Agenda cards
Currently, diabetes sufferers are monitored by the health service through regular check-ups every three -or six- months. But these sessions often fail to provide the individual support or motivation to sustain patients between visits, or to identify the real issues that may be preventing someone from carrying out their regime effectively.
With diabetes now accounting for 10 percent of hospital inpatient costs, finding more effective ways to communicate with patients and help them manage their condition has become a priority.
The Open Health team wanted to develop a tool that would differentiate and personalise each consultation to reflect the individual needs of the patient. But it wasn’t easy.
One brainstorming session resulted in a wall of Post-IT notes with patient statements scribbled on them, taken from real life examples. They were phrases like, ‘I’m addicted to sugar’, ‘I’m frightened’.
The brainstorm seemed to be going nowhere, and it wasn’t until the next day, when the team tried to revisit their idea, that they realised they were basically looking at the very tool they needed: a set of clearly defined descriptions of experience, feeling and need that could be used by patients to help them communicate better with their healthcare professional.
‘We realised we could provide patients with a deck of cards with real-world descriptions of diabetes needs, for them to choose from during consultations,’ explains Jennie Winhall.
‘The cards would help to bring out dimensions of their lives previously hidden to their care-givers, providing the flexibility for patients to define their own diabetes care agenda.’
The team immediately mocked-up a set of cards and presented them to members of the Bolton Primary Care Trust management for feedback. Although the nurses on the management team had concerns about moving away from the questionnaire format they currently used, the overall response was positive. So a second iteration of the cards was produced.
Seventy-two ‘needs’ cards were organised into themed suits (to provide help people navigate through the pack), with appropriate graphics added to help illustrate the scenario each card described.
The cards were shared with clinical psychologists, who reacted enthusiastically. But feedback from the first workshop with healthcare professionals was mixed. Some people asked for a set of cards to take away to begin using immediately, but others worried about the cards undermining the clinical nature of the consultations. 
One participant expressed concern that they might lose control of the consultation dialogue. It was pointed out, quite rightly, that the cards would need to be translated into the three Asian languages spoken in Bolton, and it was mentioned that there were too many cards for anyone get through in a few minutes.
Additional fascinating – and surprising – feedback emerged from the Bolton group of diabetes sufferers, most of whom reacted very positively to the idea. The Design Council researchers visited each participant at home to show them the cards. On one visit it emerged that the cards were not only useful for the sufferer, but also for his wife, helping her communicate more effectively with him about his condition.
Another participant asked if she could keep the three cards she had picked out and display them in the kitchen as a reminder to herself and her family of exactly how she felt about having diabetes and what support she needed from those around her.
The diabetes group also suggested including several blank cards in the pack, so if the patient couldn’t find a card that best describes how they feel, they could quite literally write their own healthcare agenda.
The cards were then developed into a third version, incorporating suggestions from both health professionals and patients. The final number of cards was cut to forty, with the addition of blank cards as suggested by patients. The cards were evaluated by an independent research associate, and received more positive comments from participants.
