The patient shouldn't be the integration layer
NHS GP and patient. Image generated by Squarespace AI.
It seems I’ve been spending more time in medical facilities lately, between appointments for myself and my child.
Don’t worry, there’s no crisis or doom. Just humans being humans.
In my case, having a rare condition makes things a little more complicated because everyone understandably wants to cover their assets. (I learned that one at Citi many moons ago.)
Here in England, we have it pretty good with the NHS, all things considered.
Lose your job and you’re not suddenly panicked about losing healthcare coverage. You don’t fear bankruptcy because you got sick.
Although don’t get me started on dentistry apparently not being medicine.
But spending this much time inside the NHS has made me start looking at it through the lens I tend to apply to everything else:
What experience have we actually designed?
When everyone is doing their job, but the system still doesn't work
I have a cluster of related symptoms that currently involves four hospitals, a specialist clinic and my GP practice.
That sounds complicated. Some of it is simply how NHS services are divided.
And honestly, it wouldn't be so bad if a couple of those hospitals weren't annoyingly close by car and ridiculously long to reach by public transport. One is about an hour to walk to and 45 minutes by bus.
Make that make sense.
But the travel isn't really the interesting part.
Today, the person taking my blood had no information in front of them indicating that I shouldn't have blood taken sitting upright.
So I explained it.
Again.
It made me wonder how much time NHS staff and patients spend introducing, explaining, confirming and reconfirming information because different parts of the system don't share one view.
Quite often when I visit a different clinic, they need to confirm their plan with haematology. Sometimes haematology then needs to contact me and the other clinic separately to verify the plan.
No one is necessarily doing anything wrong.
Each part of a system can function correctly while the overall experience remains dysfunctional.
The invisible job we've given the patient
I'm pretty good at navigating this.
I understand the nuances of my rare condition and how it intersects with other areas of medicine. I'm comfortable asking questions and explaining the relevant information concisely.
I'm also fairly tolerant of ambiguity and complications.
But what does this experience feel like to someone who expects "the NHS" to have one view of them?
Someone who isn't confident explaining their medical history.
Someone who struggles to advocate for themselves.
Someone who is frightened, overwhelmed or simply shy.
Because when information doesn't move with the patient, the patient becomes responsible for moving the information.
In other words, we've made the patient part of the infrastructure.
Then there's the digital experience
Not everything is integrated into one app.
Not every appointment or request can be managed through the NHS App. GP systems, hospital apps, portals and websites can all be separate. Sometimes NHS login provides SSO, but authentication isn't the same thing as integration.
Then comes the post.
Sometimes letters arrive quickly. Sometimes they don't. Sometimes important information, such as how to reschedule an appointment, isn't actually in the letter but hiding somewhere else.
These days, sometimes asking an LLM how to accomplish something is genuinely faster than figuring out where the answer lives.
That's an interesting signal.
When people need another technology to explain how to navigate your technology, there may be a problem with the experience.
What's the actual job to be done?
This is where my Jobs to Be Done brain kicks in.
Healthcare is naturally organised around services:
Book an appointment.
Take a blood sample.
Perform a scan.
Issue a referral.
Review the results.
But those aren't really the patient's job.
The patient's job is closer to:
"Help me get the right care without requiring me to understand and coordinate the healthcare system myself."
Once you define the job that way, the experience starts looking very different.
What if there were genuinely one view of the person?
What if important information followed the patient rather than relying on the patient to repeat it?
If someone has a rare condition, why couldn't a clinician immediately see a concise explanation of what it means and the precautions relevant to their interaction?
Could the system clearly distinguish between something that has been diagnosed, something being investigated, something being monitored and something that has been ruled out?
Could it surface the right information at the right moment rather than simply storing more information somewhere?
That's where I think AI becomes interesting in healthcare.
Not necessarily because we need AI making more clinical decisions.
But because we have an enormous information, coordination and experience problem.
Friction isn't free
I'd love to save the NHS money.
And I suspect one place to look is all the invisible work created by fragmentation.
Every unnecessary phone call takes someone's time.
Every duplicated explanation takes someone's time.
Every clinic contacting another clinic to confirm something takes someone's time.
Every patient trying to work out which app, portal, phone number or letter contains the information they need takes someone's time.
We tend to call these things "friction."
But friction has a cost.
It consumes healthcare capacity.
And it consumes patient capacity.
Which brings me to something I realised while bouncing between appointments recently.
One reason I can currently manage all of this is because I'm not working full-time.
I can take the call.
Travel across London.
Wait for the appointment.
Follow something up.
Explain the situation again.
Check whether the referral happened.
Work out which system contains the information.
But what happens when I'm back in full-time employment?
Someone pays for that friction somewhere.
Maybe it's the NHS.
Maybe it's an employer.
Maybe it's the patient.
Usually, I suspect, it's all three.
Healthcare experience is economic infrastructure
This is why I think we undersell the value of experience design in healthcare.
A healthier population can participate more fully in work, education, families and society.
Preventative care can intervene before problems become more expensive.
And reducing unnecessary stress and administrative burden gives both clinicians and patients more capacity for the things that actually matter.
So perhaps the opportunity isn't simply to digitise more NHS services.
It's to think about the NHS as a system built around a human being.
One person. One healthcare system. One continuously evolving understanding of that person.
Then use technology intelligently to connect the pieces.
Because a good healthcare experience isn't just nicer.
It can save clinical time.
It can save patients' time.
It can reduce unnecessary work.
And at population scale, that makes experience design an economic issue.
The patient shouldn't have to be the integration layer.
*This article has been written by Kimberly M. ChatGPT was the editor/proofreader.
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