3 years into my work at NHS Digital – part 1: this is transformation

Every 6 months since I joined NHS Digital in June 2017, I’ve written an update on our progress building digital capability inside the NHS. It’s a helpful discipline for me to look back and see how far we’ve come, and to remind myself what more we have to do.

Ending my 2.5 year note in December, I wrote:

I have a plan. We’re working with colleagues across organisational boundaries to make health and care more human-centred. And every week, in person and online, I encounter more people who want to do the same.

And so it has turned out.

There will be a part 2 to this report, I promise. But before I can tell you that story, I have to tell you this one.

Products and services that put people first

With our new executive director, Ben, we’re continuing to implement and iterate our product development strategy, and creating a capability that the NHS needs now more than ever.

Ben’s predecessor Wendy’s set the ambition for new programmes to be exemplars. This means employing not only user-centred, agile and iterative way of working, but also the governance and funding approaches that are right for digital delivery. We started with three pieces of work. Rochelle, our head of user research, led the establishment of user-centred design work on Cancer Screening; Tero, head of design, worked with NHS Login and the NHS App; I focused on the Book, Refer & Manage Appointments discovery.

The first step for each activity was to make sure we had the right multidisciplinary team, consistent with Government Service Standard point 6 (see also our interpretation of point 6 for NHS services). Having done that, we needed to be confident that the new service would meet users’ needs, consistent with points 1 to 5. This standard is of value to lots of teams, not just the ones that are subject to formal service assessments.

We set up show and tells where the three teams could share their work with each other. Thanks to Charlotte, our team administrator, these have become a fortnightly fixture, regularly attracting more than 40 colleagues to a Teams call.

I was really impressed by the way the Book, Refer and Manage Appointments team approached their work. They skillfully unpicked multiple layers of patient needs, policy intent, and administrative workarounds that surround appointments and referrals in the NHS. The original intent was to roll this discovery forward into one or more alphas starting in April. That had to be put on hold. All the same, there is value in what the team learned, and I’m confident it can be picked up and built upon when the time is right.

Another change arising from the product development strategy was setting up a small central design team for the directorate, with its own budget and cost code. Previously all user-centred design work had to be directly attributed to individual programmes or services, which made cross-cutting leadership hard to resource. I think we’re feeling the psychological impact of this small bit of extra flexibility, as well as the practical benefit of being able to remove operational blockers for designers and user researchers. Having been trusted with this budget, we need to prove we’re worth it, and that we can manage it responsibly.

The idea is that we can provide design leadership for all of the sub-directorates that make up the Product Development directorate. The de facto structure has shifted as our teams got stuck into some urgent new commissions, but we have worked together to ensure that priority areas sill have oversight.

I couldn’t do any of this without Rochelle and Tero. Along with leads Nancy and Dean, and supported by three of our brilliant graduate trainees, we’ve tried setting goals with objectives and key results (OKRs) to make sure that we’re working on things that matter, and that we can demonstrate impact to ourselves and others. For example, as we invest in user research operations, we’ll track the number of hours given back to user researchers to spend time on the work of research and analysis. For the user-centred design course that Tero and Rochelle have created, our measures are the number of staff who have been on the training, and the number in our team who are able to teach it.

While I have tried to set clear expectations and measures for our work as a team, I know that’s only half the story. So many of my colleagues are braver than me. They do their jobs better than I possibly could, and frequently exceed my expectations with their commitment to user-centricity, and to equality in all its forms. Not all of that can be measured, but it’s our job as managers to create the culture and conditions for them to keep on doing it.

I can see the tangible impact of this culture change in the field of digital accessibility. There’s now a lab kitted out in our Bridgewater Place site, ready for teams to test their products on commonly used assistive technology. Even though most are working from home at the moment, people are doing their best to make our products work for everyone.

Beyond NHS Digital, I’ve continued to work with colleagues in NHSX and the NHS Business Services Authority. Having these connections has proved invaluable. We’ll succeed together by creating a movement for user-centricity across national and local health organisations, and the growing number of enlightened suppliers to the sector.

Growing a profession

Alongside my direct contribution to the design of the products and services that NHS Digital delivers, I have a role as profession lead developing digital capability in our organisation and beyond.

