At one time or another, we’ve all come into contact with the army of people who work within hospitals to support clinicians. Porters, cleaners, housekeepers, and more, they’re people who are crucial to ensuring that the hospital environment functions smoothly and effectively for patients, visitors, clinicians etc.

The idea that this hardworking group of individuals – who patients are interacting with frequently, every day – could make a positive contribution to patient recovery has been discussed for some time.

But making this a reality has to date focused on vague rebranding ideas rather than examining the evidence for the validity of such a concept. What in reality could be different and deliver positive impacts on the patient recovery journey?

In taking on this challenge we employed our structured user-centred design approach that aims to understand not only the actions of actors within a service but also crucially their emotional drivers. Only by understanding these can we hope to create designs that are deliverable, adoptable and sustainable.

How we achieved this

We began by researching and proving the tangible impact that the actions of facilities management FM staff could have on patient wellbeing. This enabled us to establish an outline hypothesis for the service re-design, and we then sought to test our thinking in a number of hospitals.

Working closely with the facilities management (FM) staff – including donning porter and housekeeper uniforms as we shadowed them – we spent time observing how interactions with patients were woven into their jobs, and the difference those interactions were already making to patients.

In parallel, we engaged closely with stakeholders – including hospital trust management, patients, visitors, carers, volunteers, unions, and, of course, the FM staff themselves – to understand their needs, fears and expectations, and to understand how we might work with them to define and communicate the role of FM staff in the patient care journey.

In parallel with our in-hospital research we used agile design sessions to assimilate our huge quantity of findings. This enabled us to create a series of service blueprints, our first step towards implementation. Those blueprints were then iteratively re-tested and validated in the hospitals with key stakeholders. The result was the creation of a service design driven by those who would use it and experience it.

The next step was to move from design to delivery. This required the creation of an education and communication programme designed to engage emotionally with the variety of individuals that made up the FM workforce and provide them with the means to own the new service elements.

Making it ‘live’ commenced with a small ‘Pathfinder’ group that allowed us a controlled environment within which to refine our thinking. The final design was then implemented across 10 major UK hospitals and to date in excess of 3,000 FM staff have been through our engagement and education workshops.

But it didn’t end there. We treated implementation not as a single event but as an ongoing change in thinking and behaviour – a key priority being ensuring that the improvements we were introducing were sustainable, and would be living things, continuing to grow and develop after the initial research process was complete.

That change continues to go on now, long after the initial engagement and education sessions have been completed. The initiative is enthusiastically owned by the frontline FM staff. We have succeeded in making it a ‘bottom up’ design and implementation – not a ‘top-down’ mandated training programme. As a result, new ways of developing the initial design are constantly being identified by the FM staff themselves. The impact of this is seen every day on the wards.

It passes the key test of sustainability – FM staff are now doing things differently even when no one is watching.

The outcome

 The greatest testament to the impact of this service design implementation is that we have removed the expression ‘I am just a porter/cleaner/housekeeper’ from the vocabulary of frontline staff.

They understand their importance and so does everyone else in the hospital, which has led to improvements in service outcomes, staff morale, safety and patient satisfaction.

The design has been recognised externally as the new service was a recent winner at the prestigious Patient Experience Network National Awards. While Dr Steve New of Oxford University’s Said Business School described it as ‘brilliant’ and ‘the most impressive service design exercise for frontline workers I have ever seen’.

But best of all was a comment from one hospital porter who took part. He told us that the initiative ‘Makes you think differently about your job, the impact you are having and it makes you kind of proud’.