November 24, 2024 • 44 mins
Rochelle Gold—Head of User Research and User-Centred Design at NHS England—joins host, Sam Menter from Healthia®, to explore the challenge of making digital services more human.
They discuss how actionable insights from user research are delivering better outcomes for patients and healthcare professionals. From pioneering an AI-powered tool to manage research insights, to tackling the risk of “research vampires”, this episode uncovers innovative ways to create truly inclusive health services.
They explore how collaboration between digital, policy, and operational teams is transforming healthcare delivery, highlighting lessons from the pandemic where integrated working accelerated impactful solutions. Rochelle also shares why focusing on excluded groups isn’t just ethical—it’s essential for creating safer, more effective care for everyone.
Packed with examples from Rochelle’s work building NHS England’s user research capability, this conversation offers practical insights for anyone leading service transformation, commissioning research, or passionate about improving health outcomes.
Problems Worth Solving is brought to you by Healthia, the collaborative service design consultancy for health, care and public services.
Find out more about our work at healthia.services.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
Welcome to Problems Worth Solving, the podcast where
we explore transformativeapproaches in health and care
through the lenses ofhuman-centred design, service
design and digital.
I'm Sam Mentor, the ManagingDirector at Healthier, the
(00:23):
collaborative service designconsultancy.
Find us at healthier.services.
Join me as I speak with thepeople shaping the way health
and care is delivered.
Leaders and changemakers frompublic health, not-for-profit,
health tech and life sciences.
We'll explore how putting peopleat the heart of service design
can drive impactful change.
(00:45):
In each episode, we'll shareinsights and inspiration from
real-world examples, like usingco-design techniques to improve
mental health services, ordigital tools that empower
patients to take control oftheir care.
Today I'm joined by RochelleGold who is Head of User
Research and User Centred Designat NHS England.
Rochelle has been instrumentalin establishing a user research
(01:08):
and a user centred designcapability across the
organisation over the last fewyears.
I first met Rochelle at aconference where she was talking
about the challenges of applyinguser centred design to a patient
pathway when that pathway cantouch on multiple teams,
multiple services and multiplesystems.
I was thinking about Rochelle'swork in the context of problems
(01:29):
worth solving.
And what's the problem thatRochelle has been trying to
solve through her work over thelast few years?
And it's a big one, really.
It's how do we make the digitalside of the NHS more human so
that we meet real needs and weimprove outcomes?
So welcome to the podcast,Rochelle.
It's great to have you here.
Maybe just introduce yourself toget started and tell us a bit
about your experience that ledto you working on this problem.
SPEAKER_01 (01:51):
It goes back many years.
Depends how far you want to goback.
But yeah, I'm Michelle Gold.
I'm Head of User Research, UserHead of Design.
And I started off my life and mycareer, I trained as
occupational psychologist.
And it's really strange becauseI know when I was studying at
uni, I absolutely hatedresearch, which is really weird
because that's my life and myjob right now.
(02:13):
But one of my first jobs wasactually doing psychometric
testing of offenders.
But the other half of my job wasdoing research in university and
academic research.
And after that, I then went intovarious other roles, including
going into business consultancyto try and move towards being a
chartered occupationalpsychologist.
(02:34):
But I kind of realised maybethat wasn't my interest, which
is a bit of a shame becausethat's what I trained to be, and
actually took voluntaryredundancy from that role and
then just turned to a localuniversity.
For some reason, whilst I wasthere, I managed to get my own
module in teachingundergraduates in violent and
sexual offending behaviourbecause I did work with sex
offenders and high-riskoffenders in my research and my
(02:57):
psychometric testing.
And then after that I actuallygot a role working for what has
become CQC when it was theCommission for Social Care
Inspection and then got a roleheading up the research
department at West York'sProbation Service.
So essentially up until thispoint now I have spent the past
25 years working in research anddifferent types of research and
(03:17):
then when a role came up at whatwas the Health and Social Care
Information Centre, which was aprecursor to NHS Digital.
I saw it and thought, actually,being a user researcher, going
back to research practice,having been managing and leading
a research department, thatmight be quite a nice thing to
do, to go back to practice anddo my craft in a new sphere.
(03:41):
And that's how I ended up here.
in the role as a user researcherin health.
But when I arrived here, therewere five user researchers and
no career ladder, noinfrastructure, no tools, not
even job descriptions.
We were all matched to projectmanager job descriptions.
(04:02):
I was looking around methinking, yeah, I've gone back
to practice.
I've moved away from leadership.
I've moved from havingresponsibilities and leading a
team and leading a department ofpeople.
And thought, yeah, but thenthere's all this stuff that
needs to be done that couldreally make it much better, much
easier to do our job, enable usto have more impact.
(04:24):
And it started from there wherewe got together as a group of
researchers and built aprofession, a community, a
capability.
And I built the career ladderthat led to me becoming head of
user research.
SPEAKER_00 (04:41):
It's impressive stuff.
I'm curious as to what thedriver has been for you.
What is it about this disciplineand health that has kind of
pulled you into this seat?
SPEAKER_01 (04:49):
The discipline of research in general, I just love
learning something new everysingle day, specifically user
research.
I have worked in academia.
I've worked in social research.
I've worked in policy research.
I've worked in all differenttypes of research.
But the thing about userresearch is that you see things
(05:09):
The impact of what you'relearning and the actionable
insights that you're generating,you see it make a difference and
you see it change things and yousee it happen in front of you.
You know, you could be doingresearch on something one week
and a few weeks later, there yousee the change on the product or
the service.
And I think for me, thinkingback, I talked about how I
(05:33):
didn't actually like doingresearch when I was at uni.
I hated it.
It's because it didn't meananything.
You didn't see anything happen.
It was all very small thingsthat you saw and you learned,
but you didn't have an impact.
And the amazing thing about userresearch and particularly user
research in health is that youhave an impact.