Our graduate scheme is a big part of that. We’ve recruited more than 15 new starters to join this two-year scheme in September, in two tracks (user-centred design is one, product and delivery management the other). Thanks to Simon, the profession’s graduate scheme co-ordinator, and colleagues from NHS Digital’s academy team who ran a great selection process. When the new cohort arrive, we need to ensure they all get a good first experience of working in our organisation.

My confidence that we can look after more trainees grows in proportion to the strength of our senior user-centred design leadership. In addition to the brilliant design and user research leaders mentioned already, we’ve been lucky to bring Cate Care and colleagues over to NHS Digital from Public Health England. Several of the existing team have earned well-deserved promotions to senior designer or user researcher. And in a couple of weeks we’ll welcome Emma Parnell as a lead designer.

Having completed an organisation change process covering user-centred design roles last autumn, we were due to do the same for the product and delivery side of the profession this summer. Despite a number of existing staff transferring in from other profession groups in NHS Digital, we still don’t have enough people to fill these vital product management and delivery management roles. While the organisation change process has been put on hold for the time-being, we’re finding other ways to keep moving this forward.

If we’re going to develop digital capability across health and care, we need a clear picture of what the different roles are, and what good looks like for each one. The Digital Data and Technology (DDaT) capability framework is emerging as the best way to structure that.

In the past 6 months, I’ve worked with colleagues in NHSX and Health Education England (HEE) to promote the use of the DDaT framework in health. This culminated in two unconference events in Leeds and London, organised by volunteers from the profession and colleagues from the Building a Digital Ready Workforce programme. We were fortunate to be joined by colleagues from GDS, who run the DDaT profession across government, and participants generated lots of good ideas to advance skills in these roles across health.

Building a Digital Ready Workforce has now moved fully over to HEE, where the work has a good home and strong champions in James Freed and Patrick Mitchell. While NHS Digital no longer plays a delivery role in this work, I’ll still be involved as part of the programme board. I continue to be impressed by the small, committed team working on the programme, and the network of people from many organisations who get involved because they’re passionate about digital capability in health.

How others see me

Ahead of my performance review with Ben this month, I asked my direct reports, peers and manager for 360 degree feedback using the dimensions of the Healthcare Leadership Model.

Their assessment of me aligns pretty well to my own self-assessment – hopefully a sign that I learned something about myself on the Nye Bevan Programme last year. In particular, I was pleased to have improved in their estimation on the dimension of “holding to account”. I scored less well on that last year.

Some people have noticed that I have become more confident in influencing and leading through sharing thinking openly, voicing my options and in challenging colleagues in a constructive and helpful way. Others still tell me to be more challenging.

From my team, there’s an appetite for more development and coaching, something I must pay attention to in the next few months. I also need to be mindful that we don’t create a digital divide inside the organisation between digital exemplars and the teams that are quite a way behind in their capability.

This is transformation

All the above is the work we call digital transformation:

  • steadily developing strength and depth in our teams
  • changing the way our organisations work for the better
  • taking care of our own development
  • being mindful of the impression we make on others.

We do this so that when it matters most we’re able to apply – according to Tom Loosemore’s definition of digital – the culture, processes, business models & technologies of the internet era to respond to people’s raised expectations.

There are no shortcuts to digital transformation, no such thing as “two years of transformation achieved in two months”.

There are, however, moments that illuminate how far we’ve come – and how far we have yet to travel – on the journey of building digital capability.

And boy, as I’ll tell in part 2 of this post, have we reached one of those moments.

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Sep 13, Grand Remembrances

Today is Grandparents Day in the United States. Being a Grand is a special honor. I feel very blessed that my wife and I have two grandchildren. We were able to visit them today. Yes, we are still being cautious with the coronavirus, but we also find it very difficult to not see them when they live so close. So today we did drop by to visit Jacob (age 10) and Sophia (age 7) along with their parents. We brought donuts and caught up with them. Our grandchildren are still pretty young and this is a precious time in their lives – and ours!

I wish I had known my grandparents better. We never lived in the same place. Dad was a career Air Force pilot, so we moved around a lot. But we did get to see them once in a while when they would visit us, or we them.

A Plague of Giants

There are five known magical ‘kennings’ or types: air, water, fire, earth, and plants. Each nation specializes in of these kennings, and the magic influences the society. There’s a big pitfall with this diversity of ability and locale–not everyone gets along.

