This presentation shows a rich-picture that I designed and commissioned for work with the Department of Health\’s Death Certification Programme. It was great fun to design and always had a significant impact on participants at workshops and attendees at conferences.

1. Using rich pictures
Improving the Process of Death Certification
I decided to design and commission the rich
picture shown opposite to illustrate the whole-
system within which the current process of death
certification operates. The picture tells a story to
people who are familiar with the process and is
an excellent mechanism to get everyone „on the
same page‟ at the start of a presentation or
workshop. It also allowed the inclusion of
allegorical references to issues with which many
people were familiar.
The rich picture is intended to be illustrative
rather than accurate or complete and was
See slide 2 for a full-size copy of the rich picture.
accepted as such without causing any offence.
Whenever it was used, I always offered people
an opportunity to suggest any additions or
changes.
The picture was drawn by Richard Duszczak at
the Cartoon Studio based on a “word picture”
that I provided and a number of discussions.
This “word picture” is included on slides 3-4.
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2. Current System: People, Process & Technology
Improving the Process of Death Certification
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3. “Word picture” used in design of rich-picture
Improving the Process of Death Certification
• A crooked and rickety bridge over a river. 'End-of-Life Care' on left bank
of river and 'Bereavement' (including registration, Tell-Us-Once, funeral,
counselling, probate, ONS etc.) on right bank.
• Death Certification & Bereavement Services are 'on' the bridge with the
latter guiding / supporting a bereaved person who is blindfolded and / or
bent-over holding their heads in their hands.
• A walkway off the middle of the bridge leads down to small 'island' in the
river that represents the Coroners Service with officers speaking to
police / doctors / families and either issuing Form A's or requesting post-
mortems / conducting inquests.
• The post-mortems and inquests could additional islands upstream
linked by a walkway from the first island and connected to the right-hand
bank by a bridge or possibly a well-maintained row-boat.
• A second walkway off the bridge leads to a platform for completion and
secondary certification of cremation forms - there is a rope swing from
this platform to the right bank.
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4. “Word picture” used in design of rich-picture continued
Improving the Process of Death Certification
• There are people standing on both banks of the river.
– On the left bank, these people might include: hospital and community nurses, doctors,
palliative care teams, patient safety teams, police officers, paramedics and (at the foot
of the bridge) bereavement volunteers.
– On the right bank, the people might include: registrars, local authority bereavement
support officers (using the 'Tell-Us-Once' system), funeral directors (beckoning the
bereaved forward), faith community leaders (looking at the setting sun), other relatives,
medical referees (in football boots??), cemetery / crematoria staff, bereavement
counsellors and ONS / statisticians.
• The bridge has broken handrails, and multiple / confusing signposts.
There are gaps in the bridge with things falling through to reflect
inaccuracies in the causes of death.
• The people on either side are looking away from each other to represent
the preference for focusing on using what they know to complete what
they need to get done.
• Bereaved people are being 'processed' across the bridge rather than
properly supported and listened to.
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