You have an impact on people'slives and you are doing research
(05:56):
that can help to keep peoplewell, make people better and
often potentially in the longrun save lives.
So that's why it's huge.
SPEAKER_00 (06:05):
I love it.
Those are some of the samethings that drew me to this
craft and this profession and alot of the people that I work
with and meet in the industry.
It's that actionable research.
It's not buried in months andmonths of deep academic
research, where obviouslythere's a very important place
for all types of research.
But it's that actionable side ofit that I find really engaging.
For people who are listening whomaybe don't know what user
(06:26):
research is and how that mightdiffer from other types of
research, could you just give avery quick summary of how you
would define user research?
SPEAKER_01 (06:34):
I think the key thing to say about it is it
still has the same robustness,the same standards, the same
ethics, the same principles, thesame safeguarding that we all
have to adhere by any other typeof research.
Like I say, I've worked inacademic research and a lot of
our researchers, userresearchers, come from deep
(06:54):
research backgrounds.
But I think the difference isit's about generating actionable
insights but from understandingand looking at and observing
behavior.
So it's really not about whatpeople say or people think or
their views or theirpreferences.
It's really about understandingbehavior and from understanding
(07:17):
and through that understandingneed and unmet needs.
So one of the examples I alwaysgive about this is that I was
once in a hospital and I wasobserving someone using one of
the systems there, one of thedigital systems, and I was doing
research with them andunderstanding what was going on
and how it was working for them.
(07:38):
And they said, look, what wereally need here on this screen,
we need a button that saysprint.
And I was like, okay.
You need a button on a screen sothat you can print it.
Okay.
And you know, you could go awayand say, users are saying, or
people are saying that we needto be able to print from this
screen.
You can go and spend howevermuch money in developing that.
But actually when you sit thereand watch, you understand what
(07:59):
they're doing and what theirneed is and the outcome they are
trying to achieve is you realizethat the reason why they need to
print that screen is so thatthey can put that screen print
into a pile of paper.
And there is someone who's, dayjob is to scan all those screen
prints into a documentmanagement system and attach it
(08:21):
to a patient's record so what isactually needed there isn't a
button on that screen so thatthey can print it it is for the
information on that screen toactually be able to be into this
other system this other productwhatever it is into this
person's patient record Andthat's the example I always give
(08:42):
about the difference betweenother types of research and user
research.
It is about getting to the cruxof understanding what's going on
and what the unmet need is soyou can make recommendations or
give actionable insights to thedevelopment team or the design
team to help them to understandactually what is the problems we
need to solve here and how canwe solve them.
SPEAKER_00 (09:05):
And in NHS England, is user research always tied to
digital or does it get rolledout across patient experience in
other areas as well?
SPEAKER_01 (09:14):
It's interesting because there's different types
of research.
And I think there's a lot ofresearch with patients to try
and understand the patientexperience in hospitals and
everywhere else.
And all these different types ofresearch absolutely are valuable
and have their space, part ofunderstanding the whole wider
picture.
I would say user research ismainly based in the digital
(09:37):
space.
But when you are working in thedigital space, particularly in
health, there's always somethingphysical.
There's always a person.
Whatever the health issue is,whether it's mental health,
whether it's physical health,whatever, there's always a
person in it.
And there's no way that as auser researcher, you can just
focus on the digital thing.
(09:59):
Because actually, digital isn'talways the answer.
And when we are thinking aboutwhat we're doing in health, we
need to think about the outcomewe're trying to achieve.
And that outcome is never goingto be achieved just by a digital
thing.
It's just one part of helping usto deliver stuff for patients
and for the front line.
(10:20):
So whilst our user researchersare mainly within the digital
area of NHS England, I thinkthat's a legacy thing of where
we've grown the capability.
There is a lot of what we dothat can inform everything that
we do with patients.
And actually, I think almostlike the next step is to be
(10:41):
working much wider than that andworking with our other
colleagues and other researchersacross the business to
collaborate on that end-to-endservice and understanding what's
happening out there.
SPEAKER_00 (10:52):
And how does the user research approach fit
alongside the kind of patientinvolvement side of things?
SPEAKER_01 (10:58):
They are...
two separate things, but theyare both really important.
Our user researchers, they doresearch with different people
every single time they go and doresearch.
They're new members of thepublic, they're new
professionals that we've notworked with, interviewed,
observed, tested our stuff with.
And that's really important.
(11:19):
I actually, outside of work, I'ma patient rep also.
And so I have, I almost haveboth hats and Both things are
really so important because thatpatient voice in our sort of
more senior strategic decisionmaking, bringing that patient
voice into that is reallyimportant.
So you've almost got two sidesof it.
(11:41):
You've got a lot of the detailin terms of our product and
service design and developmentfrom user research, the insight
from that.
And then you've got the patientreps who are experts at
representing that patient voicein a room, probably where the
stakeholders and the decisionmakers are trying to make the
(12:02):
decisions and making them attuneinto the patient voice there.
So they work together and I'vegot close relationships with our
patient voice and patientinvolvement groups.
I think where they're reallyimportant, I think, It's
slightly different as opposed topatient voice and patient reps,
but working with local communitygroups, particularly community
(12:22):
groups working with people whoface the most barriers to
accessing service or have lowertrust in public services, that's
where that patient reps andpatient voice are really
important and really powerful.
SPEAKER_00 (12:36):
So your user researchers, when they're doing
the broader discovery researchfor projects, rather than the
kind of more tactical, makingsure that the things are working
type of research, when it's thatearlier doors discovery
research, the insight that comesout of that must be really
useful and relevant to patientreps as well.
SPEAKER_01 (12:52):
The insight we get from discovery has wide
relevance and wide information.
Like I say, it doesn't justfocus on the digital, it focuses
much wider.
So that discovery information,absolutely.
