Redesigning the NHS Electronic Referral Service (e-RS)

In the context of BJSS's sustained involvement with the NHS, I serve as the Design Lead for a project with the objective of enhancing the user experience of a pivotal NHS internal clinical service: the Electronic Referral Service (e-RS). This initiative is in accordance with a broader NHS-wide effort to modernize and enhance the integrity of its internal services in alignment with the NHS Service Standard.

Challenge

The e-RS system has been developed to facilitate the initiation and management of the patient referral journey by healthcare professionals and administrative staff. It also enables NHS commissioners to establish, administer and revise services that other healthcare professionals can utilise for patient referrals.

The service in its current iteration can be regarded as somewhat outdated. It is noteworthy that a service of such extensive utilisation has remained largely unencumbered by the strictures and mores of contemporary design standards and principles. The system is challenging to navigate, necessitates a substantial degree of insider knowledge to utilise effectively, and is a perennial source of frustration for its more than 20,000 daily users. This is largely attributable to the fact that, until recently, design and the value it brings has been accorded a lower priority, with key design decisions being the domain of senior stakeholders, developers and various delivery professionals.

“The question that needs to be answered is how the necessary levels of measurable usability, accessibility and scalability expected by the NHS Service Standard can be injected into e-RS without compromising its core purpose and functionality.”

It is noteworthy that e-RS is arguably the first internal NHS service to have complied with the NHS Design System.

What we did

During the course of this process, it has been noted that the following key points have been instrumental in facilitating the successful completion of a significant proportion of this project:

Feature audit

Collaborating closely with SMEs from the NHS and our team of researchers, it became evident that there was an abundance of features that were utilised by a diminishingly small number of users.

This phenomenon can be attributed to the consequences of feature prioritisation in the absence of design thinking, which results in the addition of functionality to a service that does not align with the lived experience of the majority of its users. The net effect of this is a cluttered, sometimes confusing UI that effectively only serves to increase cognitive load, especially for newer users.

In an effort to enhance comprehension of this phenomenon, a collaborative effort was initiated with our team of researchers. The objective was to ascertain the features that were utilised most frequently, and more significantly, those that were utilised with minimal frequency.

It was acknowledged that the decision regarding which features to remove lay outside the scope of this project, particularly for a service as fundamental to patient safety as e-RS. To facilitate this process, a collaborative effort was undertaken with a team of clinical risk experts, ensuring that the features selected for removal did not pose any clinical risk to patients.

This collaborative effort was instrumental in refining the scope of the necessary modifications, while concurrently providing the broader delivery team with the opportunity to demonstrate greater generosity in their estimations and deadlines.

Exploring design options

As previously referenced, the necessity for this service to conform with the expectations of the NHS Service Standard was paramount. This, in essence, necessitated the utilisation of predefined styles and components available on the NHS Service Manual. While the majority of our UI requirements could be accommodated by the components available in the NHS Service Manual, we did find it to be somewhat restricted in view of the complexity of the service under design.

Recognising this limitation, we explored alternative solutions by examining the resources available in the broader gov.uk design space when confronted with a particular design challenge that necessitated a more sophisticated approach. This was particularly evident when a tabled data component with sorting and filtering capabilities was required. The solution devised by the Ministry of Justice can be accessed on the justice.gov.uk website.

Another component that was utilised extensively was HMRC's timeline component.

It is important to acknowledge that repurposing components of this nature ensures a certain level of certainty that they have been thoroughly tested with users and that all accessibility requirements have been integrated into the code. It is also our belief that the sharing and repurposing of components and design solutions is in alignment with the open source and collaborative nature of public service design.

Identify and test critical ui elements early and often

The following hypothesis was formulated: the manner in which tabulated data is presented would be of crucial importance to the success of the endeavour. A recurrent grievance pertaining to the prevailing service pertained to the challenge of legibility in tabulated data, often characterised by the utilisation of diminutive font sizes, and the consequent oversight of off-screen data by users.

Utilising the aforementioned MoJ table as a foundation for our design solution, we embarked on the development of a fully functional, coded prototype. This prototype was then presented to users for the purpose of validation. The solution devised was comprehensive in addressing the most significant shortcomings of the original design, incorporating features such as sticky headers and columns in appropriate sections, enhancing scrollability, and providing clear indications when data was not visible on the screen. The removal of redundant columns also helped minimise the likelihood of off-screen data being problematic. This proactive measure was foundational for the subsequent design decisions.

The subsequent design decisions were informed by this foundational approach, leading to the creation of complex tables incorporating filters and column selection.

Complex tables with filters and column selection.

Documenting design components that are specific to e-RS.

Combining a form and table pattern to allow users to make informed selections from a large data-set.

My role

In my capacity as a consultant at BJSS, I collaborated with both permanent NHS team members and civil servants. My role was that of Lead Designer. The responsibilities entailed:

Outcomes

The project is being delivered to a highly ambitious schedule, and the composition of a streamlined, integrated team comprising interaction designers, a content designer, researchers, developers and a single Subject Matter Expert has been demonstrated to be highly effective. The importance of collaboration is paramount, and the utilisation of Figma facilitates a level of openness and scrutiny across multiple sign-off points with minimal friction or context-setting time.

The project has now been underway for nine months, and the feedback from the client and users has been overwhelmingly positive. The next stage of the project will involve the dissemination of design ideas to the broader NHS design and research community.