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A New Information Architecture for NHS.UK - UX Scotland 2018

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Described as the most important transformation challenge in the public sector today the NHS website, nhs.uk, is one of the UK’s largest, most important websites, with over 50 million visits a month, tens of thousands of pages, and a target audience that is, quite literally, everyone.

What will it take for the NHS website to become people’s preferred first port of call to understand, manage and take control of their health? Among other things, a new information architecture focused on how patients understand their health, not a clinical view of conditions, or a publishers view of content formats. One that, done right, should provide a solid platform for all patient-facing digital health services for the next decade.

This slide deck from a presentation at UX Scotland 2018 covers our insights from starting to tackle this massive, multi-year challenge. It introduces the new information seeking modes/personas we developed to describe how people really look for information about their health, the new navigation patterns we've introduced, and why some traditional IA approaches present particular dangers when applied to health information.

Veröffentlicht in: Design

A New Information Architecture for NHS.UK - UX Scotland 2018

  1. 1. @sophiedennis This is for everyone
 A new IA for NHS.UK Sophie Dennis, NHS.UK Transition Strategy Lead
  2. 2. @sophiedennis Mission Create a new information architecture for the NHS website that will provide a solid platform for the service over the next 5-10 years
  3. 3. @sophiedennis Richard Pope @richardjpope 7:28 pm - 13 Dec 2015 ..it should be a warning in the civil service induction pack "at some point, you will find yourself saying 'we're mostly fixing the basics'" https://twitter.com/richardjpope/status/671772934554451968 We’re still at the start of our journey
  4. 4. @sophiedennis The NHS is an idea of 
 unparalleled humanity
  5. 5. @sophiedennis A society where no sick person is denied medical aid because of lack of means
  6. 6. @sophiedennis We believe… Technology has the ability to reach a huge volume of people, mirroring the universal and egalitarian ideal of the NHS
  7. 7. @sophiedennis We believe… People shouldn’t have to understand the health and care system to get the help they need
  8. 8. @sophiedennis Alleviate Pressure on health and care services Increased patient knowledge, confidence and control Better outcomes for patients We believe… = =
  9. 9. @sophiedennishttps://twitter.com/Julie_raw/status/966426604762214400 poster often seen in NHS clinics
 THE FIGURES MAY BE WRONG! No photos please
  10. 10. @sophiedennis what is nhs.uk?
  11. 11. @sophiedennis 50m visits month Over half a billion visits a year 78% mobile 26m visits to beta.nhs.uk Most visited condition
 stomach ache, 2.5m visits Most used tool
 BMI healthy weight calculator, 8.9m starts Content syndicated by 800 partner sites and apps including 200 NHS organisations It’s big
  12. 12. @sophiedennis It’s really diverse
  13. 13. from 
 how to treat a blister to 
 am I having a heart attack?
  14. 14. from 
 how to have a better sex life to 
 being diagnosed with HIV
  15. 15. from 
 finding a late-night pharmacy to 
 choosing a new GP
  16. 16. @sophiedennis Diverse content is needed to meet different clinical, practical and emotional needs
  17. 17. @sophiedennis The domain is complex and opaque
  18. 18. @sophiedennis@sophiedennis Song Artist Album Chart A simple domain model
 “an abstract expression of a real-world system” Domain models create robust information architectures because they map how things work in the real world to users’ mental models
  19. 19. @sophiedennis@sophiedennis Condition Clinician Treatment Symptoms Side Effects PrescribesDiagnosed by Causes which are Isn’t this how health works? Service Location Organisation employed by can be seen at delivered by
  20. 20. @sophiedennis@sophiedennis the stomach ache < > stomach cancer problem
  21. 21. @sophiedennis@sophiedennis Clinician PrescribesDiagnosed by Condition Treatment Symptom Stomach Ache Indigestion Constipation Appendicitis … Stomach Cancer !!! OMG !!! Symptom
  22. 22. @sophiedennis@sophiedennis Clinician PrescribesDiagnosed by Condition Treatment Symptom Stomach Ache Indigestion Constipation Appendicitis … Stomach Cancer !!! OMG !!! Symptom Doing this safely requires curation
  23. 23. @sophiedennis Self-care and pharmacy 1
  24. 24. @sophiedennis When to see a GP… 2 1
  25. 25. @sophiedennis How to tell if it’s an emergency 3
  26. 26. Some other things it might be - but don’t self-diagnose 4
  27. 27. @sophiedennis For some symptoms, emergency care is most important 1
  28. 28. Is is safe to even try automating this with a content model?
  29. 29. @sophiedennis@sophiedennis Song Artist Album Chart A simple domain model
 “an abstract expression of a real-world system” Domain models create robust information architectures because they map how things work in the real world to users’ mental models
  30. 30. What if users’ mental models are not how the system works? One NHS? No: • 207 clinical commissioning groups • 135 acute non-specialist trusts • 17 acute specialist trusts • 54 mental health trusts • 35 community providers • 10 ambulance trusts • 7,454 GP practices Source: NHS Confederation, 2017 nhsconfed.org/resources/key-statistics-on-the-nhs
  31. 31. @sophiedennis We believe… People shouldn’t have to understand the health and care system to get the help they need
  32. 32. @sophiedennis Do the hard work to join up services so it’s easy for people to navigate them
  33. 33. @sophiedennis Direct people to action- oriented information and tools so they can make better decisions about their health and care
  34. 34. @sophiedennis Become people’s preferred first port of call to understand, access and manage their health and care
  35. 35. @sophiedennis Mission Create a new information architecture for the NHS website that will provide a solid platform for the service over the next 5-10 years
  36. 36. @sophiedennis Our information architecture provides the fundamental organising principles of our service. It is how people: 1. Understand what the NHS website is for and what it offers - placemaking
 2. Know where they are and where else they might go 
 - orientation and wayfinding
 3. Get to their destination 
 - navigation 1 2 3
  37. 37. The house we have The house we want Encyclopaedia Magazine Directory Campaigns The preferred start point for patients’ digital health interactions Joined up content, services and tools that form 
 coherent, end-to-end user journeys Knowledge, confidence and control to make better decisions 
 about your health and care Our organising principles All the best bits of the old house, plus
  38. 38. Redecorate Replace the wiring and plumbing Refit a couple of the bathrooms 
 but still fundamentally the same house Build a big extension
 Knock-through the whole ground floor Build a cinema in the basement…
 
