Care Design 2016 – A guest blog

One of my projects within the Horizons team is Care Design 2016, which has been to take the well researched design principles developed by Nigel Edwards CEO of  The Nuffield Trust and collaborate with an international expert group to fine tune these principles.  What makes this project different is that the Horizons team have gone one step further and crowdsourced the principles via a change platform by Crowdicity.

The results were fascinating  and one of the key points I would raise at this stage is that when we asked for the wisdom of the crowd, we considered all of the data received and incorporated important citizens concerns that resulted in enhanced design principles.  What we have now is rich data and terminology that resonates with everyone involved in the project.  I have written before about collaboration and how you may not receive the answer you expect when asking citizens to respond.  A point illustrated well by the BoatyMcBoatface story and the recent  EU referendum.

Citizen engagement is complex because of the multiple layers and thought processes, yet rewarding.  My colleague Sasha Karakusevic’s blog below illustrates through case study exemplars how excellence in healthcare can be achieved by design thinking.

Care Design 2016

We all know great service when we receive it.  But how often do we stop and think about how that magic moment was produced?  Was it a one off or if I return again next week, next month or next year will I still receive an outstanding experience?

Often, the difference between exceptional and merely good enough is a combination of small and subtle differences in approach.  Exceptional requires a little bit of magic and is often dependent on having the right people with the right training.  But that is often just the tip of the iceberg:  Designing, delivering and maintaining excellence is really hard.  As well as getting the design right in the first place there is a need to build in sufficient agility to change as knowledge, customs and fashion change.  This is one of the biggest challenges in health with the published literature increasing by at least 40,000 papers per month!

Exceptional goes well beyond delivering services safely or efficiently and is a judgement that people make in their heart or gut – its essence is about feeling and not analysis.  That is not to say analysis is not important, however unless that analysis leads to an insight that unlocks passion, excitement and understanding the resulting service is likely to be just good.

Over the last decade there has been increasing recognition that design thinking can contribute to improved health and care delivery.  However, in reality delivering this is tough.  Recent work by the NHS Horizons team and Nuffield Trust has identified eleven principles that people think are most important to consider.

Care Design Principles 2016

Understand who needs care and what they need – identify common needs across the population and design services to meet those needs

Design care so people can flourish

From supply side (service led) improvement to demand side (citizen-driven) change

Design care so that when people need it they flow effortlessly through the system

It’s a complex world: plan for emergent not just certainty

Technology enabled

Networks/sharing spaces and organisations

Measure outcomes that matter

Mobilising and valuing people and assets in the local place

Continuous improvement and attention to detail.  Standardise where you can, customise when needed.

Ensure environmental sustainability

For the most part these principles are about people and the environment they operate in.  Interestingly, the principles do not differentiate between people as patients, carers or care givers.  In healthcare each group needs to flourish to get the best results for communities and wider society.

How can this be achieved at an organisational level?  For boards the answer must be about creating the right environment in which excellence can emerge. The performance indicators for this look very different to those required to assess short term delivery and need to consider learning, innovation and team performance.

It is very difficult to introduce design thinking across a whole organisation or system. Therefore focussing on a few themes that matter locally is likely to be more successful.   Aligning these themes to mission critical challenges will help to ensure senior leadership interest and involvement.  Involving people with design expertise to build capacity and capability is also likely to be achievable at this level.

There are a growing number of examples emerging and I have been lucky enough to meet and talk through a number of approaches with people who are leading the design movement around the world and what follows are a few examples of what is possible:

Western Diabetes Institute

The team designed care around the needs of patients:  Recognising that patients can only deal with a number of issues at one time the team enable the patient to identify what their key issues are and address them. By working in a multidisciplinary way they can respond flexibly to the changing needs of their patients providing greater integration and better outcomes than previously achieved.

The team are collaborating with Newcastle University as documented here.


North Devon pathology optimisation

The pathology team recognised that by working with local GP’s and the CCG there was scope to improve the care of patients.  The team started work with individual stories to understand the patient experience of tests and how to improve this.  Their detailed approach involves looking at the complete patient experience.  As well as improving care the team are also saving money!

More details are available here 

Both of these case studies illustrate adoption of the design principles and delivery of high quality care for patients.  One of the challenges is how best to organise teams to provide care at the same time as supporting innovation and learning.  The Buurtzog example is very interesting.

Buurtzog Nursing

Buurtzog have developed a very successful care organisation by being very clear about what the patient needs and how teams design can be optimised.  The result is a very flat organisation that provides high levels of professional autonomy, builds on experience and is scale-able.  Read more here

These examples show that by being clear about the design principles, enabling teams to progress and keeping to a small number of rules the rate of improvement can be accelerated.

Think about changes in your own organisation.  Have the design principles been applied and what difference did they make?  In these examples teams started small and built up capacity and confidence as they developed and improved care.

