Stop disempowering people – a talk at Health Product People

stop disempowering people
Text on screen behind speaker: “Stop disempowering people.”

I was honoured to be invited to talk at Health Product People at the Department of Health and Social Care this week, especially so because I was on the same bill as Hadley, Ian and Kassandra, all of whom were brilliant. I loosely titled my talk “Stop disempowering people.” (Thanks to Ian for photo of me in full flow.) Here’s roughly what I said…

what is the user need.png
Text on back of phone: “What is the user need?”

This is former UK Government Chief Technology Officer Liam Maxwell’s phone. On the back he famously had the words, “What is the user need?” When a meeting seemed to be going off track, down some rabbit hole of business sophistry, Liam would show people the back of his phone. User needs are always a good place to start.

But then where? And which users, which needs?

I talked about how, in health and care, we need to consider people’s clinical, practical and emotional needs. (Thanks to Janet Hughes for framing that so pithily for us.)

I also laid down a challenge to the assembled product people: We talk a lot about empowering people. But who are we to empower anyone? Everyone starts with power; it’s our job to stop them being disempowered.

Illness, disability, social circumstances and fear can all be disempowering. So, unfortunately, can be the complexity of the health and care system, and the way we treat people within it.

Recently I heard the story of someone who had lived with anxiety, and had developed their own ways of coping with it. Things went downhill for them the day they were referred to a service with a long waiting list. While in that limbo, they were disempowered – they knew they needed professional help, but had no way of accessing it. The service had taken someone who was managing, and disempowered them, made things worse before making them better.

Digital service, done right, can help people to recover their power over their own health and care.

I gave the example of a new section on the NHS website about Type 1 Diabetes. Our team identified that the point where people most needed help was in the weeks and months after getting a new diagnosis. Instead of structuring information around a clinical taxonomy, or around the way our services are organised, they created a section just for people who were newly diagnosed. By bringing together some key information in a simple package, they could help people take charge of their own health and care at a time when there’s a chance of being overwhelmed.

I might have subtitled the talk “People showing their phones”, because in addition to Liam’s phone, I also showed this picture…

pointing at phone.png
A health and care worker pointing at her very old, battered, dumbphone

It’s from research I did before I joined NHS Digital, as part of a discovery for Leeds City Council and m-Habitat [PDF link – sorry]. We were investigating how health and care professionals could increase their digital capability. But often, the barriers turned out to be more basic than capability. Research participants would show us the battered dumbphones they’d been given to do their jobs. Fix this first, they’d say, then we’ll be interested in the digital tools you have to offer.

We met social workers who were trusted to go into difficult situations, and make decisions with massive implications for families’ futures. Yet they hadn’t been trusted to connect to the wifi at a local health centre. (The situation in Leeds has, I believe, got much better since then!)

It became clear to our whole project team that if we didn’t empower our workforce, they could never empower patients or service users.

Our new design principles are intended to empower. They don’t tell people how to do their jobs – but rather provide a set of principles within which anyone can apply their own expertise, and their understanding of the situation at hand.

If we’re serious about putting people in control, we need first to free our minds of deficit thinking. I presented four manoeuvres that could help to do that.

1. User needs assets

The first, and perhaps most obvious, is to mitigate the deficit thinking implicit in the term “user needs” by remembering also to consider users’ assets – what they have and can do, not what they lack or need fixing.

Assets are a design material, something we can work with to help people achieve the outcomes they seek.

For example, a user might need to exercise more, but their love of music is the asset that suggests dance classes as a good way to get started.

2. Capability stories

Who is the hero of the user stories you write? Make sure it’s the user by focusing on the last part of the construct, the bit that starts “so I can…”

Let’s call it the capability story, something that doesn’t just solve short-term problem, but leaves the user stronger and more able than before.

For example:

  • “As a person who has just been diagnosed with type 1 diabetes, I need to learn how to count carbs, so I can control my blood glucose levels.”
  • “As a person with memory problems, I need information that’s easy to understand, so I can decide for myself.”

Or maybe even:

  • “As a visually impaired web user, I have a screen magnifier on my phone so I can read web pages, provided they’re well designed and coded.”

3. Ladder of participation

Sherry Arnstein‘s ladder of citizen participation posits that there are different levels of involvement, from manipulation, through placation, and rising up through partnership to true citizen control.

Nobody wants to feel manipulated, and when they do, it’s unlikely to achieve the manipulator’s intent.

In digital service, the most passive level is being treated as a data subject – a bundle of behaviour to be analysed and influenced.

We try to avoid casting the people who help us with user research as lab rats – not testing the user, but testing with the user, taking part in research.

But let’s not stop there. I was on a team at Co-op Funeralcare with four funeral directors who were taken off funeral duties for 6 months to help the digital team design new tools and workflows.

In health and care, we should consider patient leaders as our most esteemed stakeholders, invite them to our sprint reviews, and give them seats on our programme boards.

4. What’s strong, not what’s wrong

Finally, some questions from Asset-based Community Development (ABCD), which prompt us to consider the impacts of any intervention:

  • What will be enhanced?
  • What will be restored?
  • What will be replaced?
  • What might this mutate into?

Let’s stop disempowering people.

Thank you.

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The promise of understanding – a talk at Interact 2018

Video of the talk…

Opening video: Abridged version of Your very good health, Public info film (NHS) 1948

Cartoon baby from 'Your Very Good Health'

I wanted you to see that film – 70 years old this year – because its promise, of universal healthcare, free at the point of need, is as relevant today as in 1948. But much has changed in that time. 97% of people born in Britain since 5th July 1948 – myself included – have been born in the NHS. The cartoon baby at the end of that film is now himself a cartoon pensioner. He is living a longer, healthier life than his cartoon parents. Meanwhile medicine is transformed. We’re on the cusp of another revolution in genomics and personalised medicine.

I work for an organisation called NHS Digital. We’re the national provider of data and technology services for health and social care.

Our users are:

  • 53 million patients and the public across England
  • 1.3 million health and care professionals

We support:

  • the scientific research community who use NHS-scale data for research, and
  • the service community – the people who work every day to keep the health and care service functioning, and to make it more efficient.

As head of design, I’m privileged to work with a great team of designers, user researchers and others who together are designing and delivering some vital tools and services in support of that vision. I want to tell you about that design capability. I want to show you some of the things we’re making. And I want to think about the future of health and care, and how design has a vital role to play in realising its promise.

Design capability

Sketches of designers' faces

Let’s start with the design capability we’re building. Around 40 designers work on services used by patients and professionals across the complex health and care ecosystem. There are a few services – like the national NHS website – that we design and build as national solutions from the ground up. But for many others, the digital bit we deliver nationally is just a small part of someone else’s end-to-end service, including elements bought and built locally by NHS organisations or third-party suppliers.

The make-up of our design team reflects this:

  • 23 interaction designers
  • 10 service designers
  • 5 graphic designers

We have interaction designers working directly on the digital services we deliver ourselves. They also need a graphic design sensibility, because we’re working with one of the UK’s most trusted brands, the blue lozenge. Above this, we’re building our service design capability, to be able to design health and care services, as Lou Downe at GDS says, from end-to-end and front-to-back.

It won’t come as a surprise to anyone who knows UK government design practices that our designers work in agile, multidisciplinary teams, along with product managers, user researchers, developers and other specialist roles.

