3 years into my work at NHS Digital – part 1: this is transformation

Accessibility lab with Chromebook and large letters on wall that read: Design for everyone

Every 6 months since I joined NHS Digital in June 2017, I’ve written an update on our progress building digital capability inside the NHS. It’s a helpful discipline for me to look back and see how far we’ve come, and to remind myself what more we have to do.

Ending my 2.5 year note in December, I wrote:

I have a plan. We’re working with colleagues across organisational boundaries to make health and care more human-centred. And every week, in person and online, I encounter more people who want to do the same.

And so it has turned out.

There will be a part 2 to this report, I promise. But before I can tell you that story, I have to tell you this one.

Products and services that put people first

With our new executive director, Ben, we’re continuing to implement and iterate our product development strategy, and creating a capability that the NHS needs now more than ever.

Ben’s predecessor Wendy’s set the ambition for new programmes to be exemplars. This means employing not only user-centred, agile and iterative way of working, but also the governance and funding approaches that are right for digital delivery. We started with three pieces of work. Rochelle, our head of user research, led the establishment of user-centred design work on Cancer Screening; Tero, head of design, worked with NHS Login and the NHS App; I focused on the Book, Refer & Manage Appointments discovery.

The first step for each activity was to make sure we had the right multidisciplinary team, consistent with Government Service Standard point 6 (see also our interpretation of point 6 for NHS services). Having done that, we needed to be confident that the new service would meet users’ needs, consistent with points 1 to 5. This standard is of value to lots of teams, not just the ones that are subject to formal service assessments.

We set up show and tells where the three teams could share their work with each other. Thanks to Charlotte, our team administrator, these have become a fortnightly fixture, regularly attracting more than 40 colleagues to a Teams call.

I was really impressed by the way the Book, Refer and Manage Appointments team approached their work. They skillfully unpicked multiple layers of patient needs, policy intent, and administrative workarounds that surround appointments and referrals in the NHS. The original intent was to roll this discovery forward into one or more alphas starting in April. That had to be put on hold. All the same, there is value in what the team learned, and I’m confident it can be picked up and built upon when the time is right.

Another change arising from the product development strategy was setting up a small central design team for the directorate, with its own budget and cost code. Previously all user-centred design work had to be directly attributed to individual programmes or services, which made cross-cutting leadership hard to resource. I think we’re feeling the psychological impact of this small bit of extra flexibility, as well as the practical benefit of being able to remove operational blockers for designers and user researchers. Having been trusted with this budget, we need to prove we’re worth it, and that we can manage it responsibly.

The idea is that we can provide design leadership for all of the sub-directorates that make up the Product Development directorate. The de facto structure has shifted as our teams got stuck into some urgent new commissions, but we have worked together to ensure that priority areas sill have oversight.

I couldn’t do any of this without Rochelle and Tero. Along with leads Nancy and Dean, and supported by three of our brilliant graduate trainees, we’ve tried setting goals with objectives and key results (OKRs) to make sure that we’re working on things that matter, and that we can demonstrate impact to ourselves and others. For example, as we invest in user research operations, we’ll track the number of hours given back to user researchers to spend time on the work of research and analysis. For the user-centred design course that Tero and Rochelle have created, our measures are the number of staff who have been on the training, and the number in our team who are able to teach it.

While I have tried to set clear expectations and measures for our work as a team, I know that’s only half the story. So many of my colleagues are braver than me. They do their jobs better than I possibly could, and frequently exceed my expectations with their commitment to user-centricity, and to equality in all its forms. Not all of that can be measured, but it’s our job as managers to create the culture and conditions for them to keep on doing it.

I can see the tangible impact of this culture change in the field of digital accessibility. There’s now a lab kitted out in our Bridgewater Place site, ready for teams to test their products on commonly used assistive technology. Even though most are working from home at the moment, people are doing their best to make our products work for everyone.

