Develop

Scenarios and personas

A scenario is a realistic description of how a service works. A persona is a realistic description of a type of client.

Why use it

Scenario and persona descriptions:

Help you determine exactly who your improvement needs to work for as well as when, where and how it needs to work to be successful.
Give you simple, cheap, quick ways to develop improvements.
Help you experiment with different improvement ideas, judging their value in a realistic and useful way, but without the need to involve staff and patients.

When to use it

Use scenarios and personas when:

You have a solid understanding of different types of patients and their experiences (you may have used patient shadowing, patient journey mapping and/or patient stories to gain this).
Developing any improvement ideas to keep improvements focused and grounded.
During the early stages of prototyping

Scenarios and personas example

Imagine an elderly patient with poor eyesight arriving by taxi at the front door of an outpatient clinic. He moves slowly inside (he has a walking stick) and sees a long queue in front of the reception.

The fuller persona would give more detail about his condition, needs, abilities and so his likely response to the queue.

A full scenario would describe the different things that might happen next as he tries to get the service he needs. For example, does he join the queue without question, or does he stop and look around to see if it is the right queue? If he looks around, what signage might he be able to see, if any? Or does a staff member greet him and offer help?

Scenarios and personas work best when based on realistic 'extremes', as in the example given.

They help you notice and amplify experiences that otherwise go un-noticed. They also prevent you defaulting to the 'average' patient or 'average' service delivery, which inevitably leads you to making merely 'average' improvements!

Steps

1. Identify and profile service scenarios of interest

Identify the service times and places where the issues occur or where you would like to make improvements. If you have explored patient experiences, you will be aware of the times and places where difficult experiences occur.

To create a scenario, simply list the elements of the scene, including anything that contributes to patient difficulties. To help, you might imagine you are setting up a film or stage set. What things and people need to be there, and how are they arranged? What happens in the scenario?

It is useful to avoid 'average' or 'typical' scenarios - be more specific and use extremes to accentuate and explore issues. For example, if the scenario is based on an outpatients clinic, make it very busy ? noisy, full, long queues, stressed staff, anxious patients and so on.

Make sure you focus on the exact time and place. For example, if you are exploring letters written to patients, base your scenario in a kitchen or living room where the letter might be read.

It can be very helpful to quickly sketch the scenario and make notes next to it - this helps document what it is and why you are exploring it. Then evolve the sketch as you learn - it's a very easy way to record your learnings. Keep your sketches very basic - don't worry how pretty the sketch looks.

2. Identify and profile patient and staff personas of interest

When you have your scenarios, develop your patient and staff personas.

Start by giving the person a name and then bring them to life. List their demographic qualities (age, gender, ethnicity and education); their physique with their physical abilities; their psychological state and abilities and their social supports. Do this for both patients and staff.

It can be very useful to sketch the persona (stick figures with a bit of detail are fine). Sketching often helps make the person more real.

3. Create full scenarios with personas

To create a full scenario with personas, start by taking a basic scenario and putting the relevant personas into it to develop a brief story about how things would normally work. As you do this, include issues and how staff and patient personas react to them.

Example: scenario with persona

Scenario: a patient is in bed on a shared ward. It is visiting hours and the room is full of visitors.

Persona: The patient has had a sleepless night and is distressed by the noise and activity of the visitors. She calls a stressed staff member and complains. The staff member feels powerless and somewhat annoyed but tries to respond positively.

4. Insert an improvement and experiment with it

To use the scenarios and personas to evolve an improvement, start by inserting the idea into the scenario. For example, the improvement might be a heavy, sound-deadening curtain that closes around a patient?s bed space.

Example: adding an improvement

The patient might ask a visitor to close the curtain for them. Or the staff member might agree that the room is noisy and close the curtain. Or the patient might try to get out of bed and close the curtain themselves.

Each of the variations in the scenario helps you to explore an idea and its implications. For example, a curtain might need to be especially high to help block out noise. It might need a special track to make it easy for a patient to open and close. Its outer face might feature a request for visitors to talk quietly.

Scenarios and personas allow you to experiment, create, learn and evolve your improvement ideas in a realistic way quickly and easily. There are no right or wrong answers, so be brave and explore freely.

05. Document your work

Make sure you document your scenarios and any implications or new ideas. It often helps to have a note-taker observing the 'scenario team' as they imagine the scenario, so the latter can concentrate fully on this.

You can use the scenario template below to develop a comprehensive range of scenarios and personas that explore an issue or improvement idea fully.

Scenario template

Template Instructions

Identify the issue you wish to explore. Identify worst and best service extremes of the issue. Give each one a short, easy name
Identify the easiest and most difficult patient types. Name these too.
Combine your extremes of service delivery and patients into scenarios. Give these scenarios names.
Plot these on the diagram. Try to have one in each quadrant. For example, you might combine a worst service with an easiest patient type.
Flesh out each scenario with details.
Introduce the improvement into each scenario and experiment with them!
Document your learnings as you go.

Tips

Make your scenarios and personas realistic. Be consistent with the scenario and persona - don't 'change the rules' halfway.
Go for extreme scenarios and personas, using these to amplify the pros and cons of a problem, its possible solutions and the implications of these.
Make your sessions relaxed and fun. Encourage experimenting and playing with different options. Prevent any judgement about whether an idea is right or wrong - just try it out and see what happens.
If you can, use role-plays rather than just discussion. Even very simple role-plays are useful. Are you shy or reluctant? Be brave.

Role plays

The best way to experiment with scenarios and personas is often to use role-plays and simple models of any technologies or improvements (such as cardboard cut-outs).

Role-plays are especially important when exploring intangible improvements and touchpoints (such as staff behaviours or communication) and times when people's interactions are central to the service experience.

The major advantage is that you get to experience the kind of emotions that the patient or staff member has in that scenario. For example, an acted scenario produces spontaneous reactions and behaviours by the actors - ones that wouldn't come to light without acting it out. You can then explore ways to improve the service experience for both staff and patients.

When using role-plays, it is important to have someone observing/taking notes/time keeping so the rest of the team can concentrate on acting and staying in role.

When the scenario is finished, make sure you talk about the experience of being each person in the scenario - what it felt like to be that person, why things did and didn't work for them, and so on. If you had an audience, ask them to make observations about what they saw happening and what they understood from this. Summarise what you learned from the scenario and make sure it is documented before moving on.

Example: Communicating with melanoma patients

Services involved in melanoma care at Waitemata DHB used scenarios and personas during the initial stages of their co-design work.

These were used to help scope out the work and identify which improvements to focus on.

They began by creating two patient personas to scope parameters for new service elements: a well-educated, talkative, active woman and a poorly educated, reserved, overweight man. Then they developed a service scenario, looking for places where either persona might have difficulties.

This approach highlighted the need for careful interpersonal communications right from the very start. The well-educated, communicative woman would ask lots of questions, while the poorly-educated man might need careful prompting in conversation to ensure his needs were not overlooked.

This also helped clarify that a specialist patient liaison role would be required to help 'interpret' the service for patients. And it highlighted known administration issues.

As a result, the team anticipated a need for new patient communication tools as well as improvements to existing internal systems.

A set of visual communication tools was subsequently developed to help staff and patients talk about melanoma in general and the patient's condition specifically.