Working at health service scale gives our designers another responsibility – to talk to each other – individuals and interactions over processes and tools. As the team grows, we’re also investing in design leadership capability – to have a mix of experience and seniority, a career path, and job descriptions. I might be the only person in the team who’s excited about this, but we recently got organisational sign-off for a complete set of designer job descriptions on the same NHS pay scales as nurses, pharmacists, and managers.

When I’m explaining what we do to non-designers – and, believe me, I spend a lot of time doing that – I always fall back on Jared Spool’s wonderfully economical definition of design as “the rendering of intent.” Intent without rendering gives us a strategy but cannot make it real. Rendering without intent may be fun – may even be fine art – but is, by definition, ineffective. Every one of our designers must be able to explain the intent behind their work.

Because in health and care, intent is varied and complex. User needs for health and care services come in at least three flavours:

Overlapping circles of clinical, practical and emotional with user needs at the centre of them all

  • There are clinical needs – people expect the services we offer, and the tools we recommend, to be clinically safe and effective. But that alone is not enough.
  • To be adopted and used, services must meet people’s practical needs in the context of their lives. If that context is mobile, the service must be designed mobile first. If it’s to be used in the middle of the night, it needs to connect to services that are open.
  • Finally, it’s as important to meet our users’ emotional needs. Sometimes people go to the doctor not just for information, but for reassurance. Information could be clinically accurate, but if it doesn’t connect emotionally, the user need has not been met.

Every designer in the NHS needs intelligence and empathy. They must understand the true intent behind their services, reconciling diverse clinical, practical and emotional needs.

Text on slide: Stop disempowering people.

Too easily, people become disempowered by worry, illness, disability, or social circumstances, and (even though we don’t mean to) by the way we have designed and delivered NHS services in the past.

So we need to design for the positive role of patients and carers, to think about their assets – what they have and can do already – as well as their needs and deficits. We need to co-design with patients, staff, family carers and voluntary sector who all make up our service community.

Finally we need a continual focus on digital inclusion and accessibility, because the NHS is for everyone, and those with the greatest health needs are also the most at risk of being left behind digitally.

Hastings pier

This is Hastings, where our partners on the NHS Widening Digital Participation programme have been developing models of digital health interventions for people who are homeless or at risk of homelessness.

Show the things

For a long time, we had this quote on the wall by the team working on the NHS website redesign:

“It’s just a website, We’re not going to the moon.” Mikey Dickerson on fixing healthcare.gov

This summer, we transitioned the national NHS website to a new mobile-first, accessible platform. In 2018, this should be basic stuff really, but through a series of policy twists and turns, getting to this point was a big deal. We topped it off with a new name. In research, we asked people what they called it. And we used the words they used. So the site formerly known as NHS Choices is now simply “The NHS website.”

NHS website homepage on a phone - 48 million visits per month

It’s just a website – with more than 48 million visits per month. That’s a quarter of all health-related web traffic in the UK. People expect a different relationship with healthcare, as well as different channels to access it.

There’s good evidence that people in control of their own health and care get better health outcomes. So while we’re here as the NHS for you in the times of greatest need, we also want to help you look after your own health and wellbeing even when you’re feeling fine.

The NHS website has to be there for users in many contexts, needs and emotional states. We have to design for the end-to-end user journey – whether a short, acute, episode of care, or management of a long-term health condition. Making the whole journey visible to everyone involved is powerful, because otherwise no one professional or organisation ever sees the whole picture.

Rows of sticky notes on brown paper

One team looked deeply at the experience of people with Type 1 Diabetes. They mapped a whole journey from someone not even knowing they have a problem, through the trigger that leads to diagnosis, getting to grips with a potentially lifelong condition, and over time confidently managing their wellbeing. They found – and this has echoes in other conditions too – that the point at which the NHS website could help most is the first weeks and months after diagnosis.

NHS website page on phone: Newly diagnosed - things to help

Left: NHS 111 Online on a phone; Right: Paramedic using machinery in an ambulance

Another team has taken the triage pathways that underpin the 111 non-emergency phone service and turned them into an online service. The online service is designed to get people to the help they need while taking pressure off the telephone service. But the big picture here is important, if we get it wrong, we could send worried well people in greater numbers to accident and emergency departments.

National data opt out page on the NHS website

Confidentiality, trust and consent are big, complex issues we have to navigate. We have to understand them when delivering a simple, secure way for people to log in to NHS services. And we’re giving every patient control over how their data can be used beyond their own direct care.

Design doesn’t stop at the big picture. We also have to care about the details. Here, for example, is a page on the old NHS Choices website about paracetamol. The information on the old website was clinically safe and accurate. You’d expect nothing less of the NHS. But, in research, one group in particular – parents with young children – told us the way it mixed information about adults and children was disconcerting. They worried about accidentally giving an adult dose to their child. So we’re splitting the page in two – one about paracetamol for children, another about paracetamol for adults. That way we can meet not only the clinical need, but our users’ practical and emotional needs as well.

NHS website page on a phone: Paracetamol for children

We had to diverge before we could converge on a single set of styles. When I joined the team a bit more than a year ago, everyone was telling me we had to deal with the inconsistent styles that were springing up in different teams. But I worried we were in danger of getting stuck too soon at a “local maximum”, super-optimising the first designs the NHS alpha team had come up with. So I made myself unpopular by telling designers to spend a bit longer solving their own problems, designing solutions in response to user needs.

Left: designers reviewing printed out screenshots; Right NHS website headings and colour palette

When we did come to converge, through a process of patient design diplomacy by Dean, our lead designer, I believe the results were stronger for this extra round of divergence.

While we’re getting our own house in order, developing a consistent set of styles and design principles for the nationally-delivered NHS services, patients the public, and professionals experience a patchwork of interactions commissioned and delivered in many different ways across the wider NHS family. We want to make experiences consistent, no matter whether you’re using the national website, or a condition-specific app, or a service built by one of your local NHS organisations.

interact slides.025

So we’re publishing our user-centred design standards, patterns and practices in a new NHS digital service manual. We’re working across the system to do this, and combining good public sector practice, such as the GDS design principles, with the things that make the NHS unique. The service manual team had hoped for a soft launch, but the beta has already been well-received, and I reckon we’re going to speed up this work in the near future.

Aside from the NHS website, we’ve had a team building a beta version of a new NHS app.

Design for the future

What role might human-centred design play in realising the promise of new medicine and technology? Look at the amazing trajectory of human understanding of DNA, RNA, enzymes, proteins, the genome, and the mechanisms by which they interact. This stuff will transform – is already transforming – our relationships with medicine. Crucially this generation of scientists are looking inside a black box, where their predecessors could observe its effects but not its inner workings.

Visualisation of RNA in a cell

At the same time, fuelled by petabytes of readily available data to digest, computer science risks going the other way in the framing of artificial intelligences: moving from explicable, simple systems to ones where it’s allowed to say, “this stuff is so complex that we don’t know how it works. You have to take it on trust.”

When we apply artificial intelligence (AI) to healthcare, transparency is essential; black boxes must be considered harmful. It’s not just me saying this. Here are the words of the Institute of Electrical and Electronics Engineers (IEEE):

“Software engineers should employ black-box software services or components only with extraordinary caution and ethical care, as they tend to produce results that cannot be fully inspected, validated or justified by ordinary means, and thus increase the risk of undetected or unforeseen errors, biases and harms.” — Ethics of Autonomous & Intelligent Systems

Transparency must be the order of the day. It comes in (at least) two flavours: the first is clear intent; the second, understandable operation. Both are under threat, and designers have a vital role to play in saving them.

