Persistence of vision
The strategy work continues and we’ve made a first draft. It is a video. Ralph and I have been re-learning After Effects, which is a bit like playing an arcane video game with an extremely steep learning curve (i.e. I am driven to keep chipping away at a manoeuvre for many hours beyond the workday while simultaneously shouting at my computer because the game is cheating). Initial reactions to the draft have been positive, and the video is just the starting point. From here, we need to figure out how to refine and disseminate ideas while drawing out all of the elements that will need to change for any of it to become real.
During the initial phase of the project, we spoke to a great many people. From that work, two things became clear: this place is swimming in ideas for how to improve services and no one has articulated what the experience of healthcare should feel like once you put all of the pieces together.
The surprising part of the research is how there isn’t much that is surprising in what needs to be done. A lot of the concepts we are proposing through this strategy work feel really obvious to me because we’ve known what the main challenges are for ages. Research and analytics tell us the same stuff, over and over. So does a simple walkthrough of core services, e.g. why are the types of appointments listed in the app half-gibberish? Why isn’t the same health record data available at all care sites? Why do patients need an appointment just to find out what they need to do at their next appointment? The main problems are readily apparent, but most of our work is doing what we can get away with. There are loads of very obvious ideas just sitting there, waiting to be attempted, taunting us.
Given that, the natural question is: “Why haven’t we dealt with these problems yet?” The immediate answer we reach for is “Because we can’t”. The reasons for that vary enormously, from a lack of time, to an inability to change how suppliers function, to a confusion about policy intent, to poorly formed data, to competing ideas about which version to go after. Y’know: the usual.
The less obvious answer is “Because we didn’t provide the right kind of picture of what the full experience would be like”. Our plans (of which there are many) lack tangible specificity about how the details might develop into something larger than the sum of its parts. They lack a depiction of form, and while form is not everything, I increasingly think that without it you have nothing. This isn’t so different from the “no air crits” rule we had in grad school – if you don’t show a specific artefact for people to discuss, we can’t have a productive discussion because we might all be talking about different ideas and not know it.
Service designers produce lots of maps, but maps aren’t the service anyone experiences. They are good for analysis, pointing at problems, and planning. For convincing thousands of people to work on one giant problem together for a long time, maybe not so much. (Is that treasonous?) And yet I am convinced that this work is very much service design, even if it doesn’t look like it at first. The whole point is the depiction of a coordinated, macro-level design proposal that drives system-level change, which in turn produces better user experiences. So, yeah, service design as strategy.
Perhaps we assume that all of this will organically form itself into something coherent through some sort of organisational emergence. My nearly four years here have repeatedly shown me this doesn’t happen on its own. I spend unbelievable amounts of time nudging teams to consider how their bit relates to everything else, and to redesign accordingly. Plus, I’m just one person, and this approach doesn’t scale. If we are going to achieve a more joined-up system – a phrase used over and over and over here – it seems like a good idea to describe what the totality should feel like and then work backwards from there.
We have plenty of material to play with, but depicting a complete system that is working in concert with itself requires a decent amount of editorial direction. Some things must be emphasised while others take a back seat as we draw the picture of it all. I am keen to make sure everyone can see themselves in what we produce and have no interest in trampling on anyone else’s ambitions, but some choices about what is most important need to be made. A picture of everything is a picture of nothing. It is an uncomfortable place to be.
This vision also has to be sold back to the organisation, which is a little strange, since all of the ideas contained within it are the org’s own. Last week I was watching this video, in which Dan Hon says something I’ve heard variations of many times before:
The joke about consultants is that they will tell you what the people inside have already been telling you, but because they’re telling you from the outside, you’re going to listen to them.
To a significant degree, this is what I’ve spent the last five or six weeks working toward, except I’ve been doing it from a semi-funky non-team cobbled together from a few different programmes. Our hope is that by describing how the sum total experience should feel for users (patients and staff alike) we can make it compelling enough for teams to all want the same thing and for leaders to clear the way. Or, maybe we just need to make it sharp enough to provoke a reaction.
Russell Davies interviewed Tom Loosemore the other day about the various AI experiments Tom has been playing with lately, and an early exchange gets at this:
Russell: Annoying people is one of your core skills.
Tom: It’s like you got to poke the pig or the pig don’t move, you know? You got to poke the pig or the pig’s going to sleep. So, yeah, I poke.
It is a small moment, but it feels salient to this strategy work. We’re part of this massive constellation of organisations that all operate under a single brand name, all sort of moving to their own tune, but we think there needs to be more coordinated action if we are going to improve the system in a significant way. Maybe we create a video that makes the plan explicit and see if we get a reaction. Maybe we prototype how things will work so people can try it and respond. Maybe this is all a very elaborate exercise in facilitation.
The shape of data, the structure of clinical pathways, the plumbing that moves material between sites and services – they all need to change. We need the vision (in whatever forms it takes) to describe the macro-level design in a way that keeps everyone moving in the same direction for the long haul because this is going to be excruciatingly difficult. That doesn’t answer the question of how you implement design changes when you can’t directly instruct any of the individual parts or when they can choose to ignore you. Solving for that will come later. First: what do we want it all to add up to?