How complicated can it really be?

I’ve spent the day running through the feedback from our NHS Citizen design workshop in Bristol the other week and scratching my head on where we go next with the tech side of things. We’ll be publishing the feedback once we have chance to process it a bit but I wanted to muse a little bit on one particular issue that keeps coming up – are we just making the whole thing too complicated?

There seem to be two different senses in which this could be true:

1. Are we using inaccessible language?
2. Have we over engineered the process?

I think the language point is a completely fair cop – we are still in the habit of using expert language and its just not necessary – its a professional habit that we have all got into and we need to reeducate ourselves. Being very honest I need to reeducate myself – I have a ferocious but perhaps unhelpful attachment to complicated words. What this means is that if we are using a specialist term we have to find a simple way of decoding it – explaining it in more basic terms – and making it more accessible. If we don’t do this then we have no hope of getting all the ‘experts’ in the system to do the same.

The process engineering is a more difficult issue to address – on the one hand as one participant said at the Bristol event ‘well it really is simple, we talk about stuff and then it goes to the assembly.’ However there is huge complexity in how that process works and how we make it fair and accessible. Each part of that simple sentence can be taken apart; who are ‘we’, where and how do we talk? How do we decide what goes to the Assembly? These are the questions that then lead us into the complexity and mean we have to draw on combined experience and knowledge to design how things could work.

I think it is possible to make the NHS Citizen process present in a simple way – it really is all about getting people together around an issue, working out what they want to do about it and then taking it to the Assembly or somewhere else for resolution. However we can only present the complexity that is lurking underneath in a simple way if people trust NHS Citizen to be making good choices about how things work. If NHS Citizen is about shifting power towards citizens as decision makers then trust in the system will be essential.

Perhaps the thing we need to join up and make more obvious between our design process and the system is the fact that we are working openly in order to build trust in the process. We are trying to design what we are doing it in public, opening up the detailed workings and being as transparent as we know how to be. One reason for this is that once (if!) it is up and running we can present it in a simple way and people are more likely to trust it because they can see how it was built.

Put another way, we currently have all the bits of the model out on the table (lego, air fix, meccano Рchose your own model metaphor!).  You can see all of the parts and hopefully how it fits together. Once it is working however you should just see the model but you will still know what is in there.

So – are we making it too complicated – yes we probably are. Is this a valuable part of the process? If we can get the language thing right then I would argue that it is – NHS Citizen is a complicated thing and its important that we expose and make open all of its elements if we want it to be trusted and understood.

I want the final design be simple and elegant – I just don’t think we can do that without some complexity on the way.

  1. Shelley Burke

    August 5, 2014 at 8:47 am

    My tests of your final design:

    Is there room for all kinds of language – expert and lay and everything between? What sort of “interpreting” can the system provide between those languages?

    Where and how can I see focal points for influence?

    Can you push the process questions below the line so I don’t have to know a lot of detail but I can dig in if I want?

    How do I fit into NHS Citizen if I have a campaign/grievance?

    Can I dip in and out easily?

  2. Jonathan Flowers (@jonathanflowers)

    August 11, 2014 at 8:33 am

    A few thoughts…

    1. “Everything Should Be Made as Simple as Possible, But Not Simpler”

    2. I sometimes find it useful to distinguish between the externally imposed complexity that is intrinsic to the situation and the complexity that we semi-consciously impose on the situation eg through simplifying assumptions such as organisational structures.

    3. It would be good to see a storyboard which explains why Mid Staffs won’t happen again.

    4. it would be good to see a storyboard about how NHS Citizen will help rather than hinder the process of closing down unnecessary acute capacity

  3. simonfj

    October 6, 2014 at 8:43 pm

    Hi Cath,

    Just stumbled on this post after trying to find some place to talk on the NHScit site. I was just going to answer your question with a resounding “yes”, until I read John’s No. 3 above. it’s nice to see the answer with its question for a change.

    Just comparing a few complicated mind maps. and

    Yep. Every project GROUP does seem to think the world revolves around them. Rather than talk here, i’ll point at this conversation. . The EC guys call their “engagement platform” Futurium.

    Like the NHS and GDS teams/groups, they’re attempting to bring all the issues to their hub so they can be presented, in an orderly fashion, to an Assembly. Why does everyone start their project at Stage 3?


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