Beyond NHS Digital, I’ve continued to work with colleagues in NHSX and the NHS Business Services Authority. Having these connections has proved invaluable. We’ll succeed together by creating a movement for user-centricity across national and local health organisations, and the growing number of enlightened suppliers to the sector.

Growing a profession

Alongside my direct contribution to the design of the products and services that NHS Digital delivers, I have a role as profession lead developing digital capability in our organisation and beyond.

Our graduate scheme is a big part of that. We’ve recruited more than 15 new starters to join this two-year scheme in September, in two tracks (user-centred design is one, product and delivery management the other). Thanks to Simon, the profession’s graduate scheme co-ordinator, and colleagues from NHS Digital’s academy team who ran a great selection process. When the new cohort arrive, we need to ensure they all get a good first experience of working in our organisation.

My confidence that we can look after more trainees grows in proportion to the strength of our senior user-centred design leadership. In addition to the brilliant design and user research leaders mentioned already, we’ve been lucky to bring Cate Care and colleagues over to NHS Digital from Public Health England. Several of the existing team have earned well-deserved promotions to senior designer or user researcher. And in a couple of weeks we’ll welcome Emma Parnell as a lead designer.

Having completed an organisation change process covering user-centred design roles last autumn, we were due to do the same for the product and delivery side of the profession this summer. Despite a number of existing staff transferring in from other profession groups in NHS Digital, we still don’t have enough people to fill these vital product management and delivery management roles. While the organisation change process has been put on hold for the time-being, we’re finding other ways to keep moving this forward.

If we’re going to develop digital capability across health and care, we need a clear picture of what the different roles are, and what good looks like for each one. The Digital Data and Technology (DDaT) capability framework is emerging as the best way to structure that.

In the past 6 months, I’ve worked with colleagues in NHSX and Health Education England (HEE) to promote the use of the DDaT framework in health. This culminated in two unconference events in Leeds and London, organised by volunteers from the profession and colleagues from the Building a Digital Ready Workforce programme. We were fortunate to be joined by colleagues from GDS, who run the DDaT profession across government, and participants generated lots of good ideas to advance skills in these roles across health.

Building a Digital Ready Workforce has now moved fully over to HEE, where the work has a good home and strong champions in James Freed and Patrick Mitchell. While NHS Digital no longer plays a delivery role in this work, I’ll still be involved as part of the programme board. I continue to be impressed by the small, committed team working on the programme, and the network of people from many organisations who get involved because they’re passionate about digital capability in health.

How others see me

Ahead of my performance review with Ben this month, I asked my direct reports, peers and manager for 360 degree feedback using the dimensions of the Healthcare Leadership Model.

Their assessment of me aligns pretty well to my own self-assessment – hopefully a sign that I learned something about myself on the Nye Bevan Programme last year. In particular, I was pleased to have improved in their estimation on the dimension of “holding to account”. I scored less well on that last year.

Some people have noticed that I have become more confident in influencing and leading through sharing thinking openly, voicing my options and in challenging colleagues in a constructive and helpful way. Others still tell me to be more challenging.

From my team, there’s an appetite for more development and coaching, something I must pay attention to in the next few months. I also need to be mindful that we don’t create a digital divide inside the organisation between digital exemplars and the teams that are quite a way behind in their capability.

This is transformation

All the above is the work we call digital transformation:

  • steadily developing strength and depth in our teams
  • changing the way our organisations work for the better
  • taking care of our own development
  • being mindful of the impression we make on others.

We do this so that when it matters most we’re able to apply – according to Tom Loosemore’s definition of digital – the culture, processes, business models & technologies of the internet era to respond to people’s raised expectations.

There are no shortcuts to digital transformation, no such thing as “two years of transformation achieved in two months”.

There are, however, moments that illuminate how far we’ve come – and how far we have yet to travel – on the journey of building digital capability.

And boy, as I’ll tell in part 2 of this post, have we reached one of those moments.

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