 completely different house We’ve mainly been doing this Next we need to do this Our transformation journey All the best bits of the old house, plus
  39. 39. @sophiedennis Our existing information architecture leads to fragmented, confusing user journeys
  40. 40. Live WellHealth A-Z Care & Support Health News Services 
 near you Home Sexual Health STIs 1. 
 Might I have an STI? 1 Google Search Start Here
  41. 41. Live WellHealth A-Z Care & Support Health News Services 
 near you Home Gonnorhoea Thrush Sexual Health Chlamydia STIs 1. 
 Might I have an STI? 1 2.
 What might it be? 2 Google Search Start Here
  42. 42. Live WellHealth A-Z Care & Support Health News Services 
 near you Home Gonnorhoea Thrush Sexual Health Chlamydia STIs 3. 
 It’s probably Chlamydia. What do I do? 3 1. 
 Might I have an STI? 1 2.
 What might it be? 2 Google Search Start Here
  43. 43. 4. 
 Where can I get a Chlamydia test? Live WellHealth A-Z Care & Support Health News Services 
 near you Home Gonnorhoea Thrush Sexual Health Sexual Health Clinics Chlamydia STIs 4 3. 
 It’s probably Chlamydia. What do I do? 3 1. 
 Might I have an STI? 1 2.
 What might it be? 2 Google Search Start Here
  44. 44. 4. 
 Where can I get a Chlamydia test? Live WellHealth A-Z Care & Support Health News Services 
 near you Home Gonnorhoea Thrush Sexual Health Sexual Health Clinics Chlamydia STIs 4 3. 
 It’s probably Chlamydia. What do I do? 3 1. 
 Might I have an STI? 1 2.
 What might it be? 2 5 5. How do I protect myself in future? Google Search Start Here
  45. 45. 4. 
 Where can I get a Chlamydia test? Live WellHealth A-Z Care & Support Health News Services 
 near you Home Gonnorhoea Thrush Sexual Health Sexual Health Clinics Chlamydia STIs 4 3. 
 It’s probably Chlamydia. What do I do? 3 1. 
 Might I have an STI? 1 2.
 What might it be? 2 5 One journey
 3 out of 5 site sections 5. How do I protect myself in future? Google Search Start Here
  46. 46. @sophiedennis We mainly support 
 one information seeking ‘mode’
  47. 47. @sophiedennis Information seeking needs in healthcare 1. Target seeking 
 Looking for specific information. “Known- item” search behaviours: I know what I want and how to describe it. 3. Orienting 
 Getting up-to-speed with a complex (and possibly distressing) new topic. Not really sure what I need or where to start. “Berry- picking” search behaviours
 4. Exploring
 Iteratively adding to understanding of a topic. Building a mental model. “Berry- picking” search behaviours. 6. Evaluating 
 Choosing the best option from a range. Comparing options to make an informed choice. Eg treatment options, local health services. 8. Keeping up-to-date 
 Ensuring understanding of a topic is current 1 2 3 4 5Inspired by: Donna Spencer, Four Modes of Information Seeking and How to Design for Them Marcia Bates, The Design of Browsing and Berrypicking Techniques for the Online Search Interface
 Dan Ramsden (BBC), A Model for Navigation & Information Seeking ✔ ✘ ✘ ✘ ?
  48. 48. @sophiedennis Our content and information architecture needs to better support the range of patients’ information-seeking needs - including their changing emotional state and cognitive capacity - over the course of their healthcare journey
  49. 49. BEFORE 
 “health encyclopedia”. Structured as a linear journey for target-seeking behaviours nhs.uk/conditions/type-1-diabetes Turns out this is not the most important stuff someone just diagnosed with Type 1 Diabetes needs to know
  50. 50. AFTER 
 Practical, actionable advice
 
