Roger Coleman

Design for patient safety: A review of the effectiveness of design in the UK health service

In 2002 the UK Department of Health and the Design Council jointly commissioned a scoping study to deliver ideas and practical recommendations for a design approach to reduce the risk of medical error and improve patient safety across the National Health Service (NHS). The research was undertaken by the Engineering Design Centre at the University of Cambridge, the Robens Institute for Health Ergonomics at the University of Surrey and the Helen Hamlyn Research Centre at the Royal College of Art. The research team employed diverse methods to gather evidence from literature, key stakeholders, and experts from within healthcare and other safety-critical industries in order to ascertain how the design of systems—equipment and other physical artefacts, working practices and information—could contribute to patient safety. Despite the multiplicity of activities and methodologies employed, what emerged from the research was a very consistent picture. This convergence pointed to the need to better understand the healthcare system, including the users of that system, as the context into which specific design solutions must be delivered. Without that broader understanding there can be no certainty that any single design will contribute to reducing medical error and the consequential cost thereof.

History of Inclusive Design in the UK.

The UK Design Council describes Inclusive Design as neither a new genre of design, nor a separate specialism, but as a general approach to designing in which designers ensure that their products and services address the needs of the widest possible audience, irrespective of age or ability. Inclusive Design (also known [in Europe] as Design for All and as Universal Design in the USA) is in essence the inverse of earlier approaches to designing for disabled and elderly people as a sub-set of the population, and an integral part of a more recent international trend towards the integration of older and disabled people in the mainstream of society. This paper describes the development of Inclusive Design in the UK, from its early beginnings, through its subsequent adoption as a topic of academic research, leading to its recent emergence embodied as a framework and toolkit for design.

A demographic overview of the ageing of First World populations.

The ageing of the UK population, and other similar populations, is now well advanced. The process is probably irreversible and may well be repeated across the globe. It is reasonable to assume that 40-50% of the UK adult population will be over 50 for the foreseeable future, and that the number of people in their 80s and 90s will continue to increase for some decades. Growing awareness of this may well lead to a reinterpretation of the life course with consequent changes in lifestyle and activity. In the past, the main focus of design, both of products and environments, has been the working population. There is clearly an urgent need to direct attention to older sectors of the population, including: fit and active people in retirement; affluent groups in old age; single households; women, who form a majority of the over 50s; and other groups which have been neglected in many work studies.

From margins to mainstream

Although the academic and broadsheet worlds still tend to refer to ‘the elderly’ and ‘the disabled’, as if they form distinct groups outside the mainstream of society, there is a growing trend to recognise age and disability as something we will all experience, and therefore part of a normal life course. Disabled people have become increasingly assertive about their rights to access buildings and services, while for older people the emphasis is now on independence. Both groups aspire to active participation within the mainstream of society, reject the dependency and institutionalisation that were the norm for much of the last century, and are beginning to assert themselves as consumers who control significant amounts of disposable income. Such new expectations offer a rationale for design that is ‘inclusive’ rather that exclusive, and more closely aligned to contemporary social expectations.

Systems mapping workshops and their role in understanding medication errors in healthcare

Systems mapping workshops have been applied to the problem of medication errors in healthcare. The workshops were designed using experiential group work principles. They involved a range of stakeholders from within the health service as well as those who supply the health sector, including designers who may be able to enhance the safety of products and systems used in healthcare. Research has shown that the method encourages stakeholder participation, provides robust results within a limited time and enhances understanding across specialist interest groups. Additional, creative design workshops that considered the same topic showed significant promise in developing concepts from which potential solutions could be developed further.

Designing emergency ambulances for the 21st century.

Background: In 2005 the Department of Health set out a vision for the provision of future ambulance services with an increasing range of quality mobile healthcare services for patients with urgent and emergency care needs. This paper describes a scoping study funded by the National Patient Safety Agency and Ambulance Service Association to investigate the short and longer term requirements of future emergency ambulances. Method: Four stakeholder workshops were held to explore the wishes, concerns and preferences of the clinicians, operational staff and manufacturers about the future provision of ambulance services and problems and possible solutions relating to ambulance design and use. Incident reports relating to ambulance design and use were reviewed from three national and international databases. Results: Nine design challenges were identified: access/egress; space and layout; securing people and equipment in transit; communication; security, violence and aggression; hygiene; equipment; vehicle engineering; patient experience. These were validated at the national UK ambulance conference (AMBEX 2006) with a rating questionnaire. Conclusion: The results are being used in the development of a national specification for future UK emergency ambulances.

Design and empathy

Over the past ten years, at the Royal College of Art, a body of knowledge has been built up around the practice of working closely with older and disabled users, and good evidence has emerged of the impact this has on the thinking of young designers, and the extent to which that is carried through into professional practice. The process has been one of learning by doing, and the underlying ideas are very straightforward, but the value lies in the impact this has on design outcomes and the extent to which it has prompted mould-breaking work, and driven the shift in thinking and practice, from technical aids and assistive devices to inclusive design. There are many caveats to the process, and issues about which users to work with, how to go about that, and whether or not such relationships are exploitative. But overall, what has been learnt is that given appropriate, supporting information and methodologies, and access to a well-organised and representative network of users, the process can be very effective.

A designer-centred approach

The introduction to this book pointed out how the design industry has responded to the new priorities of ageing populations and the demands of disabled people for full access and participation. A range of approaches and strategies has been developed, along with design methods that engage with the needs of a wide range of users. Increasingly practitioners now regard inclusive design as part of good design practice. They want to deliver inclusively designed products, but currently lack access to information and tools that fit the ways they work. Inclusivity is often sidelined by time and budget constraints, and a failure on the part of the client to ask for designs that target a wider sector of the population through inclusive features. This presents designers with the further challenge, and requires that they have a command of the facts and arguments that can convince sceptical clients.

Setting a standard

So, where next for professional practice and design process? Many clues have been given in body of this book: designers Nina Warburton, Graham Pullin and Mike Woods have described how their own companies are innovating around the idea of inclusivity, how they are developing new methods and practice, and how the culture of their organisations is changing as a result. But, as Martin Bontoft and Graham Pullin point out in chapter 12, ‘Connecting business, inclusion and design’, although user-centred design innovation is at the heart of IDEO’s approach and philosophy, “it is rare that inclusion is explicitly on the brief at the outset of a project.”

Activities and products for the Third Age

Designers, ergonomists and professionals with an interest in ageing were surveyed (by questionnaire) for their opinions and attitudes towards existing and potential products and services for the Third Age. They were also questioned on lifestyle expectations for their own Third Age. There is much work that needs to be done, both by ergonomists, in mapping out the needs of a changed society, and by designers, in building up an understanding of the issues and translating that understanding into guidelines, tools and strategies to underpin design in the future.