Observing an out-patients clinic

I attended a clinic of one of my colleagues; it was a referral clinic for folks who might need treatment, which could extend to surgery (knee replacements, hip replacements etc). I attended for a number of reasons:

• To get out of my digital (and executive) ivory tower. To see what the ‘lived experience’ was of hospital staff and patients
• To get a feel for where we’re at now, after the most recent wave of Covid and ‘resetting’ to treat patients who may have been waiting for treatment.
• And naturally to see how digital solutions we look after are used and experienced

And just to confirm — I won’t be using anyone’s name here, I’m not going to say anything that might mean the patients are identifiable (to themselves or anyone else), and yes of course we asked every patient if they were happy I was in the room.

Anyway, it was a really instructful if not impactful morning for me. And this is why, and what I observed.

• Taking time to know the patient — my experienced colleague introduced the folks in the room with him — held his name badge up so people would remember it, and without fail asked a few questions of the patients in front of him (yes he had extensive notes, yes he had scans, but he wanted to know about them and their life context). This is something important to remember from a digital POV. Get to know your users.
• Feeling the impact. One of the patients had life altering news in the clinic (not life threatening). He walked in the door with an unknown pain. The diagnosis was highly unusual for a person of his age. He left with a recommendation for a consultation with a specialist at another hospital. In the course of 15 minutes he had to process the news, ask questions, consider immediate changes to his life which were deeply uncomfortable (in order to prevent further damage), and start on a journey which would stay with him for the rest of his life. Have empathy with your users, understand the impact of your solutions/designs.
• The clinician went out of his way to explain the options, explain the potential impacts, used x-Rays and MRI scans to illustrate, delivered heavy news, allowed time to process and then asked ‘what do you want to do?’. The consultant might have had a view, but this was co-production at its finest. It’s a team sport: co-produce, co-design.
• It isn’t always virtual. We’ve introduced tools to support virtual clinics, and these definitely have a role to play, whether it’s the patient’s own choice or because of things like Covid. But this was a clinic that needed hands on — to feel how much a leg could be straightened or to identify where the pain was. But by seeing the person and/or their carer, by having a chat, the clinician could see ‘the whole person’. That may not always be possible virtually. Balance the virtual and the digital with the analogue and the face to face.
• Though not too much… All of the records in the clinic were paper, and there were great heaps of paper and folders stacked up around the place, including the biggest ball of string I’ve seen to tie them together! Not all of analogue is good so roll on electronic patient records (scanning started on the 10th May!)

I don’t know about you but my experience of the NHS (so far) has been light touch, mostly accompanying my mum. Seeing the experiences of just 6 patients showed the variety and range of skill needed was humbling. I already knew the surgeon’s knowledge of the body was expert, what I didn’t know was the care and attention he took to break bad news and explore the best option for the patient.

And it’s for those folks that we must provide the best user centred solutions we can for our staff and our patients.

Next I’m going to attend a DDU (digestive diseases unit) clinic and join ward rounds (including wearing scrubs!), where I think lots of chats about endoscopy results might happen…