© NHS Institute for Innovation and Improvement 2009 Dr Lynne Maher Director for Innovation and Design

Session Plan Provide an overview of some of the things happening in the area of pregnancy and obesity within the UK Introduction to the ebd approach Illustrate the potential for using this approach for obese pregnant women through case studies © NHS Institute for Innovation and Improvement 2009

The NHS is one of the largest organisations in the world £96,6 billion total spend 2009/10 Over 1 million patients every 36hours Total Number of NHS Employees 1,368,693

The NHS Institute......supports the NHS to transform healthcare for patients and the public by rapidly developing and spreading new ways of working, new technology and world class leadership.

Management of women with obesity in pregnancy-2010 Royal Collage of Obstetricians and Gynaecologists and Centre for Maternal and Child Enquiries- Research & Guidelines (March 2010) Guidance on Obesity and Pregnancy from the National Institute for Clinical Excellence (NICE) (July 2010) RCOG + CMCE research provided evidence which supported a 2 year project resulting in Centre for Child and Maternal Enquiries- report & recommendations (December 2010)

Royal Collage of Obstetricians and Gynaecologists and Centre for Maternal and Child Enquiries Research –Obesity in Pregnancy -Is a growing problem: rising from 9–10% in the early 1990s to16–19% in the 2000s

Centre for Child and Maternal Enquiries National project on Maternal Obesity in the UK –Per annum- 38,478 (4.9%) BMI ≥35 (Class II and Class III obesity) –34% of pregnant women with a BMI ≥35 were living in the most deprived areas –The majority of these women are from Black and Minority Ethnic (BME) groups.

Centre for Child and Maternal Enquiries 58% of women with a BMI ≥35 stayed in hospital 7 days or longer

Reccomendations 11 ( including a call for further research) All pregnant women with a booking BMI ≥30 should be provided with accurate and accessible information Women should be given the opportunity to discuss this information with health professionals who have been trained in the management of maternal obesity Self-reported weights and heights should not be used as a substitute for accurate weight and BMI assessment.

Nice Guidance Recomendations framed as: –Who will benefit- the woman and baby –Who should take action – everyone but the woman

What is happening Provision of advice on nutrition is inconsistent Even when it is given the quality of the advice is highly variable Most of the information is given at time of booking and gets mixed up with everything else Antenatal classes focus on the actual birth – missed opportunity No clear guidelines about level of physical activity – fear of miscarriage so professionals skip over this

Every system is perfectly designed to get the results that it gets If we want a change we need to do different things or do things differently

The ambition for change… The NHS has made huge progress. But I want it to go from good to world-class, moving away from numbers and towards what matters most - the patient's experience. Andy Burnham – Secretary of State for Health …we require healthcare organisations and their staff to understand what matters to patients and to respond to this in new ways, making sure that every contact with a patient count towards delivering the highest-quality services. Understanding What Matters (DoH 2009)

3 Ways to do service improvement 1.Don’t listen very much to our users and we do the designing 2. Listen to our users then go off and do the designing 3. Listen to our users and then go off with them to do the designing (Professor Paul Bate 2007) © NHS Institute for Innovation and Improvement 2009

The ebd approach is… …about using experience to gain insights from which you can identify opportunities for improvement …about experiences not attitudes or opinions

The components of good design Berkun, 2004 adapted by Bate Performance Engineering The aesthetics of experience How well it does the job /is fit for the purpose How safe, well engineered and reliable it is How the whole interaction with the product/service ‘feels’/is experienced Functionality Safety Usability + + © NHS Institute for Innovation and Improvement 2009

Experience Based Design is about designing better experiences… © NHS Institute for Innovation and Improvement 2009

Understanding the needs of people living with Multiple Sclerosis

Hospital Portering services 286 ideas came from using this approach

Children’s mental health services

Combating Heart Disease in our Asian Communities Traditional methods of cooking handed down over decades Engaged local community advisor Nutritional expert and local women talk to advisors in Asia Developed published and sold new recipe book

