On a cold and rainy Tuesday in March, 31 clinicians, patients, designers and technologists gathered at Health Foundry for our first Design Jam of 2018. The Design Jam was a day long event bringing together a wide range of people from Lambeth and further afield to develop design-led and tech-enabled solutions to the challenges and opportunities of social prescribing to help people living with multiple long term conditions (mLTCs).
Social prescribing is a means of enabling health care professionals and voluntary and community organisations, to refer people to a range of local, non-clinical services such as volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and sports to name a few. Patients can also be referred to a range of social services such as advice and support around employment, housing or debt as examples. (The King's Fund.)
Social prescribing recognises that people’s health is determined primarily by a range of social, economic and environmental factors, and not just their medical condition. It attempts to look at people and their needs in a more holistic way and aims to support individuals to take greater control of their own health.
Social prescribing is widespread in London and the UK with famous schemes at the Bromley by Bow Centre in Tower Hamlets, the College Surgery in Devon, and Healthworks in Newcastle. The North Lambeth Local Care Network is running a pilot in the north of the borough looking at how to improve the uptake and impact of social prescribing.
Although the evidence for social prescribing is growing, it is not without its challenges and the use of digital technology in these schemes is not widespread. This Design Jam aimed to present participants with four big challenges (and a wild card) to re-imagine how technology could disrupt the existing models of social prescribing.
Setting the scene
After a welcome Sinead Mac Manus, Startup & Innovation Manager at Health Foundry, the morning kicked off with a series of lightning talks from some of the stakeholders in the North Lambeth Local Care Network (LCN) social prescribing pilot.
First up we had Jane Stopher, Chair of the LCN. Jane gave some background to the North Lambeth LCN social prescribing pilot which started a month ago and shared some early learnings from this research phase of the pilot. Next was Will Nicholson, an independent consultant who has been working in health in Lambeth for 20 years. Will dove deeper in to the organisations involved in the pilot which are two GP practices (Lambeth Walk near Vauxhall and Grantham Practice in Stockwell) and the Black Prince Trust which is a charity providing a 2.5 acre site of first-class sport and educational sessions to the local community around the Ethelred Estate near Vauxhall.
Will was followed by Alison Vine, Volunteering & Wellbeing Manager at CoolTan Arts who explained their current model of social prescribing working with referrals from Lambeth Walk GP practice. Lastly, Alessandro Guazzi, Founder of technology company Sentimoto shared some of their learnings from a digitally enabled social prescribing pilot that they ran in Durham.
After a quick Q&A session with the speakers, it was time to get jamming! Sinead presented the four big challenges to the group (as well as a wild card option):
The traditional model of social prescribing has a link worker who knows what resources are available locally and can help support an individual to create a plan to meet their personal goals. Could technology disrupt this model?
Many social prescribing models rely on directories of local assets and support (either accessible by a healthcare professional, link worker or by the person themselves). There are challenges with this information being comprehensive, up to date, locked within someone’s knowledge or actually any good. Is there a role for technology in how patients or HCPs or others find services and opportunities in the first place, keep up to date and provide feedback on them?
Social prescribing schemes can can be professional, volunteer or peer led but all share the same challenge of how to equip people with the appropriate knowledge, skills and attitudes. Is there a role for technology in this?
Successful social prescribing schemes put people at the centre of their care, the decision making process and get patient ‘buy-in’ to the process which leads to behaviour change. Can technology support and motivate people to engage with the process and sustain positive change?
Wild Card! Design for another challenge you have identified.
The design process
Sinead then introduced the design methodology for the day which followed the Double Diamond Design Process of moving from Discovery to defining a clear problem statement to design around (Define) and then going broad again during the Ideation process before narrowing the focus again to choose an idea to prototype.
After a quick break for coffee and biscuits, teams started to form around the challenges. To aid with the Discovery process, teams were introduced to a number of different tools.
Personas are a good tool in the design process to keep the person you are designing for front of mind. Too often when we try to think of solutions to problems we think of solutions that would suit us, rather than the person we are designing for. Essential points to include in your personas:
- Demographics – What is this person’s age, gender, education, marital status, income and occupation?
- Goals – What is this person’s goal? Which services do they want? What drives and motivates them? What are their hobbies and interests?
- Challenges and pain points – What are their needs? Do they have any concerns? What do they struggle with? What health problems or conditions do they have? What do they dislike?
- Sources – What media do they use for entertainment? For information? Are there specific sources they use to find health-related information?
Personas can also be combined with User Journeys to map a day in the life of your potential user to see how your solution might fit into their world. Some of the teams created strong personas (Betty and Mary) that continued into their solution. (See below.)
How might we
Another handy tool are “How might we” (HMW). HMW questions are a way of framing problems and challenges as opportunities for designing solutions. For example, a challenge like many 80 year olds do not have access to a smartphone could be reframed as How might we use everyday household technology to communicate?
By noon each team were working towards defining a clear problem statement and moved forward into one of the most fun parts of the design process: Ideation! This is where participants are encouraged to get on their feet and brainstorm potential solutions to their problem. Individuals in each team were encouraged to spend five minutes with post-its and pens brainstorming at least seven ideas by themselves before sharing with the group. (This encourages equal participation within teams rather than just the loudest person’s ideas.) To help the process, Sinead shared the rules of a good brainstorm which includes encouraging wild ideas and building on the ideas of others (Yes, and rather than Yes, but).