It's not just the patient reps,actually.
It's almost helping to be thevoice of all the users that are
out there.
(13:12):
As a patient rep, I have livedexperience of one particular
aspect of being a patient and Ican advocate for that and I can
talk about that.
The value that often comes fromthe research we do with users is
that we get a much wider, variedspread of lived experience to
bring into those discovery portsand give a balance of the
(13:34):
different needs of a widevariety of lived experiences.
SPEAKER_00 (13:38):
One of the things we can experience sometimes is that
research can be quite siloed.
So you'll do research on aparticular problem and it will
be for a particular team tosolve a particular challenge.
actually there's always insightthat comes out that's relevant
to other teams and maybe it'sother user research teams, but
it might be other teams, forexample, patient reps.
Have you managed to solve thatas a problem inside the NHS?
SPEAKER_01 (14:00):
So there are two things about that.
I think there are two aspects tohow do you enable everyone to
have access to the insights thatyou're generating and make sure
that we're not working in silosacross the business.
I mean, organisations are...
just by the fact of the wordorganization.
They're always going to organizethemselves in some way.
And those ways they organizethemselves are always going to
(14:23):
be some sort of silo.
I just think we're never goingto break all the silos down.
But I think there's two things.
One thing is probably core tothe way I operate, actually.
It's people.
So everything you do is aboutpeople and people enable
everything to happen.
So by having things like thecommunity practice that we've
developed at Clark, probably 150members at the moment the user
(14:44):
research community practicewhere we are sharing we are
doing show and tells we're doingthings like that so there's that
more about how do you get peopleto work together to communicate
to surface their knowledge toshare their knowledge and
there's other communicationthings like really active slack
channel little things like thatwhere someone can do a shout out
but one of the things we haveinvested in and i know thousands
(15:05):
have died on the hill of thisand i don't want to use the word
i am going to use the word theidea of a repository of research
knowledge i do hate that word ineed to call it something else
but i think we've called it i'veactually called it user research
finder so let's sack off therepository word user research
finder and we've actually usedai technology to develop a user
(15:25):
research finder where people canquery what do we know about this
And we've got our user researchuploaded into it and people can
do that.
It's in a private beta at themoment and we're just
redeveloping it further.
But things like that, whenyou've scaled to the scale that
we are, are actually reallyimportant to have people
different ways and differentmechanisms for people to
(15:46):
communicate and accessknowledge.
SPEAKER_00 (15:48):
I love the way that you dropped in.
We've actually used AI todevelop this kind of research
tool.
Actually, that sounds like anincredible thing.
Can you tell me more?
Can you say more about whatyou're doing with AI and
research insights?
Because that's the first timeI've heard of someone using AI
to organise research insights.
SPEAKER_01 (16:04):
Yeah, it's just a language model that you can use
to interrogate our userresearch?
I think people use the word AIand they think it's this big
mysterious thing and I thinkit's a lot of people are talking
about it and be in the futurebut it's a large language model
that we've used and it's got afront end that's built from
(16:24):
using our prototyping kit aspart of our NHS service manual
and we've worked with people whoknow about this stuff and to be
able to build this thing And weare just testing it out and
making sure it works foreverybody.
I think one of the challengeswith it is you don't want to
just suck in absolutelyeverything.
You want to make sure it'srobust user research.
(16:46):
So that's the challenge ofmaking sure it's pointing to the
right information sources.
SPEAKER_00 (16:51):
So essentially, you've got a big pile of
insights that have come from allthis research that's going on
all the time across the NHS.
then you've got a layer that isdoing the same thing as chat GPT
in terms of the organising andthe filtering of that content.
So you can go in and you can aska question about a research
topic that you're about to diveinto and see what the system
already knows.
(17:12):
Is that right?
SPEAKER_01 (17:13):
Yes.
SPEAKER_00 (17:14):
That's amazing.
That is moving things forward sofast.
SPEAKER_01 (17:18):
I mean, we're cautious about it because
obviously we're developing thisin a user-centered way.
We are iterating.
We are trying to break it.
We want to make sure that itworks for user researchers, but
it's not just a user researchtool.
It's a tool for anybody whowants to find out about the user
research that we're doing.
Like you say, other researchersacross the organization that
(17:38):
aren't necessarily working inuser research.
SPEAKER_00 (17:40):
People will come to researchers with a brief, won't
they?
They want them to find somethingout for the tool or the service
that they're developing.
SPEAKER_01 (17:47):
Yes.
The amount of times I get asked,what do we know about this?
Because I've had a userresearch, you should know about
every single bit of researchthat is going on across the
whole organisation.
But when you've got 130 userresearchers who are going out,
every single day they're doingresearch or consolidating
evidence or planning research.
(18:07):
Every single week...
There are people in our userresearch lab conducting user
research.
There are people outside,on-site doing research.
I have a decent brain, but Icannot tell you about every
single piece of research thatwe're doing or every single
insight that we've gained fromthat.
We need something like that tobe able to interrogate.
(18:30):
It's really about knowledgemanagement, isn't it?
It's not about...
Just about user research, it'sabout good knowledge management.
And I think it's a proof ofconcept that we've got.
And once we know that it worksreally well, we will talk about
it more widely and people canlearn from what we've learned
because we're not here to holdon to good things that can help
other people to do their job.
SPEAKER_00 (18:51):
And would it be in a model that could be shared with
other NHS departments or othergovernment departments?
SPEAKER_01 (18:56):
I think theoretically, yeah.
SPEAKER_00 (18:58):
Great.
Tell me a bit more about thework you've been doing to
involve excluded groups inresearch and why that's
important.
SPEAKER_01 (19:06):
I can't claim to be the person that's done it, but I
can tell you what we're doing interms of our user research
capability.
A lot of this started by acollective of people a few years
ago during the pandemic whoWe're just like, we need to do
more about exclusion in healthand care and in human-centered
design in health.
