Theme 2: Design and technology

Large London trusts that provide excellent clinical outcomes for cancer treatment often perform badly in the National Cancer Patient Experience Survey. Geographically dispersed sites, old vertical buildings, high patient numbers and high staff turnover all contribute to a loss of personalisation in the perceived quality of care. The point of receiving a diagnosis and transitioning from treatment to monitoring are identified as moments of particular need.


HELIX has designed simple solutions to help cancer patients understand their individual care pathway, who their clinical team are, where the key locations of their care are, and what third party services (such as charity support) are available to them. The simplest solution is a printed card brochure that acts as a discussion tool between clinician and patient. This can also be used as a web or app based portal, establishing a digital connection between the patient and clinical teams.


Bowel Cancer screening is proven to be effective at identifying bowel cancer, a disease that can develop to a serious condition without presenting noticeable symptoms. Currently everyone in the UK between 60 and 74 is invited to participate in the screening programme every two years, but only around 55% of invitees actually participate. The process involves taking a swab sample of your own stool at home and returning them by post. Uptake is particularly low in urban, low-income and immigrant populations.


HELIX is working on improving the experience of bowel cancer screening. This includes a new ‘out of box’ experience when people receive the sample kit, and the development of a series of animated films that explain in accessible, elegant and plain-speaking snippets the reasons for participating, and practical advice on completing the task. These animations are ideal for web-based resources that invitees can be directed to via the sample packs and paper invitations. We also expect that the animations will contribute to increasing general awareness of the disease and the screening programme, so that when people are invited to participate, they aren’t taken by surprise. A recently completed qualitative public survey of the interventions resulted in positive feedback, and a randomised controlled clinical trial is planned with the Welsh Bowel Screening programme.

Thickened fluids are commonly prescribed to reduce the risk of aspiration and enhance swallowing safety in dysphagic patients who have difficulty controlling and managing thin fluids. Inconsistency in the labelling, definition, preparation and delivery of thickened fluids by healthcare workers increases the risks of patients experiencing unnecessary and avoidable choking, aspiration pneumonia and dehydration.

Currently there are no training programmes or standardised education tool for thickening fluids available for nurses or healthcare assistants. This contributes to great variability and frequent errors in the day-to-day preparation and delivery of thickened liquids. HELIX is producing a series of posters and stickers that use illustration and clear labelling to demonstrate the correct procedures for preparing thickened fluids to a range of specified consistencies. The posters can be displayed on wards, and stickers can be placed on appropriate storage cupboards and containers. HELIX is also producing an app version of the guidance.

Supported by the Cabinet Office and Department of Health we set out to redesign the inpatient prescription chart that is used in nearly every hospital in the NHS. Our designers used cutting edge insights from the behavioural sciences alongside their design skills to deliver a chart that has been shown in an initial pilot study to have a dramatic impact on prescribing behaviours. This work has featured in a Radio 4 programme as well as in The Times Newspaper.

A programme of research supported by the NIHR Imperial Patient Safety and Translational Research Centre investigated issues around escalation of care, failure to rescue and clinical handover. Central to each of these important patient safety challenges is how clinical activity is currently organised. Clinical tasks (blood tests, medication orders) continue to be managed using outdated communication technologies including pagers and fax machines. We recognised that a better solution was required and worked with frontline staff to define the specifications of a new digital solution.  

Hark is the name for a smartphone based app that supports staff organising clinical activity. The research undertaken in the development phase has been published in over half a dozen research papers.

Pilot study accepted for publication

The results of a pilot study with frontline staff at Imperial College Healthcare NHS Trust has been published in the Journal of Medical Internet Research, one of the world’s leading peer-reviewed eHealth journals. 

Replacing the pager. Can interprofessional communication be improved using a smartphone application? A randomised crossover trial

Patel B, Johnston M, Cookson N, King D, Arora S, Darzi A

Background: Most hospitals use paging systems as the principle communication system, despite general dissatisfaction by end users. To this end, an application based communication system (called Hark) was developed to facilitate and improve the quality of inter-personal communication.

