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Proto-Mapping NHS Citizen


This is my write up from the mapping session we held in Leeds in December. This is the first post in a new research project but it connects to  earlier work on the networks of networks concept and also the creation of digital civic space. Its part of the NHS Citizen project which you can read about here. For anyone who hasn’t visited my blog before I should explain I use this space as my action research diary and so it’s really me recording my thought processes and research progress in public. This means it can get a bit academic but hopefully not unpleasantly so.

The purpose of the mapping session was twofold:

  • to start the work of mapping the NHS Citizen ‘network of networks’
  • to create a method whereby we can co-produce this map and overtime make it open and dynamic

In moving forward with NHS Citizen one of the outputs of the October session was a feeling that this kind of map would be useful no matter what happened next and, to my mind, it’s the right starting point for the discover work if we want this to be about people and relationships rather than a data mining exercise (more on that in a future post).  Subsequent to the event I have created this simple example of the NHS reorganisation which has been created based on the brilliant Kings Fund animation which I throughly recommend people take a look at.  I have played around with the layout a bit to make it work here but even in this simple form I think the network analysis can raise some interesting questions about the whole system:

Social Network Graph of Kings Fund video

 

The event

As with all of the NHS Citizen events it is also a chance to test and develop the thinking and shaping of the project but the focus was definitely on the network building on Tuesday. The basic running order of the event was:

  • brief overview of NHS Citizen
  • brief introduction to the basis of social network analysis
  • Discussion of types/relationships (more on that)
  • Group work on maps
  • Feedback

We had 18 participants, 8 from NHS England + Project team and 10 from the wider NHS and VSO world (NB I need to X2 check these participant numbers as I am not 100% sure of the breakdown). They were all people who knew the NHS England team and were interested in the NHS Citizen project. A couple had done SNA work before but most people were new to it but this didn’t inhibit the session at all.

Method
My intention is to start to create a data set which includes the organisations, networks and other bodies which are currently involved in what we could be described as the NHS Citizen ’system’. This will span formal bodies, charities, voluntary groups, campaigns and ’other’. In the future we may extend this to include individuals. Ideally we want to capture the ’type’ of organisation plus the nature of the relationships between them as this offers some really rich opportunities for analysis beyond simple formal structures. I’m working in gephi and will post the data set here as a csv once it (hopefully!) starts to shape up.

Catagorisation
The lists below show the types and relationships that we ended up with after some discussion. The project team had created a draft of the ‘types’ before the session but the relationship types were created in the room. I think this is where the meat of the issue is for going forward as it was immediately clear that these categorisations were not commonly held views and that a number of factors were in play:

  • Participants did not feel able to create technical definitions based on governance arrangements and so were basing their categorisation on their understanding of organisations
  • We had some issues because we didn’t take the time to write up definitions of the terms. This is easily fixed for the future but it would have really helped the group work.
  • We had further issues because some of the types were genuinely contested – for example the lines between charity and social enterprise were blurred as were those between social and private enterprise in some cases.
  • We had an interesting discussion about the term VSO as well – how does this differ from Charity or Third Sector as a description? It became clear that all participants had different ideas in mind when they used these terms even when they came from similar types of organisations

This is probably to be expected when you open up discussion between actors from different parts of the system and could be articulated as one of the issues that NHS Citizen should ideally address.  This leaves us with a practical problem – ideally we would keep the definitions of terms open for a while in order to get a wider and perhaps more structured discussion happening but this does mean that the data collection will be rather difficult in the meantime.

With respect to relationships we actually had more agreement but a couple of other issues emerged:

  • In many cases participants didn’t feel that they could document relationships for organisations other than there own
  • There was some difficulty with separating individual from organisational relationships

I am sure these are not ’new’ issues so I am going to do something of a literature review to see if I can find anything useful (suggestions/pointers VERY welcome).

The final lists are here but as these were not applied to a great extent in the mapping session this is more FYI.

