Weeknote: 15 to 19 April 2019

Paddling pool in garden

A four-day week. Phew!

1. What goals were met?

This morning (Bank Holiday Friday) I submitted the final version of my first piece of written work for the NHS Leadership Academy Bevan Programme. I’m grateful for the detailed feedback of my learning set peers, who now have to decide whether it makes the grade.

In doing this work:

  • I had to reflect on key strands of my values and practice, and the influences on how I lead. I recognise my privilege and the resulting ease with which I have been able to progress in my career, given opportunities that other do not have.
  • Based on 360 degree feedback, I have focused on two aspects of the healthcare leadership model – “leading with care” and “holding to account” – and the tension between them.
  • I’ve tried to connect my professional practice of user-centred design to how we make a difference to patients and staff, and how digital should serve diversity.
  • I’m clear that in order to progress to an exec level, I need to change myself, and become more familiar with the NHS’s expectations of board-level behaviour, as well as evaluating the possible paths to that role that might be open to me.

2. What inspired me this week?

  • A good catch-up with David, the designer on the e-referrals service. He showed me a prototype he is working on, using the NHS.UK frontend, and we discussed the development of patterns and standards for systems used by professionals.
  • The enthusiasm of volunteers on our NHS Digital leadership programme, who are going to help improve our Digital Services Delivery profession’s communiation and support to people outside the profession.

3. What connections did I make?

  • An introductory chat with a colleague who is leaving soon, and handing over some work to me. I’m getting involved on an interim basis with the Building a digital ready workforce programme.  It’s a topic I care about a lot, and I’m looking forward to working with people across the different organisations involved.

4. What capabilities did I build?

  • A call to learn more about the capabilities of the Pluralsight learning platform. How meta is that?

5. What do I need to take care of?

  • With performance reviews coming up, and a change to our line management model, I’m concerned to make sure that everyone has the right person doing their performance review, and that good objectives are set for the next 6 to 12 months.

Happy Easter!

Weeknote: 8 to 10 April 2019

Close-up of text on screen “Find a”

Another short week because I took Thursday and Friday off.

1. What inspired me this week?

  • The openness of the conversations in our product development directorate all hands events. Our exec director, Wendy, and her directors are responsible for more than 600 people between them, so I’m sure their decision to run these events multiple times in different locations was the right one, enabling better quality conversations in smaller groups.
  • We had a practice leads call for my profession, Digital Services Delivery. The leads are all supporting their communities of practice brilliantly through a time of organisational change, and doing this on top of their dayjobs work on products and services. (I thought better of the word “dayjobs” there: unless you actually work nightshifts, everything worth doing at work is part of your dayjob.)
  • A conversation with Trilly, who is product manager for some new work to help people “find a health service”. Trilly inspired me to write a long-overdue blog post about what I mean when I talk about service.

2. What connections did I make?

  • I was privileged to be part of a group, convened by Stephen Hart of the NHS Leadership Academy, of people who were “new to the NHS” in senior roles. There are huge variations in people’s joining experiences, and some common themes and things that we could do to support newcomers better. As someone responsible for a whole profession group that’s new to the health service, I think we could benefit a lot from being part of this community.

3. What do I need to take care of?

  • We had to send a clarification message out to some members of the profession who had got mixed messages from two separate staff communications a few days apart. Over the next few months, I’ll need to keep on top of communication – the right message, to the right people, at the right times and the right channels. It seems to me that this is a basic component of what the NHS Leadership Model calls “leading with care.”

4. What am I learning about myself and my context?

  • I spent the train time home from London on Wednesday re-reading feedback from my learning set peers on my first piece of written work for the Nye Bevan Programme. For the next draft, I need to reflect more on my own values and practices as a leader:
    • As a well-off white man, how do I think about the roles of privilege and “luck” in my career?
    • How do I get better at holding myself and others to account, while continuing to lead with care?
    • How do I better connect what I do as a user-centred design leader to the things that make a difference for patients and workers who give direct care?
    • Given my context and the shifting landscape that I work in, what would a “board level” role in the NHS look like for me?

What I mean when I talk about service

Message in ketchup on counter: “We waited 30 min NO SERVICE”

A couple of conversations recently made me realise I should write this down.

Jane tweeted: “Public Sector Digital peeps, what is now the best definition of a ‘Service’ for people not used to working in our world? The end-to-end journey which enables a user to ‘do a thing’ – am sure many have put it far more eloquently than that?”

In a private Slack conversation Trilly asked the reasonable question: “So, if ‘service design is the design of services’ – what’s the definition of a service?”

To both I had two answers, a short one and a long one.

The short answer, credit to Lou Downe and the government design community: “A service is something that helps someone do something.” (I borrowed precisely this formulation for our NHS Digital Standards Framework.)

