Service design for Realistic Medicine

A 90 minute Case Study by:

Mike Press

Open Change

Dr Gill Paterson

Scottish Government - Chief Medical Officer Directorate, Healthcare Improvement Scotland and NHS Greater Glasgow and Clyde

About this Case Study

Realistic Medicine is a vision for the future of Scotland's NHS provision, developed and presented by Scotland's Chief Medical Officer in her annual reports in 2016 and 2017. Its aims are to:

  • build a personalised approach to care
  • change the NHS style to one of shared decision-making (involving clinicians, patients and carers)
  • reduce harm and waste
  • reduce unnecessary variation in practice and outcomes
  • manage risk better
  • empower health professionals to become improvers and innovators

'Realising Realistic Medicine' was the title of the Chief Medical Officer's annual report in 2017 that provided evidence of how health and social care provision is beginning to embrace these aims, detailing a number of initiatives and case studies that are furthering them. The report focused on 4 concepts: communicating, connecting, collaborating and changing our culture, with input from a wide range of health professionals locally and internationally as well as significant input from the Scottish Health Council on behalf of patients and the wider public.

Dr Gill Paterson, one of the speakers, is a Scottish Clinical Leadership Fellow and practising doctor based in the Chief Medical Officer Directorate, and through her contributions to Realistic Medicine has been at the heart of strategic discussions currently reshaping Scotland's health and social care landscape, which have gained considerable positive attention internationally. She will provide some critical insights on how Scotland is meeting its acute challenges of health and social care, and why new cultures of innovation and co-design with patients, carers and communities are needed.

As Director of Open Change and Emeritus Professor of Design Policy, Mike Press has worked with clinicians in applying service design to healthcare and with the Scottish Government on the development of its Scottish Approach to Service Design. The latter will lead, by the end of 2017, to the development of service design principles and policies that will be applied in all aspects of Scotland's public services. He will consider the strategic issues of developing service design policies at a national level.

Together they will present a case study that explores the progress and potential of embedding service design in a nation's healthcare system. Themes that will be elaborated are:

  • leadership - at both NHS Scotland and Scottish Government levels, cultures of inclusive engaged leadership have developed that present clear visions of the benefits of change, and the mechanisms that can bring it about
  • community building - these visions have been developed through national conversations with key stakeholders and a commitment to building communities of changemakers
  • building capacity and skills - essential to help develop the mindset to embrace change, and to best use the tools of change: most significantly, this creates an atmosphere of openness to encourage a culture of ideas

In our 90-minute session, the first half will be in the form of a presentation, while the second half will take the form of a 'world cafe' type discussion focused on each of the 6 Realistic Medicine objectives, and seeking to capture insights that can feed into the national conversation around this initiative. The aim is to seek new ideas and insights about how we can link the 6 questions of Realistic Medicine to the 4 concepts in Realising Realistic Medicine. We will use interactive prompts and tools. We will summarise the ideas gleaned from participants and feed this back to them following the session in the form of a written report, highlighting any common themes and ideas and summarising how their input will be used in future.

About the Speakers

Mike Press

Mike Press is Director of Open Change and Emeritus Professor of Design Policy at the University of Dundee. A leading specialist in design management and the application of design to social policy, he has written key texts on these subjects which have been translated into Russian, Spanish and Mandarin. He was joint director of the Home Office's Design Against Crime project from 1999 to 2005 and is a former Chair of the European Academy of Design. He has been research advisor to a number of UK universities, and has undertaken consultancy for Universities in Europe and North America. He also established the world's first (and only) postgraduate online course in service design for social workers and healthcare professionals.


Dr Gill Paterson

Gill is a practicing psychiatrist and graduate of Dundee University. She undertook early medical training in NHS Tayside before moving to the west of Scotland to continue her psychiatric training. She had a close involvement with the Scottish Patient Safety Programme (SPSP) from an early stage in her career, taking the lead on a number of local pieces of work when SPSP Mental Health was launched.

In addition to this, her primary research interest is in the area of novel psychoactive substances. She was appointed to cohort 6 of the Scottish Clinical Leadership Fellowship, working with the CMO (Chief Medical Officer) Directorate in the Scottish Government and Healthcare Improvement Scotland from August 2016 to August 2017. She was an author and member of the editorial board for the CMO's second annual report: Realising Realistic Medicine, and has continued to work on the application of Realistic Medicine both in her government role and with Healthcare Improvement Scotland. During her time working in government she also completed a master's in healthcare law and ethics.