Digital wayfinding for NHS estates: reduce DNAs, alleviate anxiety and save money
There were 122 million NHS appointments booked in 2022. Of those, around 6.4% (7.8 million) were missed. For context, that equates to more missed appointments every month than the entire population of Bristol, UK (650,000). It also costs the NHS over £200m annually.
According to an NHS review into outpatient appointments, the main reasons for missing appointments stem from difficulties with processes and communication, as well as previous poor experiences. My own research for the NHS also pinpoints anxiety as a significant factor in the relationship between patients/carers and healthcare estates.
Digital technologies are increasingly emerging as a fundamental part of the fabric of the NHS, which is embarking on a long-term digital transformation to modernise services and tools. It is transforming the NHS at all levels – from mobile apps to give people greater control of their health and wellbeing at home, to incredible advancements in AI which can identify and diagnose diseases quicker than ever before – and even perform operations. We are also seeing digital services tackling the issue of no-shows (also known as DNAs – do-not-attends), with reminders reducing missed appointments by up to 80%.
At the same time, NHS staff sickness and absence is also on the rise; there is an urgent need to find solutions that address the root cause of all these issues.
I have previously written about how digital placemaking can address many of the place-based challenges faced by the NHS. In this article, I will explore how digital wayfinding, specifically, can be implemented as a solution to improve people’s relationships with healthcare facilities and the overall experience of these places; addressing key challenges around DNAs, staff burnout and operational costs.
DNAs is a complex issue. NHS England recognises there are many reasons why people may not attend their appointments – some within people’s control, such as forgetting or feeling like they no longer need help; others outside of their control, for instance issues with transport or cost, or difficulties cancelling.
Regardless of the reason, NHS England sees ‘digital enablers’ as key to overcoming barriers and promoting wide-ranging benefits across healthcare, such as releasing capacity, improving administrative processes and communication with patients, and reducing health inequalities through understanding issues faced by particular demographic groups.
The ‘primary benefit’ noted, however, is that of a better patient experience; and the result of a better patient experience would – should– be a better hospital staff, carer and overall visitor experience.
This is where I see digital wayfinding playing a critical role. Healthcare estates are often large, busy and difficult to navigate, which we know can make people feel stressed and anxious. When some patients have heightened anxiety they can become aggressive to others, which is already a significant issue for NHS staff, so anything that can be done to relieve some of that anxiety – i.e. through making highly stressful environments easier to get around – can only be a good thing. When designed well, of course…
In the built environment – healthcare or otherwise – ‘accessibility’ can be thought about in a number of ways: in terms of navigation on-site, being able to plan visits in advance, enabling people with disabilities and sensory impairments to get around confidently and independently. Factors that are all conducive to a smoother, more inclusive, experience for everyone.
Accessibility underpins much of the work Calvium does, but there are two particular digital wayfinding projects we have undertaken to help manage uncertainty, and where I see clear applications in an NHS setting.
One of those is NavSta, a mobile wayfinding solution to help people with less visible impairments, such as neurodivergence, to navigate the complex Transport for London network independently. By providing practical assistance to people when they plan and undertake a journey, the ultimate goal is to reduce anxiety when travelling through stations. Testament to its success, NavSta was highly commended in the Neurodiverse Research of the Year category at the 2020 Neurodiversity Awards.
UCAN GO, meanwhile, is a wayfinding app that helps people with sight loss to navigate indoor cultural venues. It works by visually mapping the building, offering visual cues and audio description to help users visualise a mental map of the building and their route.
It is not difficult to imagine these apps working in a healthcare setting. In addition to helping people find the location of appointments, waiting rooms and toilets, a dedicated wayfinding app could signpost to shops and eateries, green spaces and other amenities – both on the hospital site and, importantly, in the neighbouring public realm.
It’s about making the whole area easier to navigate and thus more accessible to everyone. This wouldn’t only potentially help to reduce anxiety, but if fewer people needed to ask staff where things are, that should have a knock-on effect in terms of freeing up already-stretched NHS resources. Which, in a best-case-scenario, should also help to reduce costs.
Last year, the UK government invested £21m in AIto help diagnose patients more quickly for conditions such as cancer, strokes and heart conditions. It is one example of how ultra-efficiency is supporting the NHS, offering innovative solutions that are, in some cases, the difference between life and death.
In other industries, ultra-efficiency is what is expected and what defines success: Amazon, Uber, Deliveroo. But physical healthcare environments, where people spend time in a place, require a very different approach to agility. There is a real point of difference in getting your technology to be as effective, productive, cost-effective and frictionless as possible within the hospital setting, but not treating the hospital and its communities in the same way.
Rather than prioritising the easiest frictionless flow (as with general customer experience solutions) innovation must fundamentally be human-centred and sympathetic to a variety of individual needs – many of which will be around easing anxiety, and making things more comprehensible, accessible and inclusive.
Ultimately, hospitals are physical places where people don’t want to feel rushed; where they want to be able to get around easily and where they value the kind of human interaction and care that our online world often forgoes.
If someone has travelled a long way, they may want to find a cafe to have something to eat, or a garden to sit in to decompress after an appointment… All things digital wayfinding can enable when designed thoughtfully, with hospital stakeholder communities, especially those it will serve and benefit.
The critical role of community engagement in delivering innovative healthcare solutions was highlighted in the NHS NEL Digital Placemaking Scoping Project I undertook last year. A key output of the project was the development of a framework for Digital Placemaking for Health and Wellbeing, built around key pillars that work together to create inclusive solutions for all. Due to the interconnected nature of placemaking and wayfinding, the framework can help to guide the design of digital wayfinding solutions for this environment too.
The rate of DNAs and associated issues will only continue to grow and cause problems for the NHS if we do not find ways to support and enhance the patient and carer experience (and new staff). When considering the issues that contribute to a poor experience and the knock-on effect on the wider healthcare system – from staff wellbeing to costs – there is a clear case for investing in digital wayfinding solutions.
Designed well, with accessibility and thoughtful innovation baked-in from the start, digital wayfinding technologies can help to mitigate the causes of heightened anxieties often felt by patients and visitors. Not only will alleviating stresses around planning and navigation lead to a reduction in patient no-shows and calmer patients and visitors, ultimately it will foster a less taxing workplace – reducing the amount of times staff are asked where things are located will lead to greater staff effectiveness and productivity. It’s a win-win solution for all who exist within the NHS environment – and the NHS itself.