And that had a number ofdifferent aspects to it.
(19:27):
It included things that we'vedone to be more inclusive in
terms of our recruitment.
So we make our actual teams farmore inclusive and
representative of people withlived experience.
But one of the other focuses wasabout our user research
practice, the people we wereconducting our research with.
So we started to developrelationships with community
(19:49):
groups.
So in the same way that a lot oforganizations have contracts
with recruitment companies tobring in participants for user
research, why aren't weutilizing groups within the
community to do that?
Why aren't we reinvesting in ourcommunities, particularly those
communities who don'tnecessarily trust the NHS?
(20:10):
We know that.
People talk about NHS being atrusted brand.
It might be for the majority ofpeople, but actually there are a
significant number of people whohave had poor experiences of
government and the NHS, andactually that trust isn't
necessarily there for somepeople.
And we need to be hearing thosevoices.
(20:31):
We need to be listening.
And we need to be equally, asuser researchers, we need to be
reflecting on our practice inrelation to that.
So we have...
a number of community groupsthat we work with.
And we do co-design, we doresearch with them, but also we
work with them to understand howour practice impacts them and
(20:54):
where we need to improve as userresearchers.
And I think there's been somequite open and forthright
conversations about challengingsome of the privileges that we
have as individuals, which havereally helped to improve our
practices as user researchers.
So I think at one point peopletalked about accessibility and
how one in six of your usersshould have access needs.
(21:17):
With our research, what we'retrying to do is focus on those
groups who are most excluded,who face the most barriers to
accessing healthcare, because ifwe understand those barriers if
we work with those groups thenwe will actually make it better
for for everyone else that'swhat we're doing so we focus our
research not on the generalperson who finds it very easy to
(21:42):
navigate their way throughhealthcare systems or digital
systems or for whom it's so Alot of our products focus on the
average person, whatever thatis, and we make sure that we
recognise that there's no suchthing as an average person and
look at how we break down thosebarriers through understanding,
(22:02):
through evidence, the livedexperience of those people who
experience those barriers.
SPEAKER_00 (22:06):
One of the phrases I've heard you use before is
research vampires.
Can you tell me a bit more whatyou mean by that and how you
avoid being a research vampire?
SPEAKER_01 (22:17):
So I think this actually came from the work we
did with one of these communitygroups during covid and it's as
researchers any researcher userresearcher academic researcher
what happens is you go into acommunity or you go and do an
interview with someone you takethe research you take their
evidence take the informationthen off you go and that's it
(22:37):
it's almost you drain them ofthe information you drain them
at the knowledge and they don'tget anything back And so it's
that relationship that we'vebuilt up.
And Lisa and our team has workedreally hard at those
relationships and pulls us allup if we do anything that is
going to do anything at all thatwas detrimental to that
relationship.
And it's that that is really,really important.
(23:00):
So you're not just a researchvampire.
You are improving your practice.
You are going back to thosecommunities and working with
them, not just taking thingsfrom them.
Exclusion.
is a clinical risk and it's notenough just to make something
accessible we have an nhswebsite who you know which you
(23:21):
know we do research we design itwe try to make everything we do
is accessible everything canalways be better but we try to
build accessible products andservices and tests to make sure
they're accessible but ifthey're not inclusive then that
leads to clinical risk if ifyou're talking about a skin
condition and you only describethat skin condition about how it
(23:43):
presents on white skin that isnot inclusive and that actually
is a health inequality whichmeans that somebody whose skin
isn't white cannot identify whatthis might look like for them,
what might seem for them, and itcould be actually quite a
serious problem.
So it's a clinical risk if weare not inclusive in what we do.
(24:03):
So working with communitygroups, working with people with
lived experience is essential toensure that we are delivering
health services that actually dohelp to save lives.
SPEAKER_00 (24:16):
That sounds like an evolution of the usability as a
clinical risk, which was aphrase that I remember hearing a
few years ago being used in NHSEngland.
SPEAKER_01 (24:24):
It is.
SPEAKER_00 (24:25):
I love talking to you, Rochelle, because we go off
on these kind of paths and it'svery easy for one thing to lead
to another.
What I was going to get toearlier on in the interview was
asking you to zoom out a littlebit.
If you're thinking back aboutthe work you've been doing over
the last few years in NHSDigital and NHS England, How
would you summarise the bigproblem that you've been trying
(24:45):
to solve through your work?
SPEAKER_01 (24:47):
Probably the way to summarise what we're trying to
do is, I guess, put the humaninto digital in health and care.
The health service as a whole,it is all about people.
It's all about humans.
You talk about patient-centeredcare.
And that is a real solid part ofhow our health practitioners
work.
Then when you start introducingtech, that kind of seems to be
(25:08):
forgotten.
And it seems to be laggingbehind.
And you're almost trying to fitthe user, the human, the people,
the patient, the healthprofessional.
You're trying to fit them to thetech that you're deciding to
deliver.
and not considering the contextof use of that or the actual
underlying needs.
I guess the problem we're tryingto solve is how do we inject
(25:30):
that human into how we deliverhealth tech.
SPEAKER_00 (25:33):
And from your perspective, why is this a
problem worth solving?
SPEAKER_01 (25:37):
Well, health is literally a matter of life and
death, isn't it really?
The work that we're doing.
And digital is part of that.
The human, the people...
That's a core part of health.
And the context of use of allour digital products and
services, it's in patient homes,but it's in GP practices, it's
(25:59):
in hospitals, it's in ourcommunities.
And if something doesn't work orsomething goes wrong here or
something falls through the gapor leads to delays in care...
At best, that's something thatmeans that someone's going to
wait a bit longer to get sometreatments or health and care.
But at worst, it's literallypeople being too ill to get
(26:19):
well.
The reason why this is worthsolving is that we can help to
save lives.