Design Council-RED Project- diabetes Challenge- diabetic patients with poor control and anxiety about reporting back to the clinical teams. Understanding experience- ethnographic study Needs Cards ”I am addicted to sugar” “I’m frightened”

Design Council- RED Project- diabetes “There needs to be a shift away from teaching patients what they should do, and instead find out from individuals what they can do, identifying what barriers there are to change, overcoming them and supporting that change into the long term”

Experience Based Design is about designing better experiences… © NHS Institute for Innovation and Improvement 2009

The story of the toilet roll holder Action: Toilet roll holders now on both sides to help the patient feel more independent and be safe. © NHS Institute for Innovation and Improvement 2009

Language Blisters/Lumps/Ulcers/Polyp/ WartyThings/Necrosis/ Lesions/NaughtyTumour/ Aggressive/Progressing/ Precancerous Action: awareness has resulted in change

Experience Based Design is about designing better experiences… © NHS Institute for Innovation and Improvement 2009

Experience questionnaire © NHS Institute for Innovation and Improvement 2009

Patient story and a process map… It took ages to find a car parking space and then I found it was a 15 minute walk to the outpatients clinic. How frustrating! The room was cluttered with out of date magazines and notices on the walls and I was already feeling really nervous I wasn’t sure where to go – the signs were difficult to follow Patient waits to sees consultant Patient goes to different department for investigations (X- Ray/Pathology Patient sees consultant Patient arrives at clinic Patient registers with reception How do I find out where to go...I think I am lost. I am worried that I will be late I seem to be waiting a long time, have I been forgotten or missed my name being called out? Feeling anxious Consultant was really helpful

Patient waits to sees consultant Patient goes to different department for investigations (X- Ray/Pathology Patient sees consultant Patient arrives at car park Patient navigates to clinic Patient arrives at clinic Patient registers with reception Patient navigates to department +ve -ve frustrated relieved anxious informed nervous worried unsure pleased upset It took ages to find a car parking space and then I found it was a 15 minute walk to the outpatients clinic. How frustrating! The room was cluttered with out of date magazines and notices on the walls and I was already feeling really nervous I wasn’t sure where to go – the signs were difficult to follow Emotional mapping

Experience Based Design is about designing better experiences… © NHS Institute for Innovation and Improvement 2009

Action Planning A personal responsibility… Hugh McGrath-Patient Julie - Clinic Receptionist John Pickles-Consultant

Experience Based Design is about designing better experiences… © NHS Institute for Innovation and Improvement 2009

Reduction in weight/BMI Reduction in Morbidity and Mortality Reduction in Length of stay and so on Measure the improvement

Measure improvement Collect stories Observe Use mapping techniques Before and after – from and to

Measuring “ what matters more than raw data is our ability to place these facts in context and deliver them with emotional impact” Daniel Pink –A whole new mind 2008 “ the point is to emphasize that each of the cases involved an actual human being. Describing them as a percentage would dehumanize the physical impact on a real person, someone's mother, father, sister, or brother” Paul Levy CEO 2008 © NHS Institute for Innovation and Improvement 2008

Emerging work Southampton- really trying to understand experience- what are the high level principles that influence eating choice for women in similar socio economic circumstances ( some chose well and some don’t) Kings Collage – research starting this year on the practical aspects of behavioural change in obese pregnant women Cardiff have partnered with Slimming World Chichester- developed their own in house weight management programme

We need to start a shift..... Move from Responsibility of professionals Information giving- predominantly ‘telling’ Only working with individuals Domain of health services Move to Professionals and women working together Meaningful dialogue- include listening Also working in groups Inclusion of other experts in weight management

“The ebd approach is about sharing and understanding the experiences of patients, carers and staff together to design better services.” © NHS Institute for Innovation and Improvement All rights reserved.