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The five day design sprint with Guy’s & St. Thomas’ NHS Foundation Trust Paediatric Allergy Team

Leon Odey Knight, Jan. 11, 2017

At Unboxed, we are constantly running various workshops. But that doesn’t mean we know everything. We are always up for trying something a bit different if this will ultimately allow us to serve our customers better, so we never stop reading or exploring and are always willing to learn!

A few months ago I came across a book titled ‘Sprint’ whilst browsing Amazon. It was one of those books that had popped up due to my previous choices so I thought I’d give it a go. Meanwhile, somewhere on the other side of London, a guy called Bob Cook had also seen this book and he too had begun reading it.

Connecting these two seemingly unrelated events was Martyn, our Head of Product. Martyn had been talking to Bob about the challenges he was facing at Guy’s and St Thomas’ Hospital for a number of months and had previously run a two-day workshop with him and his team.

Bob mentioned to Martyn that he was reading Sprint, and it was at that point we realised that we were reading the same book. Wouldn’t it be great if we could somehow run a sprint in the way the book described… And the rest as they say is history…

Firstly, a bit about the book.

Sprint is a book about surprising ideas: that the biggest challenges require less time, not more… And that you can test anything in one week by building a realistic façade.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 1

10am Monday morning: Day One of the sprint with The Paediatric Allergy Team.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 2

The first thing to do was introduce ourselves to one another. From left to right: Hazel (Senior Finance Manager), Yasmin (Deputy Service Manager), Miranda (Service Manager), Roisin (Service Lead) and Ruth (Dietician for Paediatric Allergy). And at the far back - left is Cale (an Unboxed developer), myself on the right and Martyn (our Head of Product) is the man behind the camera.

The next task: The outline for the week ahead.

There was trepidation in the room. Excitement, but at the same time nervousness. We had a lot to cover and a lot riding on the outcome of this week. After all, the hospital had released everyone from their day-to-day responsibilities for this sprint. Something unheard of within the NHS. Luckily for us, we had a great champion in our corner in the shape of Bob, General Manager for Specialist Ambulatory Service.

So this big question… Could we really demonstrate real insight and value in just five days?

Day 1: Identifying the problem

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 3

Roisin had been given the role of the decider - the person who would ultimately determine the direction of this sprint. From the outset, she was very clear as to what the goal should be - and after some discussion the team all nodded in agreement. Patient waiting lists were too long, patients were arriving unprepared, there was no time for post diagnosis support and patients were suffering because of it.

The goal of this sprint:

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 4

Okay, so we have our goal. What will we need to be true for this to happen? This was the question we needed to tackle next.

“We need to create better relationships with local services” said Ruth. “They need to be better educated in order for us to have time to spend with complex cases”, Miranda chimed in. As the discussion took place, I frantically tried to keep up by reframing these thoughts as questions.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 5

Capturing these as questions, we were rolling now. The team were engaging and ideas and were flowing.

Journey Map

The next step was to create our Journey Map. This is a way of mapping the patient's journey from when they first engage with this service to their eventual outcome.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 6

We started with patients. And then moved straight to their goal. After some discussion we landed on that as being to ‘Get a diagnosis’. The aim was to keep it simple at first and then slowly getting into more detail. Once we had those details, we began filling in the blanks. Who was involved in delivering this care? Were there any systems involved? What were the steps required?

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 7

Ask the Experts

We had our Journey Map. Now… Nobody knows everything, as the book quite rightly points out, so it was time to “Ask the experts” - a range of stakeholders who work with this service on a day-to-day basis. We had Jim from the Admin team, who is responsible for booking and following up appointments. Katherine - a nurse on the ward, Tom - a consultant and Kim - a mother whose son is under the care of Guy’s and St. Thomas’.

As they went through the journey they started to comment:

  • “I often chase them up two days before the appointment as many patients haven’t confirmed their appointment”, said Jim
  • “Once the appointment had been booked I was waiting for weeks with no support or information in regards to what to expect”, voiced Kim
  • Katherine highlighted the fact that most patients hadn’t read the information that they had received with their appointment some weeks before

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 8

As comments were being made, the team were scribbling down the insights they were gathering. Each of these were framed as a potential opportunity rather than a problem. We used the “How Might We” method.

