NHS Digital Transformation meet up at Torchbox

The sheer scale of the work involved in migrating NHS.uk to Wagtail (+3k pages of information on conditions, symptoms and treatments, 45m unique visitors per month) is awesome - and this is just one part of a wider strategy to develop digital tools and services that connect people to the health information and care they need, when they need them.

Sharing knowledge and learnings beyond your immediate team is at the heart of successful digital transformation programmes. So, we were pretty excited to host the first-of-its-kind NHS meetup for the central NHS Digital team (Ian Roddis, Sophie Dennis, Matt Edgar, Stewart Fishman), regional NHS digital leaders (Tim Clarke, Alison Warren, Sarah Key, Sharon Hanley, Anna Lewis, Katie Squire, Luke Taylor) and partners (Anthony Fairweather, Nick Harewood) at our Bristol office.

Is it a conference? Is it an unconference? Or is it merely a gathering in the Torchbox Bristol kitchen? Ian Roddis, Lead Product Manager at NHS Digital, explains what the meetup is all about:

We’ve summarised the day’s talks in this blog and provided some links to where you can find out more - enjoy!

The day’s talks:

1. Creating an IA for the NHS for the next 5-10 years! - Sophie Dennis, Transition Strategy Lead / Information Architecture, NHS Digital
2. Understand your users! - Matt Edgar, Head Of Design, NHS Digital
3. Personal Health Records - Stewart Fishman, Senior Project Manager, NHS Digital
4. Creating a NHS Digital Service Manual - Ian Roddis, Lead Product Manager, NHS Digital
5. Delivering lean NHS digital projects - Anthony Fairweather, Torchbox Account Director

Sophie Dennis is well-known in the UX industry and is leading one of the biggest Information Architecture (IA) projects of our day - here’s her team’s mission statement is to create a new information architecture for the NHS website that will provide a solid platform for the service over the next 5-10 years.

This sounds tough. When you start thinking about the scale of the NHS.uk platform - the long tail of different hospital sites and apps, the many journeys you take to get to the information you’re looking for (80% of NHS traffic is from Google to a deep page), the state you might be in looking for advice and guidance after being given life-changing news, the transactional nature of the NHS online services - it boggles the mind.

In order to achieve the goal of a longlife IA, Sophie continued, the team will need to define a ‘global taxonomy’ for NHS services and the terms used (by both clinicians and patients) that define health conditions and map to clinical pathway systems.

Content, which is often clinical in nature and subject to rigid controls and systematic review cycles, will need to be produced, stored and disseminated (or syndicated) across multiple platforms and channels. This means the NHS will need to manage their content in ‘CHUNKS’ not in ‘BLOBS’.

BLOBS = lock content to specific formats, presentation and hierarchies (so full pages of styled HTML content - created in tools like Wordpress). The benefits of this approach are that content can be created and published quickly. The drawback, individual content elements can’t be reused.

CHUNKS = content is broken into well-structured, modular and semantic ‘chunks’ and content is fully separated from the presentation of the content (supported by tools like Wagtail).

If the NHS fully adopt a ‘CHUNKS’ content model, then granular pieces of content will be created and stored in Wagtail and shared via content and syndication APIs to a wide range of different apps (see the NHS Digital apps library), channels and user interfaces (e.g. voice UIs, wearables, machine learning platforms). This is a pretty exciting vision.

Keep an eye on the NHS Digital Transformation blog to hear more about how this work is progressing.

Next up was an interesting and thoughtful talk from Matt Edgar - who heads up the Design team at NHS Digital - about designing services and content that meet user needs (there’s even an ISO standard for this stuff - the catchily named ISO 9241-210:2010 Human-centred design for interactive systems).

Matt’s research has shown that ‘user needs’, in the context of engaging with health content and online health services, are complex. Services need to meet people’s ‘clinical’, ‘practical’ and ‘emotional’ needs.