  • Types:  • NHS organisation • Member-led organisation (professions) • Convenor • Citizen-led organisation • Shareholder-led (private) • Shareholder-led (Social) • Charity • Other public sector body
  • Relationships:  • Collaborates with • Influences / influenced by • Supports / is supported by • Lobbies / campaigns • Funds / funded by • Educates • Informs / is informed by • Accountable to / holds to account • Regulated by • Represents views of • Shares data with

Method
The actual mapping went well but there were some very clear pointers for how we might do it in the future:

  • People very quickly got overwhelmed by the potential size of the network and lose a sense of which part of it they were trying to define. I think that next time we will ask people to create the network with their own organisation as the centre and then ask them to work out from there
  • This is probably the kind of exercise which would benefit from good stationary choices – we need to add something special to the magic box of facilitation stuff
  • Some relevant examples of other networks would really help people – we discussed using the already rich network map which York have produced for example to then start and develop network maps for other people

I think it should be relatively simple to create a mapping kit we can take out to events and get people to work with – and then translate that for simple online data collection as well.

What next?
I am going to write up the data we collected and out up some sample network maps for people to look at. I’m also going to follow up with some of the people who offered to help with this work from the session and start by seeing if their take on what happened coincided with mine.

One of the groups took the mapping task in a completely different direction though (am not surprised – it was led by Sian from York who already had a lovely network map). The turned the whole thing on its head and looked at how the system might be perceived by the citizen – it reminded me a bit of sleeping beauty where the citizen has to hack their way through a dense forest before being confronted by what they thought they wanted – only to find it fast asleep. I have been mulling on this a lot since the session. The session showed us a few design challenges which relates to the central need to design a system which is inherently open. Language is a key component of openness and it seems to me to be a bad method to design a process which leaves the ’experts’ debating the semantics of the naming of their own organisations.

We want to conduct the mapping alongside the physical events as well as online but to do this we will need a much simpler approach I have been wondering if the way to approach this is to build a typology based on the way in which lay-people understand the system both to highlight their centrality in what we are trying to achieve but also to create a more simple approach. This could look like this for example:

Types:

  • Charity or Social Enterprise independent organisations who are paid but are not working for profit
  • Business organisations who are working for profit
  • NHS any part of the NHS ‘family’ of organisations
  • ‘Other’ Government (e.g. Local Authority) government funded organisations
  • Citizen-led volunteer run organisations and campaigns

Relationships:

  • Funding (for/to) how does money flow through the system
  • Provides services (for/to) service and contractual relationships
  • Responsible for / is responsible to regulatory relationship

We would then add some additional data specific to patient and citizen ‘voice’ for each of the organisations which appear on the map:

  • Client group: Which patient or citizen group do they work with?
  • Location: Region, plus drilled down location
  • Reach: How many people do they connect to?
  • URL / Twitter details: Are they already accessible online?
  • Contact name: Who should we speak to ask more questions!

The mapping exercise would then ask individuals to map the network from their organisations point of view using this much more simplistic topology and only ask them to go beyond this if they feel confident. As we map regions (like the York map) we should be able to ask more prompting questions and hopefully speed up the process. With this data we would be able to produce network maps based on each of these data groups and could also produce regional maps.

This is all up for discussion so please feel free to comment below – I will post an update when I have discussed it with other participants and also had a proper poke at the data.

5 comments
  1. vicky sargent (@vickysargent)

    January 6, 2014 at 9:31 am

    This is very interesting and great to hear what you are doing. Two things strike me immediately. First, there are almost no names on the network map that a citizen would recognise – names like ‘GP’, ‘social services’ (citizen consciousness has probably not transitioned to ‘social care’ yet), ‘A&E’, ‘health visitor’, ‘outpatients’ and so on. Second, there are a few organisations that are not on the map but maybe should be – eg CQC, AHSNs, LETBs, care providers, ambulance trusts. Given the current move to integrate health & social care, housing associations, many of which provide care services, should possibly also be added.

