3 years into my work at NHS Digital – part 2: Responding to change over following a plan

I hate emergencies. Some people thrive on drama, on spontaneously pulling improbable triumph from the jaws of a terrible situation. Personally, I’d much rather we didn’t get into that situation in the first place. I knew this about myself before I did the Nye Bevan Programme, and my learning on that programme confirmed it.

Leadership for me is the long, thoughtful, steady progress of building capability in individuals, teams, and organisations. That’s why I joined the NHS. When I read back through the previous six-monthly reports in this series, those are the things of which I’m most proud.

As I proposed in part 1 of this update, there are no shortcuts to digital transformation, but there are moments that illuminate how far we’ve come.

The frontline

I never much cared for the military metaphor of the “frontline” in relation to our colleagues who deliver direct care for patients, but I’m sure at times that must be how it has felt for them. I hope we in the supporting functions have done everything we can to back them up.

There’s some survivor’s guilt in knowing that others have worked long hours in literally life and death situations, while I’ve suffered nothing worse than the inconvenience of an occasionally flaky internet connection.

I feel like I’ve lived a charmed lockdown. I can comfortably work from home and our children are all teenagers who keep to their own devices. It has been very different for many others – those with younger children to home-school, those who are vulnerable, those touched personally by the horrible new coronavirus. The two-dimensionality of the laptop screen conceals it, but whenever any group appears together, there’s something different going on for every person on that call.

And yet, incomparable though it is to the direct delivery of in-person care in a pandemic, there is a digital frontline in this crisis, and there my colleagues have delivered heroically.

That frontline is the first result people see when they type “coronavirus symptoms” into Google and see structured content pulled automatically from NHS.UK. It’s the rapid updates to 111 Online and the Pathways algorithm to reflect growing understanding of covid-19, and make sure that people know what to do at time of extreme worry and stress. It’s the hundreds of thousands of people needing “isolation notes” to show their employer if they can’t go to work.

Our teams did all this while, as James, one of our product leads put it, “sticking to our UCD guns.” It has been a long haul and there’s more to go. For some of our teams, the hard work began long before the clapping, and has continued as we gingerly descend the hill from April’s sorrowful peak.

Testing times

The need to respond rapidly to changing user needs and contexts of use has shone a light on areas where we’ve achieved some agility and user-centricity, and areas where digital transformation still has much further to go.

As might be expected, the teams that rose fastest to the challenge were the ones that were already working well together before the crisis. They’ve proven the pattern of giving high-performing multi-disciplinary teams new problems to solve, rather than disbanding and reassembling resources from scratch every time. Nevertheless, the volume and variety of new problems to solve all at once meant we had to do some of the latter. Those squads found their feet quickly and also delivered some great work.

While our NHS Digital teams have been demonstrating what they’re capable of in a crisis, we have been joined by reinforcements from other government departments and suppliers. On the whole, we’ve been able to act as one team. When it comes to digital delivery and user experience, the gap between public and private sectors is narrower than sometimes portrayed.

Many people in the Digital Services Delivery profession that I lead are relative newcomers to health and care, and we still have a lot to learn. I remind myself that it’s only 3 years since I moved from consulting, and before that 12 years in telecoms. All the same, I have sometimes found myself the most experienced person in the virtual room when it comes to how our health service works, and what patients and the public expect of us. I hope I can still strike that tricky balance between knowing enough to be effective, but still looking at the unique problems we face through fresh eyes.

Different perspectives are more important now than ever before. In our constitution, we say that the NHS is for everyone, yet this crisis has thrown pre-existing inequalities into sharp relief. In the coming months and years, we must reflect on how, at key moments in our response to the pandemic, our blindspots and biases affected the decisions we made and the services we delivered.

In response to this realisation, some of our user researchers and designers have begun to expand our definitions of access. We need to move beyond our necessary but narrow focus on digital accessibility. We need to design for the wider range of barriers that prevent some people and groups in society getting the care and service they need. Until recently, I saw the wider aspects of inclusion as important and adjacent to, but not part of, our core practice of user-centred design. I’m grateful to the colleagues whose clear-thinking and determination has changed my mind about that.

I feel fortunate to be working with leaders in several of the national health and care organisations who see this too. They have held the space for teams to do their best work, to understand the real problem we have to solve, resisting the temptation to revert to less effective methods of command and control. All this has taken place with our work under a level of scrutiny I have never previously experienced, and closer to the boundary of policy and delivery than my colleagues and I usually get to operate.

What now?

As the focus has turned to the next phase, we have to strengthen and evolve the new services we built rapidly, while folding some of them back into the everyday work of the health and care system. What have we learned that can help us with that task?

First that the amazing people of the NHS can rise to a challenge of unimaginable proportions, and reconfigure whole services in a matter of weeks when they have to. Let no one ever say that health and care workers are incapable of change. But we cannot count on their heroism alone. That’s not a sustainable basis for digital transformation.

There are risks coming out of the pandemic, present before, but now even greater.

  • On one hand, we must guard against complacency arising from the gratitude people have for the care, and their love of the idea of the National Health Service.
  • On the other, we have to restore the sense of our hospitals and other healthcare settings as safe places. Having majored on a message to “stay at home”, which was essential at the time, we need to make sure no one now stays away from the help they need out of fear.
  • So much has been put on hold as the service focused single-mindedly on weathering the storm. True innovation requires some slack in the system, safe space to try new things, acceptance that sometimes we’ll fail and learn from our failures. These things will be hard to protect when there’s so much catching up to do.

Those challenges are undoubtedly systematic ones, with solutions as likely to come from communities, places and local government as from NHS organisations in the centre. The peculiar set-up of “commissioning” in the NHS has been challenged and is changing rapidly in local systems. I sense the same pressures will come for our national services too.

User-centricity and the wider skillsets of my profession have a vital role to play in determining what kind of service we become. How – to borrow some principles from accessibility – might we make the whole system more perceivable, operable, understandable, and robust for everyone who needs it, and for the people who keep it going?

If we’re not careful, generalisations about some parts of public service may collide unhelpfully with the development of genuinely multi-disciplinary delivery teams. For example, it is often observed that the science and engineering struggle to be heard in the upper echelons of politics and policy-making. I know from my telecoms experience that the solution is not to create a science, technology, engineering and maths (“STEM”) monoculture, but to nurture balanced teams, with mutual respect at all levels. Social scientists and creatives play a crucual role in channelling and amplifying the impact of talented data scientists and software engineers.

I’m cautiously optimistic. Whatever my impatience at the slowness and the setbacks – among which having to respond to a global pandemic must surely be one – we regroup and press on.

Objectives for my team and me in the next phase:

  • Continue to mature user-centred design practices across our Product Development directorate
  • Grow the digital delivery skills the organisation needs for the future, including our present and future user-centred design leaders
  • Make sure all our colleagues understand barriers to access to our products and services, and always consider the equalities implications of their work
  • From doing all the above, demonstrably deliver value to the wider health and care system.
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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.

The post The Art Of Gary Choo appeared first on Halcyon Realms – Art Book Reviews – Anime, Manga, Film, Photography.