 Supports orienting and exploring, and reflects different needs at different stages of patient journey beta.nhs.uk/conditions/type-1-diabetes Newly-diagnosed ‘orienters’ can quickly find the most important things without being overwhelmed. 1
  51. 51. Those who are ready for more detailed information can still find it easily 2 AFTER 
 Practical, actionable advice
 
 Supports orienting and exploring, and reflects different needs at different stages of patient journey beta.nhs.uk/conditions/type-1-diabetes
  52. 52. Trigger “She can’t manage on her own any more” First contact “What kind of care and support is available to us?” Users are often looking for information in a crisis situation, in a highly emotional state. They do not know what they are looking for yet. People would ideally have one person who would tell them what they need to do and when. If it couldn't be one person then the next best thing would be having one place where everyone sent them with well written information and signposting to services. LA assessment LA determines how urgent and severe the care needs are LA check level of income and decide whether to grant full or partial care funding Not everyone applies for LA funding Goal: find and arrange care and support for an old person (at home) Task Model How can we get help? Cooking meals Day centres, activities Befriending servicesMedical or psychological treatments Taking medicines Advocacy Getting up, washing, dressing Shopping Information & advice Cleaning Transport Decide we need help Planning care funding Planning for future financial commitments to funding care Choosing care types What kinds of care & support are required? What kinds of care and support are available? What is affordable? What can be provided by informal carers? What can be organised privately and what can be funded by LA? Some users evaluate affordability of p or fully privately care. It is particularly important for care hom funding where the costs are particular Recommen dations for care providers How long does it take? Talk to professionals, the council Talk to friends & family Arrange LA needs assessment Apply for LA funding Gather financial info LA “Support offer” Personal budget Needs level determined by LA Self- financing Accept care chosen by LA Home adaptations Council- provided Private Informal carers Make benefit claim Meal delivery Ineligible for LA support Advised to apply for benefits Support for carers What are we entitled to? How much does it cost? What do I need to know? Understand the process of arranging care & suport What is available locally? Who will provide care?What type of care do we need? What types of care are there? LA funding decision Apply for LA funding Needs level determined by LA End user’s opinion of needs Family’s opinion of needs Locally available services Choose care types Affordability Care needs Domestic help Homecare services & personal care Community support Emotional care Gardening Voluntary sector Care provision Professional advice Private funding top up Benefits received (Attedance / Carers Allowance) Urgency of need Conflicting advice and opinions Price Long-term cost What happens if private funding runs out Long-term affordability Priva top-u fundi Funding responsibil ities when prices increase When LA might increase funding LA funding available Plan care funding for the long term Orienting Get up-to-speed quickly - Primer, getting started guide, do this first - Guide to the system - Signpost deeper understanding Target-seeking Evaluating Exploring & evaluating What funding options are there? What works best for us? - Outline available options, pros and Exploring & evaluating What care is available? What elements do we care about? What’s best for us? Exploring & evalua What are the options? What What’s best for us? Task models help us understand people’s information seeking needs and behaviours at each step in their journey And then design our content and navigation to support those behaviours If we can create task models and IA patterns for the main abstract user journeys for NHS.UK We can then scale the design patterns we’ve developed to other user journeys that fit the same model Task models help us understand and design for the changing information seeking needs across patients’ user journeys www.cxpartners.co.uk/our-thinking/task-model-cheat-sheet-pdf www.slideshare.net/JesmondAllen/the-lost-art-of-task-modelling
  53. 53. Type 3
 Small amount of content. Highly-focused. Optional tasks pattern. Type 2
 Orienting and exploring a topic. Structure suitable for different stages of health journey. Our evolving suite of ‘hub’ layouts will help us group and cluster content so people can orient in and explore complex health information Type 1 High-level topic cluster. Directional - get you to the particular topic you need.
  54. 54. @sophiedennis We also need to rethink our
 global navigation and information hierarchy
  55. 55. @sophiedennis Card-sorting at scale with Taxonomics: 12 months 42,000 domains/websites 7 million search terms c.4,500 “user goals”
  56. 56. @sophiedennis The 340 most popular topic clusters in healthcare by search engine demand. We can use this to prioritise our work based on areas of largest need. Analysis by Taxonomics
  57. 57. @sophiedennis Deep dives into each topic shows where our content doesn’t match how people search for information - their existing mental models, and how they express their needs Analysis by Taxonomics
  58. 58. @sophiedennis A potential new information hierarchy, ready to validate with users Analysis by Taxonomics
  59. 59. @sophiedennis Thank you sophie.dennis1@nhs.net

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