After a health lunch from local caterers Eden, the teams pitched their ideas that they would prototype and attempt to validate in three hours.
Team One were looking at the problem of a person (Betty) who has been referred to an organisation such as CoolTan Arts from her GP, then falling through the cracks from not having a benefit of being part of a wider social prescribing ecosystem.
Team Two looked at the valuable role of Patient Participation Groups (PPGs) in supporting social prescribing and the problems of raising awareness of the existence and possibility of involvement within their surgery PPG.
Team Three wanted to create a solution to Challenge 3 and the problem with directories. The group wanted to solve the issue of there being lots of great local services and resources but knowledge of them is limited with the community.
Team Four examined the problem of how to make social prescribing more personalised and also to get over the barrier of attending a first session.
The teams had three hours to prototype their ideas and (hopefully) validate them with users before the pitch deadline as 5pm. Fuelled by endless cups of tea and cake, it was fast-paced afternoon as everyone rushed to meet the deadline. At 5pm the teams gathered back in the main space to hear each others’ pitches.
First up was Team One with a great project name of “Stop Betty falling through the cracks”. The problem the team were trying to solve is a person, like Betty, being referred to a service like CoolTan Arts but the charity not having a way of knowing if she engaged with the activities suggested, having no way for Betty to give any feedback on the service, and, crucially, no way for CoolTan Arts to then refer Betty onwards to further support.
Their solution was to first set up an social prescribing ecosystem within North Lambeth and co-design a Memorandum of Understanding with roles and responsibilities that social prescribing organisations can sign up to. The next step would be to make the ecosystem visible by creating a brand mark.
Once the ecosystem is in place, Betty can be given a QR code or similar when she registered with her first provider. She will then bring this to her first activity and scanned by the provider to register her attendance. If Betty does not turn up, the system notes that she has not made the appointment and sends this information to the service who sign posted her. Betty receives a text message to offer to reschedule, thus helping her avoiding falling out of the net. Using the same tracking code, one service provider can refer Betty to another service provider (getting Betty’s permission of course). This should take a pressure off primary care to be the holder of all the referring relationships. It would also create a big network of services and providers who can communicate together about individuals and obtain useful feedback on user’s activity.
Next up it was Team Two who developed a project called PPG Engine. Their design challenge was how to promote the Patient Participation Groups (PPGs) of GP surgeries and let patients know that PPGs are their for them and can help support them.
Their solution was an analog one. The team co-created three different marketing messages for three different audiences of the PPG: the patient considering joining the PPG telling them how it’s going to help, one from the PPG chair outlining how participation can help, and one from a real PPG member explaining how it helps to connect with others. The team designed template materials (flyers and posters) that they PPG could use in their surgeries.
Next up was Three Three who had the project name Love Lambeth. The problem they identified is there is a lot going on in North Lambeth but people (local residents, GPs, those running own activities) don’t know about them – despite several online websites. The team wanted to explore how do we make North Lambeth a ‘village’ and create a sense of a community and belonging?
There solution was a one stop shop for healthcare professionals, PPGs, VCSs, shops, individuals to go to to get information. The idea was to be able to pull information from all the existing websites and directories at the right time. This project should build on the existing ones and include people involved in love.lambeth, MYSocial, Lambeth Together and The Collaborative. The functionality of the website Hoop with possible additions of accreditation/kitemark and a chat function would give the universal ‘one’ platform’ site for citizens, health and care staff, community connectors. Categorisation could be based on the Five Ways to Wellbeing.
The team also had the idea of creating a ‘badge’ and ambassador programme (like the 2012 Olympics) creating a visual sign of affiliation worn by people and where it’s visible in the neighbourhood where support and advice can be found (shops, cafes, libraries, healthcare premises).
The last team had the intriguing project name of Magical Matching. The problem they were looking at was how to make social prescribing more personal to the user and make it easier for people to engage in activities. The team gave the helpful persona of Mary who is in her 70s, from an ethnic background and has a number of long term health conditions. She loves getting her hair done. Her challenges are that she is not feeling valued, struggles with her health issues, and does not feel she receives support to get help.
Mary find out about Magical Matching at her local hairdresser that trusts. She is encouraged to give it a go. Through some intervention (SMS, web, app) she outlines what she likes to do which is gardening. Magically she then gets access to information about three people who are a bit like her who live locally and are doing activities she is interested in. After reading the profiles, Mary selects an option to be connected with Jenny (email, phone, SMS), They have a chat and Jenny invites Mary to her weekly gardening club and goes to her house to accompany her there. After a while of going to the gardening club, Mary’s confidence has increased and she agrees to be profiled on the Magical Matching system and is connected to Bob whom she brings to the club.
It was a fantastic day full of energy and ideas with lots of new connections made. We are now looking how to take the ideas forward and test them in the community as part of the North Lambeth Local Care Network social prescribing pilot so … watch this space and get in touch if you would like to get involved.