When any technology moves from pure to applied science, intent must be centre stage. If we fixate too much on the computer science of AI, and not enough on the context of its application, intent will always be unintentionally obscured.

Many discussions about the “ethics” of AI or genomics are really, I think, discussions about the opacity of intent. If we don’t know who’s setting the goals for the machine, or how those goals are derived, how can we know if the intent is good or bad? For health and care, we have a new code of conduct intended to make sure this doesn’t happen.

1. Define the user; 2. Define the value; 3. Be fair, transparent and accountable - Initial code of conduct for data-driven health and care technology

In the words of Professor Margaret Boden, “the computer couldn’t care less.” She says:

“…computers don’t have goals of their own. The fact that a computer is following any goals at all can always be explained with reference to the goals of some human agent. (That’s why responsibility for the actions of AI systems lies with their users, manufacturers and/or retailers – not with the systems themselves.)” — Robot says: Whatever

It’s time for designers to double down on intent – true human intent that can be difficult to encode. In a domain as complex as health and care, intent is rarely straightforward. It can be changing, conflicting and challenging to untangle:

  • a boy was triaged on first contact as in less urgent need, but has suddenly taken a turn for the worse
  • an elderly woman wants to get home from hospital, but her doctors need first to be sure she’ll be safe there
  • the parents want to help their children lose weight, but know that pester power always leads them back to the burger chain.

User-centred design must clarify who the service is for, what problem they’re trying to solve, and what benefits we expect them to realise.

Text on slide: Time for designers to double down on intent.

It’s time for designers to double down on intent, and – let’s be honest – this is not an area where design has always covered itself in glory. We know what design without intent looks like, right? It’s an endless scroll of screenshots presented without context – the Dribbblisation of design. If you think that was bad, just wait for the Dribbblisation of AI. Or the Dribbblisation of genomics.

Thoughtful designers on the other hand can bust their way out of any black box. Even if they’re only called in to work on a small part of a process, they make it their business to understand the situation holistically, from the user’s point of view, and that of the organisation.

Experienced designers are confident moving up and down the stack – through graphic design, interaction design and service design problem spaces. Should we point an AI agent at optimising the colour of the “book now” buttons? Or address the capacity bottlenecks in our systems that make appointments hard to find?

People looking at sticky notes on two walls

One of my team recently talked me through a massive service map they had on their wall. We discussed the complexity in the back-end processes, the push and pull of factors that affected the system. Then, pointing at a particular step of the process: “That’s the point where we could use machine learning, to help clinicians be confident they’re making a good recommendation.” Only by framing the whole service, could they narrow in on a goal that had value to users and could be usefully delegated to AI.

Designers are well placed to show the workings of their own (and others’) processes, in a way that proponents of black box AI never will. This is my second flavour of transparency, explainability, clarity of operation. Show what type of algorithm you are building, why that algorithm, how you check if it’s working the way you intended.

How might we:

  • communicate probabilities and uncertainties to help someone decide what to do about their disposition to a form of cancer?
  • show someone exactly how their personal data can be used in research to develop a new treatment?
  • involve people waiting for treatment in the co-design of a fair process for prioritisation?

In a world of risks and probabilities, not black and white answers, we should look for design patterns and affordances that support people’s understanding and help them take real, fully informed, control of the technologies on offer. This is not an optional extra. It’s a vital part of the bond of trust on which our public service depends.

Fifty iterations of DeepDream, the network having been trained to perceive dogs CC0 MartinThoma

The cultural ascendancy of AI poses both a threat and an opportunity to human-centred design. It moves computers into territory where designers should already be strong: exploration and iteration. I’m critically optimistic because many features of AI processes look uncannily like a repackaging of classic design technique. These are designerly machines.

  • Finding patterns in a mass of messy data?
  • Learning from experiments over many iterations?
  • Sifting competing options according to emerging heuristics?

User-centred design does all those things too.

interact slides.042.jpeg

"Double diamond" model of design process - Design Council 2014

Some diagrams explaining AI processes even resemble mangled re-imaginings of the divergent/convergent pattern in the Design Council’s famous double diamond. The threat is that black box AI methods are seen as a substitute for intentional design processes. I’ve heard it suggested that AI could be used to help people navigate a complex website. But if the site’s underlying information architecture is broken, then an intelligent agent will surely just learn the experience of being lost. (Repeat after me: “No AI until we’ve fixed the IA!”)

Designers should embrace the new, more design-like metaphors of rendering intent. As a profession, we have a great story to tell. We should talk more about our processes for discovering and framing problems, generating possible solutions and whittling them down with prototypes and iteration. Sure, we’ll need new skills, to change and evolve our methods – we’ve already mastered web, mobile, assistive tech. As Ursula le Guin wrote:

That’s the neat thing about technologies. They’re what we can learn to do.

Text on slide: Pair designerly machines with collective, human intelligence.

As the title of Ellen Broad’s wonderful book has it, AI is ‘Made By Humans’. We can pair human intelligence with artificial intelligence, and harness the combined power of us all, through collective intelligence.

How might we give power to the communities of health and care (and help them understand each other better in the process)?

  • Patient community – taking advantage of collective knowledge and data
  • Clinical community – integrating machine learning into clinical practice
  • Scientific community – extending existing modes of collaboration
  • Service community – co-ordination problems and realtime system status

(Credit to Stefana Broadbent for framing the first three categories at a recent Nesta event on Collective Intelligence.)

Some people say that the pace of change in accelerating, and that big organisations like the NHS can never keep up. I don’t believe that. For 70 years, the NHS has known nothing but change. Back in 1948, Nye Bevan, the founder of the NHS said something remarkably prescient. I think this attitude is one of the reasons, against the odds, we’re still here as a 70-year-old institution today.

“We shall never have all we need. Expectations will always exceed capacity. The service must always be changing, growing and improving – it must always appear inadequate.” — Nye Bevan, 2 June 1948

AI, black boxes, and designerly machines

On my holiday, I started reading into some topics I ought to know more about: artificial intelligence, genomics, healthcare, and the fast approaching intersection of the above. Here follow some half-baked reckons for your critical appraisal. Please tell me what’s worth digging into more. Also where I’m wrong and what I might be missing.

1. Opening the black box

large ribosomal subunit (50S) of Haloarcula marismortui, facing the 30S subunit. The ribosomal proteins are shown in blue, the rRNA in ochre, the active site (A 2486) in red. Data were taken from PDB: 3CC2​, redered with PyMOL.
By Yikrazuul CC BY-SA 3.0, from Wikimedia Commons

Reading Siddhartha Mukherjee’s ‘The Gene: An Intimate History’, I discovered the amazing trajectory of human understanding of DNA, RNA, enzymes, proteins, the genome, and the mechanisms by which they interact. There’s no doubt that this stuff will transform – is already transforming – our relationships with medicine. Crucially this generation of scientists are looking inside a black box, where their predecessors could observe its effects but not its inner workings.

At the same time, fuelled by petabytes of readily available data to digest, computer science risks going the other way in the framing of artificial intelligences: moving from explicable, simple systems to ones where it’s allowed to say, “this stuff is so complex that we don’t know how it works. You have to take it on trust.”

When we apply artificial intelligence (AI) to healthcare, transparency is essential; black boxes must be considered harmful.

