#Weeknotes 41 (29 Oct) — Reflections of a service designer as a service user
As service designers, we need to have a good grasp of the service experience both from the service user perspective as well as from the service delivery side. This is done via user research: we speak to the users of the service to understand their experience and challenges; as well as we speak to those that help to deliver the service to understand the infrastructure and limitations of the service.
Often as service designers, we find ourselves in the shoes of service users when we need access to services. This is because everyone is a user. We’re all users of multiple services: banks, shops, schools, hospitals, accommodations, internet, transportation etc. Surviving in the current time without dependencies on any service seem rather impossible. One can attempt to grow their own food and shelter but to independently source all the materials without a third party feels painfully difficult. I will need to lean on the knowledge of the world wide web to even know if I’m doing it all right. Oh wait, that’s a service too.
Being pregnant for the first time, I started accessing NHS England’s maternity services in April this year. I’m now 33 weeks into my pregnancy, just 7 weeks away from my due date which fills me with mixed emotions… mostly with anticipation and excitement. 😊
I thought I’d use this week’s post as an opportunity to reflect upon my experience as a service user to help me in my work as a service designer. This is more relevant than ever now as I’ve been working with NHS England and NHS Digital with the aim to improve patient experiences in the mental health space.
I’m fortunate to be categorised in the low-risk group amongst pregnant moms-to-be. As I understand it, one is considered low risk if they don’t have underlying or pre-existing health conditions and that the initial scans and tests did not raise any concerns that might put me or the foetus at risk.
What I’m about to share is my individual experience and I don’t and cannot speak for others going through seemingly the same process when pregnant.
- Information is disparate
My need: As this is my first pregnancy, I want to know what are the things I need to do or watch out for when pregnant.
Challenge: I’ve been handed information on pamphlets and web links as well as verbally via my maternity appointments. There’s a lot of reliance on me as a service user to make sure I have understood and read through everything that’s been handed to me. The initial learning can feel overwhelming
- The onus is on the service user to ensure they receive entitled benefits
My need: Provide me with the documents necessary to receive recommended health appointments
Challenge: It wasn’t clear to me that as a pregnant woman, I’m entitled to receive flu jabs, dental cleaning, and NHS prescriptions at no cost. Even when I did find out, I had to request the exemption certificate that is required to receive such entitlements. Ideally, such documents should be provided to all pregnant women from the onset.
- Lack of understanding around health data
My need: I want to understand how my health data is used to inform the risk assessment of my pregnancy
Challenge: Every midwife appointment I went to required a urine sample as well as blood pressure levels. Sometimes blood tests are needed. While I am happy to do all the necessary tests, I don’t always know the implication of test results. I’ve been told by one midwife that I have low iron in my blood and recommends that I take iron pills, to which I listened. Then later another midwife showed surprise that I’ve been told to take iron pills as my iron levels aren’t that low. I’m not sure what to make of it and feel somewhat helpless as to how to address this iron issue.
- Strong need for reassurance
My need: I want to know what to expect at different stages of pregnancy. And I want reassurance that I’ve got the right level of care and support in a consistent manner.
Challenge: While I was provided with an overview of all the appointments I can expect to have throughout my pregnancy, the information on the sheet isn’t the easiest to understand. What’s fundal height measurement? What’s Anti-D? IOL? It feels more like a checklist for clinicians rather than for the patient. I was also told by the first midwife over our initial phone consultation that she’ll be my assigned midwife, which means I’ll be seeing her in my midwife appointments. However, since my appointment with her, I haven’t seen the same midwife twice which makes me feel slightly uneasy despite my complete trust in the capability of the team of midwives at the maternity clinic as a whole.
- Those who hold the knowledge has the control and confidence
My need: As a person going through pregnancy for the first time, I want to make sure I can make the best choices throughout pregnancy and labour so I can ensure the best health outcome for me and my baby: a smooth delivery to a healthy baby.
Challenge: The reality is I had to do my own research and download apps to stay on top of all the info a new mom should know to prepare herself for labour and work towards an optimal state to give a smooth birth. This requires time a fair amount of motivation. I had to make sure that the information I was getting are from trusted sources and that I don’t get sucked into the edge cases where things go horribly wrong and get traumatised needlessly. If I can recommend any reading for a first-time mom, it’d be Ina May’s Guide to Childbirth book that explains the different stages of labour and what to expect. The book is very thorough about what one can expect at different stages of labour and it provides stats around the risks of interventions that aren’t always too clear and explicitly known to those going through labour. With the help of this book along with other research I’ve done, I was able to create a birth plan I feel confident in and know that even when things don’t go as planned, I will be okay and well informed of other options available to me.
The above are sample things I’ve observed as a service user. As a service designer, experiences like these really help to shape and inform my work. Sure while it’s only from a single perspective, it’s enough to uncover the various complexities and challenges in delivering and accessing a service like the NHS. While every service user will have different experiences depending on their (physical, mental, social, and life) situations and geographic locations, the dimensions uncovered above are still relevant.
So to translate the above as reminders and considerations for me as a service designer:
- How can we ensure that the service users will understand the key information necessary to feel informed and in control of their health and wellbeing?
Consider accessibility, putting all information in one place, making information easy to understand and digest.
- How can we reassure service users that they’re getting the best support and service?
Recognise individual circumstances and tailor experiences based on their needs. Provide consistency in service delivery. Set the right expectations.
- How can we better anticipate the needs of service users so that we can provide the right support at the right time?
Address common concerns at relevant stages of the service delivery. Focus more on prevention rather than intervention. Be more proactive at anticipating needs even before service users request support.
Being a service user as a service designer is a humbling experience. It’s a constant reminder that there’s potential for improvement for all services. Looks like I’m in the right career. =)