Design is not a privilege, it's a real necessity

I used to think of 'design' as 'something superficial, done to make things pretty'.

The GP Record, by Fran Orford www.francartoons.com
The GP Record, by Fran Orford www.francartoons.com

But the true function of design is much deeper and more holistic. Good designers ensure that whatever is being created will function efficiently, be easy to assemble, look good, have minimum cost, maximum reliability and no weak points.

Sadly, most people think of design as an optional extra, to be jettisoned when money is tight. It's the exact opposite. Poor design (or, even worse, no design) can be very expensive.

Take poorly-designed NHS processes: they waste time and money. A lack of integrated design has allowed our local hospitals to produce outpatients department referral proformas which are annoyingly different from each other - and paper-based, when primary care is largely paperless. Some providers still use coloured paper and non-carbon paper forms for discharge letters: neither scans easily, so they have to be kept separately rather than being scanned and shredded.

A lack of overarching design underlies the current incompatibility between primary and secondary care IT. Often there is no mechanism to update the name of the patient's GP automatically, so hospitals frequently send letters to the wrong doctor or even the wrong practice. This takes time - lots of it - for practice staff to disentangle.

Poor design results in convoluted and intrusive referral protocols: our crisis team insists that the patient must be seen that day by the GP, face-to-face rather than over the phone, no matter how well the doctor knows them.

What about definitions and coding? The QOF definition of an asthma patient is subtly different from the PRIMIS one in relation to flu immunisation; there's no Read code to indicate the removal of a patient from the sex offenders' register; and the convolutions of logic behind the QOF rules on smoking habits have to be seen to be believed.

All this has occurred because the NHS has developed piecemeal, without co-ordination. Or to put it another way, no-one thought to design it properly. In turn, this lack of design has made for clumsy administration, increased mistakes, poor-quality statistics, wasted money and frustrated staff.

Co-ordinated design - of systems, procedures and definitions - isn't an optional extra. It's essential for the smooth running of the NHS - and it needs introducing urgently.

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