Posted on 30 August 2022
Considering the large number of strategies and policies that mention service design, you might conclude its potential is well understood in NHS Scotland and Scottish Government. This is encouraging! I am excited to see my field at the centre of conversations about future possibilities.
Yet these conversations rarely articulate what they mean by ‘service design’. It can sound like a catch all buzzword for doing things differently. That’s okay. Now we need to take the next step and work out what service design in health and social care looks like in practice. This needs lots of experimentation, thinking, failing, and learning. And sometimes neither teams nor leaders are ready for this. We would like a shortcut. Designers have advertised their field as the solution to a range of problems. Now we’d like them to get on with it, to get us to this brighter future!
Much of the current focus is on trying to bring these skills and methods into the system quickly and at scale. Of course hiring an army of service designers is not practical or possible. So we try to speed up the transformation in the traditional NHS way. We coach and train non-designers to apply service design tools. This is not a bad plan, but we need to talk about and address what it leaves unresolved:
Service design is a mindset and a team sport, not a single method or a toolbox. So showing someone how to use one specific tool, or teaching a single design method just doesn’t work. It oversimplifies and leads to people deciding this is not as powerful or useful as they thought. Instead giving broad theoretical introductions is meaningless and difficult to apply for newbies. Yep you guessed it, that slideshow with the double diamond we all have is the worst offender here. It sounds so abstract that people get frustrated or intimidated by the jargon. This adds to the pressure for staff who are already stretched and under pressure.
Limited training can be a good start. It is never going to be enough to tackle the vast and complex challenges the NHS is currently working to solve. It is naive to think it is going to equip people with all they need to tackle urgent and important issues as design experts. In fact, it is harmful. It knocks people’s confidence and creativity and belief they can learn to design. Meanwhile people who do have the skills to work on such issues are busy training beginners. The balance isn’t right here. Newbies need more space to learn, to practice, and to fail. And experienced designers need space to build on their skills, and to adapt them to health and care.
It’s great there’s agreement for embedding design skills and methods into the system. But there are lots of questions left unanswered. How do we do this in a way that enables design practitioners to get to work and make an impact? This ranges from technical requirements to process to organisational structure. For example, designers may need certain software to work visually and collaboratively. They need infrastructure in place to allow user research to happen ethically and timely. And they need representation at leadership level. Design mindsets, skills, methods, and tools need to be embedded meaningfully. They need space to do things differently, but also ways to integrate with existing NHS structures to collaborate, adapt and learn.
Of course these three factors will always be a question of balance. We need to shift between teaching design methods and cultivating design mindsets, between training beginners and working on complex challenges, and between doing things differently and integrating with existing ways of working. This needs a considered strategy and deliberate experimentation but currently it is too often left to chance. It causes frustration, resentment, and disillusionment for people new to design as well as designers new to health and social care. There’s a risk that service design will become the next failed hype. This would be a real shame and a missed opportunity. Service design is not a silver bullet, it’s a profession like any other. How it is set up within an organisation matters.
In my own work, I did my best to meet colleagues where they are, but I didn’t always manage. And it often felt unhelpful for introducing new ways of working as well as for adapting to the current state. Various approaches from service design to quality improvement to community engagement became entangled. This made it difficult to give direction or identify next steps and I did not have the answers or direction teams expected. I kept thinking I simply would not have started from here. But ‘here’ we were, and we needed to move forward.
Of course making change feel easier, simpler, and less uncertain by creating a safe space was part of my role. Yet it was equally important to challenge, to be aspirational, to work with complexity, and to create a brave space. Another difficult balance. And sometimes projects, teams, or organisations aren’t in the right place or set up for this. I had to learn that my work as an individual cannot always solve these wider issues around set up. I found this hard to accept and quite humbling. Now it gives me hope. Designers working in these old and complex systems are not failing. But our collective effort needs to focus on the strategic level at least as much as the practical work of solving problems for users.
I am encouraged that there is thinking underway in my former team at Healthcare Improvement Scotland. There is much to work out about creating a more design friendly organisation, from scoping programmes better to supporting multi-disciplinary teams to get the most of each other's approaches to service transformation. These steps sit at an organisation-wide level, and they are vital in enabling design work. They need much deeper rethinking and reorganising, and careful advocacy at all levels.
This is a conversation I am leaving with the next generation of designers and improvers in the NHS. Good design simply doesn’t happen in isolation, it needs the enthusiasm and collaboration of a range of people to make it a success. This has been a valuable lesson for me, and I am honoured to have been part of laying some of the groundwork. I can’t wait to see what the growing NHS design community can do with the help of much needed nurturing, leadership, and strategy.
I care deeply about creativity, imagination, collaboration, and inclusive design. I have worked as a designer and researcher for startups, consultancies, charities, healthcare and social care organisations, and governments. Here I think, reflect, learn, and share what I have learnt about understanding humans and designing services over the years.
You can find more of my work at www.uteschauberger.com