Design is one of the most authoritarian and annoying practices that modernity has created.
– Antonio Caronia in ‘What Design Can’t Do’ by Silvio Lorusso

Had a big week at work last week. It was overwhelming to see how much press our work on HPV self-testing at home got. My comms colleagues are geniuses really.

While that was happening, I was busy mulling over the fact that I don’t think we do service design in the way that Lou and others think of service design. I’m five months into my role now and I have seen a fair few service maps and blueprints but they don’t exactly hit the nail on the head for me personally. They don’t address the fact that participants will feel what they feel about our service on the basis of the compounded experiences they’ll have had of the NHS at large. How do you map the impact of a relationship you were not involved in?

Our sphere of influence as a digital screening team is in direct relationship to other parts of the NHS and how participants have interacted with those. There’s a halo effect everywhere you turn. This is really the kind of mapping problem that can only exist when you’re in the 7th largest employer in the world.

And then there’s just modern digital life. We might be sending potential participants an email in a very full inbox, another notification in a phone they’re trying to spend less time on, an SMS they think might be spam, a phone call coming from a GP practice they have difficulty engaging with for reasons we don’t know.

What do you do then? Do you keep mapping all these possible scenarios and dependencies? I think you could but then (again from What Design Can’t Do) “as every problem is chased by another problem […] every attempt to bring order to the world produces a certain amount of disorder”.

So there’s a point where you just have to pick some things to figure out, some discreet touch points to improve, while living with the uncertainty and the discomfort that you won’t be able to work on the whole in the way you’d like. I don’t think that’s a failure, it just requires a little less arrogance. Better to recognise that there are dragons than to imagine you can avoid them by drawing a better map.

It’s felt like a long week for some reason. Maybe it’s the lunar eclipse, maybe it’s the end of a long oppressively hot summer. In any case I’m delighted to have a few days to reset under the rain.

Dolly Parton’s song was inspired by  9to5, a 1970s feminist movement in Boston / I generally try to stay away from cake but the chocolate cake at Crumbs and Doilies is insane / on the content design and timing of national emergency alerts / an excellent article on late late tech and knowledge work / am spending a weekend in Budapest soon and might try to see some modernist gems / I don’t think the title is very helpful but this autumn evening tech critical programme is interesting / the 1980s TFL flood warning posters might come in handy again / a friend let some poppy seeds behind so i’ll be trying to plant them this autumn / I wonder if ‘trad wives’ have read about the New Woman movement of the late 1800s / on love as a skill  / I’m not saying tools for AI aren’t good, I’m just saying they’re incredibly badly designed as learning experiences / one of my local barristas thinks I look like the television cook Claire Saffitz and I accept the compliment / a very funny Bluesky thread on the gender opinions of tableware collections.

Added to my commonplace book:

“[…] both people with good purpose and people who are completely lost move forward and it’s impossible to differentiate them.” (from Alastair’s excellent blog post).

In social news:

I’m prepping for Papercamp 5 in a couple of weeks. There’s only one ticket left which I’m really pleased about as I held back from paying for advertising. I’ll be taking beginners Greek classes at City Lit this autumn as I keep going back to Hydra. I also decided to take off for two weeks during the Christmas break. I’ll be heading back to Hyères and look forward to discovering more of that bit of the Med (including Toulon).

Wrote most of this in YUL airport in anticipation of the horrible jetlag I’m suffering from. Past me was smart.

