Summary
It was noted that the standard clinic structure was not suitable for all patients, specifically those with neurodiversity or additional mental health needs. Following feedback from these families, key issues were identified, including the clinic environment, length of appointment and professionals present. A clinic was introduced specifically for patients who found the standard approach challenging. Changes included minimising the number of professionals and ensuring consistency, removing the waiting room and providing the patient with one room where they remain for the duration, a structured programme of health checks across the year and availability of appropriate resources.
Innovation/Novel approach to an existing problem
A young person attending the standard diabetes clinic initially sits in the waiting room with other young people, before going to the measurement room with an outpatient HCA and finally being called into a consultation room for the appointment. The consultation is with different members of the diabetes multidisciplinary team (MDT). It was surmised that this environment and approach may have been overwhelming for some patients, specifically those with neurodiversity or additional mental health needs. The team identified patients with complex needs and conducted telephone discussions with the parents or, where appropriate, the young person, to gather their thoughts about the clinic experience. Some of the families were happy with the current clinic structure, but eight families felt that the current approach did not meet their needs. Of these, seven young people had autism spectrum disorder (ASD) and one had other mental health needs. These seven families completed an initial questionnaire about their current clinic experience and completed an ‘About me’ sheet with information such as how the young person shows they are distressed, what techniques or approaches help them to regulate, and what activities or interests they like. This information was the basis for developing the new clinic. The features of this clinic are as follows. Only the identified families attend the clinic, with staggered arrival times, to maintain a quiet and calm environment. The family is greeted and taken immediately into a consultation room. There are only two professionals per family and where possible it is the same two professionals every time. If this is not possible, there is always one consistent person. The same consultation room is used for each clinic. The ‘About me’ information is reviewed prior to each clinic. Medical checks are kept to a minimum, depending on individual need. For example, height and weight will not be routinely done at every clinic and key health checks are planned across the year. Sensory toys and activities are available in the consultation room and the second professional focuses on the young person, allowing the parent to participate fully in the appointment. Equipment is obtained from charities. Appointment length is kept to a minimum and additional virtual reviews are given if further discussion is needed with the parents. The appointment is adapted to meet the individual need of the specific young person.
Equality, Diversity and Variation
The pre-clinic questionnaire and discussions with the families allowed the identification of the key areas of the clinic experience which the young person found challenging and was the basis for appropriate changes to the approach. The families were given a follow-up questionnaire once they had attended the child-centred clinic and feedback was very positive, showing an improved patient experience for all. The ‘About me’ information ensures the clinic experience is individualised. Social stories have been developed for attending clinic and all the different key health checks to further support the young person.
Impact to Patient Care
Patients have an experience that is more suited to their individual needs, rather than a one-size-fits-all clinic visit.
Results
Families completed identical surveys before and after attending the new style clinic. A Likert scale questionnaire was used to assess six key experience domains. Respondents rated statements from 1 (Strongly Disagree) to 5 (Strongly Agree). Improved satisfaction was recorded, with all six experience domains showing increased ratings, with five out of six reaching 100% ‘Strongly Agree’ post-clinic. Prior to the redesign, many responses were neutral or mixed. After the redesign, all responses shifted towards strong agreement. Notably, comfort and environment improved significantly, suggesting a more child-friendly, inclusive clinic atmosphere. The redesigned paediatric diabetes clinic has had a substantial positive impact on families' experiences. The environment, communication, and structure of appointments are now better aligned with the needs of the individual young person and their family. There were no additional costs to the NHS.
User Feedback
Pre-clinic families and children shared specific suggestions and concerns regarding their experiences in the previous clinic environment. Their feedback reflected needs related to the clinic’s sensory environment, communication style, and overall logistics. They noted that children may feel disorientated or stressed when moved between multiple rooms and a calm, consistent setting reduces feelings of being overwhelmed. Clear, simplified communication and familiarity with staff build trust and reduce anxiety for children. Visual supports, like picture cards, can enhance understanding, especially for children with communication needs. Predictability and brevity help children feel more in control and reduce stress. This feedback highlighted the need for fewer room transitions, predictable routines, visual communication aids, familiar and trained staff and a calm, quiet environment. These insights directly informed the design of the new diabetes clinic. Post-clinic implementation feedback highlighted the positive changes, particularly reduced waiting and movement and improved calmness and focus.