    Reply
    • curiouscatherine

      January 6, 2014 at 6:07 pm

      its a fair cop! I had to use the abbreviations to make it fit but I agree it would need decoding for citizen use.

      Also agree that there are a lot more organisations to add – this map is just based on the data from the Kings Fund video as an example but #NHSCitizen needs to be a complete a picture as possible. I am thinking we need to keep testing the language to make sure it works for people – as well as creating bigger images!!!

      Reply
  2. Pingback: Proto-mapping #NHSCitizen « NHS Citizen |

  3. Rod

    January 10, 2014 at 2:09 pm

    An intriguing project. The examples of maps that you provide (yours and the York one) seem interesting at first glance but I can’t think of anything I might use them for.

    Suppose, for example, I have some interest in my local community hospital. It comes under Community Health Services, which happens to be at the bottom of your map. I certainly wouldn’t have to start at the top, which happens to be Public Health England, and “hack…through the dense forest” of the map. This fallacy is repeated in the King’s Fund video, in which the voiceover (in the final sentence) evokes the idea of being “a patient trying to navigate your way through”. But patients don’t need to navigate their way through the map of the entire NHS.

    More generally, when you write that “the network analysis can raise some interesting questions about the whole system”, it’s not obvious that this is really true. Many of the questions that seem interesting are artefacts of the map, and tell you little about the system. I wonder whether you can give an actual example of an interesting question that’s raised by the analysis but isn’t an artefact of the analysis.

    The York map illustrates some further problems. It has obvious errors — for example, some nodes have no labels. And it’s obviously out of date — for example, NHS North Yorkshire and York (the PCT) no longer exists. Maintaining this kind of map, even just for York, is challenging.

    It’s not clear what the lines and distances on the York map mean. For example, York Hospitals NHS Foundation Trust (bottom left-ish) is shown as a separate organisation from its Council of Governors, with a lot of distance between the two. The trust’s members aren’t shown at all. The description claims that the trust “runs” the council. But this is backwards. The members elect the council, which appoints the directors who run the trust (although it’s more complicated than that). The map’s seductive simplicity is deeply misleading.

    I think the lists of organisations on the York site are potentially useful, more so when the data was current. However, some organisations might choose not to participate in the local “partnership working” groupthink, and they might not always appear on such lists. For example, where’s the entry for York Samaritans?

    I get the impression of a costly project with uncertain benefits, but I know it’s early days, and I look forward to your update.

    Reply
    • curiouscatherine

      January 11, 2014 at 10:10 am

      Thanks for your comments Roy and for taking the time to read.

      I think you make a hugely important point about the graphs – there is a very thin line between something informative and something which is just eye-catching. In the example which I created I have manipulated it for presentational purposes (I needed to fit it on the page!) which means that whole the node sizes and relationships are significant things like the lengths of lines are not. This is often the case with network graphs and I don’t think it rules them out but they do need to be used with some care. I can’t comment on the York map but I would imagine it is the same there.

      With respect to keeping this up to date – one of our objectives is to create a dynamic map which kept up to date – obviously challenging but we have some ideas which we will build from the mapping process that I want to test at the next event (BTW – we have events this month in Birmingham, Sunderland and London and are in Exeter in Feb – details are on the website and all are welcome!). If this test goes well over a couple of events then we will look to get this online. The advantage of a dynamic map should be that people can address it from their own point of view and relevant starting point – which should help – but this will need to be tested.

      Finally – the interesting questions point – will be keen to know if you think this is too subjective! So, For example, I think the network analysis highlights the dislocation of local government and Public Health England from much of the decision making despite the recent shifts in public health. It also brings to the fore the position of the primary care commissioning which also appears fairly isolated in this map.

      Its dangerous to make assumptions based on one analysis but as with any formative data is about helping to ask the right questions – hopefully by building a richer picture over time we will ask better and better questions.

      Please stay in touch with the project – next update from me will be with a design of the mapping process and then some feedback on how that goes in the real world but you can find out about our wider efforts at http://www.nhscitizen.public-i.tv

      Reply

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