I don’t really know how I feel about comparing how the Victorians lived to our own predicament. Consumer products are such a poor metric for societal progress. / A growing number of friends have been diagnosed with generalised anxiety so I decided to listen to “The Unfragile Mind” as a sequel to “The Body Keeps the Score” / my friend Patrick recommended dense discovery / I didn’t know hymeneal meant something related to marriage / I picked up some pieces by Seetal Kusbia at the Clay College degree show / thinking about why we choose to forget women / i am not sure anyone should be promoting urine testing as a replacement for blood works / I should probably check out the Spinster cookbook / pluralistic ignorance is an interesting concept / Sam Dolbear is making his way through all classical music in a very organised way / when it starts raining again, i’ll go spend an afternoon walking around Flatford in Suffolk and maybe head to Dark Peak for a weekend /  I still have my French carnet de santé / this AI, imaging and Art seminar at Columbia University looks great / I was not prepared for Kafka’s plans to open a café in Israel / a call for evidence for Smart Data  / seriously considering trying this lovely awning system for sash windows / maybe I’ll attend the Creative Bureaucracy Festival next summer.

That’s all for now. I’ll settle down again and return to your usual broadcast quality next week.

Being a designer in the public sector might not mean a public sector job.
It’s important to understand that an opportunity might not come directly to you as a freelance person.  Public sector bodies like the NHS and others both hire people directly and procure services from companies who then hire contractors. You can choose to complain about that or you can work with it. I work as a contractor.

Finding out who has been contracted to work with the NHS is a bit more fiddly but you can look through Find a tender service and select the ‘Award’ criteria in the search box to find out who has been awarded a contract to procure services. It’s them you need to meet. Those private sector organisations might not offer permanent positions but they might offer you a fixed term or rolling contract. If you’re on a graduate visa and looking to get sponsored, you should check if they’re up for doing that eventually.

Learn the tools of this trade. 
My colleague Frankie and Ed and others maintain the NHS Prototype Kit. You should get comfortable using it because no matter what kind of design profession you are, you’re going to have to deal with it quite often. If you’ve never used a design system, well, get learning.

Learn to love clinical assurance.
Working in the NHS means working with clinical assurance and information governance processes all the time. Every time you propose a new feature which might have a repercussion on someone’s data or someone’s experience of the NHS, it needs to be approved by a clinical assurance colleague. You could choose to see this as ‘getting in the way of progress’ or simply what the environment is made of. It’s not about tech for tech’s sake, it’s about a careful consideration of all possible spillover effects at every possible opportunity. It’s not for everyone. If you want a dynamic, fast paced development environment, I would recommend the private sector. If you want to make an impact, well that takes time and it takes working with colleagues who rarely work with anyone that doesn’t have a medical background. You should be learning about their world, and hopefully they might find a little bit of time to learn about yours.

Learn to work with tech colleagues. 
One of my colleagues has been working as a designer on a project which has taken years to get to the point where now, some design work might be possible. This told me two things: one that the project was very tech focused, and two that the right conditions do not exist. You have to create them. You have to be willing to make yourself just a little useful to a tech colleague to get to know something that would unlock a lot of UX value. You have to be willing to show some visual experiments to paint the art of the possible. And you have to be willing to deal with the shrugs you might get back or the clinical assurance questions.

I hope this is helpful. It’s great work, just be ready for it.

I’ve lived around Brixton since 2009 but I’m still discovering things as I walk the streets. The history behind this old radio shop sign is wonderful / a familiar stranger introduced me to sati in Buddhism / an excellent long read about AI mania in the tech industry / I listened to this great piece about the end of reading so I must be part of the problem / there’s a wonderful piece on in the great hall of Tate Britain which includes a mini cinema experience. As part of it the founder of the Cinemathèque recommends the 1973 film Touki Bouki so I should probably watch it / a lovely piece from Rob about growing up today / went on a city break to Vienna with some friends and kept thinking about Before Sunrise / the Secession’s Beethoven Frieze audio experience is exactly the kind of immersive experience I like (ie. it’s just some music on headphones)/ this show on the ‘neutral’ role of Austria in global architecture was absolutely fascinating / the closure of the MIT Dewey Library is really sad.

