Learnings from my time in the NHS coronavirus universe
Whilst there have been many things that I have learnt over the course of my second placement at NHS Digital, I have whittled it down to two broad topics for this blog post. The first section concerns some practical things I have learnt from working in a programme responding to an unprecedented national crisis, whereas the latter focuses more on introspective learnings about how I approach my work. These are learnings that are very much bound within the context of working in a fast-moving, national scale programme that was built from zero to respond to an exceptional situation, I do not know when I will find myself in a similar situation again however it has been an experience which has irrevocably shifted my way of working and thinking.
Setting the context of my coronavirus universe
On my first day of my 2nd placement, the team I joined was disbanded until further notice in order to redirect resources to create new services for coronavirus. That was in early March when nobody really knew how disruptive the virus was going to be. I was initially placed in 111 online with my supervisor Eric Lemarca to help with the new coronavirus pathway. I then spent the next 7 months working on various projects around the NHS coronavirus universe. March was spent working weekdays and weekends to deliver a service which was ultimately paused when the country went into a complete lockdown. I spent the majority of April and May working on a mental health discovery for 111 online, followed by work around “seldom heard voices” for the central service design team for Test, Trace, Contain and Enable (TTCE) in June and July. At this point my supervisor went on parental leave until 2021. I then spent August and September working for the Trace service.
Midway through this all, George Floyd was killed in the USA, and Coronavirus was found to be affecting people of Black African, Black Carribean and Asian communities at much higher rates than their White British counterparts in the UK. I became sharply aware from a project I was working on at the time about how our work as designers and researchers for the NHS also had a causal effect in allowing deep rooted societal inequalities to continue to exist. When the needs of certain groups of people are continuously overlooked over and over again, it maintains the structures that will eternally deprioritise their needs. Over the course of several months, I alongside others have been working very hard to take baby steps towards addressing and changing this, both within the NHS Test and Trace world, and within NHS Digital.
Whilst each project had its particular design challenges, they all had similar parameters to work with which I imagine are all inevitable factors of any new large scale programme. From what i’ve observed, all the coronavirus projects I worked on were asked to deliver to very short deadlines, sometimes days, with limited resources with the right capabilities available. An additional challenge was the continuously changing targets of the programme as it responded to the changing needs of the country. It is within these exceptional circumstances that delivery teams are asked to design and build something.
First learning: “Go slow to go fast”
The phrase “Go slow to go fast” was something I started to hear frequently from around summer, and there are several levels at which I resonate with this phrase. The first from a graduate perspective as someone that worked on the NHS Service Manual for my first placement then moved into a completely different working environment, and then from a delivery level from the perspective of someone doing user research for covid projects.
Graduate perspective
Although at the time the lack of an user research supervisor felt destabilising, I can recognise in hindsight that I was blessed with an incredible safe space to explore and practise user research in my first placement in the NHS Service Manual team. Not only did the project have clear and stable delivery objectives, but my team was multidisciplinary and experienced in user centred design practises, and I also had a strong support network of NHS.UK user researchers who I leaned heavily upon.
The things I learnt in my first placement became the cornerstones on which I grounded myself when all structure and consistency did not exist in my second placement. The NHS Test & Trace programme comprises multiple organisations and multiple consultancies working alongside NHS Digital. It is constantly influx. I encountered different methods of working, in which there were important things I have learnt (which I will outline later), but also moments where I needed to stand my ground. To explain why we couldn’t have assumptions in a deck of findings, why we could not record a session on an external pc because it would breach GDPR, why we shouldn’t have the deck building as a replacement for analysis. I cannot say I have not doubted my conviction, wondering often whether I have been difficult or too stuck in the ways of working in NHS Digital, or perhaps not more attune to the realities of delivering work to tight deadlines in a crisis world. However, ultimately I am not regretful of the times in which I have voiced my thoughts that I believe were grounded upon the principles of what good looks like that I learnt during my time in the Service Manual team. Taking my time to slowly explore in a safe space in my first placement allowed me to work at pace in a faster environment in my second placement.
Delivery level perspective
I cannot possibly write about all the intricacies of conducting user research for covid-19 services, however I have selected 3 cases in which going slowly at the start helps to ultimately go fast.