If you want to apply the design principles in your work have a look at our resources for advice and guidance and if you need more help please get in touch.


Sasha Karakusevic

Project Director – Horizons NHS England

Twitter @Karas01









Digging deep into social leadership

What does social leadership look like?  I have been reflecting on my experience at the #socialagesafari a few weeks ago.  People from different backgrounds came together on a quest to deconstruct the term and untangle the elements.  It was incredible to meet face to face, people that I have previously met through serendipity on twitter and share experiences of social age learning.

I came to listen, share my story of international, national and local communities and learn from others.  Over the last year there has been an exploration of hacks and sprints in the Horizons team within the National Health Service.  We have led them, facilitated for others and shared our narrative of transformational change.   The first day at the safari was different as I fully immersed myself in the experience of being a participant, letting the waves of learning crash over me and challenge my perceptions of social age leadership.

To be honest, my aim was also to understand how other people run hacks and sprints listen to the conversation and watch how people use social media.  For an extrovert, my interaction during the day has been unusual.  My normal mode would be to tweet from the event capturing everything going on to share with a wider audience.  Working out loud through my twitter feed and sharing the key points from the day.  The first day I was introverted, observing others and saved my energy for the two day sprint.  Flipping my usual preference in behaviour to a polar opposite was a unique experience.  So what did I learn?

New terminology is a key area for discussion and misunderstanding.  Social age leadership is a great example.   This graphic by @gapingvoid sums up our group work around this term.


Our hack groups debated the essence of social leadership.  Is it about the tech or is it about how the individual uses their leadership and communication skills aided by technology.  The discussions could become about specific platforms such as twitter, facebook, yammer, instagram you name it, we probably talked about it.

Being introverted for a day was fun.  I could take part in the groups, but it felt very different.

The community of the safari came together to produce a newspaper several times a day.


This focused people’s reflections and learning from the event.  It gave urgency and meaning to the time we were together.  It made people stop procrastinating and start writing about subjects they were passionate about now and potential subjects for future blogs.   There was even a press office which diligently put the copy together led by @lauramalarkey.   I loved this element as I saw faces of concentration working on their copy for the day and was amazed at the creativity taking place.

So do I have an answer for – What is social leadership?  I have my view that it’s not about the tech but what you do with it!  Today’s Facebook may well be a distant memory in the future, a bit like Friends reunited is today.  Therefore, whatever tech we use will help us to be great social leaders by essentially going back to basics and telling better stories that people can believe in. leadership leadership



#Working out loud week 2

Thought it was worth sharing this blog from the Care Design 2016 project I worked on during WOLweek.   There will be further blog posts from the project as we move into design sprint 3.   Check out the update report with the new design principles and a call to action for case studies to be submitted that reflect good practice for each principle.

One wonderful aspect of the Care Design 2016 project was the way that individuals engaged with the crowdsourcing platform and contributed their thoughts and ideas generously to the project.

In the same spirit of generosity during #wolweek another Banksy mural appeared as a thank you to a Bristol school, which made me smile.  True working out loud Banksy!




#Working out loud week

Here’s the thing.  Sharing your work is scary and full of decisions.  What to share? Will people be interested?  How can you do this generously?

I have been sharing my work via twitter on health, innovation and social age leadership for the last three years. Connecting with people all over the world that give generously of their time and experience.   Blogging is fairly new to me although I have been an avid reader of many blogs which help me to develop my work in so many ways.

Seth Godin suggests that we read more blogs and filter the internet in our own unique way.  I subscribe to that plan. There is a lot of distracting noise from the internet and it is for us to curate and find the important stuff that matters.  The challenge is to ensure that you give credit to the authors and image makers at all times.  I will always try to do this and if I fail, will admit honestly and credit when the source is made known to me.   The featured image on this blog is from Boni Stachowiach Ed. D.  and the image below combines several individual’s work.  Curation brings challenges, but also a great opportunity to share tacit knowledge.


A great example above of combining knowledge from the internet – Helen Bevan, Harold Jache and Mitchell Kapour.

#Workingoutloud week is a great opportunity to encourage others to share their work online with Jane Bozarth generously offering her book in a competition that runs for this week.  Reflecting on my purpose for working out loud it is to learn from others and going forward develop a habit of writing a blog weekly to share my learning with others.  I guess that at the moment my blogging is a big experiment to find my voice and understand what works. Simon Terry covers the benefits of experimenting and that makes sense at this stage.

Does blogging fill me with fear?  Yes!  Do I want to curate the good stuff on the internet and make sense of it through my blog? Yes!  So I am starting a new habit this week, taking fear in hand and experimenting with freedom as outlined by John Stepper and the late, great Janis Joplin.  Would be great if you could join me.


own adventure