Added to my commonplace book:

It is ok if things are unfamiliar to you. (Terence Eden’s blog)

If you want ACTION, don’t write. Go and tell the guy what you want. (David Ogilvy’s 1982 memo)

Histories of violence that are geographically distant yet psychologically near. (Tomoko Yaneda’s work in the excellent Photographer’s Gallery show)

When you’re clever, everything teaches. (Denise Scott Brown retrospective)

They wrote, as everyone does, in the heat of a chaotic present and in the face of an unknowable future. (Great piece in the NYTimes about the US Constitution)

What does love feel like? Safety or alarm, I can never decide which. (Esther Freud in the Guardian)

People generally find fault with substractive solutions more readily than they do with additive ones. (A piece on doing less in the Guardian)

All the other jobs seemed so common. (Thomas Lupo, owner of American Wood Columns Corp.)

In social news, I’m heading to Québec for some time with family (first time since mum’s funeral last year) and friends and Boston for a weekend to see a childhood friend. I’ll report back.

I was in the first day of a two day away day at work and I was thinking of Jenny Holtzer’s truisms. They feel true (even if they might not be), which is what’s so cool about them. I think it’s the same for some myths about the NHS and what it is and isn’t good at. It’s sometimes in the eye of the beholder.

So I thought I’d imagine what Digital Screening truisms might be (inspired by the 2018 NHS Design Principles of course):

1. Decide what differentiates staff facing interfaces from participant* facing ones and what should feel the same.
2. Decide how you will measure your impact from the beginning.
3. Design for as many people as you can, then have a plan for those you can’t reach just yet.
4. Consider that clinical safety might trump ease of use.
5. Remove as much complexity as you can, given the circumstances. Then make it easy for others to pick up where you left off.

I’m in my 11th week so this might age like milk, but hey, it’s just a weeknote after all.

* Participants is what we call members of the public who need to be screened. We don’t know if they’re ill, so they’re neither patients nor service users.

There’s a new tech leader in the NHS which means whatever he thinks about design, UCD or designers will probably trickle down at some point. I am listening closely to the signs and this week, he said that things were not as a complicated as he was expecting. I thought that was interesting because it reminded me of a 2017 article someone reshared recently on instagram:

At every step and every level there’s an abundance of detail with material consequences. […] The more difficult your mission, the more details there will be that are critical to understand for success. You might hope that these surprising details are irrelevant to your mission, but not so. Some of them will end up being key. […]

The design work that is done by my colleagues in Digital Screening across 15 different projects is really reliant on the details, the local conditions, the politics of that project, sometimes an individual’s power. It’s going to be hard to communicate the critical role of those details well in a short, digestible way. But we have to try. Because if we want senior stakeholders like Rob to support the work, they have to understand the shape of the work is an accurate reflection of the detail and not an exaggeration or amplification.

So I’m going to be preparing assets that shed light on the conditions that drive our UCD outputs. Let’s call it ‘design headlines’ instead of ‘stories from the trenches’. My objective is to create digestible tweet-sized statements that can help leaders above me share the value and hint at the complexity of our work. It’ll hopefully be something easy to copy and paste into a deck (because that’s where leaders live) or a newsletter (which colleagues across the whole of the NHS might skim). I’ll figure out pretty quickly if it’s the right format or not. Pretending that detail isn’t there is not an option, but I don’t have to make that the whole story.  I’ll report back soon.

I had two classic ‘behind the beat‘ moments this week. The first involved taking the reigns in relation to a runaway situation. The second involved seeing something happen and letting it happen (temporarily).

My two Deputy Directors were on leave at the same time for a few days so that temporarily exposed me and other Heads of to the complexities of their work and removed some of the direction we’d normally be given. This is not usually a problem but something escalated and we spent some time working through what we could do as a team. This doesn’t normally happen as we co-work with DDs in real time most days. It felt like we time traveled to pre-pandemic times where you had time between video calls and could reflect and regroup about something multiple times. We spent quite a few hours co-working and mulling over a leadership response. I’m happy with what we came up with as a group because we got to really work something out deeply. A rare treat. I feel like I know (and appreciate) Dan and James even more because of that time spent together, talking about hard things and finding a possible solution.

