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Rapid service blueprinting

Diana Ayala and Rosanna Alam, March 11, 2024

Virtual wards service blueprint

Service blueprints are a great way to map out and give a ‘birds eye’ view of what is happening behind the scenes during a customer journey or a user’s experience.

While they are a useful way to pinpoint challenges and opportunities with stakeholders and the delivery team for designing better solutions, they can also be time consuming. Especially when there is limited time to gather insights and get input from people internally to add to the map.

With this in mind, we’ve decided to share an example of how we have managed to do this quickly and efficiently when faced with this problem.

The design challenge

We worked in partnership with the South East London (SEL) Integrated Care System (ICS) and its providers from June to November 2023 to understand the barriers in using existing virtual ward beds across the region. This was to help meet the NHS England ambition (February 2022) for all ICSs to deliver 40 to 50 virtual ward (VW) 'beds' per 100,000 of the population by December 2023.

What is a virtual ward?

Virtual wards, also known as hospitals at home, are services that help patients receive medical care at home. In other words a patient can still receive hospital-level treatment from a mulit-displinary clinical team without having to be in a hospital. Care includes remote monitoring (eg using software to check things like their heart rate etc) and face to face treatment. The use of virtual wards help by:

  • enhancing patient care
  • reducing hospital admissions or readmissions
  • avoiding the deconditioning and prolonged recovery from staying in hospital
  • improving patient monitoring
  • increasing capacity in acute care settings
  • freeing up clinicians’ time and resources for other critical tasks

Time boxing collecting data

As with most short-term projects such as this one, we were faced with the limitations of time, budget and people’s availability.

So our approach was to keep research realistic within our limitations. We did this by carrying out semi-structured interviews with a sample size of 10 people who run the service in South East London to gather insights.

This gave us enough information to be able to map out an initial service blueprint and highlight obvious systemic barriers that prevent patients being referred to a virtual ward.

We then time-boxed the service blueprinting to 2 weeks after we gathered our insights.

Zooming in

For this project we found there are two ways patients are referred to a virtual ward:

  • step up care, which helps prevent hospital admissions
  • step down care, which helps patients leave the hospital earlier

This helped us to narrow down the problem to what we needed to focus on, as it became apparent there was a clear need to discharge patients from the hospital more quickly (step down). Our evidence showed this was hindering South East London's ability to use available virtual ward beds. We found concerns for secondary care consultants were their clinical responsibility for patients on virtual wards, the quality of home-based care and the lack of early involvement in the design and implementation of the service model.

South East London ICB virtual wards service blueprinting session

Iterating the service blueprint to prioritise how to address problems through co-design

To ensure what we mapped out was correct we ‘sense checked’ it first with a clinical lead to iron out anything glaring that we may have missed. As a side point, when she saw it she commented: ‘finally I can see the service in one document clearly.”

Once we were satisfied we’d captured all the key touch points in the service blueprint, we were ready to refine it with the different NHS Trusts in South East London. To save time we did this in a workshop during one of their Community of Practice meetings that included representatives from all the Trusts. We decided to use a forum like this as it generally is hard to get people in the same room when you are working with a large organisation, so it’s best to utilise standing meetings where possible.

During this particular session we covered the following:

  • a review and refinement of the service blueprint virtual ward referral step-down (early discharge in each NHS Trusts in South East London)
  • a review of opportunities/barriers that had been identified
  • narrowing and prioritising one of the opportunities/barriers the Trust wanted to focus on

The result

Throughout and following the session, each Trust had the chance to talk about the key areas needing attention in the short and medium term. This gave them clear actions on what they needed to do to enhance the number of referrals to virtual wards and boost the use of existing beds.

By taking this 2 week approach we were able to get to the answer quickly and help people from within the service to see clearly where dependencies, constraints and opportunities are so they can start to improve the service and see where to make the biggest impact.

If you want to see how you can map out your service rapidly and take on a more lean project when you are restricted by time, check out our Digital Accelerator.

Further reading

The service blueprint: a useful design tool

Service blueprints: definition

5 benefits of making blueprints when you build or improve a service