NHS Citizen design – agile but structured

I wanted to capture my first reflection from the final NHS Citizen design workshop last week. I say final – the intention is that the shape and nature of NHS Citizen will continue to evolve but this is the last workshop that we will have before we reach a point of rest and a complete design at the end of March.  You can read the storify here and we also webcast our team meeting at the end where we reflected on what had worked and what didn’t.

We organised this workshop a little differently – we had identified particular questions or options in the design that still needed work and then created programme that allowed us to address these questions. This is a big change from the mainly open space methods that we have used on other occasions. I think it worked well – and we got a lot of feedback on some of those critical issues. However there were three main issues with this approach:

1. We had deliberately tried to invite a different audience to this workshop as we were concerned that we had not had extensive involvement from NHS staff in the process. We did succeed in a different participant mix (more on this in a different post as we used targeted invite strategies to achieve this) but the consequence was that we needed to spend more time with group in getting them up to speed with the design. This will need to be designed into the format next time we do this.
2. This was the first workshop where the design was no longer up for complete debate and you could tell that this jarred with some of the people who are have been regular attendees. We have had to make choices that not everyone agrees with. This is inevitable but I can’t help feeling we have failed to communicate these choices as well as we could.
3. I think it really worked to webcast our final team reflection rather than doing this in private but I know it was not comfortable for everyone – I would be interested to hear what other people think

We also ran a session for researchers which was hugely helpful – I think a number of research themes can emerge from NHS Citizen and from these discussions. We will put these out on the NHS Citizen blog – along with opportunities to get involved. It was also really reassuring to get some other more objective observers into the process and to have them agree with the fact that it is fascinating and in many ways unique!! These sessions also provoked some personal reflections about our research methods:

• I really enjoy working in a multidisciplinary team but it does add an overhead in terms of making sure you have really nailed down what specific terms mean – and this needs to be done as soon as possible
• One of the issues with multidisciplinary working is that there is always another article to read from another perspective – I need to sort some strategies for staying on top of the relevant literature in other fields
• Life is a lot simpler if you also nail down data collection methods – I may get that tattooed somewhere…..
• I think the next phase of NHS Citizen needs to shift from action research to participatory action research – and I need to have a mull about this and discuss it with the rest of the team
• The agile programme design has really worked – but next time I want to make sure that the research questions have greater visibility as well as creating more of a research hub where we can open up our thinking to the research community

I think the path is now pretty clear to us delivering the prototype for the end of March – and the more focused format of this last design workshop has helped enormously so we will be adding this into the agile method we have been using when we write it up. I think the design that we will present will clearly show the input and collaboration of the people who have taken part in the process and I think that is entirely right – NHS Citizen is something that can only be created in way which reflects the values it is trying to embody. It will also reflect the skills and experience of the design team (including the team at NHS England) and I also think that is right – we draw on a wide range of knowledge and we have learned how to challenge and balance each other effectively over the last 18 months.

As we move forward the real challenge will be in making sure that the process of designing NHS Citizen shifts to a place where it is seen as more of a collective responsibility and this will need the current design team to model the behaviour we have been talking about and create spaces where more people can contribute.  I think this comes down to the fact that at this point there is little distinction between designing NHS Citizen and it being real.  While there are technical and practical aspects to NHS Citizen so much of what it really is is about new ways of working together which is something we have been modelling throughout the design process.  We now need to dig a little deeper into that process so that those ways of working are embedded and connected through the system.

More formal feedback from the sessions to follow on the NHS Citizen blog….