Designing a digital bedside manner for NHS Test and Trace

The NHS Test and Trace service was a key component of the UK's strategy to combat the COVID-19 pandemic.

Our research observed that users felt guilty about asking for a test and this perception was at the crux of the question: how do we effectively change the bedside manner of the service for a nation in a health crisis?

My team and I designed the service and user experience for testing, contact tracing, and isolation support.

Our engagement focused on 3 things:

  1. Operation changes (immediate focus) – Short term

  2. Tactical changes (what next) – Mid term

  3. Strategic changes (plan for the future) – Long term (policies and politics)

“I'd worked previously with Duncan when he re-skinned the Evolve EMR product, which was very successful. When I recently transferred to a new NHS Digital project and found out Duncan was on the team, I was excited to have the chance to work with him again.”

Manus O’Reilly, Program Manager @ Kainos

Putting pen to paper is an important part of my design process

The Worry/Wellness Balance: Shifting to an experiential service

The worry balance references a model to suppose (until we have research) the degree of mental pressure a person is under when they arrive at, and proceed to use the service.

The wellness balance references a model to suppose (until we have research) the physical condition of a person when they arrive at, and proceed to use the service.

Relieving guilt

Some research observed that wording made some users feel guilty about asking for a test and this perception was at the crux of the question: how do we effectively change the bedside manner of the service, for a nation in a health crisis?

  • Check boxes caused anxiety and unhappiness and users felt bullied into consenting to this

  • Some of the wording seemed to be designed to make people feel guilty for requesting a test

  • Once people have symptoms and feel ill, they’re not as willing to give priority to key workers

While these were valuable insights, we needed to do more research around the perception of the entire experience from the perspective of whether it felt intimidating.

It was easy to suppose that, before the service journey even started, we were engaging an emotionally affected customer. This made customer service a strategic requirement from the outset.

This was not only a physical health crisis, but a mental health crisis too. Many of our visitors to the service arrived in a state of negative emotion:

  • Anxiety

  • Depression

  • Discontent

  • Fear

  • Frustration

With this in mind, we needed a shift from a transactional service delivering tests to service that considers how people are affected.

A “subject” joined in an anxious or frustrated state of mind, which persisted or worsened as they journeyed through the service. This experience became their perception and that perception dictated how they felt about the service and how they communicated that experience to others.

How would we shift?

Redefine the journeys to answer the needs of the people, not only as a service requirement, but as a care pathway.

Create a taskforce whose purpose is to build a longer term strategic direction, with a focus on wellness

Example enablers

Clear start points for triggers, with early exits and transparent, measurable goals.

Reducing cognitive loads to alleviate information overload.

Information to be structured to provide care support

What did we think the main blockers would be?

Head down approach to short term requirements means we would perpetually make small incremental changes that would not necessarily provide the change we need.

We would need stakeholder buy-in.

There were a few different reasons that people might be using this service:

I think I have COVID

The person is showing symptoms or has been exposed to someone with COVID

Mentally: They are worried, concerned, and in a state of panic.

Physically: The could be having coughing fits, high temperatures, dizziness, headaches, diarrhoea and others.

Someone I care about has COVID

Someone close, or in the persons care has been exposed, or has symptoms of COVID.

Mentally: They are worried, concerned, and in a state of panic.

Physically: Healthy, but could be trying to take care of someone, so they could be distracted

I need to maintain my wellness

The person is required to monitor their exposure.

Mentally: To a lesser extent the person is frustrated by the need to maintain this.

Physically: Healthy

I need to get a test to partake in social activity

The person is required to get a test to partake in social activity (Like attend a show or a football match)

Mentally: They are worried, frustrated, but possibly excited.

Physically: Healthy

Understanding the physical and mental impacts of Covid on our personas

If we're using inaccurate personas to measure the effectiveness of our journeys, what we design will be all wrong.

Near the start of this engagement, I came to the realisation during the observational studies, when we were watching people interact with some of the stuff that we're doing, that the personas that we designed were completely one-dimensional. Every single persona that we were putting in front of the product to test was a persona that was 100% healthy. And when you think about it, nobody is ever 100% healthy in any situation.

With Covid, you had headaches, your vision was blurring, you were coughing all the time. When you take those things into consideration, it means that everything you know about a person shifts slightly. Like if you've got headaches, it's going to take you longer to read so while we may have written it at a low reading level, we needed to write it even lower.

The breaks between spaces need to be larger. The buttons need to be more prominent. If they have a coughing fit or a moment of diarrhoea that has them in the loo for 5 minutes, is the system going to time out while they’re gone? All of a sudden, it changes how you approach this person drastically.

So I ran this concept of the 100% persona, where I created all these personas, and then I created lenses to superimpose over our existing personas.

And these lenses are all the things that are affecting them in their world today. So one had a fever. One’s husband's just lost his job. One had a loved one in hospital. And then as I started to put all these lenses on top of the personas to see how they were affected; there was a compound effect that changed the dynamic of what a persona is and made it much more lifelike.

  • Persona 1 - Has Covid

    Feeling poorly, suffering from any number of symptoms, including one that makes concentration and actions difficult.

    Suffering from overwhelming worries and concerns am I going to be okay? Am I contagious? Who’ve I infected? Who do I need to let know? What do I need to do?

  • Persona 2 - Parent of a child with Covid

    Caring physically for the patient, and trying to maintain some form of distance/care to try not infect anyone else. (Shopping, deliveries)

    Suffering from the same overwhelming worries and concerns as persona 1.

    Fatigued from running the house as well as looking after the patient/s.

  • Persona 3 - Partner has Covid

    Physically needs to carry the load of maintaining the household and caring for the patient.

    Suffering from the same overwhelming worries and concern as personas 1 and 2.

    Fatigued from running the house as well as looking after the patient/s.

  • Persona 4 - Carer of a high risk individual

    Concerned about their patients, concerned about themselves and infection, concerned about becoming an infection vector and infecting other patients.

  • Persona 5 - Monitored Worker

    Frustrated that they have to do this for their work. Concerned and worried about things returning back to “normal”. Worried about work, jobs, family and friends getting ill.

    Worried about schools, and education for kids, if they have.

  • Persona 6 - Collaborating person

    Frustrated that they have to do this for their work. Concerned and worried about things returning back to “normal”. Worried about work, jobs, friends getting ill.

    Concerned and worried by unintentionally not following guidelines.

With all of these things in mind, the service we designed looked like this:

  • Introduced journey taxonomies

  • Decreased amount of steps in the journey

  • Introduced user accounts

  • Created new entry (trigger) points

  • Created exit points for users

  • Content was addressed for hierarchy of priority, reading age, and tone of voice

  • Showed progress to help the user digest where they are and how much they still have to do

  • Ensured repetition pattern consistency

  • Used metaphors

Once this was all delivered, I went on to design the NHS Treatment service which you can see here.

Next

NHS Pandemic Response Service — Treatment