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At THIS Institute, we believe in the importance of developing evidence for healthcare improvement alongside people whose expertise is rooted in lived experience – particularly NHS patients and staff. As part of this mission, we’ve published a five-step framework on how to co-design a clinical practice tool. This includes its application in a case study to develop a tool to help maternity professionals recognise and respond to changes in a baby’s wellbeing during labour.

Our paper about this framework – ‘How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study’ – was selected as one of the BMJ Quality and Safety top ten articles of the year . Excitingly, Victoria Brazil and Ben Symon – two well-known authors and clinicians in the area of clinical simulations – also highly rated the paper in their podcast Simulcast. In their podcast, Victoria and Ben wondered if we could share some top tips when using the framework. The lead author Matt Woodward – a human factors engineering specialist and Research Associate at THIS Institute – was happy to pick that up. We’ve interviewed him to share some more insights about the framework and how to practically apply it.

1. What do you think are the main problems with designing clinical tools?

“Clinical tools are often designed on an ad-hoc basis, from a single clinician’s perspective. This means that there’s often not much thought given to design fundamentals, such as considering different users and use of the tool in its broader context, at the start of the process. Often, tools don’t receive much evaluation – they are designed, run past a few people, and approved with little engagement with end users. Sometimes, basic usability considerations aren’t covered, for example a tool might include fonts that are too small, make excessive use of colour or cram too much text onto the page. Important checks, like considering whether a tool still works in black and white, can be overlooked.

2. What are the benefits of using the five-step framework?

“Crucially, the framework brings people with different skills together, including clinicians with experience of conducting the task, designers/human factors engineers with knowledge of design principles, and service users with experience of what it’s like to receive care relating to the tool.

 “The framework encourages co-design, evaluation and iterative design cycles. This means designing, testing, and reviewing throughout the design process. For example, we know there’s often a tension between those who want a simple, straightforward form, and others who want to add every detail and cover all eventualities. Using a clearly set out design process lets different users say what they need, with each bringing in their unique views. This way of working also helps to focus on important issues like the structure and flow of a tool, its purpose, and how well it matches the needs of its users.

“As an example, one of the steps of the framework, the “think-aloud” technique, helped us identify design elements that worked well, such as providing evidence that colour-coded rows led to better usability than a text-based table. Workshops were also helpful, giving us a chance to ‘walk through’ clinical cases together using the prototype tool, to identify any potential issues. We also found that separating testers from design partners helped, because independent testers approached evaluations from a fresh perspective.

3. What are your top tips for clinical tool design?

  1. Understand the task from the user’s perspective. A great way to do this is to involve a multidisciplinary team from the outset. Who are the users? What are their goals? What are their constraints? This also brings collective creativity to the process.
  2. Relate the layout of the tool, and navigation through it, to the structure and flow of the task.
  3. Don’t fixate on a single solution too early. Start out with two or three drafts and explore the relative strengths and weaknesses of each.

4. “Victoria called the framework the “Rolls Royce version of how to design a clinical pathway,” and made the point that the level of resource for the case study might be out of the reach of some tool development projects. What are your thoughts about that?”

“Yes, I completely agree that there is a trade-off. However, the framework doesn’t prescribe a lot of resource per se. Efforts to follow the framework can be scaled up or down to suit the circumstances and resources. In our case study, resources were available for a national level project, but the framework could be tailored for a smaller, local project. Either way, it’s important to cover all five steps – but there are ways they could be scaled down, for example:

  • Adapt the size of the core design group to fit resources.
  • Remember that early concepts and sketches don’t need to be perfect. Hand-drawn images or simple block diagrams are enough to help brainstorm and refine ideas.
  • The think aloud technique (in which participants verbalise their thinking as they use the tool for a clinical scenario) can be conducted with as few as five or six people.
  • Keep the simulations (to evaluate the tool) simple by using a script to fill in details of additional roles or events.

It’s great to hear the reflections on the Simulcast podcast, which ring true. We hope the framework gives people the confidence to co-design clinical tools in an inclusive and systematic way.

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