Interview a few patients and shadow those in the hospital in real time. Then feed the results of that to the team in detail

WHAT IS often said in the health industry is: "we have already done stuff here and nothing changes". So, the most important thing is to ensure that there is senior sponsorship and that the design and implementation team get briefed and fed into board level executives, so that everyone is clear on what is happening.

Secondly, change should be an ongoing process. We would need to understand what has happened to date, what worked well, what didn't and what has been learnt in the past, so that any previous work didn't feel wasted.

The way to gain staff confidence is to give them control of the project - elect a staff leader - and ensure that the team is a diagonal slice of the organisation. It should include frontline nurses, other clinicians, managers and specialists.

Confidence only comes with time - the most important thing is to connect to the pain of waiting and the emotions/experiences of patients, and reawaken the staff ethos of service.

Involving patients should be done in a number of ways, but not too formally or too quickly.

Interview a few patients who had recently been through the clinic and shadow those in the hospital in real time. Then feed the results of that to the team in detail.

Later, it could be good to convene a patient group to develop solutions alongside the team. Return to patients with ideas and plans to gain their feedback and input as a form of prototyping.

Prototyping lightly with paper, sketches and scenarios is essential and probably where the project went wrong the first time.

Prototyping should develop into experience prototyping, where proposals are simulated to test them in a more real environment. Resources are scarce, but in the UK, hospitals are under even more pressure to reduce waiting times.

Good flow in the hospital setting is efficient and essential for a better patient experience. A new service need not cost more and could well cost less; it may even bring more revenue into the hospital.

Focus on the process rather than the resources required and aim to do more with less. Less kit, less time, less waste.

- Ben Reason

THE HALLMARKS of applying design to business process are: transparency (clarity and communication); guided input from many sources, particularly those directly affected; a shared/known process to develop best ideas; and championship ("go-to" team members, who are associated with progress and the understanding of goals).

The successful implementation of a change programme requires a good design process and a good implementation process.

In a low morale organisation, the best advice on starting is to make sure you will be able to implement something, because a programme that is cancelled or drastically changed mid-way through can worsen staff morale and confidence.

Be clear about representation, responsibility, resources and expected outcomes. Demonstrate that senior management will carry through on the commitment.

Don't hide the resource constraints. Be open from the start about what's available and make it the responsibility of the team and its Management Review Committee to allocate the budget (whatever it is) to the best effect.

Talking to current, past - and future - patients is good. The most natural setting for this would be in the waiting room.

Being in actual context is best if the change team wishes to get the deepest and most relevant information.

Quietly accompanying a willing patient and listening to what's on their mind at any moment in the process is priceless.

Trying to be a patient yourself is also helpful. Stretching the involvement time to include other parts of the journey will reveal patient needs and desires around planning, navigation, decision-making, appropriate behaviours and follow-up.

In other industries, end-users can be much more involved in actual redesign exercises and creative experiments, but in some parts of the healthcare industry, this is often inappropriate.

If there is a history of failed initiatives, the organisation may well be suffering from low morale and very little belief in new possibilities.

A couple of low-key projects can help lay a foundation of trust and shared practices; the commitment to making sure something positive happens, however small, is vital.

- Keith Finglas

START BY looking at the bigger picture, holistically - mapping the hospital and its role and relationship within the community it serves.

Describe all relationships, stake-holders, activities and all the experiences end-users (not just patients) have while using the different services the hospital provides (the costumer-journey).

This might seem a bit over the top, but it needs to be done. A hospital is a complex organisation made up by many different interconnected parts. Some relations are more visible than others. Changing one part of the organisation will, one way or another, affect the other parts. This holistic approach is not the easy way out. In the end, it won't even provide you with an easy answer.

However, this method will show you the complexity of real life. And this information is of vital importance.

Usually decisions in hospitals are taken by senior management and implemented from the top down.

Staff on the frontline, who are actually delivering the service to the patients, have little or no influence on policy.

Patients have no voice whatsoever. But times are changing. New technologies are making organisations more transparent, more vulnerable. Consumers are slowly getting more influence, more power.

A change in attitude within management is crucial. Hospitals must dare to be vulnerable, open the doors to the heart of the organisation and let everyone in.

Give end-users a channel, a platform to share stories, experiences - good and bad. Don't hide. Instead, join the conversation and listen to the people using the service. And don't forget the staff on the frontline.

They, together with the end-users, must always take centre stage within a service organisation and participate in the design process.

By using these channels or platforms, end-users will co-produce the service. It will shorten the distance between end-users and the people who deliver the service.

They will feel involved and responsible. And this ongoing conversation and feeling of co-ownership and responsibility is the key to a successful relationship between hospital and patient.

It will improve the service experience (even if nothing is changed) and it will give the hospital a new and rich source of feedback and ambassadors.

Staff at the front-line should be given the responsibility to report problems and potential opportunities.

They are the eyes and ears of the hospital. The organisation should be able to respond quickly to their reports (the so-called short feedback loop).

This way, hospitals can change into open and flexible organisations, constantly making adaptations and changes.

- Arne van Oosterom