An example to bring this to life

Matt’s team have recently prototyped and tested improvements to the Paracetamol pages on the NHS Choices platform:

• The pages contain simple to understand information about Paracetamol (meeting users clinical needs).
  
• However, some users (in this case parents) were looking for guidance about giving Paracetamol to their children (identifying a practical need).
  
• Now, consider an anxious parent is seriously worried about giving their baby the wrong medicine and is struggling to navigate through all the mixed content for parents and children (an important emotional need is not being met).

The learnings from this user testing informed new prototype designs where the content for adults and children was split into two tabs.

Another Example

Looking at the NHS Choices analytics, Matt’s team learned that 86% of people looking at the insomnia pages do so on their mobiles, with the peak time between 11pm and 2am - helping shape the design to meet the needs of this audience group.

These two examples really highlighted the importance of continual user research and always iterating and improving upon designs and journeys for your users.

Matt’s final insight made us all smile… people struggle to give negative feedback, especially when it comes to the NHS. But, as Matt points out:

Next up, Stewart Fishman gave the team an update on two key projects that will empower patients in the UK to manage their own health - Personal Health Records (PHR) & Citizen Identity (CID).

PHRs enable people to record their own health and care data, to talk with health and care professionals and in some cases provide digital alternatives to physical services. Tasked with encouraging the adoption and development of PHRs at a local level, the team has been travelling around the country to discuss the project and learn what support and standards are needed to assist NHS organisations and PHR suppliers to enable local PHR initiatives. Some of the findings from these events are summarised in this blog.

The Citizen Identity programme are looking into how we can identify people to allow them to securely access their record or other services. Currently they are looking at both online and offline journeys and are also working with existing services such as GOV.UK Verify. People will also be able to nominate others such as carers to get access to allow them to manage their care on their behalf.

Anthony Fairweather, who heads up some of our big NHS projects ran an interactive session exploring how NHS organisations can be effective within the constraints of tight budgets and small digital teams.

Drawing on our experience working with Gloucestershire Hospitals NHS Foundation Trust (whose new site will launch soon!), Anthony decoded the concepts of agile and lean, offering insights on the advantages they can bring and how to overcome the challenges of a very different mindset to waterfall management. Here are four points that I thought were particularly important:

1. Get comfy with WIP ( work in progress) - agile working means learning to accept constant change and things being unfinished, and whilst this might feel unsettling, it’s a real benefit. Sharing deliverables with your client as early as possible generates valuable feedback and ensures you’re moving in the right direction. And you can stay in control by limiting the amount of stuff you work on at any one point in time.
   
2. Work as ‘one team’ - your agency partner doesn’t need to deliver every single aspect of the project. Your in-house team will have more organisational context and understanding than your supplier partners - so, with a little coaching, they can deliver parts of your project (think managing large stakeholder groups or helping conduct user research) to keep budgets down. This is also about breaking down communication barriers (by, for example, having weekly standups with client and agency project teams)
   
3. Establish projects principles (early in the project) - Alison Warren describes what this is all about in her thoughtful blog.
   
4. Share! - it seems crazy that every NHS trust should start their digital projects from scratch, when their websites serve such similar user needs (e.g. find a GP, locate parking etc.)…

Unsurprisingly, point 4) sparked a healthy debate:

• How can we share learnings or assets from NHS projects? How would this work? A Slack group? The NHS Digital Transformation blog?
• How do we ‘open source’ user research?
• How far can we go? A standard NHS hospital template? Code?
• Would Trusts welcome this approach?

We agreed to an action to establish a mechanism/platform for more, and better, sharing. This might be in the form of a Slack group.

Ian Roddis shared plans for an exciting project he’s working on with Torchbox and various NHS Digital teams to create a new NHS Digital Service Manual (akin to the GDS Service Manual). In this video, Ian gives an overview of what the project is all about:

The scope of this project is potentially far reaching, from establishing NHS accessibility standards, to designing NHS front-end patterns. The NHS Choices site will be the first adopter of the digital standards & patterns in 2018.