Can we create public services that are valuable to the public, so that they are delighted, even proud of their existence - whilst simultaneously saving money?
Just over a week ago I was fortunate enough to join the NHS Chief Executive, Simon Stevens at an annual charity policy dinner to discuss user-centred design, innovation and how collaboration, data and design can deliver better patient outcomes. I wondered why are so many of our hospital signs are still written in Latin. It is one example of how patient centred care translates into real experience for patients and the public. Healthcare is not alone in this, there is undoubted ambition across Government to be more user-centred. But how does this work in practice? A key challenge is in absorbing new ways of working into existing ways of thinking about problems.
In recent years, notable policy and business experts have been discussing the value of design and ‘design thinking’ as an approach to improving the way Government delivers services in one form or another for (and with) citizens. Examples include Roger Martin from Rotman Business School, Christian Bason formerly of Mindlab, Marco Steinberg of Sitra, Hilary Cottam of Participle, and many more who have been promoting the use of design as a tool for service transformation.
So what is design and how is it being applied in government? This is the question that has been posed this week at the Service Design in Government conference in London. This week is also the launch of some of the Policy Lab tools in the Policy Toolkit.
The Policy Lab have produced a short introduction to design, service design and design thinking. It serves to explain how we are defining and using the term design in various ways in a policy context as well as provide practical tools and examples of design being used in policy making.
We tend to spot design when it goes wrong: badly laid out forms, websites we can’t navigate, confusing signage, transport links that don’t join together, queues for services that are in demand. Bad design is a time thief. We can also spot good design when we see it, but how is it achieved?
Is good design so tricky that it is the exception rather than the rule? Take service design work at the Olympics creating a new visitor experience, or the reimagined Routemaster bus, which restores its iconic status with audiences around the world. These are the ‘big D’ Designs, proclaimed as design excellence and rightly award winning.
In contrast to designer services, most design can be described with a ‘little d’. The design thinking behind the Oyster Card service may not win many design awards, but delivers significant value to service users. In my view good design doesn’t need to be iconic or cost more, it needs to do more. As Dee Cooper once said ‘good design costs the same as bad design’. I would add to this that bad design can cost a lot more in the long run. What if design approaches were widespread in our policy-making process to improve the design of services?
Service design approaches have been gaining traction in the public sector in recent years. The Design Council, created by government 70 years ago, have been working across the public sector. Service design is also being adopted in house in large corporates like Capita and Barclays. And in consultancy, design agencies are tailoring their work to respond to more strategic public sector needs. For example, the 200-strong service design consultancy FJORD has recently been acquired by Accenture.
Service design is also increasingly being applied in Government. A range of departments from HMRC to MoJ are strengthening their service design capabilities. The Ministry of Justice and UKTI have just hired service designers into their teams as are the Social Finance team at the Cabinet Office. And of course the Government’s Policy Lab which I head up, has been created by the policy profession to help bring design techniques to policy making.
What can design deliver?
We are acutely aware of the cost of public services, but are we equally clear of their value to citizens? In public services quite rightly there is a lot of focus on cost, but we should also be equally mindful of quality, desirability and ultimate outcomes. Do we create a better queue in the doctor’s surgery or redesign the service experience of booking an appointment end-to-end? The King's Fund have written about this ‘experience based design’ and have an excellent toolkit of methods for applying user-centred design in improving the patient experience. In one case study in Canterbury, New Zealand experiments showed that reducing patient waiting time increased efficiency across the system. As Dr Nigel Millar, Chief Medical Officer suggested: ‘The goal was to deliver ‘the right care, right place, right time by the right person’ – and that a key measure of success was to reduce the time patients spent waiting.’*
How radical the redesign ambition is determined in the policy, in the brief, designed into the procurement. According to David Meates, in New Zealand: ‘The biggest waste we have in our health system is patients’ time. Historically we have designed health systems that build in waiting at every point and which bounce patients from one part of the system to another. By focusing on removing waiting we can make far better use of the existing resource. We are convinced that 30 per cent of what we do is wastage.’
If design can deliver this kind of transformation as well as delivering savings for the public purse it could be key to delivering better public services for all.