- Email before ringing research participants
Midway through an interview session I received a call from someone from the cyber security team, saying a concerned member of the public had reported us. The heightened awareness in the public of fraudulent activity surrounding coronavirus had caused a member of the public to raise the alarm when a colleague of mine had rang her to ask whether she wanted to participate in a research session. Despite adding some extra time, it is now advised that we email potential participants before ringing them. This is a prime example of going slowly to build trust at the start so we can ultimately go faster, by avoiding rescheduled calls and no-shows.
2. Analysis is not a waste of time.
I have found that there is a tricky balance that needs to be struck between speed of delivery and spending ample time on analysis, in which I have often swung toward the latter. This is not always feasible in a fast-paced timescale, and there are many useful methods that can be used to shave some hours off. And yet the ultimate waste of time is when analysis is given no time at all, and the research provides no new insights from what was already known before conducting it. This is the ultimate mistake of going too fast, that must be remedied later by someone somewhere else in the programme.
3. Understanding how your stakeholders works
This placement was the first time I interacted with stakeholders, and what I observed from them is that they are working at immense pressure with very little time. In the case of one of the projects I worked on, the stakeholder changed midway. This meant we needed to understand how this new person understood information and how best we could engage them with what we knew. This may be a process of showing them different types of service maps and seeing what rings best for them, or it may be compiling the most important user research findings on the first slide of a deck so they can screenshot it and circulate the information. What was apparent to me was that there would be very little chance of implementation unless they could resonate with the output.
How to care a lot without burning out
Caring a lot about health inequalities in coronavirus times has been incredibly emotionally and mentally taxing (I had a case of what my colleague calls caringtoomuchitis). Sometime in July, I asked twitter “how to care a lot without burning out”, to which Lou Downe answered to “care less, or at least as much as you care about yourself.” And yet despite this wise advice, I carried on pouring my heart and soul into my work until the end of August. At which point I burnt out, and the health debt I had accumulated over the 7 months suddenly caught up with me. I lay in bed for 5 days physically incapable to work, but plenty of time to think.
First of all, there are no compromises possible in taking care of my mental and physical well being. Burning out sucks, and it has taken about a month to start feeling healthy again. That’s all I have to say on that. In terms of caring a lot, I think there are two things I can do to make sure all my care and energy is channeled into the right places, with the most effect. Firstly understanding the parameters in which the team will work in, and secondly to deliberately set my own scope for what i feel is an accomplishment.
Understanding the parameters in which we work in
There was a lot of frustration from working on projects that I could see was not getting the best of everyone’s capabilities. The most frustrating thing was to know that everyone working on it cared a lot, yet there were overarching structures set in place from the start that didn’t permit us to work as effectively together as we could have. Some more clarity on what our roles were and alignment around what the parameters were at the start of the project would have benefited everyone. There were channels in which my caring a lot could be heard and turned into positive outputs, whereas there were also channels that were harder to work with because of these parameters. I do not know yet how to distinguish the point at which I should divert my care and energy from a channel that seems blocked, to one that has more possibilities. This will undoubtedly be a recurring theme that will happen time and time again in the future in different projects and different work environments, and only time can tell whether I will ever be able to distinguish that point.
Setting my scope
Someone told me at the end of my placement to google the phrase “nevertheless, she persisted”, which feels like an apt phrase for the work that many user centred design designers and researchers do everyday. I have learnt that much of my drive and fuel to work comes from caring a lot. I have also found that I have a slightly obsessive streak in me that allows me to work the way that I do, but also allows for burnout if I do not carefully watch myself by setting myself a scope at the start of work. Sometimes it has felt like I have been trying to put out a burning tree to realise that the whole forest is on fire, which distracts me from noticing that I’ve been burnt too. It was only when someone pointed out that through the work we have done, people whose voices were previously not heard are starting to be listened to that I can acknowledge there have been some steps forward. So whilst the forest is still on fire, we have managed to put out a branch and that is an achievement that needs to be acknowledged. I am learning to create my scope, so that I can do the work that I love doing without burning myself again.
To end
Any and all work I have managed to accomplish during this placement was based purely upon the help and support I received from people that surround me, both in my private life and amongst my colleagues. I would like to extend a special thanks to Eric, who taught me to be more patient to understand the why before the how, Nancy Willacy and Sophie Dennis for being incredibly supportive and inspirational (and continue to be so), and Tosin Balogun and Amy James for being wonderful friends.
