Category Archives: Digital Strategy

Where’s our National Health Digital Service?

Technology is often seen as the solution, but so often it’s really just another huge problem.

I have the unfortunate task of visiting our local hospital King’s College more often than I’d like at the moment. Nothing too serious, my wife fell down a few stairs in the middle of the night and broke her ankle. She’s on the mend, thanks for asking.

The NHS is a phenomenal beast. Most of the time, you’re just along for the ride, “go to the X-Ray, then come back here, don’t go to the front desk, come straight to us” a nurse tells us, “have you been referred or are you a self referral?” asks the assistant at the desk, “you’re not on the list, sorry” says a nurse practitioner. You have to give yourself up to the system, let it carry you along it’s digestive system. You have to remind yourself not to second-guess or doubt the nurses and doctors because they trained a very long time to be able to treat you at this moment. But at a rough guess, I’d say pretty much 50% of the experience in a hospital is what John Seddon would term ‘failure demand’ of some sort, or what Bob Deming would have called rework. Everyone there is preoccupied with coping with the system.

When you succeed, you do so despite the technology, not because of it.

The NHS is one big edge case, it’s a system made entirely of edge cases. Everyone in there is an edge case, they are all outliers, nobody wants to be there. Yet the way the system works seems designed only really to handle cases perceived as ‘routine’. As an example, I had a letter with a barcode, which stated our appointment time. There’s a kiosk type of thing in the X-Ray place where you can go and scan your barcode and check yourself in, like you would in an airport. Except, there’s a friendly man who is assisting people. The friendly man is the interface for the machine, they don’t even let you see the machine’s face. The friendly man is the interface. It’s welcome assistance because when he scans the letter for me, the machine bleeps like it’s slightly miffed but it offers no real explanation. The friendly man explains that we’re two hours early for our appointment. I tell him that the consultant asked us to come at 8.30am not 10.30am so that she could see us first and my wife wouldn’t get barged about in the rush that happens around 10am. The consultant had improvised and created her own priority for her patients, except the formally procured system didn’t really allow for this. Why should it really? These kind of technical solutions have been purchased through a rigorous procurement system which doesn’t put patients first.

Another example, after we saw a nurse on our first visit, we were given an appointment card detailing the time and place, with a handy little map to show exactly where we needed to be. I was pleased that it had a map. Except, when, as instructed, I took the card to the reception (they didn’t explain why) they took the useful card away from me and replaced it with a less useful object- a piece of paper with the same information, except there was no map.

It’s relatively easy to write off the problems as simply a result of its vast complexity. But it’s obvious to see why the problems exist. They exist precisely because of technology.

You can see where the technology works and where it doesn’t. My experience of plaster casts was previously limited to what I’ve seen in Carry On movies. I thought it would take forever to set but it didn’t. They have an incredible synthetic product which behaves like a bandage, but once wet, it sets very hard, very quickly. Now that’s a technology solution that works. Also, the X-Rays are no longer plastic sheets, they are sent between departments as high-res images on the computer with something that looks a lot like email. Walking from department to department, the X-Ray results seem to follow us around in the cloud. And also, there’s clear wait times displayed everywhere, which seem pretty accurate. So it’s not all bad.

But the failures of the NHS aren’t just within our hospitals, the NHS is the National Health Service, not a collection of hospitals. You can see the failures of our system on the streets begging for change, shivering a pale- our systems are failing to pick up and treat mental health and addictions that lead to homelessness.

For NHS hospitals, most problems seem to come about because of the interfaces and IT systems put in place by a vast array of different providers, mostly fixes that fail, systems that don’t evolve towards their purpose.

When will the Department of Health conceive of a digital strategy as strong as that of the Government Digital Strategy? We need a set of principles for the National Health along the lines of those created for the Government Digital Service. We need a strategy that…

  • … puts patients before The Trust, for example by using Plain English, not the language of the system. I have no idea what a ‘self referral’ is.
  • … works iteratively by not procuring expensive and useless technology systems sold by the private sector which never improve and only get in the way of people doing the work they need to do.
  • … makes things open so that systems and departments can communicate together more effectively

Where’s our National Health Digital Service?

