ Dividable between family members ◦ Pro-actively find calendar slots

• Add images• Shareable

Key features

1 2 3 4 5 6 7 8 9

Insights

36

Livework © 2015

A visual timeline that provides a simple overview of the entire pregnancy journey featuring what happens when, where and why (e.g. appointments, scans, tell your employer you’re pregnant), and with who.Takes both a physical and a digital form. The physical, e.g. a large

fridge magnet (or paper poster), gives you an overview of the 40 weeks and beyond, and serves as a visual reminder for the entire family of your pregnancy and what takes place when. The digital is more interactive, links to timely information, and syncs with your (and potentially also your MWs and HVs) calendar. Will also contain contact information for your MW/HV team, and a guide to who to contact when. Links with the NHS Alpha project.

Planning / conception Pregnancy

Labour, birth, and first days First weeks

PREGNANCY TO EARLY YEARS CONCEPTS1. Pregnancy overview

Challenge it addressesMany families, particularly early on in the pregnancy, struggle to gain an overview and keep track of what should/will happen when, where and with who.

Essential information and contact details are either often forgotten, lost or drowned in the plethora of information available.

Pregnancy journey

• Timeline overview ◦ Key appointments, scans etc. ◦ “When to prepare what”• Synchronisable calendar

• Reminders• Linking to time-based information

• “My MW/HV team” contact information• List of prioritised tasks

◦ Filterable by type ◦ Dividable between family members ◦ Pro-actively find calendar slots

• Add images• Shareable

Key features

1 2 3 4 5 6 7 8 9

Insights

37

TODAY

3. Stakeholder engagement

Livework © 2015 38

CONCLUSIONS

How to…

Test your messages

Find an ally

Get everyone in a room together

Be open

Go to where the people are

Set some deadlines

39

TODAY

4. Project story

Livework © 2015 40

Livework © 2015

Pregnancy overview – timeline

41

Mums 1. Pregnancy overview

Overall Mums were very positive about the pregnancy overview, appreciating ‘everything in one place’, the variety of content and the ability to zoom in and out of the pregnancy timeline.

“All in one, useful for partners too. Don’t need to use google”

Positives “Everything in one place” was the main benefit mums saw in this prototype, plus the ability to see what was coming next using it as a diary so that they could plan and prepare.

It was seen as a practical replacement for printed material ‘Those leaflets, you’re guaranteed to lose them.”

Knowing WHO you’re going to see as well as WHEN is also very useful, plus tips on what to pack in your hospital bag, and the videos, which are especially attractive to younger people.

Mums see all sorts of possibilities for additions…

“I would find it useful to have a reminder 'pop up' to do pelvic floor exercises as kept forgetting and now have slight bladder control issues!”

Having up to date phone numbers for the midwife and maternity unit especially useful as these can change, plus all information contained is useful in an emergency or if mums go into labour early.

“I wouldn’t have to carry my notes everywhere I go and if an emergency occurred I could quickly show anyone around this page [personal preferences] on my phone as I always have that with me and not my maternity notes.”

Negatives None to speak of, except for reassurance needed over privacy and security of information.

Note. There’s something about the interactivity making it more appealing than books and websites, which surely much include all this info already.

4.4

Livework © 2015 47

1. Pregnancy overview

Overall Health Professionals thought the pregnancy overview timeline best for first time mums, with lots of information about the whole pregnancy all in one place. They also saw it as an effective tool for sharing and involving their partner.

“A really good start point.”

Positives Being able to zoom in and out, seeing the detail through rich media, and the full and future picture of the pregnancy.

Using preferences to personalise the tool to enable mum’s key dates and information to be accessible and control notifications.

“It will make women and their families more aware and keen to be proactive about their care and wellbeing.”

“Accurate, succinct information with pictoral representation, so visually appealing and if personalised, a relationship is already developing prior to birth, especially for 1st child.”

“It has all contacts in one place and can be updated by the health professionals as teams change.”

“…would cut down on DNAs and save MW time and NHS money.”

“ Health professionals can make their services more accessible to parents and parents may be prompted to engage with professionals more.”

Negatives Some professionals noted that not all mums have smartphones and /or good access to the internet, so this mobile service would not have universal access.

There were also concerns over privacy, security and data protection (in line with all digital services but especially where personal health information is concerned).

4.4

Professionals

Livework © 2015 48

Professionals

7

Overall ranking scores

4.4

5.0

4.9

4.8

4.7

4.6

4.5

4.4

4.3

4.2

4.1

4.0

3.9

3.8

3.7

3.6

3.5

3.4

3.3

3.2

3.1

3.0

3.1

4.1

3.6

Mums

4.2

3.7

4.1

4.5

3.0 Livework © 2015 49

4.4 4.3

4.1

2.6

4.4

Livework © 2015

5. Project conclusions

TODAY

Three final conclusions: 1. Choice and decision-making 2. Health promotion and safety 3. Freeing-up time to care.

50

2. More empowered choice and decision-making Through our prototyping of concepts, it’s been clear that there are

opportunities to support families to make better decisions - whether

by simply giving them the right information at the right time, or by

setting out the options and alternatives for maternity and beyond birth.

For example:

The characteristic cards provide accessible, even basic information,

through pull, not push.

The pregnancy overview sets out what will happen when, where, why

and with who – so helping them be better prepared – and to make

the right decisions.

CONCLUSIONS

Livework © 2015 51

3. A platform for health promotion & safety Many concepts are focused on providing targeted information through

channels and in formats which users are currently familiar with (eg,

interactive timelines, video, user-friendly language, characteristic cards).

This will help cut through the ‘information overload’ and support the

promotion of health and safety.

For example, we heard of timely notifications for pelvic floor exercises.

This personal approach can also help service users perform at a higher

level, for instance by staying safe and healthy, reducing DNAs, or being

able to differentiate fact from fiction.

Finally, better informed and higher performing families also help reduce

the strain on resources.

CONCLUSIONS

Livework © 2015 52

4. Freeing-up time to care This project explored needs among ‘low’ and ‘high’ risk families and

provoked debate about access to digital services which support safer

pregnancies leading to better outcomes for mother and child.

We think there is an opportunity to explicitly satisfy the ‘worried well’,

especially through encouraging higher levels of online ‘self service’.

By doing so we could potentially save time and resources which we

are then able to direct to the more ‘at risk’ or disengaged mums and

address more serious health risks.

This hypothesis deserves further investigation and validation.

CONCLUSIONS

Livework © 2015 53

Sustained impact…

Influencing policy via the NHS maternity review

Informing the design of national services e.g.

NHS.UK

The lasting impact of bringing teams together

(Public Health England, NHS Business Services

Authority) informing Healthy Start and maternity

exemptions.

A model for a new way of working.

70

NEXT STEPS

If DH did the project again…

Warm stakeholders up early

Decisions don’t get made in the summer

Plan for research days throughout

Keep it simple

One point of contact

Be even more open.

70

LEARNINGS

If Livework did the project again…

Get the right people in the room for early decision-making

Lead with our experience and expertise (Ethics)

Pragmatic but flexible around scope and decision points

Share more tasks with the client

Visualise even more (Gov - “we operate in publications”)

Finally, never forget why you’re doing it.

70

LEARNINGS

Helsinki Livework © 2015 9 March 2016

Thank you March 2016

SD IN GOV

CASE STUDY

Alice Ainsworth

Head of Digital Services

Department of Health

@aliceainsworth

Alex Nisbett

Senior dervice designer

Livework

@alexnisbett

We’re having a baby!

Healthcare

Transcript of We’re having a baby!