Case study in progress
SERVICE DESIGNFACILITATIONINSIGHT & ANALYSISHEALTHCARE2023

Improving mental health services through the eyes of healthcare specialists

The engagement end to end: four insight lenses converge into one shared challenge picture of 15 challenges, co-created and prioritized with the clinics, ending in a roadmap toward stable and predictable operations
Role
Consultant, insight lead and facilitator (Deloitte)
Duration
3 months
Client
Helse Sør-Øst RHF / Akershus University Hospital's Mental Health and Substance Abuse division
Impact
Shared understanding of challenges, co-created improvement roadmap. Well received by leadership and published openly.

Worn-down clinicians. Growing referrals. Long pathways. No shared, evidence-based picture of why.

+83%
growth in referrals at one clinic since 2019, while clinicians grew only 38%
43 → 96
days of waiting time at the hardest-hit clinic, 2019–2023
412
patients on internal waiting lists across the three hardest-hit clinics (Nov 2023)
7–13
months of pathway duration for the same diagnosis, depending on the clinic
Two pictogram panels with years along the bottom, 2019–2023, at the hardest-hit clinic. Left: per year, three stacks of icons rise from the baseline (referral documents, clinician figures and patient figures), one icon per 20% of that measure's 2019 level. All stacks start equal in 2019; icons above the marked 2019 level are solid, and by 2023 referrals reach +83% against +38% for clinicians and +31% for active patients. Right: five calendar columns of day squares growing from the same baseline show average waiting time climbing 43, 48, 52, 80, 96 days, the days beyond the 2019 level highlighted
Development trends at the hardest-hit clinic
The approach

How we worked

Three stages: Map and Understand connected by two arrows as a circular loop, then a single arrow to Co-create and prioritize. Map: triangulate hard activity data with what leaders, clinicians, and office staff experience every day. Understand: build a shared picture of how the clinics actually plan staffing and run patient pathways, not how the routine descriptions say they do. Co-create and prioritize: co-create solutions and a shared roadmap.
Insight approach

Four lenses on the same system

The project combined a service design approach to research with Prosjektveiviseren, the Norwegian public-sector project framework, and examined the clinics through four lenses:

01 · Data analysis
Activity data from the hospital's clinical and staffing systems (DIPS, GAT, Power BI): referrals, clinician capacity, active patients, and waiting times, 2019–2023.
02 · Interviews
Conversations with leaders, psychologist and medical advisors, clinicians, and office managers at the three deep-dive clinics, about how the pressure actually lands in their day.
03 · Journal review
Patient records for two diagnosis groups (recurrent depression and ADHD), reviewed together with leaders and clinicians: were treatment plans used as living tools?
04 · Document review
Governing plans, guidelines, and role descriptions. Had the division set the clinics up with clear roles and responsibilities?
Findings

Five places where the system worked against the people in it

Staffing planned by habit
Next year's staffing was based on this year's, not on patient demand. With referrals surging, clinicians were assigned new patients weekly; the 30-patient list target was routinely exceeded.
Operations run day to day
Exact appointments were only booked about one month ahead, against a six-month requirement. Patients beyond that got tentative slots, and joined internal waiting lists.
The invisible long-runners
A surprisingly large share of "active" patients had started treatment years earlier. The scale was unknown to the clinics themselves. Capacity was being consumed without anyone deciding it.
Same diagnosis, different journey
Average pathways for the same diagnosis varied from 7 to 13 months and 11 to 24 consultations between clinics. Variation without a visible clinical rationale.
Treatment plans as paperwork
Where treatment plans existed, they were static template documents. Evaluations were hard to trace, so nobody had a working overview of where each pathway stood.

Underneath it all ran one human thread: specialists who wanted to give good care, squeezed between targets they couldn't influence, tooling that made routine work heavy, and lists that never got shorter. We synthesized the full picture into 15 distinct challenges.

The structure of the challenge picture: each challenge mapped to its consequences and underlying causes, with four representative challenges shown and eleven more indicated
The challenge picture: 15 challenges, each mapped to consequences and underlying causes
Co-creation

Prioritized by the people who live with the problem

I designed and facilitated two workshops where leaders, clinicians, and office managers did the work together.

Workshop 1
Common understanding
Making sense of the research together. Every challenge was discussed and placed in a prioritization matrix: the operational effect of solving it against the effort required, from quick fix to radical change. The top challenges moved on to the next workshop.
Workshop 2
Co-creation
Multidisciplinary groups shaped solutions to the prioritized challenges and placed them into a shared roadmap.
Prioritization matrix with 15 anonymized challenges placed by the effect of solving them against the effort required, from quick fix to radical change
Effect of solving each challenge vs. effort required (challenges anonymized)
Roadmap with anonymized initiatives across three half-years in four lanes (leadership, staffing planning, capacity, and patient pathways), converging on the goal of stable and predictable operations
The roadmap format: three half-years toward stable, predictable operations (initiatives anonymized)
Retrospective

A challenge picture the organization recognized, and a plan it helped write

The engagement was delivered as a report to the hospital's CEO, the division director, and the CEO of Helse Sør-Øst, and published openly on the regional health authority's website. The report was well received by leadership. Because employees from every level had shaped it, the work created engagement that a traditional audit rarely does.

A public, board-level report
A thorough, evidence-based challenge picture delivered to hospital and regional leadership, published openly.
A co-created roadmap
Improvement actions across three half-years, prioritized by effect and effort, owned by the clinics themselves.
Early effects during the project
One clinic introduced half-day assessments along the way, already reporting the desired effect on continuity and treatment start.
Engagement at every level
Leaders, advisors, clinicians, and office staff all contributed, turning an audit into a shared improvement effort.

What I learned

Specialists are users too
Service design usually centers patients. Here, designing the inquiry around clinicians' reality revealed problems no patient survey would have found.
Audit and design are allies
Audit-grade data gave the design work credibility; design methods gave the audit empathy and ownership. Each made the other land harder.
Shared facts unlock hard talks
Prioritizing painful trade-offs became possible because everyone argued from the same evidence, not from anecdote against anecdote.
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