Human-centered design is allabout, I've talked about moving
barriers to accessing healthcare, but it's also removing
barriers to delivering healthcare.
And if we've got really poortech where our health
professionals are having toThink about workarounds on
(26:40):
paper.
I've seen this in practice.
I've seen it in context.
Or systems that take too long toget into the information that
they need to be able to workwith a patient or takes any
amount of time from patientcare.
One minute of time away frompatient care is a minute wasted
in the NHS.
And if you think the amount ofpeople who work in the NHS who
(27:00):
take one minute of their timeaway that we don't need to,
that's a pretty unethical thingto be doing.
And if tech is doing that, Ifthe products we're delivering,
we're not making sure doesn'tadd extra burden or don't take
away that time, then we'reworking unethically and we
really have to be thinking aboutwhat we're doing in health and
(27:22):
digital and tech to make surethat doesn't happen.
SPEAKER_00 (27:25):
We've done work across the NHS where we see
people struggling with sign-insto multiple systems that take a
very long time to load uppatient data.
And once you combine all thosethings, it's almost such a
spaghetti of systems andprocesses.
You can just see a point whereactually it's not possible to do
any patient time in the futurebecause it's all tied up with
using services and systems.
SPEAKER_01 (27:45):
I once described health tech in relation to
spaghetti.
It's actually somebody that Iwas working with who talked
about being spaghetti.
And I elaborated on it and sortof said, actually, it's not just
that it's multiple plates ofspaghetti and they're all joined
up and what happens is you starteating them and what you realize
is you can't just eat one plateyou need to eat all the plates
(28:07):
and so you're going to be sickbut then you've got someone
outside quite frankly knockingon the window going oh i could
make pasta okay and they look atit from the outside and go yeah
what are you worried aboutwhat's the place yeah i can make
pasta i'll solve it all Andthat's how it feels in health
tech to some extent.
SPEAKER_00 (28:25):
And there's someone in there who's, actually, we
haven't tried that sort of pastabefore.
That would be really tasty.
Let's have some of that in themix.
SPEAKER_01 (28:30):
Yeah, but you always need to have the pasta there,
otherwise you actually can'tfunction.
That's the other thing.
You always have to have the liveservice.
It's not like you could just,you might want to burn it all,
but it's not like you could justset it all on fire and start
again.
SPEAKER_00 (28:42):
So thinking about the problem you're trying to
solve is how to make the digitalside of the NHS more human.
How many barriers or whatbarriers did you experience in
trying to solve this?
SPEAKER_01 (28:53):
Oh, shed loads.
SPEAKER_00 (28:56):
And I imagine a lot of them are still there.
Does it feel solved?
SPEAKER_01 (28:59):
Oh God, it's never going to be solved.
I think, okay, when we, and Imean we, because it isn't just
me that's helped to make it morehuman.
And when we first set out onthis journey, we came in and if
just from a user researchperspective thinking about that
people like what's your jobisn't that what i'm doing or i
(29:20):
got told you're here to tick abox for a gds assessment or
you're here to tell the stuff wealready know or there was that
sort of barrier where peoplefelt it was a threat some people
maybe for their roles their jobor whatever because yeah
anything new or seemingly new,people will say it's not really
(29:41):
new, or it feels like a threat.
So I suppose that's Barry fromthe start, but once you almost
start delivering, you get peoplewho see the value.
So it was about starting small,starting in one area.
So the area that first kickedoff working in a user-centred
way, was real human-centred way,was when we moved what was the
(30:03):
Choices website to the NHSwebsite that we see today.
And that's where it started outand people saw the value.
They saw what was happening.
They saw that actually peoplewere talking about this in a
really positive way.
And even if you're someone thatwas adverse to change, or
someone that actually wasn'tnecessarily on board.
If you were someone who maybelooked over and thought, this is
(30:25):
something that people aretalking about, I'd better get on
the bandwagon.
You've got some people who maybe more resistant going, yeah,
this is a way we should beworking.
And then they started seeing thevalue and other people see the
value and demand gets more andmore.
But I think the point at which Ithink it really matters open the
(30:45):
floodgates was during thepandemic because this was a time
where nobody had experiencedthis before it was really
ambiguous situation there werelots of people who were working
in this new area but they had tomake lots of decisions and they
had to do that in a context thatwas constantly changing where
(31:09):
the policies hadn't even beenwritten and we had to constantly
flex ourselves.
And what was really apparent isthat this was something where
human-centered design and userresearch excelled.
It gave senior decision-makersthe ability to almost de-risk
their decisions because it gavethem just enough information to
(31:30):
enable them to make some sort ofdecision with some sort of
evidence.
And it meant that we could beflexible.
We flexed the product.
We flexed the service reallyquickly.
We turned things around reallyquickly.
It's where our design system andservice manual came into its own
because you could quickly spinup things using it.
And I think that really didsolidify that working in this
(31:52):
way actually helps us to deliverwell, deliver faster, deliver
more robustly, more efficiently.
I think really shone through andmade some people who maybe were
more sceptical or not on boardreally stand up and listen and
realise the value of this work.
SPEAKER_00 (32:10):
At the same time as being a really stressful
environment, it must have been areally exciting environment to
be working inside the NHS duringthe pandemic.
SPEAKER_01 (32:17):
Yeah, it was really tough because people had
pressure of work that was goingon, the rapidity of it, the very
short notice of actually whatneeds to be delivered that week.
And sometimes that was actuallyannounced in the press before we
even knew about it.
But there was a huge reliance ontechnology and it being remote
(32:38):
access to care and we werespinning up new products and
services within days and it wasan unsustainable pace I would
say but what happened was partsof the organisation that really
need to work together tocollaborate had to and were
forced into a situation wherethe only way to deliver was to
do that and to some extent Ilook back now and go we did it
(32:59):
then we could do it now we hadYou said design folk, policy
folk, operational folk, allworking together to deliver an
outcome.
