Health for live's people.

Overview 

By 2010, one in ten of us will have diabetes. By 2030, the incidence of chronic disease in over 65s will more than double. Current NHS spending on diabetes alone stands at £10 million every day. And yet about 90% of healthcare takes place in the home.

Chronic disease and conditions related to an unhealthy lifestyle have reached epidemic proportions and are rising still. This presents a momentous challenge for our current healthcare system.

Improving existing services is not the answer. Preventative approaches to health mean radical changes in our individual lifestyles - eating well, exercising more, self-managing chronic conditions. These changes can't be delivered through hospitals and GPs surgeries alone. We need to design new types of services that tap into people's motivations and relate to their daily lives.

Working with the Bolton Diabetes Network and Kent County Council over nine months in 2004/5, RED designed and prototyped two new health services. Me 2 supports people to live well with Type 2 diabetes, and activmobs helps people to stay active. These services are designed to be co-created by people and professionals. They represent a shift in thinking in the way we approach preventative healthcare, and demonstrate how design can be used to put patient centred thinking into practice.

activmobs: new services for active lifestyles

With Kent County Council we worked with people in one of the most deprived wards. We prototyped 'activmobs"' - a platform that supports people to get active and stay active in a way that fits with their lifestyle, interests and abilities. Groups of friends choose an activity and gain access to support from a personal trainer. It's an economical way to enable people to be active in a context that is comfortable and social.

The diabetes agenda: new services for type 2 diabetes

In Bolton we worked with the Bolton Diabetes Network to enable people to live well with type 2 diabetes. Here we developed 'Agenda cards' - a simple tool that reframes the interaction between patients and professionals. We also prototyped the Me2 coach service - a new and powerful support role, like a life coach but for people with diabetes.

The Agenda cards allow patients to set the agenda for their consultation; getting to the heart of the problem in the first few minutes of a typical diabetes check-up and freeing up valuable consultation time to work on solutions.

The design process

Design at its best involves the collaboration of people, organisations and experts in devising new solutions. Our design team included people with diabetes and their families, local residents, nurses, doctors, podiatrists, dieticians, health managers, local council officials, psychologists, sports scientists, personal trainers, economists, statisticians, health policy experts and social scientists, alongside service designers, interaction designers and communication designers. The design process acted as a conduit for these different perspectives.

The process we use starts from the point of view of the individual, not the system. We use design research techniques to understand people's needs and aspirations and co-design methods to develop and prototype concepts. People, patients and front-line workers collaborated on this project by brainstorming ideas, critiquing concepts, testing things out in context and suggesting improvements.

Impact

Current status as of November 2006:
Kent County Council is setting up activmobs as an independent social enterprise. The Bolton Diabetes Network is trialling elements of the new service with GPs in the local area. The work is being evaluated by Leeds University.

RED Report 01: Open Health

The Wanless report advocates a shift in emphasis to a system that enables the full engagement of people in the maintenance of their own health. This engagement cannot be delivered by institutions - a new model is required. These prototypes point towards a radical new model of healthcare organisation:

Co-creation

Open Health shifts the focus from delivering treatment to engaging people in their own healthcare, supporting self-management and enabling healthy lifestyles. This means that the biggest untapped resource in the NHS is people themselves: how can we harness the power and expertise of patients and their families to co-create better health outcomes?

Systems like ebay, wikipedia, the Grameen Bank and youtube rely on ordinary people generating the content themselves. Their participation shapes the nature of the service: it is co-created. We set out to see whether we could apply the principles behind these 'open' systems - distributed tools, collaboration between people and professionals - to healthcare systems in order to engage people in their own healthcare. We call this approach co-creation, and seeds of it can already be seen in the health sector. Read more about communities of co-creation, and how they could create health services that are strengthened by participation rather than burdened by demand,

What we learnt

Through the course of this project we learnt some useful things about designing for 'behaviour change':

- It's all about motivation, not medicine: design the service to tap into people's existing motivations.

- Build services around people, not diseases: starting from the perspective of the individual creates radically different solutions.

- Create meaningful metrics: the measures of the system should be just as useful to the users themselves.

- Make it aspirational: people must 'opt-in' to these services so it's important to make it desirable to take part.

- Make progress visible to people: use visual forms and lay terms rather than medical jargon.

- Give people the tools to do things themselves: this helps them to take responsibility for their own healthcare.

- Create shared interfaces: tools, like the Agenda cards or the diabetes blog, are good ways of breaking down patient/professional hierarchies and putting the rhetoric of 'patient participation' into practice.

- Support roles are important: these may not always be medical roles.

 -Distribute tools and services into people's daily lives: health services should exist where lifestyle decisions are made - in supermarkets, not just surgeries, for example.

- Make use of social networks: design services to work with the economics and social dynamics of groups (like the 'mobs' in activmobs) to create more sustainable activities.

- Let people themselves own the system: designing services that allow people to set their own agendas and goals, and self-assess their progress, creates greater engagement.

