Quality Improvement Zone

Understanding service user experience is a key step in moving towards person-centred services. Looking at various aspects of experience can help us to understand the extent to which people are receiving services that are built around what people really need and want - their preferences, needs and values.The things that matter most to them.

The terms satisfaction and experience are often used interchangeably, but they are not the same thing. To understand someone’s experience, one must find out from them whether something that should happen in a service (such as clear communication or being fully involved in decisions) actually happened or how often it happened. Satisfaction, on the other hand, is about whether a person’s expectations were met. Two people who receive the exact same service, but who have different expectations, can give vastly different satisfaction ratings because of their different expectations.

We often default to quantitative surveys measuring “satisfaction” when seeking service user insights, but this is one of the least effective ways to gain useful and meaningful information. The Scottish Government has committed to developing a more participative approach to improving Scotland’s public services and has published online guidance to support services to create a more user-focussed approach.

The Scottish approach to service design sets out principles for involving service user experience to inform improvement. It uses the double diamond method to explore experiences and potential improvements which can then be tested, refined and implemented.  Some specific methods to help you explore and understand service user experience are outlined below.   Links to further resources and tools are at the bottom of the page.

1. Narrative methods.  Narrative can be collected in various ways, including:

• Service user stories gathered specifically or from pre-existing sources such as Care Opinion, or complaints can help to identify common themes or specific issues.
• Face-to-face interviews with individuals or groups can be recorded as audio or written transcript. These conversations should be very open and exploratory if you are in the early stages or more focused and structured if you already have a specific improvement identified from earlier work.
• Interactive group methods provide a fun way to bring groups of people together to generate new insights and ideas. Liberating Structures is a collection of tried and tested ways to facilitate groups of people in innovative ways with a focus on generating new connections, insights and ideas.  Experience-based co-design (EBCD) is an improvement method that blends service design methods with quality improvement methods and enables service providers and service users to co-design services or care pathways, together in partnership.

2. Observational methods.  Observation can be used in isolation or combined with a narrative approach to deepen insights.  There may be times when observation is the only option because a service user finds it difficult to tell their story because of severe illness (such as advanced dementia) or for other reasons. The following methods can help you observe experiences and interactions in your service:

• Non-participant observations. This normally involves an observer spending a period of time in a service setting noting what they see, hear and feel focusing on anything that seems impressive, unusual, surprising, confusing or worrying. It can be helpful to try and imagine being the service user, or if you know the service well, trying to look with fresh eyes as if you were a visitor to that area. There are links below to frameworks that can help you carry out observations and collect information in a methodical organised way. 
• Shadowing. This is a mobile method of observation where the observer moves with the service user as they navigate a service.  This could be following a child during their day at school, a person attending a hospital appointment or someone moving through the criminal justice system.  It is particularly helpful in generating insights about how effectively different teams or elements of a service link together. The Patient and Family Centred Care Toolkit uses shadowing to generate improvement ideas and have developed an app to support this process.  Teams from Alder Hey Hospital have also developed a shadowing method.

Care Experience Improvement Model

Service user journey maps

Experience-based co-design (EBCD)

The 15 Steps Challenge

EBCD observation method

GoShadow App

The Scottish Approach to Service Design – How to design services with and for users

Measuring Patient Experience. The Health Foundation (2013)

Measuring What really Matters. The Health Foundation (2014)