But what am I doing right now?
The UK Design Council is undertaking a pilot programme to establish the feasibility and desirability of supporting "design" in the public sector. I have been helping them to develop, test and refine the content and process they will use in that programme. So far, the 7 public sector bodies involved have not yet completed the full programme, but early indications are great and more organisations are beating at the door.
I'm working with Sheffield City Council and the Coventry Total Place team on separate but related projects. Both are trying to use design thinking and its process and techniques to connect the people they serve with the talented staff at their disposal. These days I often talk about how design has become a political process, a way of mediating creatively between the sometimes conflicting needs of society and what our public institutions can provide: finding the 'sweet spot' or union in that particular Venn diagram.
I've just restarted a really interesting piece of work with North East Lincs Care Trust Plus. Earlier they had asked me to help create a method for getting a "community voice" on their implementation of services for safeguarding vulnerable adults. Changes to policy and legislation, changes in public perceptions and in the way social care is remunerated (with more direct payments and personal budgets) all have increased the need for improvements. However, the Care Trust wanted to implement change in a way that was sensitive to, and reflective of, local opinion: exactly what constitutes abuse, and what is just bad familial behaviour? This is the sort of dilemma faced by carers and health professionals every day. I completed a feasibility study, did a lot of consultation with providers, clinicians and managers and developed a way they could gather opinions through their existing mechanisms.
They have just asked me to proceed with the next stage, to design that 'community of interest'. Clearly there are two parts to this: the easy bit is to bring together a group of interested people and groups, and facilitate the growth of a sustainable and active community. Frankly, the harder part is to help the organisation to be able effectively to use that intelligence and to feed back the results in a timely and meaningful way. This is the stuff I love - connecting it all up, making research valuable.
I'm also working with a couple of medical device start-up companies. In the first of these I'm helping Matt Marsh of FirstHand to develop an Oral Glucose Tolerance testing device that can be used by people independently at home. The usability and desirability of this is proving to be challenging but Matt has a careful and incremental approach and we're testing and co-designing extensively with users.
The second has just started: with a Leeds University group I’m helping Single Use Surgical to develop a new product that builds on their experience of low cost, high quality disposable instruments. I am planning user research to understand the patient experience of a simple but uncomfortable and invasive procedure. This will inform their development of the product’s features and positioning.
Late 2009 I completed a series of 3-day workshops on co-production with a group of clinicians and managers called "the Darzi Fellows". This is part of a leadership programme offered by CIHM, with whom I have done a number of projects. These sessions built on our work with Derby and Leicester City PCTs, with Grimsby's Open Door, and with partners such as the Rushey Green Timebank.
I'm not strictly doing anything here, but I am featured in an exhibition of designers in the UK Design Council. Keeping good company, too.
I've been working with Hammersmith & Fulham PCT as they explore how they should implement some of Lord Darzi's plans for Polyclinics. This work is likely to be extended, but I have been helping them to engage with 'seldom heard' groups on the White City estate, which will be one the first recipients of this new form of health delivery.
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Trafford PCT are exploring a radical reinvention of the way they deliver healthcare in this part of Manchester. An Integrated Care Organisation will connect people with their GP, hospital and other services in a far more seamless manner. In creating the design the ICO wanted to understand more about the current experience of healthcare in the area, in particular they wanted to know more about groups that are often termed "vulnerable" and "hard to reach"; people whose views might not feature in traditional methods of consultation and enquiry. They asked me to conduct in-depth 'ethnographic' interviews with a wide range of people including problematic drug users, sex workers, etc. It's always a lot of fun doing this sort of thing - part detective, part social worker, part designer - and you find out some amazing stuff. I'll put the report here as soon as it's public.
I'm also doing more work on knee surgery for DePuy - confidential, I'm sorry.