We also learnt some things about designing co-created systems:

- Co-created systems cannot be fully designed from the outset - there must be room for people to contribute and shape the service themselves. We think this can be done by designing platforms, tools, rules and roles.

activmobs
With Kent County Council

activmobs is a system that supports people to form 'mobs' to get active and stay active. activmobs was designed and developed with the people of Park Wood, Maidstone, and with Kent County Council.

Obesity and chronic disease, especially amongst older people, are major health challenges in the UK. Underlying these problems is a trend towards less physically active lifestyles. Staying active can mean a reduction of up to 50% in the risk of heart disease, stroke and diabetes.

People find exercise hard to prioritise. For many it is something that happens 'in the gym' rather than in their day-to-day lives. Some feel too embarrassed by their size or abilities to go to a class, or too vulnerable to go walking on their own. Tapping into people's own interests, like dancing, capitalising on informal activities, like gardening, and building on group motivation gave birth to activmobs.

Mobs are small groups of people who choose an activity to do together on a regular basis. Mobs are connected by the activmobs system. The people of Park Wood in Maidstone formed mobs around activities like dog-walking, exercises to relieve back pain, or by combining walking with an interest like local history.

activmobs is a platform for activity. It provides web-based tools to help people find, suggest and start mobs. Registering with the activmobs system gives your mob a number of hours with an activmobs trainer, who helps to make your activity effective for improving fitness. Any activity can be mobbed as long as it is beneficial for fitness. With the right support, walking the dog can be a great way to stay fit. The system motivates people by helping them to recognise tangible benefits of activity (through self-assessed 'wellbeing cards'), visualise progress, set goals and reward commitment.

activmobs is self-organising and co-created by the community of mobs. It is being developed by Kent County Council as an independent social enterprise, representing a new approach to preventative healthcare.

The diabetes agenda
With the Bolton Diabetes Network

Me2 is a system that supports and enables people to live well with type 2 diabetes. It was designed with people with diabetes in Bolton, their families, and the Bolton Diabetes Network.

In Bolton alone, 29 people are newly diagnosed with diabetes every week. Nearly 11,000 people are already living with the condition - 1 in 20 of the town's population. If not managed well, diabetes can lead to loss of eyesight, kidney failure and nerve ending degeneration. A person with diabetes spends, on average, just three hours a year with doctors, but thousands of hours self-managing their condition.

The onset of type 2 diabetes can be slowed by a healthy diet, regular exercise and ceasing to smoke. Bolton has a good patient education programme, and the majority of patients know what they should be doing to manage their diabetes. Putting it into practice, however, is not so easy. People with diabetes, and their families, must make significant changes in their lives and routines. Designing from the perspective of the individual generated a new kind of solution.

Me2 is a system that supports and enables people to live well with diabetes in their everyday lives. It provides a platform for people to co-create care services with professionals that are right for them as individuals.

The Agenda cards reframe the interaction between patients and professionals, giving the patient the agenda. Me2 coaches are independent of the health service, and support people in making changes to their lifestyles. The Diabetes blog allows patients, their families and professionals to develop and share management strategies and experiences.

Me2 represents a major shift in thinking on the way we approach the management of chronic conditions, and demonstrates how a new organisational model for doing so can be designed to work in practice

The RED team for this project comprised:

Colin Burns, Jude Codner, Hilary Cottam, Tory Dunn, Kirstie Edmunds, Holly France, Charles Leadbeater, Nicholas Morton, Robin Murray, Chris Vanstone, Jennie Winhall.

The Health project team:

The team was helped during the project by the project team: Richard Linnington, James Kent and Noel Lyons (Kent Lyons), Matt Hyde and George Agnelli, (Matt & George) Tracy Currer, Kate Taylor, Helen McCarthy, Justine Wilkinson and Anne-Marie Leggatt. The project process was captured on film by photographer Giulio Mazzarini.

RED advisors and contributors:

We would also like to thank those who helped us to develop our ideas: live|work, Engine, Plot, Callum Lowe, Jim Maxmin, Robin Stott, Mathew Lockwood, Martin Bontoft, Pam Garside, Trudi Ryan, Christine Bundy and Gary Lee.

User research participants:

In addition we would particularly like to thank the residents of the Parkwood Estate in Maidstone and the people with diabetes in Bolton who took such an active role in developing the prototypes.

Professionals:

We would also like to thank the members of the Bolton Diabetes Network and Kent Council who worked with us and without whose enthusiasm our work would not have been possible.

Bolton:

David Fillingham and Carole Smee from Bolton Hospital, Kevin Snee, Steven Liversedge and Hannah Dobrowolska from Bolton Primary Care Trust, John Dene, Harni Bharaj, Adam Robinson, Renate Ormerod, Louise Hilton, Jane Pennington, Nita Patel, Jayshri Pankharnia, Mike Hollinshead, Steve Wilson, Patricia Eccles, Peter Hilton, Sharilee Thorpe,Tracey Higginson, Jackie Bene, Jackie Hibbert, Annette Young, Julie Macangus, Sue White and Anne Robinson from the Bolton Diabetes Network.

Kent:

Keith Ferrin, Peter Gilroy, Mike Pitt, Graeme Brown, Judy Doherty, Caroline Toher, and Richard Spoerry from Kent County Council.