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How NHS Digital is developing user-centred design maturity

Rochelle Gold, Head of User Research at NHS Digital, describes how our user-centred design maturity model helps teams to achieve outcomes and manage risk. 

Everyone that works in the NHS, whatever their role, is working towards one common goal – to provide the best care to patients and keep people well.

User-centred design enables us to deliver on that intent and our maturity model supports teams to develop their user-centred design capability. 

Rochelle Gold is pictured at home

At NHS Digital we work towards that common NHS outcome by developing products and services for both patients and health and care professionals and working with technology suppliers and developers.

There is, however, a large risk associated with the achievement of that outcome. When there is too much distance between where decisions are made and the day-to-day delivery, we risk not understanding what is truly needed.

We need to understand how things will work in the day-to-day front-line context from the start. Otherwise, by the time we’ve gone through the process of developing an idea and rolling it out, it's too late to find out whether or not it was the right thing to do.


Why we need to work in a user-centred way

What user-centred design does is manage that risk and bridge the gap between our intentions and what actually happens. It helps us to understand what our intent looks like within the reality of the NHS and helps us to make sure that as we develop products and services, they will deliver on that intent.

Skilled user research, content and design professionals continually provide feedback to help establish whether we’re achieving what we set out to and adapt the design until we have confidence that it works.

Without user-centred design, we do not know whether we’re delivering the right thing and achieving the outcomes we intend to. User-centred design helps us manage the risk of delivering the wrong thing and, in turn, not achieving the outcomes for the health and care system that we’re commissioned to deliver. It also is a key part of assurance processes within the system.

At NHS Digital we have developed a user-centred design maturity model to help teams manage this risk.

It’s a tool to:

  • facilitate team conversations about how user-centred they are
  • establish where teams currently sit on the user-centred design maturity ladder and where they want to be
  • support teams to develop an action plan to get there

To implement that action plan the tool provides further support, links into user-centred-design communities of practice and practical advice on how to grow their ability to embed user-centred design into delivery.  

Since we developed it, the Laura Wade-Gery report on the transformation of the NHS has been published. A core part of the report’s recommendations is to work in a user-centred way.

It recommends that the NHS:

  • ‘adopt a user, patient and citizen centred approach'
  • ‘foster a more agile and flexible workplace focused on meeting user needs’ 
  • ‘ensure that those in decision making positions are constantly aware of the day-to-day reality of the citizen experience, and make real the commitment to a patient and citizen centred approach’

Our model has not only helped to mature user-centred design in NHS Digital, it can also help the wider system deliver on the recommendations of this report.


User-centred design maturity

At NHS Digital we have been developing our user-centred design capability and maturity over the past 6 years. We started out small in one product area and gradually scaled outwards.

We started at first with the introduction of user-centred design roles, bringing designers, content designers and user researchers into teams. This helped teams to start working in a user-centred way and as the benefits began to be realised, more and more teams started to work in this way too.

It started in patient and public facing services and expanded into health and care professional services, to APIs, standards and tech supplier services.

A key feature of maturity is when a user-centred approach moves beyond being only the concern of the user-centred practitioners in the team and something that the whole team sees as part of their work.

As user-centred design scaled up, the support the teams needed to move to this way of working needed to scale too. We supported user-centred design practitioners through communities of practice, and user research and design operations, but there needed to be support for whole teams - teams new to working in a user-centred way, those that did not yet have user-centred design capability or were buying in that expertise.

A key feature of maturity is when a user-centred approach moves beyond being only the concern of the user-centred practitioners in the team and something that the whole team sees as part of their work. This doesn't mean everyone is interviewing users and making prototypes. It means the whole team know who the users are, what problem they are solving, and are actively taking part in the process the user-centred design practitioners are facilitating.

We identified a need for a user-centred design maturity model that provides practical guidance for what good looks like and how to get there.


How we developed the model

NHS Digital's version of the Danish design ladderWe started by piloting a framework based on the Danish Design Ladder as part of a review of a programme NHS Digital had recently taken over responsibility for. The model worked well and provided robust recommendations that were taken on board for future delivery. We had a framework, but what people needed was a practical guide on how to apply it.

Maturity frameworks are only useful if people know how to apply them in practice. To increase the user-centred design maturity of the organisation we had to go beyond practical application being in the heads of experienced user-centred design leaders.

The scale we are working on means that knowledge sharing and upskilling are essential. We cannot expect colleagues to work in a user-centred way if we cannot and do not articulate what this means in practice. Our question was, how might we support teams within the organisation to understand how mature their user-centred design thinking and practice is and how they could improve it.

To do this and to do it well, we needed to invest in developing the model. We engaged with our service design delivery partner and created a team to focus on this specific task. Through the 3-month project we developed a multidisciplinary working group of colleagues with a range of experience of working in a user-centred way, including many who had no experience.

It included people who worked in project, programme and risk management, strategy, engineering, product and many other roles that play key parts in the delivery of our work.

Our regular show and tells were also attended by a similar variety of colleagues including executive directors and senior business decision makers.

The model is just the trigger for ongoing work with the teams to adopt and mature their approach to user-centred design.

We spoke with people across the business to understand the user needs for the model and linked in with colleagues who had developed similar models to learn from their experiences. User-centred design is all about multidisciplinary collaboration to understand and meet identified needs. It made sense to develop the model in the same way. The model evolved and we tested it out with a number of teams, continually iterating along the way.

Continuous improvement is crucial to this work. The model is just the trigger for ongoing work with the teams to adopt and mature their approach to user-centred design.

It’s a framework to see progress over time and we have invested in essential follow up support to enable teams to do that. We are also working closely with our engineering and product colleagues and their maturity models.


The user-centred design maturity model

user centred design maturity framework extract

We now have an evidence based, tested model for user-centred design maturity. The model uses the Danish Design Ladder as its basis - we built on this in the context of health and care services.

This model includes:

  • a 5 step maturity ladder
  • self review tools for teams
  • trained review facilitators
  • action planning guides
  • user-centred design community support

At each level of the maturity ladder, we articulate what this looks like in practice for different aspects of teams. This includes not just user research, design and content design but also:

  • equity, inclusion and accessibility
  • commissioning / business decision making
  • product and delivery
  • the team as a whole

Key to the model is support for teams. It is a tool to support and facilitate delivery.

We know that there is a lot being asked of colleagues across the organisation and system. We are busier than ever. Given how busy we are, we simply cannot afford not to mature our user-centred design practice.

We cannot afford to deliver things that are not going to achieve outcomes for the NHS and the people that use it. We cannot afford not to deliver on our intent.

To find out more about the model contact: ucd@nhs.net

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Last edited: 7 January 2022 2:25 pm