The slightly longer, and definitely more jargoney version: “Service is the application of competences (knowledge and skills) for the benefit of a party.”

The second version comes from Steve Vargo and Robert Lusch’s marketing concept of Service Dominant Logic. I prefer this one for certain important nuances…

People need service, not services

Discussions about services plural are really about boundaries. What constitutes a “whole” service? How do I know when the service is finished? These are important questions for people designing and delivering service, but less so, I think, for users. To users, service is an uncountable noun. I work for the National Health Service, which has served the nation, from cradle to grave, for 70 years and counting. In reality, the NHS is lots of separate organisations, systems and plans. Our job as service designers is to make them work coherently so that patients never need to care about our structures.

We’re all knowledge workers now

Vargo and Lusch’s use of “competences” gets to the heart of the first “something” in “something that helps someone do something”. It doesn’t prescribe a particular sequence of steps in a customer journey. It doesn’t presuppose a digital or non-digital solution. It could be a human or non-human competence. Knowledge and skills can be encapsulated in human minds, in paper processes, and, increasingly, as software. (See also “Alexa skill”). What if the building blocks of service were not steps at all, but skills? We’re all knowledge workers now, and every service organisation is a learning organisation.

Value only in use

For service value to be created, knowledge and skills must be applied. In the world of goods, if a company makes a widget and stores it in a warehouse, the unsold widget appears at once as an asset on the company’s balance sheet. In the world of service, if we make an appointment and the patient doesn’t turn up, or we write a web page but nobody accesses it, there is no value creation. The beneficiary is always a participant in co-creating value.

The benefit of a party

In public sector discourse, service is often transactional by default, delivered by a paid provider to a passive recipient. It’s true, many services are configured like that, but other more creative configurations of the parties are also possible. Picture, for example, a diabetes education course where a group of newly diagnosed patients support each other. In that case, who is the “provider” and who is the “recipient”? So I like the vagueness of “the benefit of a party” or “beneficiary” as a more inclusive term than “recipient” or “user”.

“Service is the application of competences for the benefit of a party.”

That’s what I mean when I talk about service.

Update, 14 April 2019

Caroline challenged me to say that again using simpler words. My best attempt:

“Service is doing what you can to make stuff better for someone.”

Weeknote: 1 to 4 April 2019


Wallpaper with an H monogram

A 3.5 day week at work because I took Thursday afternoon and Friday off and went to a play with my family.

1. What goals were met?

  • the NHSX website launch! Testament to the power of making things open and investing in teams.

2. What inspired me this week?

3. What connections did I make?

  • I gave a presentation at the Royal Society of Medicine (slides here). Good questions and discussions. I was sorry not to be able to stay for the whole day.
  • A good chat with someone on our internal NHS Digital leadership programme who might be able to help with the Digital Services Delivery profession that I lead.

4. What goals were set?

  • We got clearer timelines and scope for the next wave of NHS Digital’s internal reorganisation.
  • My director, Ian, asked me to pick up ownership of a couple of things from people who are leaving.

5. What do I need to take care of?

  • Andy’s post, linked above, is a reminder of how important it is to let colleagues know that we value them for who they are and what they do. This will be especially important for those affected by the reorganisation over the next few months.

Weeknote: 25 to 29 March 2019

Posters of NHS digital design principles 5, 6, and 7

1. What inspired me this week?

  • Meeting up with my learning set peers on the NHS Leadership Academy Bevan Programme. Our set facilitator, Caroline, is incredibly skilled at creating the conditions for safe and productive conversations
  • Extended senior leadership team meeting with Wendy, our inspirational exec director
  • The NHS.UK team taking a sprint out of their normal work to prototype, test and build a website for X – keeping it user-centred, and putting the NHS.UK Frontend through its paces

2. What connections did I make?

  • Linking Darren at the NHS BSA with Emma, one of our product heads, to talk NHS Numbers
  • The first of what I hope will be many chats with Martyn, another new profession lead. We’ll need to work closely over the coming months

3. What caused the cold that wiped me out for a day and a half midweek?

  • A virus
  • Leaving my hoodie in the car when out for the day at Newstead Abbey, Lord Byron’s ancestral home
  • The curse of Lord Byron’s skull cup

(You decide!)

4. What goals were met?

  • Quite a few year end things wrapping up this week, including work from a supplier team who have been working closely with NHS.UK for the past couple of months. Deliverables delivered and batons passed to our in-house team
  • The service manual team who have met many of our ambitions set out in the NHS digital, data and technology standards framework, including: accessibility guidance, a content style guide, look and feel and interaction patterns and components, the NHS.UK front-end toolkit and prototyping kit. It’s already helping teams make things better and faster.