Objectives: to assess the quality of information transfer using pager and application based communication systems (Hark); to determine whether using smartphone applications for escalation of care results in additional delays in communication; to determine how end-users perceive smartphone applications as an alternative to pagers.

Methods: Junior (PGY-1 & PGY-2) doctors and nurses from a range of specialties were recruited and randomized into two groups who used either a pager device or a smartphone-based Hark App. Nurses were asked to give handover about simulated patients while doctors were asked to receive handover using these devices. The Quality of Information Transfer (QUIT), time taken to respond to messages and users’ satisfaction with each device was recorded. Each participant used both devices with a two-week washout period in between uses.

Results: 22 participants (13 nurses, 9 doctors) were recruited. The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118 (range 100-121) vs. pager 77 (39-104) P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers although this difference was not statistically significant (Hark mean 86.6 seconds (SD 96.2) vs. pager mean 136.5 seconds (201.0) P=.106. Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P

Conclusions: Hark was found to improve the quality of information transfer in simulated patients and has been rated by users as more effective, efficient and less distracting than pagers. Using this device results in no delay in patient care.

Keywords: Communication; smartphone; pager; applications; escalation of care; simulation 

1. Escalation of care and failure to rescue.A multi-centre multi-professional qualitative study. Surgery. 2014: 155;989-994. Johnston M, Arora S, King D, Stroman L, Darzi A.
2. Escalation of care in surgery: A systematic risk assessment to prevent avoidable harm in hospitalised patients. Annals of Surgery. 2015. 261(5) 831-8. Johnston M, Arora S, Anderson A, King D, Behar N, Darzi A.
3. Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis. Journal of Evaluation in Clinical Practice. 2014. 20: 486-497. Johnston M, King D, Arora S, Cooper K, Cox, C Darzi A.
4. A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery. Surgery. 2014: 157; 752-763. Johnston MJ, Arora S, King D, Bouras G, Almoudaris AM, Davis R, Darzi A.
5. Improving escalation of care:development and validation of the Quality of Information Transfer Tool. Annals of Surgery. 2016: 263(3):477-86 Johnston MJ, King D, Arora S, Darzi A.
6. Smartphones let surgeons know WhatsApp: an analysis of communication in emergency surgical teams. American Journal of Surgery. 2014. 209: 45-51. Johnston MJ, King D, Arora S, Behar N, Athanasiou T, Sevdalis N, Darzi A.

 

 

 

 

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The Liverpool Care Pathway, a controversial protocol for clinicians to provide care to patients believed to be in their last days and hours of life, was phased out in July 2014. The medical profession generally regarded the LCP as a good way to provide for a good death, with dignity and comfort. However, the Liverpool Care Pathway was heavily criticised in the popular press, and there were some cases of bad communication with families and loved ones.

An alliance of 21 organisations has written new guidance for clinicians to help preserve the provision of dignified and good quality deaths. HELIX was asked to use design to help communicate this guidance to clinicians in a useful and practical way, but in a manner that is not a protocol or pathway. HELIX produced a portfolio of communication products, including a strong, clean and simple visual identity, using appropriate formats to present the guidance to clinicians on the front line, including posters, leaflets and apps. Simplicity, clarity and accessibility were central to the presentation. The resulting guideline have nationwide distribution and are made available through the NHS Improving Quality website.

More recently, our End of Life Care work has included redesigning the Do Not Attempt Resuscitation (DNAR) process in collaboration with the public, the Resuscitation Council and a patient-facing advance care planning (ACP) platform that allows patients to plan, document and share their wishes and priorities for the end of their life in both electronic and printed format. Pilot trials of the DNAR process are underway in collaboration with Warwick University, and trials of the ACP prototype began in August 2016.