What color is it?

In healthcare, there is a simple and necessary question that can nonetheless cause confusion, embarrassment and wasted time: "What colour is it?".

At the School of Health and Social Care at Edinburgh Napier University, we are launching a new, free digital tool designed to do one thing: provide a common, clinically relevant visual standard for communicating the colour of bodily fluids.

In lean terms, it is a poka-yoke (mistake-proofing device) based on visual management for communicating with patients. The aim is to take a process that is subjective, variable and prone to misinterpretation (asking a patient to remember and describe the colour of something) and apply a clear standard to it.

And yes, we are talking about urine, stool and sputum!

The problem: using words to describe colours

As lean thinkers, we know that ambiguity can be the enemy of quality. Yet in clinical practice, we often rely on vague words to describe things that verbal language cannot represent well.

For example, when a patient describes something as "sort of dark yellow", the clinician imagines "probably amber", but writes "concentrated" in the chart, we break the chain of accurate communication. In paediatrics, or in the care of people with neurological conditions or language barriers, this communication gap widens even further.

There is also a human problem: talking about stool is embarrassing. We rush to find the right words because, understandably, we want the conversation to be over quickly. This leads to vague descriptions and poor-quality data, which in turn can lead to less appropriate clinical decisions.

To help with this, we realised that we did not need more words, but a standardised visual control.

The idea: a visual control for communication

The "What Colour Is It?" tool is a simple, accessible website. With minimal text, it presents validated colour palettes for urine, stool and sputum.

Instead of asking the patient to describe a colour, the healthcare professional can simply show the palette on a phone or tablet and ask them to point to the colour that most closely matches what they remember.

This changes the question from a descriptive, subjective "open question" into an objective, identification-based "closed question". It is the difference between asking someone to describe a specific shade of blue and showing them a colour swatch. Even if the swatch is not perfect, it is a starting point for a more useful conversation about the perceived differences.

Communication, of course, will never be perfect; there will still be grey areas and situations in which the tool will not be fully accurate, but our initial research shows that the tool will help significantly.

The development: clinical, technical and lean expertise

Our development process was collaborative, with the team bringing together a combination of clinical and non-clinical expertise. One of us, Hazel, our clinical lead, is an Advanced Nurse Practitioner and lecturer with extensive experience (soon to be a PhD), as well as a synaesthete — for her, colour is practically a second language. Another team member, Stephen, brought the lean perspective, the improvement architecture and the initial concept for the solution. Manish Khatri, our web developer, made sure the tool was fast, accessible and easy to use.

During our development conversations, we realised the need to identify technically the colours we were discussing. Later, we understood that this insight could become part of the tool to be used in clinical practice. To ensure the data are robust enough for clinical records, each shade in our palette is associated with a specific HEX code.

For those unfamiliar with it, a HEX code is a six-digit alphanumeric identifier used to define colours on screens. By using these codes, we can record descriptions of symptoms much more precisely. So "straw yellow" becomes #F8F6E1. It is searchable, consistent and universal. It turns a subjective observation into a concrete data point. If you type #F8F6E1, the colour will appear on the screen.

To create the colour palettes, we carried out a systematic development process. We reviewed existing clinical posters, leaflets and charts, consolidated the information, eliminated duplicates and grouped the colours by hue. We then rationalised similar shades to avoid visual overload, without compromising the accuracy of the clinical description, a process validated by expert colleagues.

We found that there are, in fact, plenty of colour charts out there, but that they are mostly diagnostic resources aimed at specific clinical conditions or particular patient profiles. We were genuinely surprised not to find general, accessible tools for clinical communication about colour — which is exactly the role we intend "What Colour Is It?" to fulfil.

We took these prototype colour palettes to an expert panel of 13 senior nurses working in paediatrics, acute care, general medicine, surgery and neonatology. The feedback was unanimous: 100% found the tool beneficial, and most said they would use it daily.

"I think it's an excellent concept. In practice, it is always very difficult to identify truly accurate descriptors, and it tends to be quite subjective. Having a universal colour system would help with diagnosis," said one of the experts.

"It's very useful when colour can be so subjective. It gets everyone working from the same reference and makes things easier for parents, instead of them having to describe it. Older children are often embarrassed by this kind of topic, so the tool would also be ideal for them," commented another participant.

"I really liked the idea, and I have been in many situations where a tool like this would have been particularly useful for accurately identifying colours, supporting patient assessment," said another nurse.

The people we spoke with were clear about what would be needed for the tool to work in practice: it had to be free, work offline (since hospital Wi-Fi is often unreliable) and be adaptable for use on mobile devices.

That is exactly what we built!

The reflections: lean thinking in practice

This project is a practical example of lean problem solving. We often try to solve communication problems with more training or longer forms. By observing the process, we realised that, as is often the case, the simplest solution is the best.

By applying a visual control, we achieved several benefits at once:

• Standardisation: everyone works from the same reference.
• Efficiency: the process of taking the clinical history becomes faster.
• Dignity: it reduces embarrassment and social friction for the patient.
• Safety: it highlights important symptoms that could be lost in translation and ensures more accurate records of the descriptions patients give.

The response to the launch of our test website earlier this month was excellent, with people accessing the tool in many parts of the world.

Moving forward: small changes, big differences

We have always believed that small changes, well executed, add up to a big impact. This tool is not a multi-million-pound business transformation. It is a simple, elegant solution to a complex and sensitive problem. And if it scales? It will produce a far greater impact than any multi-million investment.

The tool is currently available as a trial. We are inviting the global lean healthcare community to test it, explore it thoroughly and tell us what works. We are collecting usability data and will refine the palettes based on real-world feedback. You can find an e-mail address for this on the website or use the feedback form available there.

We want to move away from some of the "guesswork" in clinical colour description and toward a future in which colour is a more reliable data point. So, the next time you ask a patient to describe the colour of something and they are lost for words, don't ask them to describe it. Ask them to point.

Visit the website, share the tool with friends and colleagues and, if you are a healthcare professional, don't forget to bookmark it so you can find it easily when you need it.

You can access the tool for free here.