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Improving Improvement

A toolkit for Engineering Better Care

 

Service Stakeholders

A service stakeholder is someone who has a direct interest in the service that is improved by use of this toolkit.

Contents

 

Introduction

Descriptions of potential service stakeholders are useful in reminding an improvement team who is involved in or has an interest in the delivery of a particular service. Knowledge and understanding of the needs and aspirations of such stakeholders, and their capabilities and limitations in delivering the service, provide crucial insights for those designing and improving care. A useful way to capture and convey descriptions of these users is to use personas, or caricatures of people, designed to display certain pertinent attributes.

Personas can be used to represent different groups of people, describing not only typical stakeholders, but also a range of non-typical, or rarer, characteristics of individuals. They can also be used to deliberately emphasise certain characteristics or behaviours as a means to ensure that the service is designed to be as inclusive as possible. Personas are fictional characters, but can be inspired by knowledge of real people. They can represent members of the health and care community or be chosen to be more representative of a particular stakeholder population.

This section describes a number of personas, representing stakeholders from different parts of the health and care system. They are typical of personas in that they convey some personal information about the individual along with a more factual description of their capabilities or limitations. They are intended to represent a wide spectrum of the stakeholder population, with no particular bias towards any clinical pathway, and inspire the creation of further, and potentially more bespoke, personas as required.

Personas represent real people. They help system improvement teams to keep in mind the needs of patients or the public in their work. As a result, it is important that the personas used in any given programme of improvement form a representative set, describing all possible service stakeholders.

Personas should be named and annotated with simple demographic data and details of their role in the system. In addition, their goals, challenges and habits should be presented, remembering that stakeholders are also people. Sets of personas should have complementary descriptions, representing the population of service stakeholders, and may be related or linked in some way.

Personas inspire creative thinking when improvers are trying to conceptualise new services. They also provide assistance in the evaluation of the performance of current or new services. In both cases, improvers, putting themselves in the shoes of personas, can reimagine how a service performs or might perform from the perspective of each persona, arguing the case for particular consideration of their individual capabilities and needs. This ensures that services are improved with a wide range of service users in mind.

The selection or creation of personas is an important step for any improvement team and due thought should be given the role and value of using such personas in the improvement process. There should be clarity and consensus on what constitutes a sufficient set of personas for this task, in order that new personas can be created or existing ones selected and the completed set circulated to the team.

Finally, it is important to note that while personas provide a convenient reminder of the needs of service stakeholders, they are no replacement for engagement with real individuals. Hence, the challenge in any improvement programme is to find the appropriate balance between the cost and benefit of learning from literature, data, protocols, personas and real people.

List of Service Stakeholders

Service Stakeholders

Academic

Bill is a consultant urologist and runs the department in his hospital Trust. He is also director of an internationally leading research team with significant charitable and industry funding.

What matters to Bill:

  • Efficient running of the Urology Department
  • Adequate space for the expanding research team
  • Time to attend international research meetings


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Administrator

Tracy works on a busy outpatient ward. She is responsible for a wide range of tasks that ensure a smooth flow of patients through the ward, which is staffed by an ever changing team.

What matters to Tracy:

  • Patients arrive on time for their appointments
  • Patient records are delivered on time to the clinical team
  • Internal referrals do not disrupt the prearranged list


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Allied Health Professional

Sophie is a physiotherapist in a busy hospital unit specialising in sports injuries. She is interested in the role of novel wearable technologies for delivering and monitoring therapy.

What matters to Sophie:

  • Timely appointments to facilitate maximum therapeutic benefit
  • Access to the latest thinking on therapies and assistive technologies
  • Consideration of modern social media to engage with patients


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Carer

Josie has been the main carer for her bedridden husband for the past five years. Their son rarely visits and she is constantly tired and increasingly worried about her own health.

What matters to Josie:

  • The ability to continue to care for her husband at home
  • Adequate and regular support from community services
  • Visits from their son and his family which bring much pleasure


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Community Worker

Natasha enjoys helping people in their own homes. She is not as fit as she used to be and is frustrated by the increased physical demands and travel delays associated with her job.