And that's exactly how we shouldbe working.
That's exactly how we should beworking moving forward.
And that was the real hugebenefit and value in COVID was
actually just working in thatway because we're forced into
(33:22):
doing it.
Because that's the only way wecould deliver for the country
and deliver that rapidly was ifwe actually did collaborate so
closely.
And I think...
That's where we need to bemoving to on a more permanent
basis now.
SPEAKER_00 (33:36):
It's interesting because we talked earlier about
user research being used in thecontext of other disciplines and
other challenges.
And actually what you're talkingabout there is that discipline
collaborating closely withpolicy.
And that's an area that we'veworked in a bit ourselves and
just feels like the right way ofworking because there's the
insight, what should we do aboutit as an organisation?
SPEAKER_01 (33:55):
Yeah, absolutely.
And almost, I think the policywas being developed by
developing the user-centeredproducts because there was no
policy.
And so as you're designing whogets access to tests, how do we
develop the test system?
How do we develop thevaccination system?
(34:17):
Who are we going to allow accessto book a vaccination or get a
test?
you're developing the policythat wasn't there and the user
research and insights you'regetting from that was helping
our policy colleagues to makethose decisions and it's almost
like that's we should never goback to working at that pace
with that much pressure in thatsort of way again because we
(34:38):
will burn every single personout but that joint working and
collaboration is something weshould try to keep from that
situation.
SPEAKER_00 (34:46):
We work in these product teams where you've got
various disciplines from tech,from content, from design.
If you could have a policyperson involved in that product
team as a way of working asstandard, it would move things
forward.
SPEAKER_01 (34:59):
Yeah, and I think there are some teams who do have
that, but I think it's in theminority and I think it's rarer
than it should be.
And I think it's not even justpolicy folk, it's the
operational folk on the frontline as well, the people who are
working in the context too.
the people who do theimplementation and the change
(35:20):
across the system.
That's really a trulymultidisciplinary team.
I think people talk aboutmultidisciplinary teams in a
sort of standard, whatever astandard product team is, a
product manager, a deliverymanager, design, content,
business analyst.
For me, the trulymultidisciplinary team, and
we're looking at this in termsof health, is about having those
policy folk in, operationalfolk, improvement folk.
(35:41):
That is where we really shouldbe moving towards.
SPEAKER_00 (35:45):
So you talked about there being, I think, five,
people when you joined theorganization five researchers
how have you gone from fivepeople up to 100 and how do you
find the right people andnurture the talent when you you
find those people
SPEAKER_01 (36:00):
yeah how did i go to five people to 130 that's a
really good question you startyou just start and you just
build it over time actually thisis probably where my background
in occupational psychology comesin quite well because a lot of
that was recruitment selectionassessment and career
development and organizationaldesign and organizational
(36:20):
development and organizationalchange and I think what happened
was I seized on an opportunityat this point I was I was a user
researcher and they brought insomeone to lead what they were
calling the digital deliveryprofession.
So develop the profession ofdigital delivery folks.
(36:40):
So that was product delivery,design, content and user
research.
And I basically contacted thatperson and spoke to them and
said, look, how can I help?
This is my background.
And having gone into the jobthinking, I don't want any more
responsibility.
I don't want any stress.
I don't want to be responsiblefor a team, people, department.
(37:02):
I couldn't help myself.
I couldn't help myself and tryand solve the problem.
I don't know.
I just saw stuff around me and Ithought we could do this.
We could do that.
I could do the other.
And so I spoke to this personand looked with them to look at
how we can expand it.
So it was about slowly growing.
But I think the key thing for mewas to first start off with what
are the core competencies we'reexpecting from people in user
(37:25):
research, making sure weactually had job descriptions
that were user research jobdescriptions not not not maxtra
project manager project managersare brilliant there's a
different job description for auser researcher but also
creating a career ladder forpeople so that when we got
people in there was somewherefor them to move through and
move up to i mean i created thecareer ladder that i moved
(37:48):
through i moved to senior imoved to lead and i moved to
head of it i was almost put therungs out in front of me as i
moved up from them actually andAnd then once you start
expanding, you need the tools,you need the infrastructure.
And there wasn't necessarilyfunding for that tools and
infrastructure.
So I almost got the communityitself to start looking at,
(38:08):
okay, what are the things weneed to develop?
What are the things we need todo?
And they led on certain aspectsof that.
And that sort of provided theproof that actually we need this
function.
We need this capability, whichled to a individual doing
research ops, which then ledexpanded when we realised
actually there's so much more wecan do, there's so much more we
(38:31):
should do I took advantage ofthe fact that I was given the
central UCD budget to look afterand we had some vacancies and we
could use that vacancies to dosome good work and I suppose I
just saw things that neededdoing and I worked out ways to
get them done and I got peopleon board and I got people on
side I think we had an execdirector that came in and we had
(38:54):
something in common so I got intouch with them and said oh and
by the way when was the lasttime you observed user research
and would you like to observesome user research and I spoke
to her about the work that wedid.
And then she advocated for us ather SLT and got me there to talk
to her directors about what userresearch was.
And I think it just gatheredmomentum and gathered momentum.
(39:17):
It was a great group of people,some brilliant people across the
community who wanted this tohappen, who worked together, who
collaborated.
The user research community inNHS England are, I don't know,
they're one of the best parts ofmy job.
supportive, skilled people whoknow so much about this work and
(39:39):
other work and I think it justsnowballed and gathered momentum
and I knew I wanted to be at apoint where user research was
embedded in our product teams.
Initially, my role working forthe person who's heading up the
digital professions was almostto bring people in, get a pool
(39:59):
of researchers and allocate themto places and almost like an
agency model.
And when you've only got a fewuser researchers, that's okay.
But really you need people whoare embedded in the products,
who understand the products.