Sheering and Slippage in Big Orgs

John Willshire introduced me to Stuart Brand’s How Buildings Learn last week because it talks a bit about how buildings have different levels, which change at different speeds and it’s interesting how the web is another layer of a building.

Coincidentally, I came across the same point in Dan Hill’s  Dark Matter and Trojan Horses yesterday;


This is useful not just for thinking about the nature of change of buildings but how change occurs in any system, such as a large organisation.

Large organisations change at different paces. The marketing department is usually faster to change because, quite frankly, talking is easier than doing. Or at least, it used to be.

It used to be that building products and services was difficult. But it’s not any more. Now it’s actually really very easy to make good stuff. It used to take a team of 6 designers and developers working for a year just to put together a website that would take a form input, do some calculations in a cgi bin and spit out a response. Now we can make working, usable software within hours or weeks. So, while cycle times for software development have reduced to 1-2 weeks, finance planning cycles are still happening once a year, marketing is still happening once a year, strategic reviews are happening once a year. So what we’re seeing now is this sheering and slippage happening in new places. This is why we’re seeing things like #noestimates, because all the teams that are delivering things in cycles are wondering why the rest of their businesses is still stuck on a different layer on a different cycles. And where there’s slippage and sheering, there’s friction and waste.

So if marketing is capable of the required pace and so is the making of software, then what’s the next level feeling the friction?

Rather than #noestimates, perhaps we should be training a new generation of Financial Directors in the ways of agility? What about procurement departments?

Facebook’s full-spectrum media play

So Facebook just bought Oculus Rift.

I interviewed many many UK teenagers in 2012 and 2013 about sport, life and technology on behalf of a client. Even then, none of them admitted to using Facebook any more, it was all Twitter and Instagram. Though I suspect they were still popping in to see old friends in the same way they were still popping in to see their nans on a Saturday afternoon to plunder her Quality Street. Since then a lot of clever media innovations have cropped up that teenagers have lapped up like Vine and Snapchat. ‘Facebook is dead‘ studies said, because their audience was ageing fast. But it seems now that all you need in order to stay young forever is access to massive reserves of capital. It makes me think that if Facebook’s model is to stay as an advertising platform, they are simply buying access to the eyes of the complete spectrum of internet society. is really the bottom of the barrel, the dregs of the internet the ‘1 weird tip that will make you thin’, WhatsApp perhaps offers something a little younger and more connected, while Oculus offers the absolute bleeding edge of interactive hardware. It’s akin to Google’s recent acquisition of Boston Dynamics and their work on driverless cars.

It makes me think that something huge that’s missing from Facebooks spectrum is a really popular video platform, it has nothing like that which might rival YouTube. I wonder if Facebook will buy Vimeo in the next year or so?

Words are design

There’s little surprise in the idea that a job description for a content designer at GDS would be well written. It’s matter-of-fact, it has clarity without over-simplification, it’s resigned without being obsequious and it manages to avoid being officious or patronising. It’s a language like that of pre-war, Reithian BBC- the voice of the establishment. Now that the BBC’s voice is that of impartiality and diversity, it feels that in our internet age, the words of GDS could become the voice of the establishment. It’s the kind of language that I would like the robots of the future to use. I want most of my communication with services to be utterly characterless. In fact, if I could just have a button on my browser that could ‘GDSify this’, I wouldn’t hesitate to use on most websites.