It’s not just me saying this. Here are the words of the Institute of Electrical and Electronics Engineers (IEEE):

“Software engineers should employ black-box software services or components only with extraordinary caution and ethical care, as they tend to produce results that cannot be fully inspected, validated or justified by ordinary means, and thus increase the risk of undetected or unforeseen errors, biases and harms.” — Ethics of Autonomous & Intelligent Systems [PDF]

Transparency must be the order of the day. It comes in (at least) two flavours: the first is clear intent; the second, understandable operation. Both are under threat, and designers have a vital role to play in saving them.

2. The opacity of intent

It’s a commonplace to say that technology is not neutral. I won’t labour that point here because Sara Wachter-BoettcherEllen Broad and others do a good job of highlighting how bias becomes embedded, “AI-washed” into seemingly impartial algorithms. As the title of Ellen’s wonderful book has it, AI is ‘Made By Humans’.

That doesn’t seem to stop stock definitions from attempting to wall off AI beyond the purview human control:

“In computer science, AI research is defined as the study of ‘intelligent agents’: any device that perceives its environment and takes actions that maximise its chance of successfully achieving its goals.” — Wikipedia

But what goals exactly? And how did the AI get them? The Wikipedia definition is silent about how goals are set, because, in the words of Professor Margaret Boden“the computer couldn’t care less.”

“…computers don’t have goals of their own. The fact that a computer is following any goals at all can always be explained with reference to the goals of some human agent. (That’s why responsibility for the actions of AI systems lies with their users, manufacturers and/or retailers – not with the systems themselves.)” — Robot says: Whatever

When any technology moves from pure to applied science, intent must be centre stage. If we fixate too much on the computer science of AI, and not enough on the context of its application, intent will always be unintentionally obscured.

Many discussions about the “ethics” of AI or genomics are really, I think, discussions about the opacity of intent. If we don’t know who’s setting the goals for the machine, or how those goals are derived, how can we know if the intent is good or bad?

Moreover, true human intent may be difficult to encode. In a domain as complex as health and care, intent is rarely straightforward. It can be changing, conflicting and challenging to untangle:

  • a boy was triaged on first contact as in less urgent need, but has suddenly taken a turn for the worse
  • an elderly woman wants to get home from hospital, but her doctors need first to be sure she’ll be safe there
  • the parents want to help their children lose weight, but know that pester power always leads them back to the burger chain.

In these situations, even Moore’s Law is no match for empathy, and actual human care.

3. Designers to the rescue

Design, in Jared Spool’s wonderfully economical definition, is “the rendering of intent.” Intent without rendering gives us a strategy but cannot make it real. Rendering without intent may be fun – may even be fine art – but is, by definition, ineffective.

It’s time for designers to double down on intent, and – let’s be honest – this is not an area where design has always covered itself in glory.

We know what design without intent looks like, right? It’s an endless scroll of screenshots presented without context – the Dribbblisation of design.  If you think that was bad, just wait for the Dribbblisation of AI. Or the Dribbblisation of genomics. (“Check out my cool CRISPR hacks gallery, LOL!”)

Thoughtful designers on the other hand can bust their way out of any black box. Even if they’re only called in to work on a small part of a process, they make it their business to understand the situation holistically, from the user’s point of view, and that of the organisation.

Design comes in many specialisms, but experienced designers are confident moving up and down the stack – through graphic design, interaction design and service design problem spaces. Should we point an AI agent at optimising the colour of the “book now” buttons? Or address the capacity bottlenecks in our systems that make appointments hard to find?

One of my team recently talked me through a massive service map they had on their wall. We discussed the complexity in the back-end processes, the push and pull of factors that affected the system. Then, pointing at a particular step of the process: “That’s the point where we could use machine learning, to help clinicians be confident they’re making a good recommendation.” Only by framing the whole service, could they narrow in on a goal that had value to users and could be usefully delegated to AI.

4. How do you know? Show your thinking.

School exam paper. Question:

Crucially, designers are well placed to show the workings of their own (and others’) processes, in a way that proponents of black box AI never will.

This is my second flavour of transparency, clarity of operation.

How might we:

  • communicate probabilities and uncertainties to help someone decide what to do about their disposition to a form of cancer?
  •  show someone exactly how their personal data can be used in research to develop a new treatment?
  • involve people waiting for treatment in the co-design of a fair process for prioritisation?

In a world of risks and probabilities, not black and white answers, we should look for design patterns and affordances that support people’s understanding and help them take real, fully informed, control of the technologies on offer.

This is not an optional extra. It’s a vital part of the bond of trust on which our public service depends.

5. Designerly machines

Applying fifty iterations of DeepDream, the network having been trained to perceive dogs CC0 MartinThoma
Applying fifty iterations of DeepDream, the network having been trained to perceive dogs – CC0 MartinThoma

The cultural ascendancy of AI poses both a threat and an opportunity to human-centred design. It moves computers into territory where designers should already be strong: exploration and iteration.

I’m critically optimistic because many features of AI processes look uncannily like a repackaging of classic design technique. These are designerly machines.

Dabbers ready, eyes down…

  • Finding patterns in a mass of messy data? Check!
  • Learning from experiments over many iterations? Check!
  • Sifting competing options according to emerging heuristics? House!

Some diagrams explaining AI processes even resemble mangled re-imaginings of the divergent/convergent pattern in the Design Council’s famous double diamond.

Diagram showing how design moves from problem to solution in four stages, shown as one diamond after another. There are two pairs of divergence and convergence: Discover and Define, Develop and Deliver
© Design Council 2014 – https://www.designcouncil.org.uk/news-opinion/design-process-what-double-diamond

A diagram outlining a forward pass though three 3D generative systems, data is divergent and then convergent
“A diagram outlining a forward pass though our three 3D generative systems.” – Improved Adversarial Systems for 3D Object Generation and Reconstruction [PDF]
The threat is that black box AI methods are seen as a substitute for intentional design processes. I’ve heard it suggested that AI could be used to help people navigate a complex website. But if the site’s underlying information architecture is broken, then an intelligent agent will surely just learn the experience of being lost. (Repeat after me: “No AI until we’ve fixed the IA!”)

The opportunity is to pair the machines with designers in the service of better, faster, clearer, more human-centred exploration and iteration.

Increased chatter about AI will bring new more design-like metaphors of rendering that designers should embrace. We should talk more about our processes for discovering and framing problems, generating possible solutions and whittling them down with prototypes and iteration. As a profession, we have a great story to tell.

A resurgent interest in biology, evolution and inheritance might also open up space for conversations about how design solutions evolve in context. Genetic organism, intelligent software agent, or complex public service – we’re all entangled in sociotechnical systems now.

“Look after the water” – reflections 1 year into my work at NHS Digital

Other people’s jobs are endlessly fascinating. At a birthday celebration a couple of years ago I got talking to Johnny, a family friend who works as an aquarium curator. He told me a surprising thing about his work: how little of his time he spends actually looking after the fish. Johnny’s job is to look after the water. “Look after the water,” he said, “and the fish will take care of themselves.”

So it is with design leadership. Our designers have different specialisms – service, interaction and graphic design. They’re embedded across a wide range of endeavours, both public and professional facing. They’re the ones who see users in research, and stakeholders in show and tells. My role is not to tell them how to design; it’s to create the safe and supported conditions in which they can do their best work, individually and collectively. When those conditions come together, it’s a wonderful thing.