5. What do I need to take care of?

  • There were some conversations I found frustrating at work this week. As designers, we care about consequences. We solve problems in the world as it is. (NHS design principle #2 is “Design for the outcome”.) But I found myself talking at cross-purposes with people who had taken a rules-based approach, for whom considering consequences seemed irrelevant or even illegitimate to their task. Challenge for next week: find a different way to have those conversations.

Weeknote: 18 to 22 March 2019

T-shirt that says: “Make things open, it makes things better”- thanks to Terence Eden!

1. What inspired me this week?

  • Seeing Caroline working with Zoe, a graduate who has just moved into the NHS website redesign team. When we put skills transfer into our contractors’ outcomes, we really mean it.
  • FutureGov kicking off their work with our Urgent and Emergency Care team in London, while simultaneously in Leeds Tero, Rochelle and Michael were running a service design workshop on Type 2 Diabetes for their “Empower the Person” colleagues. (You wait ages for a portfolio-level service design workshop and then 2 come along at once.)
  • Reading the draft submissions of my peers in my Nye Bevan Programme learning set. Can’t wait to meet up with them all on Monday.

2. What did I learn about myself?

  • Thanks to Sally in our OD team for helping me interpret the feedback from my Healthcare leadership model 360. My line manager, peers and direct reports all said nice things, but also gave me pointers to ways I need to be a better leader. Of the 9 leadership dimensions in the model, I’ve identified “holding to account” as the area I need to work on most.

3. What goals were met?

  • We supported the team going for a service assessment that I mentioned in last week’s note. Fingers crossed for them. Whatever the outcome, we will use the assessment feedback to make things better.

4. What goals were set?

  • I proposed some criteria to be applied as our organisation changes its line management model. The intent behind the change is good, and I want to make sure it works out well for the people in the profession that I lead.

5. What connections did I make?

  • With Mohammed and Trilly, I spent some time talking project management and HR colleagues through our delivery management and product management roles.
  • In a few conversations this week, I came back to the interdependence of clarity – the expectations of quality set out in our standards and design principles – and  capability – delivery organisations having the knowledge, skills and experience to meet those expectations. It’ll take plenty of both to transform the way the NHS does digital.

6. What do I need to take care of?

  • This week brought home to me the need to lead our people with care through a time of reorganisation.
  • I also need to think about my own professional priorities over the next few months. There’s lots I want to achieve, and an uncertain window of opportunity to do so. I can’t do it all, at least not on my own, and not all at once.

Weeknote: 11 to 15 March 2019

I’m trying a different format for weeknotes to see if I can be more consistent in keeping up with them if I limit myself to a few simple questions. Thanks to Sam Villis for the definitive survey of weeknote styles which I’ve used to choose this format. If I’m doing it right, the questions will vary week to week. Here goes…

1. What inspired me this week?

  • Meeting the shortlisted candidates for our NHS Digital User Centred Design Graduate Programme, and getting to spend time with my brilliant colleagues who volunteered to help out at the assessment centre. Growing the talent of the future has to be time well spent.

Team photo of all the user researchers, designers, content people, and graduates who helped in the assessment centre for our first ever cohort of NHS Digital user-centred design graduates
  • Meeting design master’s students at the Royal College of Art. They asked many smart questions about designing for health and care.

2. What connections did I make?

  • Spent a couple of hours in the user research lab with the National Data Opt Out and NHS App teams. For several of our teams, 2018 was a year of minimum viable product to get the basics right, one service at a time. Sitting in the observation room with members of both teams together, I understood how 2019 will be the year we connect all that stuff into coherent user experiences that work together to fit our emergent understanding of users’ goals.

3. What capabilities did I build?

  • I joined designers, developers, and testers in a session of accessibility training with Alistair Campbell of Nomensa. Alistair had tailored the training based on manual and automated testing of the NHS website, and used examples from the site to show us where things could be improved.
  • Conducted second interviews for a lead researcher on the NHS website. Exciting news on that soon.

4. What goals were set?

  • I uploaded my learning contract for the NHS Leadership Academy Nye Bevan Programme. The learning contract describes how I will demonstrate to myself and my peers in my learning set that I have met the programme learning objectives. I also ran through this with my director, Ian, who was encouraging and made helpful suggestions.
  • Picked up a high priority action to help one of our teams with their forthcoming service standard assessment. I was pleased we were able to pull together trained assessors at very short notice for a mock assessment on Monday.

5. What do I need to take care of?

  • One of our teams is feeling under pressure because a few people have left and we’re still in the process of replacing them. The work to bring in replacements takes up the team’s time too, so colleagues need to go easy on them in the meantime.
  • With all those brilliant, high-value things this week, I got to Friday having hardly made a dent in my email inbox. Around mid-week I took a hard look at the gaps in my calendar and identified the things I realistically had a chance of getting done by the end of next week. Note to keep prioritising, delegating and saying no to lower value work.