If you’re looking for a best-practice standard on how best solve problems and deliver outcomes to your users, you could do worse than follow the now more than 20-year-old international standard for ‘human-centred design for interactive systems’, BS EN ISO 9241-210:2019.
The ISO 9241-210 provides best practice guidance organisations should follow to ensure they are designing their systems, products, and services with users at the centre of the decision-making process.
Why am I telling you all this?
It’s the foundation to our own NHS service standard and the GOV.UK service standard, and despite its ‘catchy title’, it’s one of my most quoted ones. I often bring it up to demonstrate that this user-centred design stuff is not something we have only recently come up with.
The standard and its content was created in 1999 as ISO 13407 and has been known since 2010 as ISO 9241-210. Ask your organisation’s knowledge management team if you already have a licence, or visit your local library for a free access.
6 principles of human-centred design
The standard does not assume any particular design process or activity. It is complementary to existing processes and methodologies. The main part of the standard is the 6 principles it describes for a human-centred approach:
1. The design is based upon an explicit understanding of users, tasks and environments
To achieve this principle, we need to conduct observational, explorative user research on the users of the service to find out where they use the service and what the tasks and goals are.
ISO 9241-210 describes users not just as those who will use the product or service, but also people who may be directly or indirectly affected by its use. These groups need to be identified and their needs discovered. The standard says explicitly:
“Constructing systems based on an inappropriate or incomplete understanding of user needs is one of the major sources of systems failure.”
The standard refers to "human-centred design" instead of "user-centred design", emphasising that it also “addresses impacts on a number of stakeholders, not just those typically considered as users." This echoes service design thinking, which focuses attention on all the users, stakeholders and people involved in running the service, not just those who are the users or customers.
The first principle of the NHS Constitution, 'The NHS provides a comprehensive service, available to all', means we have to follow a human-centred design approach. It specifically highlights equity in the design of health services. We must “pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population."
Equity can only be achieved by actively listening to those user groups who are most affected by our design decisions and ensuring they get the support they need.
2. Users are involved throughout design and development
This means that we cannot just do user research once, at the beginning. We must involve users throughout: through design, going live and for the life of the service. The standard is also very clear, that involvement must be active; users must be able to interact with the design, whether it’s an early paper prototype or a detailed prototype built with code. The involvement cannot simply be via a focus group or a survey.
3. The design is driven and refined by user-centred evaluation
There’s little point in user research if the findings don’t impact the design. Is your backlog refined, based on recent user research findings?
4. The process is iterative
Design is driven and refined by user-centred evaluation and the process should be iterative. We never get too far with our designs before we test them with users and then revise what we are doing based on their feedback. Our teams working on the NHS website, NHS login or the COVID-19 testing service have frequent user research sessions planned into their agile sprints. The whole or parts of the service are tested with users every couple of weeks.
This iteration, incorporating feedback from all users, progressively eliminates uncertainty during the design and development process and mitigates risks.
5. The design addresses the whole user experience
To make sure the user experience we consider is not confined to the user interface or 'usability' of the system, I often use the excellent 'UX honeycomb' by Peter Morville. This describes the 7 facets of user experience: from usefulness and accessibility to ultimately providing value to users and the service provider.
This principle ensures we are not solely focusing on the single user interface and its usability. We should consider all the elements of the user experience. What are the different channels and touchpoints? Do users access a help desk and how does that affect their experience. What are the effects of long-term use? Do people come to our service with knowledge of previous or other systems?
6. The design team includes multidisciplinary skills and perspectives
'Design' is not the preserve of people with the job title 'designer'. It is the concern of everyone in the team who has a part to play in the design process.
In his book 'Rebel ideas', Matthew Syed talks about cognitive diversity and demographic diversity and explains how individuals simply cannot solve complex problems on their own. A homogenous team with people from similar backgrounds and beliefs can’t cover the whole problem space.
The ISO 9241-210 standard asks team members to become “more aware of constraints and realities of the other disciplines." At NHS Digital, we have seen huge benefits when technical architects and service designers work together to solve problems.
Sustainability and human-centred design
The Greener NHS programme is aiming to make the NHS net zero by 2045. We have got to do our bit on the emissions we control but also on those we can influence.
The ISO 2941-210 has a chapter on sustainability and human-centred design. It describes how human-centred design directly supports the economic and social pillars of sustainability by matching user needs and abilities to useful and used products and services, “providing cost-effective solutions and reducing the likelihood that systems, products and services will be wasteful or rejected by their users."
It says a human-centred approach results in “systems, products and services that are better for the health, well-being and engagement of their users, including users with disabilities.”
We do not have the luxury of devoting time and money designing, building and delivering products, services or systems that are not used and do not deliver the outcomes they were intended to deliver. The human-centred design process described in the ISO 9241-210 minimises the risk of this kind of waste.
How is this relevant to today's and tomorrow's health and care services?
For more than 20 years, we’ve had a standard that simply and clearly describes what organisations and teams should do to ensure they follow a user-centred approach.
ISO 9241-210 is used in industries across the world, it underpins the GOV.UK service standard and the NHS service standard, both of which build on its 6 principles. And yet we still have to argue why we should apply it into what we do, as if it is just 'nice to have' that can be ignored if we don’t have the time or money.
We know from our experience in working with healthcare products and services what bad user experiences mean: how they waste badly needed time and scarce resources and imperil clinical safety. For example, putting the wrong information into a health system because of poor usability can and does harm patients.
And this approach must be adopted by the whole organisation. As I described in my blog 'It takes a village to design a service'. User-centred design doesn’t just happen by hiring the right professionals. Everybody must accept their role in the process.
User-centred design is not just 'nice to have'; it is a must have approach, ultimately to deliver the outcomes and to ensure the clinical safety of our health services.
How do you enable researchers to do their best work? Claire Holt, founder of the research operations team at NHS Digital, shares her experience of building a successful service that has now broadened its remit to supporting the whole user-centred design team.
Last edited: 22 September 2022 5:35 pm