What matters to Natasha:

  • Enough time to provide a minimum level of service to everyone
  • Helping heavier patients is leading to recurrent back problems
  • Increased traffic makes it difficult to complete the daily list on time


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Consultant

Sue is an Accident and Emergency consultant and patient safety lead in her hospital Trust. She has direct experience of the value of risk management in improving care.

What matters to Sue:

  • Efficient triaging of patients to ensure each receives timely care
  • Access to hospital beds for those who most urgently need them
  • Clear reporting of all safety-related near misses and accidents


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Drug Manufacturer

Sarah works in development and production for an international drug company. She has a particular interest in both preventative and rescue inhalation technologies.

What matters to Sarah:

  • Drug formulations are fit for their intended medical purpose
  • Drug delivery devices are safe and effective for all potential users
  • Devices are manufactured to meet sensible cost and quality targets


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Equipment Supplier

Michael has supplied imaging technology for over twenty years. His company makes most of its income from products and services sold to fewer than ten NHS Trusts.

What matters to Michael:

  • Profitable long-term service contracts with larger NHS Trusts
  • A good relationship with equipment users and senior clinicians
  • Direct influence on the drafting of global equipment standards


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Family Pet

Fred is a loyal friend who is never far from his keeper’s side. He likes plenty of walks, food from the table and the chance to snuggle up before bed. He is upset by changes to his routine.

What matters to Fred:

  • Someone to talk to him and feed him his favourite food
  • Regular walks in the park near to his home
  • Time to snuggle up at the end of the day with a bone


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Finance Officer

Evgeny is a senior finance officer in a large NHS Trust. Over the years he has accumulated an encyclopedic knowledge of the workings of the trust and of its finances.

What matters to Evgeny:

  • A clearly articulated and argued financial case for change
  • An obvious link to existing or proposed budgets
  • A clear understanding of the risks of delay or under-performance


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Foundation Doctor

Karl is a foundation doctor about to start a new placement on a critical care unit. He is nervous about his lack of experience working with complex medication regimes and equipment.

What matters to Karl:

  • Learning new skills quickly from the senior doctors and nurses
  • Showing that he has the potential to become a trainee surgeon
  • Juggling the needs of a young family with the demands of the job


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General Practitioner

Nick is a local GP with a particular interest in service improvement. He works for a collective of Medical Practices committed to delivering better healthcare.

What matters to Nick:

  • Collective ability to deliver outstanding healthcare
  • Effective communication with secondary and mental health care
  • Skills to facilitate continuous improvement of local practice


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Health Minister

Mark is responsible for oversight of all NHS delivery and performance. He holds a portfolio ranging from public health and social care to mental health, primary care and secondary care.

What matters to Mark:

  • Equity in the delivery of health and well-being services
  • Public and patient participation in health and care improvement
  • Fair wages for NHS employees and other care providers


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Laboratory Technician

Tatiana is responsible for a range of activities in the pathology laboratory including the automated diagnostics. She particularly enjoys the variety and that every day is different.

What matters to Tatania:

  • Clinicians provide clear information to guide her investigations
  • There is a good balance between routine and emergency cases
  • The availability of automated analysis equipment at all times


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Local Government Officer

Lloyd has worked in local government for all his life. He likes to make a difference, but is increasingly frustrated by the lack of budget to deliver effective community services.

What matters to Lloyd:

  • Doing things that really matter to the local community
  • Sufficient local budget for community and mental health care
  • Engagement with the NHS to try to provide continuity of care


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Nurse

Moira is the senior nurse on a busy surgical ward. She works long shifts and is in charge of preparing patients for the surgical list. She has a good rapport with the surgical team.

What matters to Moira:

  • Ensuring patients and their families are well prepared for surgery
  • Working with the same team of nurses on a regular basis
  • Feeling valued as part of the surgical team


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Paramedic

Liz is a recently qualified paramedic with aspirations to join the region’s air ambulance service. She enjoys the challenge of emergency care, but is frustrated by the lack of resources.

What matters to Liz:

  • Speed of response to minimise time to the initial intervention
  • Timely handover of the patient to Accident and Emergency
  • Skills necessary to maximise intervention possibilities


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Patient Representative

David is a patient representative for a mental health Trust. He has been a service user in the past and provides insight into current service provision and the potential for improvement.