This week it’s one year since I joined NHS Digital to lead the design team. I’ve been thinking about what has changed, and what we have yet to achieve. As ever, views all my own.

Growing a team

Our third whole design team event took place a couple of weeks ago in Leeds. We ran two rounds of rapid fire show and tells: 14 designers showing their work in the space of 90 minutes. I was massively impressed that every designer who presented was so good at telling their story, under time pressure, to a room of 35 people.

We’re lucky to have two excellent lead designers. Tero heads our growing service design practice, while Dean has taken on interaction and graphic design for the NHS website. Design-minded product managers Emma, Ian, and Sophie join us in our fortnightly design leadership meetings. Stephen, who left a couple of months ago, was always insightful, knew his way around the organisation, and took on the unglamorous task of writing job descriptions. I miss our Friday morning coffees.

Hiring for designers in both London and Leeds has been a long journey but rewarding in the end. Over the past few months, it has been great to see the new seniors settling in. I believe we now have talent at every level, and a good foundation for design leadership here in the future. If my bike went under a bus on Chapeltown Road tomorrow, weekly design huddles would still happen in Leeds and London. I count that as a win. Having designers who talk to and trust each other is the foundation of a coherent experience for our users. The designers and I are rewarded on the same pay scales as nurses, doctors, and other NHS professionals. That’s a sobering reminder of the value each new recruit to the team is expected to add.

A year of recruitment in numbers:

  • Just over 50% of the design team are now newer than me to NHS Digital
  • Of the permanent staff, 11 are still here from the team when I arrived, 8 are new recruits, and 3 have left
  • Among contractors, it’s 1 still here, 7 new, and 3 left
  • On top of that are a dozen or so supplier staff with whom we work closely as members of our extended team
  • Permanent team, contractors and supplier staff alike, 100% of them want to do their best for users and the health service.

Designers work best as part of multi-disciplinary teams. After a year here, I’ve had the privilege to see a few of those teams go through the delivery cycle from discovery, through alphas and on to release private and public beta versions. It hasn’t always been straightforward. Some teams have got stuck. Some things have stopped when we realised they would not achieve the outcomes we hoped for. But it does feel that teams are getting slicker at this – learning about user needs, and learning how to work together as true multidisciplinary teams. I’m fortunate to be part of a senior leadership team with brilliant product, delivery, technology and content leaders too.

As a design team, we have access to two larger communities of practice. NHS Digital’s Digital Service Delivery profession includes design along with user research, product management, delivery management and content design. We’re also part of the amazing cross-government user-centred design community, giving us access to Government Digital Service (GDS) training and community events. I especially appreciate my meetings with Lou Downe and the other government heads of design.

Here are some things I’ve learned…

Power is a big theme in health and care.

My focus has been with teams designing and delivering for patients, carers, and families – users who don’t work for the NHS or social care. There’s good evidence that people in control of their own health and care have better health outcomes. But I can see from our research how people’s power is diminished – by illness or disability, by social circumstances, and (though we don’t mean to disempower) by us, in the way we design and deliver health and care services.

Digital information and service have the potential to make people more powerful again. This can only happen when people can get them, trust them, understand them, decide with them, and act on them. For people to take power in the NHS, we need to work across the whole system, a partnership of patients, families, professionals, and service providers.

Sometimes we need to diverge before we can converge.

A healthy tension between divergent and convergent working should be part and parcel of any design approach.

Soon after I arrived a year ago, I worried that, in some areas, we were trying to converge prematurely on solutions that had not been tested against a wide enough range of user needs and contexts of use. To reach the required quality, we had to go through a phase of divergence in which teams went off to solve their own problems, while sharing their work and looking out for common patterns. (Patterns, by the way, are never designed; they can only emerge when teams are empowered to work independently, but transparently.)

Now, we’re back to a phase of convergence around design for the NHS website, led by teams explicitly tasked with redesign and standards creation. I have greater confidence that we’re building on firmer foundations this time, because we’ve tried more things, and understood more user needs.

I’m a design system sceptic (but we’ll probably end up with a design system anyway).

Everyone seems to be talking about design systems right now. I caution that explicit efforts to create a system can easily tend towards design for its own sake, disconnected from validated user needs and contexts of use. I hope we can keep ours rooted in reality by rotating designers through the overall redesign and standards teams, in and out of squads working on specific health condition categories and services. Nothing should get into the design system without being researched with users in multiple need states and contexts.

Rather than all swarming on the same problems, we need to conserve our energy and focus. Like birds flying in formation, each team can take a turn to lead on a design challenge, before falling back to let others fly ahead for the next stage.

Critical optimism is the order of the day.

When I wrote my 6-month update, the always-perceptive Stefan Czerniawski noted:

There is a sweet spot in any job, or more generally in understanding any organisation, when you still retain a sense of surprise that anything could quite work that way, but have acquired an understanding of why it does, and of the local application of the general rule that all organisations are perfectly designed to get the results they get.

Since then I’ve tried to bottle that feeling. Healthcare certainly proves Dr Deming right: that the same system can at once be brilliant at some things and terrible at others. There can be world class care, medical and technological innovation side by side with the shocking failure waste that comes from poorly designed service. Being a permanent member of staff, I feel a responsibility to work with the grain of the system, while retaining a sense of urgency to make things better.

One of my objectives is to grow the whole organisation’s commitment to human-centred design. This definitely feels like a multi-year commitment, but I’m confident that we have director-and-above-level support for improving the quality, consistency and accessibility of digital services for NHS patients and professionals. Our head of profession Amanda has been the definition of an empowering manager. Our portfolio director Alan has an exceptionally user-centred vision for someone in a such high-profile delivery role.

Update on some things I committed to do at the 6-month point:

  • Develop my own capability – I am investigating leadership courses that might be right for me. Ideally, I’ll do something that brings me into contact with a more diverse range of health and care leaders, not just the ones focused on digital.
  • Reflect and plan – I started by block booking Friday afternoons as a meeting-free zone in my diary. Clearing emails and weekly reporting always swallowed them up. Now I’ve blocked out the whole day. I don’t always keep to it, but it’s a good reminder of the value of meeting-free time.
  • Listen better – There’s a bit almost at the end of David Marquet’s ‘Turn the Ship Around‘ video, in which he says you will fail repeatedly at giving control to your team, but get up and go again. That’s where I feel I am with my coaching practice right now. After some conversations, I come away kicking myself. When it goes right though, it’s so much more rewarding to hear a colleague solve their own problem than to hear myself offering my solution. Ultimately this is the only way that a design capability is going to scale.
  • Influence more – Lots more to do here. There are so many opportunities for improvement that our small team will never be able to address them all. By sharing standards and setting clear expectations of good practice, we can multiply our impact and give power to the many other people across the health and care system who want to make a difference with design.
  • Say no to more things – One of the adjustments in moving from a micro-business to a biggish organisation was appreciating that lots of things get done even if I don’t do them. Every week or so, I look through my to-do list for the things I really ought to delegate, and the things I’m just never going to do. Adding a “Not Going To Do” column in Trello has done wonders for my sense of productivity.
  • Say yes to more things – I’ve been lucky enough to be invited to some brilliant events and conversations. A recent highlight was working with Victoria Betton and Lenny Naar to deliver a hands-on user-centred design session at HIMSS e-Health week. In October, I’ll be speaking at Interact London, and the conference theme is “Intelligence in Design”. Fingers crossed I’ll have something intelligent to say.