And it'd be less about thepeople pulling research in But
the research, user research hasbeen in there to advise them
about what user research needsto happen.
(40:21):
Because I think by the timepeople think about user
research, sometimes it's almosttoo late and the time has
passed.
So I think I just saw a lot ofproblems to solve and I wanted
to solve them and I couldn'tstop myself.
SPEAKER_00 (40:34):
And what's it like now in comparison to when you
first started at the NHS andtied to that?
Do you feel responsible for someof that change and feel a bit
proud?
SPEAKER_01 (40:43):
I'm incredibly proud of the capability that we have
in NHS England, the userresearch capability.
I'm incredibly proud of thepeople that we have in it and
the people that have developedthrough that.
There are people who started offas graduate UCD folk who have
moved up for larger.
There are people who started offas associate user researchers
(41:05):
who are now lead userresearchers.
There are people who have goneon to other places to greater
things.
And it is...
I'm incredibly proud of everysingle person within that
community and what we haveachieved together as a
collaboration.
To some extent, we're victims ofour own success.
We still don't have enoughpeople to do everything we want
to.
But what I think is brilliant isthat it's no longer me
(41:29):
advocating for user research oruser-centered design.
It's no longer even just our URsor our UCD folk advocating for
it.
It's now got to the point whereI've been in meetings and
someone said something and oneof our directors has advocated
for working in a user-centredway or doing user research and
challenged other people in thatroom to work in that way.
(41:52):
That's when you've delivered onwhat you're trying to achieve,
when you're no longer the peopleor the person that's advocating
for it.
It's someone else and you don'thave to be in the room for
people to be advocating aboutit.
I remember Someone was tellingme about one of our clinicians
who I worked with in the veryearly days who was quite
skeptical about user research.
(42:13):
Then she saw how it wasidentifying clinical risk and
someone told me they were in ameeting with her and she was
challenging everyone in themeeting going, where's your user
research?
Why are you working in auser-centered way?
And I don't have to be in allthe meetings anymore.
I don't have to be the voicetalking about this in the
meetings anymore.
I think we still have ourchallenges.
(42:33):
It's not perfect.
It's not a utopia.
but there are more and morespaces in the organisation when
our researchers, our designers,our content folk don't spend
half their time advocating justto be able to do their job.
It's just part of the way theteam works.
And that I see as a hugesuccess.
SPEAKER_00 (42:54):
And what's next for you, Rochelle?
What's the next challenge thatyou're working on?
What would you like to moveforward?
SPEAKER_01 (42:59):
I think it's that thing I was talking about
earlier I think it's about howdo we bring the digital policy
and operational together to workat and understanding how we
deliver youth-centered servicesacross the NHS we can't deliver
out into the NHS we can'tdeliver services for the NHS
(43:19):
without working across digitalpolicy and operational and I
think that's where My passion atthe moment is in that space and
wanting to bring that togetherand look at how do we do that.
SPEAKER_00 (43:31):
Thank you so much, Rochelle, for taking the time to
talk to me.
I look forward to our nextconversation at some point,
whenever that may be.
Have you got anything that youwould like to close on?
SPEAKER_01 (43:39):
I think I would say, I say this a lot in relation to
my job, it's the closest I amever going to get to using my
skills and abilities to savelives.
And I don't think there's anyjob in the world that's more
valuable or better than that.
SPEAKER_00 (43:55):
problems worth solving is brought to you by
healthier the collaborativeservice design consultancy for
transformation in health careand public services find out
more about how we can help youdeliver user-centered change at
(44:18):
healthier.services
Welcome to Problems Worth Solving, the podcast where
we explore transformativeapproaches in health and care
through the lenses ofhuman-centred design, service
design and digital.
I'm Sam Mentor, the ManagingDirector at Healthier, the
(00:23):
collaborative service designconsultancy.
Find us at healthier.services.
Join me as I speak with thepeople shaping the way health
and care is delivered.
Leaders and changemakers frompublic health, not-for-profit,
health tech and life sciences.
We'll explore how putting peopleat the heart of service design
can drive impactful change.
(00:45):
In each episode, we'll shareinsights and inspiration from
real-world examples, like usingco-design techniques to improve
mental health services, ordigital tools that empower
patients to take control oftheir care.
Today I'm joined by RochelleGold who is Head of User
Research and User Centred Designat NHS England.
Rochelle has been instrumentalin establishing a user research
(01:08):
and a user centred designcapability across the
organisation over the last fewyears.
I first met Rochelle at aconference where she was talking
about the challenges of applyinguser centred design to a patient
pathway when that pathway cantouch on multiple teams,
multiple services and multiplesystems.
I was thinking about Rochelle'swork in the context of problems
(01:29):
worth solving.
And what's the problem thatRochelle has been trying to
solve through her work over thelast few years?
And it's a big one, really.
It's how do we make the digitalside of the NHS more human so
that we meet real needs and weimprove outcomes?
So welcome to the podcast,Rochelle.
It's great to have you here.
Maybe just introduce yourself toget started and tell us a bit
about your experience that ledto you working on this problem.
SPEAKER_01 (01:51):
It goes back many years.
Depends how far you want to goback.
But yeah, I'm Michelle Gold.
I'm Head of User Research, UserHead of Design.
And I started off my life and mycareer, I trained as
occupational psychologist.
And it's really strange becauseI know when I was studying at
uni, I absolutely hatedresearch, which is really weird
because that's my life and myjob right now.
(02:13):
But one of my first jobs wasactually doing psychometric
testing of offenders.
But the other half of my job wasdoing research in university and
academic research.
And after that, I then went intovarious other roles, including
going into business consultancyto try and move towards being a
chartered occupationalpsychologist.
(02:34):
But I kind of realised maybethat wasn't my interest, which
is a bit of a shame becausethat's what I trained to be, and
actually took voluntaryredundancy from that role and
then just turned to a localuniversity.