For example:

Jims comment: “I often chase them up two days before the appointment as many patients haven’t confirmed their appointment.”

... was reframed as:

“How might we enable Jim to better manage scheduling and the appointments process?”

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 9

So, we had the goal, the journey map had been verified by our panel of “experts” and we had a number of opportunities to focus on. To close out day one, the team needed to decide on one area that we would take over the remaining four days. The team were given dot stickers, along with 10 minutes to place dots on the journey map they felt could add the most value to their patients. As the decider, Roisin would have the final say. The team settled on the preparation and booking of the appointments as this was an area that the experts had also focused on when sharing their insights.

Day 2: Visualise

Today was all about getting out of our comfort zone.

We looked back over what we had covered on Monday in order for us to focus on the goal of the day. We all sat down to quickly reflect on how much ground we had covered. We had a clear idea of the goal and the problem we were going to try and solve today.

Lightning demos

The team spent 40 minutes researching websites and services that they felt addressed similar challenges to the those that they had identified. Before getting started we spent a few minutes throwing a few ideas around.

“Easyjet booking systems?”, “What if we treat it as if you are going through a check-in?” “Maybe we could have a timeline in order to help people to understand the number of steps involved…?”. As the team got to grips with the idea, we all sat down and began researching on our various devices.

When we reconvened, each team member was given three minutes of airtime to talk through what they had found and how they felt it might answer our problem.

My job was to capture each of these ideas in a small sketch on the whiteboard.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 10

Some great ideas came out of that session and by the end of it the team were ready to move onto the next exercise…Sketching!

This would make up the rest of the day, divided up into research and inspiration, crazy 8’s and a final storyboard outlining their idea for the service we were going to create. The research consisted of looking at everything we had covered during the previous day as well as looking at the work we had done that morning. Jotting ideas down…

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 11

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 12

After lunch it was onto Crazy 8’s. 60 seconds to sketch out your service ideas of rapid sketching.

This was a real challenge for the team. How could they simply and effectively communicate their service through a sketch in 60 seconds? The idea was that they would then repeat this exercise eight times - each iteration helping them to move their idea forward.

Half way through, we took a break. It felt to me as if it was working better for some than for others. I asked the team to share their thoughts on the process and had those who were finding it useful to share their experiences with those who were struggling a little more.

We pushed on.

That conversation mid-way really helped and by the end the whole team felt that they had a much clearer understanding of the services they were trying to create.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 13

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 14

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 15

The final part of the day was spent taking that idea and really getting into the detail. The sketch we were producing would now be put up on the wall for more “experts” to see on Wednesday and they wouldn’t be able to talk through their ideas. Therefore, these sketches would need to be well-annotated and speak volumes for themselves.

By the end of the day we had five really strong ideas.

Day 3: Decide

This was quite exciting. Before the team arrived, I put each of their ideas up on the wall. We’d be hosting a bit of an exhibition this morning. The goal was to come out of the session with a view as to which idea we would be running with.

10am and the experts we’d invited along began to arrive...

We all had to spend 25 minutes reviewing the ideas in silence. I’d given everyone a sheet of dots so they could stick them on anything that they had seen that stood out or any ideas they liked. They also had post-it notes so that they could write down any questions they had along the way.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 16

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 17

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 18

This was quite nerve racking for the team. Their work was up there and all they could do was watch as their peers looked on. You could almost sense the relief each time a little dot was added to each piece of work.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 19

Once the 25 minutes was up, Martyn walked through each idea. The “artist” was then given the opportunity to show themselves and fill in any blanks and answer any questions the team and panel of experts had.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 20

Once the experts had all left the team had to make a decision. Which idea would we run with?

This would ultimately come down to Roisin (the decider). Having had a broad discussion with the team looking over the areas highlighted by those who had attended the session, she picked key elements from a number of the sketches based on how well they addressed the current issues with the service and how far they could help us to reach the team's long-term goal.

Once selected, we set to work creating the final storyboard. We would be using this to build our prototype on Thursday.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 21

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 22

Day 4: Make

Time to build this thing! By this point everyone was starting to feel a little nervous. We’d spent three days thinking, sketching, talking… But we had to create something that patients could interact with and they were coming in tomorrow!!

A swig of coffee and a quick overview of the day ahead, in-between mouthfuls of croissants and grapes, and we were good to go.

