Today it’s six months since I started at NHS Digital. Along the way, I’ve written a bit about how we work on the NHS Digital Transformation Blog. For today though, I wanted to share some personal reflections here on my personal blog. I’ll do it in two parts, starting with the digital experience we deliver, and the platform for learning and delivery. Part two has more about building a team and design capability. These thoughts may not all reflect the opinions, strategies or positions of my employer — but I’m working on that :)
I’m still learning about the breadth of digital experiences we need to enable in health and care.
In every show and tell I’ve attended, every research session I’ve observed, there are unique nuggets of insight that show the sheer scale and diversity of the user needs we are here to meet. But there are some themes that come up time and again.
Simpler, clearer, kinder. Even more than other public services, we owe it to our users to make everything simple and clear. Many patients are the unrivaled experts in their own histories and conditions, but clinicians hold the medical knowledge and experience. Service insiders see and do procedures many time a week that their patients may encounter only once a lifetime. People who can perfectly well navigate complex services when in the best of health come to us at a low ebb. Fear and urgency act as temporary cognitive impairments. We need to make things simple, but never simplistic. We need to find ways to support people along journeys that seem straightforward in the abstract, but have many twists and turns as individual lived experiences. Often the best thing digital service can do is to get out of the way.
Sometimes an answer is not the answer. There’s evidence that people with knowledge, skills and confidence in managing their own health and care have better health outcomes across many conditions. This “patient activation” means moving beyond a learning paradigm of knowledge transmission – to a coaching-led approach, in which users construct answers that make sense in their own lives, and make up their own minds, with appropriate support. Before we get carried away about artificial intelligence, let’s build on our users’ human intelligence.
Design for humans, together and alone. Even when delivered by a cherished nationwide institution, healthcare is always personal. This plays well to our practices as user-centred designers. Throughout design and delivery, we aim to involve the individual beneficiary of the service. In health, however, that user is rarely one person, alone, accessing the health service for themselves. We must broaden our perspectives to perform not just person-centred, but family-centred, locality-centred, even population-centred design. The further down that list we venture, the more we must borrow tools and techniques from other disciplines, from policy and the social sciences.
Own the line of visibility. The line of visibility on a service blueprint separates the stuff that happens “frontstage” – seen by the service user – from “backstage” activities that may be just as vital to the delivery of the service but need not be witnessed by its beneficiary. Sometimes the curtain is there for a reason. To glimpse behind it would be a needless distraction. Sadly, many NHS communications are still filled with backstage jargon. That only baffles and disempowers the public. On the other hand, information may be withheld because it is wrongly assumed to be of no value to other parties. Letting people see behind the scenes can put them in control, and make them creative participants in the improvement of our service.
I can see the makings here of a platform for innovation across health and care.
One of the most rewarding days so far was the one I spent with colleagues and collaborators thinking about design principles for health and care.
This system is complex, in a Cynefin sense. We cannot control and understand it all, but we can probe and learn what patterns of digital intervention work in different contexts. The people who succeed here do so by working with, not against, the networked nature of the NHS. If we can grow enough of those people, and make it easy for them to run safe experiments, then we’ll have a platform for lasting system change.
A learning platform. We start by understanding the intent behind the things we’re trying to make. We prioritise and make decisions based on the best evidence available. Working at pace, we make prototypes and test to see if they have the impacts we intend. Sometimes it takes time for these impacts to be felt at the point of need. But when felt, they’ll be stronger, and scale faster, because of the care and attention put into learning in tandem with delivery.
Emergent patterns and standards. When I see a piece of work from one of our teams, I often ask myself, ‘are we trying enough different ways of doing this?’ We need to diverge before we converge on proven solutions. Only patterns that have proved themselves should make it into our pattern library and service manual.
Everybody wants to help. It’s been humbling how many people have been in touch wanting to help with design for digital in the health service. Thanks to all of you, and apologies to those I haven’t yet managed to meet with. We have lots to do here, and will need help in many different forms.
Read on to part two.