Electric woks or eating together? Time for human-centred designers to care about the community

Mick Ward is sick of people trying to sell him electric woks. As chief officer leading transformation and innovation for social care in Leeds, he sees a never-ending procession of providers claiming to solve enduring human problems with expensive, complicated, isolated, digital solutions.

Mick believes we’d do better to start with people and their communities, with their strengths and how they can work together to make things better for themselves. Communities like Seacroft in east Leeds, where the LS14 Trust asked a simple question: “What would happen if we spent a whole year eating together as a community?”

“You can have the healthiest greens on your plate, but if you eat in isolation every day this might not always be good for your long-term wellbeing.” – LS14 Trust video

A couple of weeks ago I was privileged to be on a Leeds Digital Festival panel with Mick, Howard Bradley from the LS14 Trust, and Roz Davies from the Good Things Foundation. The event was organised by Victoria Betton from m-Habitat, who has also written up her impressions of the event.

On the agenda, I was there to be the “digital” voice in the conversation as a counterpoint to Mick and Howard’s advocacy of asset-based community development (ABCD). But I also accepted the slot on the panel to listen and learn, because I’ve long had a hunch that ABCD contains much that could improve my practice.

While we digital designers talk a good talk about focusing on people, I can’t help thinking our processes are still too often tilted in favour of electric wok solutions, and too rarely towards things like eating together.

In my contribution to the event, I offered what I hope was a critical description of the principles of a human-centred design process, as set out in the international standard ISO 9241-210:2010. I talked about the good things we always try to maintain:

  1. an explicit understanding of users, tasks and environments
  2. users involved throughout design and development
  3. design driven by user-centred evaluation
  4. a process that is iterative
  5. addressing the whole user experience
  6. multidisciplinary skills and perspectives

There need not be a gulf between human-centred design and ABCD, but often, by sins of omission, there is.

The problems start with the deficit-based way we often talk about “user needs.”

Inherently, a user need is a deficit, a thing a user lacks, a gap that we service providers claim to fill with our special expertise. Human nature makes it so easy for us to slip into electric wok thinking: this person is hungry; we make electric woks; what they need is an electric wok.

When the user protests that she never eats stir fry, many of our community double down on this deficit-thinking, by asserting that “people don’t know what they need.” The Henry Ford quote about a faster horse is trotted out, or something about how Apple don’t do user research (He never said it; they do.)

Human-centred design theory emphasises that we don’t take people’s stated desires at face value. We say no to that market research staple, the focus group. Instead, we uncover latent needs using ergonomic and ethnographic observations of actual behaviour (“Saturday, 1:27am: Participant orders takeaway chicken chow mein.”)

Rushed or done badly, such approaches render the research participant little more than a lab rat. The experimental subject’s only stake in the transaction is a shopping voucher to thank them for an hour of bemusement that they’ll never get back.

Empathy is essential in any human-centred design process. The trouble is, we often get it muddled up with sympathy.

When we see someone in pain, or with problems, or less fortunate than ourselves, our instinct is to help them. That’s a brilliant human thing. It’s mark of a civilised society that we have a safety net, no questions asked, to pick up a person when they’re knocked off their bike or floored by acute illness.

Cartoon man on stretcher
Still from ‘Your Very Good Health’ – Central Office of Information, 1948

Once the initial crisis has passed, however, sympathy must give way to a fuller understanding of the person and their capacity to recover. True empathy means feeling their hopes for the future, the things that make them resilient, knowing which activity they’ll enjoy the most to rebuild wasted muscles.

The factors that make someone strong are so personal and so varied that they are often forgotten in the focus on what’s commonly wrong. And in the name of equality, “not everyone has capacity” becomes a reason to ignore the assets of those who do. It’s then only a short step from fixing the problem to fixing the person, applying the faulty logic that if we are well, then making them more like us will make them well too. True empathy takes people as they are, not as we wish them to be.

It doesn’t have to be this way, but human-centred design has become, by default, individualistic.

There is a rich heritage of more social strains of service design and participatory design. In recent years, these have been drowned out by digital user experiences, where the context of use is invariably a person alone at a computer or on their personal mobile device.

Reacting against the phoney seance of the focus group, we prefer one-to-one usability sessions and depth interviews. To drive out ambiguity, we write user stories in the singular: “As a user, I want to… so that…”.

When we over-rely on these methods, we miss the plethora of relationships beyond the individual user and service provider. When we think about inclusion and accessibility, we fail even to ask users whether they consider it more “independent” to complete a task alone with assistance from a service provider, or by sharing it with a family member or friend.

Finally, as a questioner at the event pointed out, the language around this stuff has always been problematic.

We borrow the words of marketing “activation” as if people were machines waiting to be switched on. I work in a portfolio dedicated to “empowering people”, but who are we to give power in the first place? How about “stop disempowering people!”

In what direction will the new partnership of the professions and the 'consumers' work to carry out their purpose of meeting the medical needs of the people adequately, everywhere?
Extract from 1948 booklet ‘The New National Health Service’

I take consolation from the fact that a 1948 leaflet on the new National Health Service places the word ‘consumers’ of healthcare in scare quotes, as if our founders knew the word was unsatisfactory, and that sooner of later someone would come along with a better term. 70 years later, we’re still working on that.

I ended my discussion by posing two related questions:

  1. How might we move beyond purely transactional models of provider and consumer to more fluid configurations of actors, in which all contribute to and take from the service according to their needs, wants and abilities?
  2. How might we (especially those of us charged with making digital services at national scale) recognise that service is co-created and co-produced in communities, and provide platforms for those communities to discover, express and meet their own needs?

We can stick to our principles of human-centred design, but we need to broaden their interpretation.

ABCD reminds us to consider user assets at least as much as user needs.

User research should include everyone as equals, helping them to beneficially articulate things they do know at some level, but have not yet consciously considered. Only then can they become active participants in the co-design of solutions that suit them.

Asset mapping is a common research activity in the ABCD world, but Mick from the council is very clear: the asset maps aren’t for him, they’re for the community, to realise what they already have. And when they’re made in a participatory way, the assets they surface are very different from the usual libraries and sports centres that turn up on maps made by the service providers.

I was recently challenged about user needs in a learning context, where people literally “don’t know what they don’t know”. Yet learners do know many other things that are highly relevant to the design of their learning, such as what they know already, how they will fit learning into their everyday lives, and what they hope to achieve with their new knowledge and skills.

The whole user experience is situated at least as much in places and communities as in individuals, devices and service providers.

Beyond the place-based work of community development, there are some promising developments in the digital world.

The always insightful Cassie Robinson at Doteveryone is thinking with Citizens Advice about collective action:

Collective action is a strand of work we’re committing more time to over the coming months at Doteveryone, discovering other opportunities and contexts where collective action can play a role in scrutiny, accountability and influencing change. As part of this work we are also looking to civil society organisations to take a role in empowering the public and their audiences to take collective action in directing the impacts of technology on our lives.

Projects by If’s new report with the Open Data Institute considers some of the many instances when organisations deal with data about multiple people:

Services that allow data portability need to consider social relationships to ensure they are respectful of people’s rights. It’s also important that services don’t make assumptions about how groups make decisions about moving data: instead, they need to allow people the time, space and awareness to work things out for themselves.

Users must be involved throughout design and development in more than one way:

  • as participants in user research specified by the Government Digital Service
  • as senior stakeholders such as patient leaders in some NHS organisations
  • as fully fledged members of a multidisciplinary team, for example by bringing experts by experience onto Care Quality Commission inspections.