We split the team up as the book had suggested:

  • Makers
  • Content Creators
  • Resources, etc…

It made sense for Ruth and Roisin to focus on the content as they were the experts in this area. Cale was the maker, I’d say he’s now a dab hand at Keynote… Hazel, Miranda and Yasmin were the asset collectors. There was a lot to find and without them we’d have been in a real mess.

Cale, as the maker, began collating all of the assets and words together in Keynote as the team emailed them over. We used Keynote as it was something the team could all get to grips with quickly and found it to be the best way of collaborating. It came together surprisingly quickly and by the afternoon we had the basic elements in place. It was time for us to add a little fairy dust. Enter our trusty friend Photoshop.

We took the general styling already established across the Guy’s & St Thomas' digital estate and applied it to our screens. Once done, we stood back and took a look. This was going to work. It was then a case of linking them up in Marvel.

We referred to the storyboard. We’d covered everything. (There aren’t many photos of this day as we all had our noses to the grindstone :-))

By the end of the day we had something that we felt would pass as a believable experience for our patients.

We took a moment. We’d achieved so much and felt pretty good about ourselves. We were shattered. We all felt quite foolish for banging on about our fatigue when Hazel bowled in wearing her Good Gym get up. She was off to do a run and renovate a park for the community whilst she was at it!

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 23

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 24

Day 5: Test

We’d made it!!

We set up an area for the interviews to take place. Thankfully, Martyn was on hand as I was spent. He was going to do the interviews and I would gather insights with the rest of the team.

What would they say? What would we learn? It really was exciting. We set everything up and sat tentatively waiting for Martyn to connect the video.

The screen came to life, the wait was over. We were looking at our first patient. Would she believe it was a real service? Martyn had warmed her up as only Martyn can. Blunt, direct but with just enough charm. Once he’d finished his introduction she clicked on the link and she was in.

Take a look of the prototype for yourself here - best viewed on mobile.

“That’s interesting, I didn’t know that”, she said. “It would be really good if…”.

The team, situated in the backroom’ began scribbling down the comments on post-it notes. It was incredibly valuable having the team listening to the feedback directly. To see their insights, assumptions tested in a live environment.

First interview down… Three more to go.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 25

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 26

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 27

By the time all four interviews had finished we had four A2 sheets of paper covered in post-it notes. So much to digest, a great deal of feedback and so many insights. It felt as if we were really onto something. It didn’t hurt having a number of the patients asking: “When does it go live?!”.

Guy’s & St. Thomas’ NHS Foundation Trust Sprint 28

It’s a wrap

That was it. The week was over. So what next…? Since completing the sprint, the team has taken the prototype out to more patients. They have shared it with another 25 so far with a goal of getting to 50 in total. The feedback has thus far been overwhelmingly positive both from patients and internally.

The speed at which we were able to create something that we could put in front of patients and gather feedback on has made a real difference to the teams at Guys & St Thomas’. So much so that we are looking at running several more sprints with other teams there.

So will I be throwing everything we do here at Unboxed out the window? Not at all. I feel that there are some great methods wrapped up in this that will compliment the way we work. Having a dedicated team for five days made a real difference. Getting customers in on the first day is now a goal for each and everyone of my workshops and I’m sure there will be other elements that I will integrate into my way of working.

As for the team. They have now returned to their day jobs but I hope to be working with them again in the not-too-distant future in order to move this forward.

One of the biggest takeaways for me has been how this approach quickly gets people sharing ideas they have never had time to explore fully before. But also takes them out of their comfort zones, keeping them there just long enough for something magical to happen.

They arrived with a number of frustrations and a feeling of powerlessness, they left with a shared understanding of the challenges they face, a new set of skills and hopefully, a view that they all have the ability to affect change in their day to day working environment.

From my perspective, I found it hugely rewarding. I must admit that by the end of Wednesday I was feeling more than a little exhausted. There were some elements that we adapted slightly as we felt it would be of more value. For example, we added a patient to the list of experts on the first day to ensure we weren’t way off base and as mentioned above we paused mid way through Crazy 8’s. I’m not sure if I’d be able to run these sprints back to back without falling over. :-)

All in all it was an incredible experience for me. I couldn’t have asked for a more dedicated team of people to work with on this sprint and I very much look forward to the next one!