Listen: Tom Lloyd

The term 'design thinking' is central to the creative process and can help a designer look at a problem or process from the point of view of the user experience, says Tom Lloyd, of practice PearsonLloyd.

The move of the Design Museum to the reimagined Commonwealth Institute in Kensington has once again stimulated a debate around what makes ‘design’ relevant today.

Design spans an arc of practice ranging from the decorative arts and the making of industrial products to a more critical response to our ever-changing world. In among this smorgasbord the term ‘design thinking’ has emerged in recent years to describe the process through which we can address and affect the experience of people’s daily lives, without the necessary ambition to create ‘things’ at the end of the process.

A Better A&E, a project PearsonLloyd has been working on since 2011, is an example of such a process. An A&E department is almost by definition a place of stress. Patients arrive in pain accompanied by worried family members and are looked after by staff experiencing heightened levels of adrenaline in the performance of their duties of care.

Add to this a sense of powerlessness over their induction into an unknown world and patients frequently reach a threshold of intolerance that ends in conflict with the system: ‘I don’t know what is happening to me.’; ‘Why am I waiting so long?’; ‘Why did he get seen before me when he arrived after me?’ In 2011 a team led by PearsonLloyd was commissioned by the Department of Health, through the Design Council’s Design Challenges programme, to look into how ‘design’ could address the problem of aggressive behaviour between patients and staff in UK hospital emergency departments; a problem which costs the NHS upwards of £70m a year in reduced patient care, staff absenteeism and litigation.

Our first goal was to understand how an emergency department works and what a typical user journey might look like. We soon realised though that due to the extreme variety of patient types, injuries, arrival modes and acuity, there is no such thing as a typical user experience. Although the instinctive response was to address the behaviour of those patients, mentally impaired by alcohol, drugs or clinical issues, who were most likely to lash out, we noticed that, like a late-night pub or football stadium, even the lightest verbal conflict often gives those people who witness it permission to join in.

In an attempt to amend such behaviours of the social group, it was this low-level verbal abuse that the team focused on. It turned out that a lack of understanding of the system, the pathway and the likely interaction with staff, was a key trigger leading to frustration, anger and abuse. Our own need to understand the system led us to illustrate the processes that a patient might expect to encounter on a visit to the department in something akin to a Tube map.

It occurred to the team that giving patients and their families a real understanding of the system would allow them to feel more in control. This judgement formed the basis of our response to the project; a communications programme that guides patients and family through the care pathway, providing basic information to patients, such as where they are, what happens next and why they are waiting.

Evaluations at pilot healthcare trusts in London and Southampton found that the solutions improved patients’ experiences of A&E and reduced levels of frustration and hostility. Patients and staff observed significant reductions in aggressive behaviour, with a 50 per cent fall in incidents. This was supported by improvements in staff morale, retention and wellbeing, with stress-related staff absences falling significantly after the implementation of the solutions. The Guidance Solution has been implemented in 10 healthcare trusts across the UK following inquiries from 46 trusts around the world.

‘Design thinking’ is a term that describes what has always been central to the creative process: looking intensely at a subject, problem or process through the lens of provider, producer and user; seeking to understand what makes a system act in a particular way; thinking about how that system can be affected or amended to alter the experience of system, product or space.

The act of design in all its guises demands the similarly elusive combinations of analysis, intuition and context, and in promoting the power of ‘design’ to the world we should celebrate that which unites the extraordinary diaspora of our industry, as well as that which divides.

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