I've just completed a review, after two years of successful operation, of the Open Door service I helped design in 2007. I was asked to come back in and compare the reality with the original vision; this will be published in the next few months. In the meantime, the service has won the 2009 NHS Health & social Care awards for tackling inequalities; this recognises the really valuable work they have done in a difficult area.
During 2007 and 2008 I was leading a 12 month project with Derby & Leicester City Primary Care Trusts (PCTs). Their ambition was to embed 'co-production' in all of their service development work, to go beyond stakeholder engagement and try to create more equal relationships in the delivery of health. Doing this also provided them with the competencies to be World Class Commissioners, too - there really is a very good fit between WCC competencies and the fundamentals of co-production.
The aim was to train a small group in the techniques of experience based design and co-production, to provide them with practical means to empower all stakeholders. Our team also included organisational development experts who complemented the development of these skills by creating a sustainable environment for the team.
Liverpool PCT asked me to help design a method of consultation for a £10m treatment centre they plan for the south of the city. They take stakeholder engagement very seriously (see this as an example); they have developed a few options for this centre but wanted to get the community to broaden these options and appraise them. They have realised that, even at its best, consultation places people at a distance from the design. Given the right facilities and skills, people can work alongside architects and health planners and input directly to the decisions. This was the approach we developed. It also helped overcome the sense that Liverpool is "over-consulted": they have been asked and asked, now they simply want to see well-designed change.
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I've been working with the staff and people on dialysis at the Wigan Renal Unit. Most of my time has been spent getting to know the people there and understanding the dynamics behind their situation. I was directed to focus on their diet and management of phosphate, which is inefficiently removed by dialysis and can cause bone problems. I've been concentrating on developing ways of sharing good practice amongst people on dialysis, on empowering them to say or ask things they want but feel uncomfortable about, and allowing them to discover more about their food and its effect on their bodies. As a result of my work with them a number of design and improvement projects started and culminated in winning the prestigious 2008 British Journal for Renal Medicine National Award for Innovation in Renal Medicine.
One of the things I co-developed with the Wigan people was a "patient held care plan", a document that is kept by the person, that records all the information they feel is valuable to them and to their care team, and which is given to clinicians at the appropriate time - it helps transfer some of the authority for care to the 'patient'. The prototype care plan I designed got a "highly commended" at the 2009 BMA Patient Information Awards.
I've also been working with the NHS
Institute. The project started by being an exploration of the role of bedside terminals in the provision of information and entertainment for long stay patients. We quickly realised that their needs (for information and entertainment) are enormous and wide-ranging yet can be delivered in numerous, simple and cost-effective ways. We rediscovered the extent of the isolation and "de-socialisation" that occurs to people when they stay in hospital for a while. We're still working out the implications of this work, but one immediate opportunity seems to be to influence the Institute's work on "productive wards", which engages front line staff in providing solutions to questions they know about but haven't the time to deal with.
As part of a team from Leeds Business School, I helped Bradford
Care Trust in their bid to achieve Foundation Trust status in the next 2 years. My
role was to help them develop a governance model that was based on
good membership engagement and a clear channel between user needs and
service development.
Kent County Council is rightly proud of its "4 star" status
in the Audit
Commission's Comprehensive Performance Assessment (CPA) 2008 scorecard.
Staying innovative and close to their community's needs is fundamental
to KCC. To maintain this they initiated a pilot development with
Sophia
Parker ex of DEMOS, establishing a Social Innovation Lab for Kent. I
was working with Sophia to help co-create a methodology for service development;
one that builds on best practice within the council and which engages
and empowers the public.
In August '07, and again in '08, I gave a presentation at the Health
Foundation's Leadership Fellows meeting in York. In '08 I talked about user-centredness and service design, and showed its relevance to co-production. Previously I talked about the
similarities between the BBC and NHS as they try to stay relevant in a
changing world. In particular I reflected on the methods the BBC has used to engage people outside their organisation in first
having and then developing ideas; something the NHS places great
importance on but they seem to struggle
to achieve.
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