The second thing happened on Friday afternoon. Someone showed me something that I don’t think is of a particularly high quality but the repercussions of that piece of work on the user experience could make or break the upcoming test. My overactive saviour complex (every designer has one) went into an absolute frenzy and I cracked open Illustrator to try to fix the problem. It was 19:30 by the time I looked up, realised this was a pointless, closed the file, not saving any of what I’d just spent almost two hours doing. I’ll talk to someone about my thoughts tomorrow. I’m not paid to fix something directly anymore, I’m paid to shape the conditions so that someone else is able to take the time to fix it.

So it was a full on week, but it reminded me that design leadership is about being either on or slightly behind the beat. Not ahead of it.

I woke up at 6am so here’s a quick link dump before I head out to work.

On existential cringe / reading another Ben Lerner book and one of the characters talks about milieu therapy / Slavenka Drakulić was pretty kick ass and I hope her last book comes out in English some day / on colours you can’t see on screens / putting a hat on a hat is a terrific expression / my friend Scott wrote an excellent essay about trillionaires / if i could afford the time off, I would run a temporary department / unit.d gallery looks lovely and i should try to make it to their next exhibition / i love libraries so Biblioteka at the AA is my cup of tea / dragging a couple of friends to Vienna next weekend and going to go look at some Papyrus /  Climate + Cities have published their latest project on the manipulation of climate data.

Added to my commonplace book:

An elegant woman who dressed often in amethyst silk jackets with matching nail polish, as a politician she would drum those manicured nails on the table to make her point. Like others of her generation in intelligence, she never married – until 1973 it would have meant immediately leaving the service – commenting casually once that it would be difficult to explain at home the broken fingernails caused by “things that you do with machinery or guns”. (Met Ramsay’s obituary)

He was only interested in a technique as long as it provided resistance. (BBC Radio 4’s Front Row special on David Hockney)

Trauma is the ultimate experience of ‘this will last forever’. (re-listening to The Body Keeps The Score)

Escher, this utterly traditional artist, makes you see that we walk a world we don’t understand. We are his funny little people, going up and down the stairs, thinking we ascend or descend when we’re on the flat, propping up our everyday lives with cosy assumptions to hide from the infinite, the impossible real. (Unusually flattering review by Jonathan Jones)

This is how the entire course of a life can be changed – by doing nothing. (from On Chesil Beach)

I’m now running late. Happy Thursday.

It’s amazing how long a nation can live with a bad idea. And how that idea ages, sours, rots and attracts all sorts of rodents. Of course I’m talking about Brexit. I was ten years younger when I watched the Newcastle results from a hotel room in Anstruther, where I was taking part in a workshop organised by Mozilla with people from all over the world.

I would later spend almost £1.5K to get naturalised in January 2018. I learnt how to deal with import/export/duty to the EU & US for a client. I pay incredible amounts of duty on parcels to Canada now. Some of my favourite bands stopped travelling to the UK. Some friends moved away with their European partners or plan to leave as soon as their Irish passport comes through. Others lost their jobs and had to move back to where they came from because of their work visas. The list of losses is long.

The problem is that loss turns into shame and we know where that takes us. In Albert Bandura’s Moral Disengagement, Why People Do Harm and Live With Themselves (2015) he states in the introduction:

Because individuals have to live with themselves, they strive to preserve a self-view as decent, self-respecting people. There is no self-view more personally devastating than self-loathing. 

I’m sure time will need to pass before we add Brexit to our history books and describe it as a period of deep isolation and self-loathing. But only 1,500 took to the streets last weekend to ask for change. None of my friends went as far as I’m aware. I didn’t hear about it until I started writing this post. The silence is deafening.

Theresa May accused people like me of being citizens of nowhere, but I think we’ve turned the country into a Nowhere Man instead. Without a point of view, blind as we can be. Hoping someone else has a plan for us. Ideally based on our past glories. I’m sure they’re there if you go back far enough.