Content design isn’t a common job title. There isn’t a ready and able workforce of people already calling themselves Content Designers ready to take this work up. It’s a new role for linguists, designers, IAs, UX and CX folk, call them what you will, those people that still haven’t really found a role for themselves between strategy, planning, design and analysis. But the idea of someone actually taking the time to design (not just write) content is quite new. It’s not an opportunity for someone to express themselves creatively. It shows a serious belief in the structure of words and their absolutely inseparable purpose from the colours, fonts, layout and structure of pages on the internet that we use.

Another thing that jumps out at me about this description is the idea that design can be a framework for other design- there is a visual language of boxes and type sizes and colours and all that, but the words also need a standardised and structured and useful framework too.

Government is setting new standards of behaviour, like it probably should. The creation of public information isn’t an opportunity to emotionally engage with our audience. If only brands could understand that when someone takes the time to visit their website to read about their product, that’s often just what they want to do, they don’t want to bathe in adjectives that ’emotionally resonate’, usually they’re after facts- they probably just want to find out if they contain wheat or where the stuff is made.

The big challenge for Washington Post’s 12 new hires

So the Washington Post is going to be hiring “More than a dozen new employees across design and tech…”. The group will “…rethink the web and make our site more dynamic, flexible and easy to use”. A whole 12 people! That’s like a football team right? This compact team seems typical of Jeff Bezos’ preference for pizza sized teams (he will only hire people who are as small as a pizza, or something). This is positive for an industry that in the past has been incapable of thinking small and nimble. Remember Project Euston? Yeah the project that was going to reimagine the future of news? They had a similar brief which sounded much more incendiary- “capitalise on cutting edge ideas” and “drive new revenue streams”. That was in late 2009, they recently absorbed the group back into the mothership after Lewis and MacLennan couldn’t decide where they wanted to go. Most press coverage of the Washington Post announcement has centred on how much it’s like the way in which BuzzFeed and Vice are doing all their own creative work now and how it’s the end of agencies, or something like that. There’s some merit to that argument, given that the group will be placed pretty much where all their big clients are and where the talent lives.

Except, I suspect it’s going to be hard for a small group of 12 people to do both the very creative advertorial work that ad agencies do e.g. understanding brands and briefs, creating clear propositions, media strategy and such and make fundamental improvements to the platform, which require editorial prototyping, workflow improvements, DevOps and such. But hell, it’s all digital right? I do wonder how separate the brand content and platform development teams are at places like Vice and BuzzFeed.

It sounds interesting and I am hopefully for what Bezos can add to the Washington Post, but it’s going to be interesting to see if they can pull off both an integrated creative offering and a platform improvement agenda with such a small team.

Empathy Mapping with Lego Figures | smithery

Here’s Mr. Smithery himself John V. Willshire with a nice idea for bringing empathy mapping to life with LEGO Minifigs.

Empathy Mapping with Lego Figures | smithery.

I commented on it, here it is.

I’ve tried empathy mapping a few times in the past, not with minifigs though (lovely idea). I think this is a brilliant way of engaging organisations in thinking critically about their customers- lots of room for serendipity, it gets people thinking outside of their day-to-day habits and constraints and most importantly it’s massive fun. Where I think it this has limitations is that it can compound our assumptions about customers which are surfaced in the nature of the characters* but without being challenged, these assumptions can be taken on board as fact and accepted by the group.

I would definitely think this approach could be improved by having your participants meet a handful of real customers before this activity maybe in a World Cafe approach or a ‘speed dating’ kind of format where they get to learn as much as possible about people within a short amount of time.

I realise, like you mentioned on twitter, that it’s difficult in some circumstances to get people to talk openly about particular topics. But I think this is worth over-coming. I’ve had these kinds of conversations with highly personal topics from puberty to finance to cancer and I’ve found people to be ridiculously open when you approach them in the right way e.g. explain why their opinion matter to you.

Anyway, that’s my two pence. I don’t mean to be too critical of what is essentially an excellent approach.

*now this is useful, if we can develop ways of surfacing assumptions in order to convert them into hunches, then that’s progress. 

Feels a bit odd quoting myself but there you go.