While many organisations employ people in one of these modes, very few yet combine all three. This means false conflicts are set up. User researchers complain that consultations are conducted with “proxy users” instead of the actual people who will use a service. The most committed service users, with much to contribute, can be told their experience disqualifies them because “they know too much”. In truth, we need them all!

If we want fewer electric woks in our future, we’d better stay open to unexpected outcomes.

Howard described compellingly how the LS14 Trust works to “hold spaces” where people can explore and create at their own pace – “laptop in one hand, cup of tea in the other”. They start conversations on people’s own terms, asking “what do you want to change?”

As a question from Victoria highlighted, we must always be aware of power imbalances in these spaces. People will be inhibited from contributing fully if they feel they should say what the most powerful people in the room want to hear, or if, on the basis of their past experiences, they don’t believe their participation will really change anything.

And Mick shared a set of questions that ABCD practitioners use to check the impact of their interventions:

  • What will be enhanced?
  • What will be restored?
  • What will be replaced?
  • What might this mutate into?

A great set of questions to ask when designing almost anything.

In shared light: why making thing visible makes things better

“In Elizabethan amphitheatres, like the 1599 Globe Theatre, performances took place in ‘shared light’. Under such conditions, actors and audiences would be able to see each other… This attention to a key original playing condition of Shakespeare’s theatre enables the actors to play ‘with’ rather than ‘to’ or ‘at’ audiences. Actors therefore develop their ability to give and take focus using voice, gesture and movement.” — Emma Rice to Step Down From London’s Shakespeare’s Globe, Playbill, Oct 25, 2016

Some rights reserved - Phil Glockner
Phil Glockner, the Original Starbucks

Early, too early, one morning I blunder into a railway station Starbucks for a coffee and croissant to take onto the train. I’m the only customer. I place my order and shuffle along to the end of the counter where the barista will hand down my drink.

What happens next in the customer experience is critically important. We know that Starbucks knows this too, because of a leaked 2007 memo from chairman Howard Schultz, in which he bemoaned the commoditisation of his brand:

“For example, when we went to automatic espresso machines, we solved a major problem in terms of speed of service and efficiency. At the same time, we overlooked the fact that we would remove much of the romance and theatre that was in play with the use of the La Marzocca machines. This specific decision became even more damaging when the height of the machines, which are now in thousands of stores, blocked the visual sight line the customer previously had to watch the drink being made, and for the intimate experience with the barista.”

As I said, it was early, much too early for an intimate experience with a barista. And in any case, the barista was still learning the ropes. I guess first thing on a shift, when there’s one customer and no queue, is a great time for some coaching from the supervisor. This is what I heard him say:

“You have 23 seconds for the milk… Oh, and relax. You can’t concentrate when you’re stressed.”

23 seconds! That’s what removed the romance from my coffee.

“You must either make a tool of the creature, or a man of him. You cannot make both. Men were not intended to work with the accuracy of tools, to be precise and perfect in all their actions. If you will have that precision out of them, and make their fingers measure degrees like cog-wheels, and their arms strike curves like compasses, you must unhumanise them.” John Ruskin, The Nature of Gothic

Some things in this carefully commodified service experience were never meant to be seen by the customer. When they do burst into view, it feels wrong, uncanny.

In this post I want to explore the reasons for that uncanniness, and how we might play with it to develop new service opportunities. Is it really so obvious what should and should not be visible to the user? What’s the impact on users when a component slips out of sight? And how might we make service better by keeping more things, more visible for longer?

The line of visibility

Some rights reserved - JP Swizzlespokes
JP Swizzlespokes, Experience Design wk05 #whiteboard

The line of visibility is a well-known concept in the fields of customer experience management and service design. To use, like Howard Schultz, a theatrical metaphor, it divides the service blueprint into front-stage activities seen by the customer, and back-stage ones unseen by the customer but nonetheless essential to the delivery of the service.

In the coffee shop:

  • Front-stage: the theatre and romance of taking the order, writing the customer’s name on a cup, grinding the beans, making the coffee, presenting the coffee to the customer
  • Back-stage: the operational efficiency of managing rosters, training staff, timing operations, replenishing stock, and so on.

At first glance, the allocation of activities to front or back-stage appears uncontroversial. In reality, it is much murkier, and deserves more critical attention:

  • A restaurant might make a show of fresh food preparation with an open kitchen on full view to the diners, but still have a room behind the scenes for the freezers and dishwashers.
  • Recently, after returning a hire car, I was given a lift by a new member of staff. The conversation we had about the rental company’s graduate scheme made me warm to the company and more likely to return.
  • Much has been written about the 8 simple words on the underside of the machine on which I’m typing this now: ‘Designed by Apple in California. Assembled in China‘.

Visibility and the value chain

I’ve been thinking about visibility in the context of whole value chain maps. In his mapping technique, Simon Wardley arranges components from the most visible user needs at the top to the unseen at the bottom:

screen2bshot2b2015-02-022bat2b20-25-38
A value chain – wardleymaps.com

In this interpretation, visibility is said to recede as we traverse the network – the more “hops” away from the customer, the less it needs to concern them. But is that really true?

Invisible things can have very visible effects. Amazon’s recommendation engine is deeply buried in the company’s infrastructure, yet customers experience its insights and biases every time they use the site.

Visible things may get up to all sorts of unseen activities. What if that camera or video recorder in the corner is participating in a distributed denial of service attack right now?

Invisibility and commodification

barcoded wood

Why is it that some things naturally seem to merit visibility while others have to hide themselves from view?

I think it has to do with commodification. To turn something into a commodity is to take it out of its context, to make it fungible so that it can be substituted, traded and transferred. In an example by the philosopher Andrew Feenberg:

a tree is cut down and stripped of its branches and bark to be cut into lumber. All its connections to other elements of nature except those relevant to its place in construction are eliminated.

This is what people are doing when they commit metaphorical sleights of hand such as “data is the new oil“. They take something that has deep meaning to an individual and, by aggregation, transform it into something that can be traded without further challenge or debate.

The logic of commodification prohibits the end user from interest in, or influence over, anything but the surface-level components. Before we know it, any breach of the line of visibility feels illegitimate. From Fairtrade foodstuffs to the employment rights of Uber drivers, demands to deepen visibility into the supply chain come to be seen as “political” incursions in the supposedly rational domains of technological production and economics.

Consider the much-maligned EU cookie directive.

Unregulated, the behemoths of the attention economy would place all their tracking of users below the line of visibility. “Users don’t need to know about that stuff,” they’d say. “It’s technical detail. Nothing to worry about. Move along now.” The Jobsterbedunners might even hold up web users’ continued browsing of sites in such compromised circumstances as some kind of “revealed preference” for covert tracking.

But people who care about privacy have a different opinion on where the line should be drawn. Their only option is a “political” intervention to drag the publicity-shy cookie blinking over the line of visibility. Now Europe’s internautes can take back control, every time they visit a website. Say what you like about the implementation, but we Brits will miss those privacy protections when they’re gone.

Shared light

What if there was another way to realise value? One that didn’t depend on enclosing the value chain by making it opaque to end users?

