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At ThoughtWorks we wanted to look deeper into the User Experience challenge of getting healthcare when a person is non-binary. Once we defined the problem space, we then looked at what could we do to make a change. Oh and like you didn’t see the pun coming!

There are big changes needed, like lobbying NHS England to include Non-Binary (or X) as a gender marker. These will take time.

We wanted to use our Agile and Lean principles to find ways to address the problems.

We got together, via an open call, a small but enthusiastic group of both patients and medical professionals (mostly nurses) and started to look at what could be done: what are the minimal things that would improve the experience of a non-binary person interacting in a healthcare environment?

We decided to focus on changes that would have minimal impacts on software - sounds odd for a technology company, until you look at Lean principles. We want to prove these ideas out before we have to ask anyone to put money into development.

The three solutions we came up with cover all situations - from initial greetings to bed bound admissions - and give the patient the care and attention they need, and the medical professionals the information they require.

One: Ask “Which pronouns do you prefer?”

When a nurse or any other healthcare professional reads a name, they are prompted to ask, “What should I call you?” - because Robert might be Bob, and Margaret could be Rose. At this time, asking pronoun is going to be natural and easy - and it’s the right time.

Adding a pronoun to a form isn’t a huge thing - and it can be hand written in.

This can happen in all interactions where someone is meeting and checking in with a patient.

It is simple. Add one question.

Two: Ask “What hormones do you make and what do you take?”

When looking at medication, hormones need to be taken into account. There are reasons why anyone will be taking hormones: cis men will take testosterone, as will cis women of a certain age for different reasons.

Asking in a clear way about hormones, and not making assumptions about bodies, will allow everyone in this conversation to know what hormones I am making, and what I am needing to take.

By doing so, the medication anyone is given will not have unexpected side effects due to hormones.

Medications are already listed on forms - this is prompting people to talk about their hormones, which some people may not view as medication until prompted.

This can happen with all interactions where someone is being given a new prescription, or something is being changed.

It is simple. Add one question.

Three: Ask “Would you need a bottle or a pan?”

When anyone is admitted to a hospital bed, and may at some point not be ambulatory enough to get themselves to the toilet or commode, nurses will need to know the right option to offer. Getting it wrong under time pressure is embarrassing to both the nurse and the patient, and potentially messy and traumatic.

Asking on admission what is going to be needed, and not making any assumptions about bodies, will allow everyone in this conversation to understand a patient's needs should they be bed bound.

Adding this information to a form isn’t a huge thing - and it can be hand written in.  

This can happen as part of the conversation when anyone is admitted.

It is simple. Add one question.

There we have it: three simple questions.



Our next steps are to work with an organisation to put these into practise in a pilot group. Already the nurses involved in this have taken these three questions into the field and started to use them in their wards. These are single person trials, and not systemic.

I’ve seen this work myself: as a non-binary person I’ve prompted my healthcare professionals with “My name is J and my pronoun’s They”. When we’ve talked medication, I’ve ensured there is a space in the conversation about what hormones I make, and what I take. When I was having day surgery, I ensured the team understood what was needed when I was bed bound for a couple of hours in recovery.

Knowing that these three questions covered all this journey meant I could relax. The nurses and doctors I dealt with became more relaxed as they got the information they needed without having to ask awkward questions about my medical history.

Not exactly proof it works yet - we want to test these ideas out further. Do they work beyond the British NHS system? Are these international enough? What tweakings will they need to be truly cross cultural?

Feedback and suggestions to add to the solutions most welcome!