Enter the Hathrim giants, or ‘lavaborn’ whose kenning is fire. Where they live the trees that fuel their fire are long gone, but the giants are definitely not welcome anywhere else. They’re big, they’re violent, and they’re ruthless. When a volcano erupts and they are forced to evacuate, they take the opportunity to relocate. They don’t care that it’s in a place where they aren’t wanted.

I first read Kevin Hearne’s Iron Druid books and loved them (also the quirky The Tales of Pell), so was curious about this new venture, starting with A PLAGUE OF GIANTS. Think Avatar: The Last Airbender meets Jim Butcher’s Codex Alera series. Elemental magic, a variety of races, different lands. And it’s all thrown at you from page one.

But this story is told a little differently. It starts at the end of the war, after a difficult victory, and a bard with earth kenning uses his magic to re-tell the story of the war to a city of refugees. And it’s this movement back and forth in time and between key players in this war that we get a singularly grand view of the war as a whole. Hearne uses this method to great effect.

There are so many interesting characters in this book that I can’t cover them all here. Often in books like this such a large cast of ‘main’ character can make the storytelling suffer, especially since they don’t have a lot of interaction with each other for the first 3/4 of the book–but it doesn’t suffer, thankfully. And the characterization is good enough, despite these short bursts, that by the end we understand these people and care about what happens to them.

If there were a main character it would be Dervan, a historian who is assigned to record (also spy on?) the bard’s stories. He finds himself caught up in machinations he feels unfit to survive. Fintan is the bard from another country, who at first is rather mysterious and his true personality is hidden by the stories he tells; it takes a while to understand him. Gorin Mogen is the leader of the Hathrim giants who decide to find a new land to settle. He’s hard to like, but as far as villains go, you understand his motivations and he can be even a little convincing. There’s Abhi, the son of hunters, who decides hunting isn’t the life for him–and unexpectedly finds himself on a quest for the sixth kenning. And Gondel Vedd, a scholar of linguistics who finds himself tasked with finding a way to communicate with a race of giants never seen before (definitely not Hathrim) and stumbles onto a mystery no one could have guessed: there may be a seventh kenning.

There are other characters, but what makes them all interesting is that they’re regular people (well, maybe not Gorin Mogen or the viceroy–he’s a piece of work) who become heroes in their own little ways, whether it’s the teenage girl who isn’t afraid to share vital information, to the scholars who suddenly find how crucial their minds are to the survival of a nation, to the humble public servants who find bravery when they need it most. This is a story of loss, love, redemption, courage, unity, and overcoming despair to not give up. All very human experiences by simple people who do extraordinary things.

Hearne’s worldbuilding is engaging. He doesn’t bottle feed you, at first it feels like drinking from a hydrant, but then you settle in and pick up things along the way. Then he shows you stuff with a punch to the gut. This is no fluffy world with simple magic without price. All the magic has a price, and more often than not it leads you straight to death’s door. For most people just the seeking of the magic will kill you. I particularly enjoyed the scenes with Ahbi and his discovery of the sixth kenning and everything associated with it. But giants? I mean, really? It isn’t bad enough fighting people who can control fire that you have to add that they’re twice the size of normal people? For Hearne if it’s war, the stakes are pretty high, and it gets ugly.

The benefit of the storytelling style is that the book, despite its length, moves along steadily (Hearne is no novice, here). The bits of story lead you along without annoying cliffhangers (mostly), and I never got bored with the switch between characters. It was easy to move between them, and they were recognizable enough that I got lost or confused. The end of the novel felt a little abrupt, but I guess that has more to do with I was ready for the story to continue, despite the exiting climax.

If you’re looking for epic fantasy with fun storytelling and clever worldbuilding, check out A PLAGUE OF GIANTS.

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The Artwork Of Gary Choo

Gary Choo is a concept artist/illustrator based in Singapore. I’ve know Gary for a good many years ( 17, actually ), working together in animation studios in Singapore like Silicon Illusions and Lucasfilm. Gary currently runs an art team at Mighty Bear Games, but when time allows he also draws covers for Marvel comics, and they’re amazing –

The Art Of Gary Choo
The Art Of Gary Choo
The Art Of Gary Choo
The Art Of Gary Choo
The Art Of Gary Choo

To see more of Gary’s work or to engage him for freelance work, head down to his ArtStation.

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