To Feenberg, decontextualisation is “primary instrumentalisation” the first part of a two-step process:

The primary instrumentalisation initiates the process of world making by de-worlding its objects in order to reveal affordances. It tears them out of their original contexts and exposes them to analysis and manipulation while positioning the technical subject for distanced control…

But the story doesn’t end there. There’s a crucial, secondary step where visibility has to be re-established:

At the secondary level, technical objects are integrated with each other as the basis of a way of life. The primary level simplifies objects for incorporation into a device, while the secondary level integrates the simplified objects to a social environment.

Through this secondary instrumentalisation, this resource integration, users tell us what they want technology to be. Think, for example, of the camera-phone as a concept worn smooth by countless buying and use decision over the course of a decade. This part of the value creation process cannot happen in strategy and planning; it can only happen in use.

Premature commodification would close down such possibilities just when we ought to be keeping our options open. Co-creation, on the other hand, places the service user, the service designer, and the service provider on the same side – and all of us play in all those positions at one time or another.

We maximise value when the interests of all the actors are aligned, when asymmetries of knowledge between them are reduced. To borrow another controversial theatrical analogy, co-creation flourishes in “shared light” when actors and audiences can see each other equally.

  • Not only do we see the coffee being made, we see the staff being trained.
  • We are no longer passive recipients of the recommendation algorithm, we can understand why and how it behaves.

Some service design patterns

Here are just some of the patterns that play with the line of visibility. By making things visible, they make things better.

Seeing over the next hill: We meet much of the most valuable service when facing a change or challenge for the first time. But unless we know what to expect, it’s hard for us to make decisions in our best interests, or to trust others seeking to support us. Deliver service so that people can always see over the next hill, so they know what to expect, what good looks like, and who they can trust to help them along the journey.

Provenance: People can take reflective pride in where their things come from – and be repulsed by a supply chain’s dirty secrets. Design like they’re watching. Document the journey and make it part of the service. My Fairphone may have been a little pricier than an equivalent smartphone, but it comes with a story of fair materials, good working conditions, reuse and recycling.

Individualisation: Service is intrinsically full of variation. When we treat its delivery like factory mass production, we make it inflexible, unresponsive, and ultimately destructive of value. Anticipate variation, embrace it and celebrate it. This will likely means fewer targets and processes, more self-organising, empowered teams. Be like homecare organisation Buurtzorg, which prioritises “humanity over bureaucracy” and “maximises patients’ independence through training in self-care and creation of networks of neighbourhood resources.”

A last word from actor-network theorist Michel Callon in his afterword to Feenberg’s ‘Between Reason and Experience’:

“Keeping the future open by refraining from making irrevocable decisions that one could eventually regret, requires vigilance, reflection, and sagacity at all times. Politics, as the art of preserving the possibility of choices and debate on those choices, is therefore at the heart of technological dynamics.”

Up the school! Or, a passive-aggressive letter to the headteacher on the occasion of the unveiling of a new logo

school logo on inside of jumper

Dear headteacher,

Welcome to your new role! As a parent of two children at the school with another still in primary school, I’m delighted to see your commitment to making ours an outstanding school in line with your new motto and values.

The problem is the new logo.

In the course of my annual visits to Jo Brand Plus of Harehills Lane (where I am always welcomed like an old friend) I have made a study of the state of the art in school insignia design. In this there appear to be three basic genres:

  • The first, preferred by primary schools, is the “Earth Child” trope: brightly coloured trees, linked hands, happy blob children or some combination thereof.
  • The second is the “Modernist Corporate” style, in the spirit of the late Paul Rand’s IBM, FedEx and Enron identities. The school’s current logo falls into this category. Here a thoughtful designer has considered the ascenders and descenders of the school name in lowercase, along with the relative lengths of the words to create a tightly locked up wordmark. It’s a little weak but is done with integrity.
  • The third – and by far the hardest genre to execute successfully – is the “Heraldic Achievement”. Some schools have this ready-made in the form of a local family coat of arms, or, if a church school, the crest of their sponsoring religious establishment. A few manage to combine local insignia and scholastic symbols – books, quills, etc. – to make their own convincing heraldic combinations.

The thought process that leads a school like ours to the Heraldic Achievement is easy to imagine. We inhabit an old country where aristocratic deference has deep roots. What better way for a mid-century secondary modern to announce its arrival at the top table of outstanding schools than to put on the clothes of elite institutions that pre-date it by centuries?

To achieve the desired effect, the heraldic design has to play by the rules. As the aspirant newcomer here, you do not make these rules. They are determined by the holders of archaic positions such as “Maltravers Herald Extraordinary” and “Rouge Dragon Pursuivant”. I Am Not Making These Up.

Our school’s new logo makes a brave start. A blue field with a white Yorkshire rose feels genuine, if a little generic. It could apply equally to hundreds of other schools in the county. Except that the rose used is the East Riding version, which has a sepal pointing upwards. Traditionally here in the West Riding the rose is the other way up with a petal at the top. Who knew? I do now because I have taken the trouble to Google for this important detail.

The credibility rating starts to go rapidly downhill when we add the motto to the shield. Heraldically, this should be on a scroll below the escutcheon, not plastered straight onto the field. Not only is this distinctly unheraldic, it is also ham-fistedly done. The geometric sans font worked well within the Modernist Corporate style but has no place in the traditional genre that this logo attempts to emulate. Then there’s the distribution of the words in a semicircle above the rose. Because “Aspire” is a shorter word than “Succeed” the whole arc ends up being lopsided. I fear I shall look at this and cringe every time I send my children off to school.

Finally, the name of the school perched like a black granite tombstone at the top of the shield adds nothing to the ensemble. The way the word “School” is orphaned on a line of its own raises the question of why it was needed in the first place. In many uses of the logo this wording will be redundant or duplicative, and its overall effect is to make the whole thing thoroughly pedestrian. This is such a missed opportunity to add a distinctive charge to the black band. Rouge Dragon Pursuivant would call this band a “chief”. It is commonly used to make a coat of arms unique – but never simply by slapping the name of the holder on as text.

All these points may in themselves appear to be nit-picking. But cumulatively they make our school’s new logo the exact opposite of its ethos. A school on course to being outstanding would have the creative sure-footedness and intellectual curiosity to get these details right. It would know from its careers department that design is a job, done with skill and care, with users engaged, contexts considered and alternatives sweated over.

How can the situation be saved? We could stick with the Modernist Corporate approach. The current design could be improved on but has a clarity and originality that is lacking in the new logo. We could even hark back to the noble spirit of the school’s foundation in the 1950s. The award-winning GOV.UK website, for example, successfully marries the genuine heraldic device of the Crown with the clarity of Margaret Calvert and Jock Kinnear’s road sign typography from that era.

But if you are determined to head the kind of school that has a coat of arms, I plead with you to do it properly. I myself attended a 450-year-old school that took its heraldic identity from a founder with a walk-on role in Wolf Hall. There I got to know the attitudes that still pervade the institutions your highest-achieving students must navigate if they are to realise their full potential.

Please ask yourself how our sons and daughters will be received when they arrive at the doors of an Oxford or Cambridge college that has a grant of arms from around the time of Magna Carta. Will they be taken seriously? Or will the new “aspirational” logo elicit a silent sneer? This should not matter but it does. The elite networks of this country are tilted against some of your students enough already. The last thing they need is for an unthinking act of cargo cult design to subtly undermine their life chances even further.

Regards,

Matt Edgar

Parent

Eagle eyed readers have pointed out that I have published a 1000-word tirade without showing you the actual logo. This is mainly to protect the innocent. You can get a glimpse in this video of my lightning talk at Bettakultcha…