Frustration to innovation: service design, healthcare and minimum expectations

I had the best experience trying to arrange a GP appointment this week. Life changing.

After getting through the first painful 3 minutes to make sure I chose the right option (and slowly - bordering on sarcastically slowly - advised me to hang up and dial 999 if it’s an emergency instead), I was asked if I would like a callback when I reach the front of the queue. Absolutely! I’m surprised it’s an option and not an assumption. Maybe people like the hold music.

Service Design

There is far more to healthcare service issues in the UK that I won’t pretend to understand. I am not naive enough to think everything will improve once they sort out the infuriating appointment process. However, my callback experience reminded me how much our minimum expectations change across our daily services. For example, my bank has provided callback options for years. My minimum expectation from the service has changed with them: I now expect a callback more quickly or the information sent straight to me via text with helpful links. We have the minimum expectations with healthcare services, and it seems so much could be done in the overall service design. There seem to be endless efficiencies that could be made for healthcare professionals dealing with calls and reduced stress for patients trying to get the help they need. 

For example, wouldn’t it be great if:

• There was flexibility with the call routing for patients who needed to contact the GP regularly - skipping optional messages and being able to join the queue without waiting 3 minutes to go through the usual notices. We know the services are continuously busy, and their emergency calls should go elsewhere!
• There wasn’t a need to receive multiple letters to push online portal access delaying eventual treatment and appointments (the fact this still happens baffles me).
• Have some expectations on when a GP will call - not necessarily by the hour, but at least the day and whether it will be morning or afternoon to reduce the risk of missing the unknown number of calls and needing to go back to the queue.
• We spent less time recalling previous events to different receptionists due to a lack of concise notes on the systems.

So, why is the seemingly simple not achievable? It might be because the machine is too big, with too many moving parts, departments, and disparate companies trying to push forward in all the directions needed while simultaneously dealing with politics and red tape. A portion of the problem could also be the shortage in skills reported highlighting a significant shortage of digital skills in the NHS as people opt to work for private companies for numerous reasons, including pay and personal growth opportunities. But things could be changing.

Big Tech

Now, as is often the case, it’s the big technology companies looking to move things on at pace, benefitting from being able to move fast, ‘break things, ’ pushing ahead at speed with the flexibility to do what’s needed. Yes, Apple, Amazon, Google and Microsoft are steaming into the healthcare industry. Big tech bulldozing its way into health is a scary prospect, but at the same time, I think they’ll force change at a service design level - and hopefully far quicker than it took public services to implement a call-back option. And with that change, our expectations will change. Perhaps soon, receptionists can use AI to summarise patient call notes so there will be less dependency on accurate note-taking as they rush to deal with the influx of calls.

Or, even more significant, the inevitable use of AI for preventative care and diagnosis, reducing the burden on the NHS. triaging appointments and comms and diagnosis, and tech raising, when there are health issues before they become heavy burdens on health services will allow that time for the services to do an Airbnb and take a step back. 

Again these are the minimum expectations that we don’t have for any other service or resource we use. I can’t help fix the NHS service design, but it made me think about its importance in the organisations we work with and our services.

Taking A Step Back

I used healthcare as an example, which got me thinking about this, but this article is about the basics. It’s about taking a step back, looking at the whole picture and seeing where the most straightforward improvements can be made. We’re all guilty of speeding ahead, looking for growth at all costs, new channels, new products, new features and neglecting the basics. And the more that goes on, the more complicated it gets, and everything becomes unachievable. All that’s left are minimum expectations.

One to note that I enjoyed reading up on was Air BnB. The company recently launched significant updates for its app that didn’t promise a swanky new feature but lots of optimisations and tidy-ups informed from taking a step back, listening to customers and mapping the end-to-end journeys for hosts and guests. I love this approach - stop, take the pressure out of the room, take a few steps back, look at the service being provided end to end, and get the basics right. You might need to take 100 steps back, but you’ve got to start somewhere, right?