What matters to David:

  • Services are regularly evaluated and improved
  • The voice of the patient is heard when discussing services
  • Expenses for attendance at events are paid promptly


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Pharmacist

Naveed runs a small chain of independent community pharmacies. He prides himself on knowing his regular customers and works very hard to provide a good service to them.

What matters to Naveed:

  • Providing an excellent service to local customers
  • Keeping up with ever changing prescription technologies
  • Government pricing challenges the profitability of the business


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Porter

Andrew has been a porter for nearly forty years in the same hospital. He is well liked by patients and staff, and knows all the best routes, but is not as fast and agile as he used to be.

What matters to Andrew:

  • The ability to help people in a time of uncertainty or crisis
  • That the lifts between the wards and theatres are in service
  • Time to chat to people on his travels around the hospital


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Practice Manager

Thomas works for a general practice unit. He is responsible for a wide range of tasks that ensure a smooth flow of patients through the practice, which is staffed by an ever changing team.

What matters to Thomas:

  • Patients arrive on time for their appointments
  • Patient records are delivered on time to the medical team
  • External referrals are followed up in a timely manner


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Public Health Worker

Gabriella is a nutritionist with a wide brief to engage with the local community to promote good health through nutrition and monitor the impact of national policies.

What matters to Gabriella:

  • The ability to engage effectively with vulnerable people
  • The support of local community groups and health centres
  • Knowledge of the latest best practice in good nutrition


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Senior Trainee Doctor

Aoife is a senior anaesthetic registrar supporting a number of surgical teams across the hospital. She enjoys the variety of her work and is keen to continuously improve her skills.

What matters to Aoife:

  • Tracking of patients’ progress before and after surgery
  • Effective team working in all surgical environments
  • Standardised equipment available in all surgical units


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Service Commissioner

Sally is a regional commissioner who has seen many changes in procurement practice. She is increasingly frustrated that she is unable to take a more holistic approach to service provision.

What matters to Sally:

  • Patients’ interests are at the heart of all service provision
  • Individual providers understand their position in the wider system
  • Providers take a broader financial view of service proposals


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Service Funder

Geoff has held senior roles in healthcare management for over thirty years. He has seen national directives and internal initiatives come and go with little apparent impact on care.

What matters to Geoff:

  • The relative strength of the clinical and financial case for change
  • The risks associated with development and delivery
  • How the proposed service relates to best practice


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Service Manager

Dawn is a nurse by training and service manager for a regional hospital. She has limited experience of change, but has a good working relationship with the wider team.

What matters to Dawn:

  • How the proposed changes will impact patients and staff
  • The resources required to develop and deliver the new service
  • How the transition to the new service will be achieved


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Service Regulator

Richard is a former pharmaceutical executive turned regulator. He has responsibility for the accreditation of medicines and care practices for general and specialist use.

What matters to Richard:

  • Access to reliable evidence for the efficacy of medicines and practices
  • Up-to-date knowledge of national regulatory frameworks
  • Some influence on research funding to plug evidence gaps


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Third Sector Worker

Anna is a former community nurse now working for a charity specialising in end-of-life care. She typically supports an individual and their family during their final months of life.

What matters to Anna:

  • Making a real difference at a time of particular need
  • Time to get to know and support the individual and their family
  • Timely clinical support from community and specialist doctors


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Literature

Adlin T and Pruitt J (2010). The Essential Persona Lifecycle: Your Guide to Building and Using Personas. Morgan Kaufmann

Cooper A (2004). The Inmates Are Running the Asylum: Why High Tech Products Drive Us Crazy and How to Restore the Sanity. 2nd Edition, Sams.

Dam R and Siang T (2019). Personas — A Simple Introduction, Today. Interaction Design Foundation, https://www.interaction-design.org/literature/article/personas-why-and-how-you-should-use-them.

Goodwin K (2008). Perfecting your Personas. Cooper Journal. https://www.cooper.com/journal/2008/05/perfecting_your_personas/

LeRouge C, Sneha S and Tolle K (2013). User profiles and personas in the design and development of consumer health technologies. International Journal of Medical Informatics, 82(11):251-268.

Miaskiewicz T and Kozar KA (2011). Personas and user-centered design: How can personas benefit product design processes? Design Studies, 32(5):417-430.

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