Brains trust: notes from my session at UK Healthcamp

A couple of Saturdays ago, still buzzing from a week of NHS website and service manual launches, and the NHS Expo, I took part in my first UK Health Camp.

I learned loads, put faces to names I’d long followed from afar, and posed a question of my own to a windowless basement room full of thoughtful healthcampers: “What do people need to be able to trust a digital health service?”

It’s a question I’ve been thinking about a lot, because the fifth of our new NHS design principles is “Design for trust”.

I ran the session as a loose variant of the 1-2-4-all liberating structure. Asking people to think about the question first as individuals, then in growing groups, the format was a great way of eliciting contributions from everyone in the room, then distilling down to some common themes.

At the end of the session, I left the room with a stack of sticky notes on which I had scribbled the key themes as groups reported back. Below is a summary with my own grouping and interpretation of the themes after the event.

The weighing of trust starts before we use a service, as we evaluate it to see if it’s going to meet our needs.

A few groups in the session talked about relevance: will it help me achieve what I need to do? To be relevant, a digital service will likely have to be part of an end-to-end journey, quite possibly including both digital and non-digital elements. Even in this digital world, having an offline presence is one of the things that can give a service credibility.

Once we believe a service might be useful, the next question, not far behind, is “has it been tested – for safety, practicality, and effectiveness?”

We trust things that come recommended by people we trust. Reputation matters, especially when expressed through peer recommendation. We make decisions about services in a web of relationships; a service will be more trusted if it is “culturally embedded”. In the context of British healthcare, there’s nothing more culturally embedded than the NHS.

To earn trust fully, there are things a service has to demonstrate in use.

Is it confidential? People set high standards for data protection, security and privacy. A service shouldn’t collect data it doesn’t need, and must be totally anonymous when you need it to be.

Is it personal? Provided confidentiality is assured, one of the ways a service can gain credibility is by showing information that only it should know. While anonymity is sometimes necessary, so too can be personalisation.

Is it transparent? Transparency of intent and clarity of operation are essential for any digital health service. Why is it asking me this? How did it get to that answer? Is it clear what I’m consenting to?

It is professional? The boring qualities of stability, reliability and consistency should not be underrated. If they go missing, trust in a service will be rapidly undermined.

Finally, there’s a quality of continuous improvement. Without this any trust gained is likely to be short-lived. Does the service take feedback? Is it accountable for its actions? Can you see in its present state the traces of past user feedback? “You said… we did…”

Those were the combined ideas of a self-selecting group one Saturday in Manchester. But tell me what you’d add? What would you need to be able to trust a digital health service?