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Improving Improvement

A toolkit for Engineering Better Care


Service Users

A service user is someone who is a direct beneficiary of the service that is improved by use of this toolkit.




Descriptions of potential service users are useful in reminding an improvement team who the service is for. Knowledge and understanding of the needs and aspirations of such users, their clinical and care requirements, and their capabilities and limitations in receiving the service, provide crucial insights for those designing and improving care. A useful way to capture and convey descriptions of these users is to use personas, or caricatures of people, designed to display certain pertinent attributes.

Personas can be used to represent different groups of people, describing not only typical users, but also a range of non-typical, or rarer, characteristics of individuals. They can also be used to deliberately emphasise certain characteristics or behaviours as a means to ensure that the service is designed to be as inclusive as possible. Personas are fictional characters, but can be inspired by knowledge of real people. They can represent members of the general population or be chosen to be more representative of a particular patient or care population.

This section describes a number of personas, representing people at different stages of the life course. The are typical of personas in that they convey some personal information about the individual along with a more factual description of their condition or capabilities. They are intended to represent a wide spectrum of the public, with no particular bias towards any clinical condition, and inspire the creation of further, and potentially more bespoke, personas as required.

Personas represent real people. They help system improvement teams to keep in mind the needs of patients or the public in their work. As a result, it is important that the personas used in any given programme of improvement form a representative set, describing all possible patients or service users.

Personas should be named and annotated with simple demographic data and details of their medical condition. In addition, their goals, challenges and habits should be presented, remembering that patients are also people. Sets of personas should have complementary descriptions, representing the population of service users, and may be related or linked in some way.

Personas inspire creative thinking when improvers are trying to conceptualise new services. They also provide assistance in the evaluation of the performance of current or new services. In both cases, improvers, putting themselves in the shoes of personas, can reimagine how a service performs or might perform from the perspective of each persona, arguing the case for particular consideration of their individual capabilities and needs. This ensures that services are improved with a wide range of service users in mind.

The selection or creation of personas is an important step for any improvement team and due thought should be given the role and value of using such personas in the improvement process. There should be clarity and consensus on what constitutes a sufficient set of personas for this task, in order that new personas can be created or existing ones selected and the completed set circulated to the team.

Finally, it is important to note that while personas provide a convenient reminder of the needs of service users, they are no replacement for engagement with real individuals. Hence, the challenge in any improvement programme is to find the appropriate balance between the cost and benefit of learning from literature, data, protocols, personas and real people.

Useful toolkit resources: Cards for each of these personas are included in the Resources part of this toolkit. A number of blank cards are included to allow additional personas to be added.

Text list of Personas

Pictorial list of Personas

You can click on any of the images below to find out more about that persona.

Cards for each of the personas are available in the boxed version of this toolkit. If you would like further information on how to get hold of these cards, please contact



Tomasz is fifteen months old with a history of viral chest infections. This causes his parents some distress. He is otherwise a healthy, active toddler who is into everything.

What matters to Tomasz:

  • I need my parents to speak for me and help me when I am sick
  • I can fall ill very quickly and can bounce back just as fast
  • I need to be cared for by a team with experience of people my size

Back to text list of Personas     |     Back to pictorial list of Personas


Sam is a nine-year-old who has a congenital heart condition that requires regular monitoring in hospital. She is very bright, enjoys school and is keen to participate in activities with her friends.

What matters to Sam:

  • I need lots of reassurance when asked to do something
  • I am often in hospital and like it when people recognise me
  • I want to be included, but need my parents to make decisions for me

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Jaden is a young adult with a history of anxiety and depression that is now affecting his studies. He is coping with life away from home, sharing a house with other students in a busy part of town.

What matters to Jaden:

  • I do not need my parents or sister fussing over me
  • I do not know why I feel anxious or sad and would like to feel better
  • I like to be part of the gang, but also need some time on my own

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Maria is the mother of baby Tomasz, whose bouts of croup cause her and her husband much distress. Tomasz has recently been hospitalised and she now becomes very anxious whenever he is ill.

What matters to Maria:

  • I am scared when Tomasz has croup and need to know what to do
  • I need to be taken seriously when I know something is wrong
  • I am reassured when the doctors understand young people

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Jess is thirty and was recently diagnosed with breast cancer. She faces a combination of chemotherapy, invasive surgery and radiotherapy. She lives near her mum who helps with the children.

What matters to Anusha:

  • I am scared since my sister died a few years ago from cancer
  • I am not sure how to cope with treatment and look after the twins
  • I want to know more about my cancer and what I have to change

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Jim is nearing sixty and finding that not everything is now working as expected. His fitness has been compromised by too many business lunches and little time for his earlier outdoor hobbies.

What matters to Jim:

  • I would like to lose some weight and I worry about diabetes
  • I am finding reading and night driving increasing difficult
  • I am always pleased when the hospital calls me in for tests

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Elias is in his seventies and generally in good health. He is the main carer for his wife, Ingrid, who has dementia. He used to go to watch the football, but now feels uneasy leaving the house.

What matters to Elias:

  • I find it very difficult when Ingrid becomes agitated or aggressive
  • I often feel lonely in my own home and look forward to seeing visitors
  • I do not like being separated from my wife

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Rose is a frail 80-year-old who lives alone. She has diabetes, pulmonary heart disease and kidney problems. She is worried she will end up in a home and so are her family who live far away.

What matters to Rose:

  • I like living in my own home, but wish more people would visit
  • I do not understand why the colour of my tablets keep changing
  • I am very frightened that no one will find me when I fall

Back to text list of Personas     |     Back to pictorial list of Personas


Adlin T and Pruitt J (2010). The Essential Persona Lifecycle: Your Guide to Building and Using Personas. Morgan Kaufmann

Cooper A (2004). The Inmates Are Running the Asylum: Why High Tech Products Drive Us Crazy and How to Restore the Sanity. 2nd Edition, Sams.

Dam R and Siang T (2019). Personas — A Simple Introduction, Today. Interaction Design Foundation,

Goodwin K, Cooper A (2009). Designing for the Digital Age: How to Create Human-Centered Products and Services, Wiley.

LeRouge C, Sneha S and Tolle K (2013). User profiles and personas in the design and development of consumer health technologies. International Journal of Medical Informatics, 82(11):251-268.

Miaskiewicz T and Kozar KA (2011). Personas and user-centered design: How can personas benefit product design processes? Design Studies, 32(5):417-430.


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