For some reason, whilst I wasthere, I managed to get my own
module in teachingundergraduates in violent and
sexual offending behaviourbecause I did work with sex
offenders and high-riskoffenders in my research and my
(02:57):
psychometric testing.
And then after that I actuallygot a role working for what has
become CQC when it was theCommission for Social Care
Inspection and then got a roleheading up the research
department at West York'sProbation Service.
So essentially up until thispoint now I have spent the past
25 years working in research anddifferent types of research and
(03:17):
then when a role came up at whatwas the Health and Social Care
Information Centre, which was aprecursor to NHS Digital.
I saw it and thought, actually,being a user researcher, going
back to research practice,having been managing and leading
a research department, thatmight be quite a nice thing to
do, to go back to practice anddo my craft in a new sphere.
(03:41):
And that's how I ended up here.
in the role as a user researcherin health.
But when I arrived here, therewere five user researchers and
no career ladder, noinfrastructure, no tools, not
even job descriptions.
We were all matched to projectmanager job descriptions.
(04:02):
I was looking around methinking, yeah, I've gone back
to practice.
I've moved away from leadership.
I've moved from havingresponsibilities and leading a
team and leading a department ofpeople.
And thought, yeah, but thenthere's all this stuff that
needs to be done that couldreally make it much better, much
easier to do our job, enable usto have more impact.
(04:24):
And it started from there wherewe got together as a group of
researchers and built aprofession, a community, a
capability.
And I built the career ladderthat led to me becoming head of
user research.
SPEAKER_00 (04:41):
It's impressive stuff.
I'm curious as to what thedriver has been for you.
What is it about this disciplineand health that has kind of
pulled you into this seat?
SPEAKER_01 (04:49):
The discipline of research in general, I just love
learning something new everysingle day, specifically user
research.
I have worked in academia.
I've worked in social research.
I've worked in policy research.
I've worked in all differenttypes of research.
But the thing about userresearch is that you see things
(05:09):
The impact of what you'relearning and the actionable
insights that you're generating,you see it make a difference and
you see it change things and yousee it happen in front of you.
You know, you could be doingresearch on something one week
and a few weeks later, there yousee the change on the product or
the service.
And I think for me, thinkingback, I talked about how I
(05:33):
didn't actually like doingresearch when I was at uni.
I hated it.
It's because it didn't meananything.
You didn't see anything happen.
It was all very small thingsthat you saw and you learned,
but you didn't have an impact.
And the amazing thing about userresearch and particularly user
research in health is that youhave an impact.
You have an impact on people'slives and you are doing research
(05:56):
that can help to keep peoplewell, make people better and
often potentially in the longrun save lives.
So that's why it's huge.
SPEAKER_00 (06:05):
I love it.
Those are some of the samethings that drew me to this
craft and this profession and alot of the people that I work
with and meet in the industry.
It's that actionable research.
It's not buried in months andmonths of deep academic
research, where obviouslythere's a very important place
for all types of research.
But it's that actionable side ofit that I find really engaging.
For people who are listening whomaybe don't know what user
(06:26):
research is and how that mightdiffer from other types of
research, could you just give avery quick summary of how you
would define user research?
SPEAKER_01 (06:34):
I think the key thing to say about it is it
still has the same robustness,the same standards, the same
ethics, the same principles, thesame safeguarding that we all
have to adhere by any other typeof research.
Like I say, I've worked inacademic research and a lot of
our researchers, userresearchers, come from deep
(06:54):
research backgrounds.
But I think the difference isit's about generating actionable
insights but from understandingand looking at and observing
behavior.
So it's really not about whatpeople say or people think or
their views or theirpreferences.
It's really about understandingbehavior and from understanding
(07:17):
and through that understandingneed and unmet needs.
So one of the examples I alwaysgive about this is that I was
once in a hospital and I wasobserving someone using one of
the systems there, one of thedigital systems, and I was doing
research with them andunderstanding what was going on
and how it was working for them.
(07:38):
And they said, look, what wereally need here on this screen,
we need a button that saysprint.
And I was like, okay.
You need a button on a screen sothat you can print it.
Okay.
And you know, you could go awayand say, users are saying, or
people are saying that we needto be able to print from this
screen.
You can go and spend howevermuch money in developing that.
But actually when you sit thereand watch, you understand what
(07:59):
they're doing and what theirneed is and the outcome they are
trying to achieve is you realizethat the reason why they need to
print that screen is so thatthey can put that screen print
into a pile of paper.
And there is someone who's, dayjob is to scan all those screen
prints into a documentmanagement system and attach it
(08:21):
to a patient's record so what isactually needed there isn't a
button on that screen so thatthey can print it it is for the
information on that screen toactually be able to be into this
other system this other productwhatever it is into this
person's patient record Andthat's the example I always give
(08:42):
about the difference betweenother types of research and user
research.
It is about getting to the cruxof understanding what's going on
and what the unmet need is soyou can make recommendations or
give actionable insights to thedevelopment team or the design
team to help them to understandactually what is the problems we
need to solve here and how canwe solve them.
SPEAKER_00 (09:05):
And in NHS England, is user research always tied to
digital or does it get rolledout across patient experience in
other areas as well?
SPEAKER_01 (09:14):
It's interesting because there's different types
of research.
And I think there's a lot ofresearch with patients to try
and understand the patientexperience in hospitals and
everywhere else.
And all these different types ofresearch absolutely are valuable
and have their space, part ofunderstanding the whole wider
picture.
I would say user research ismainly based in the digital
(09:37):
space.
But when you are working in thedigital space, particularly in
health, there's always somethingphysical.
There's always a person.
Whatever the health issue is,whether it's mental health,
whether it's physical health,whatever, there's always a
person in it.
And there's no way that as auser researcher, you can just
focus on the digital thing.
(09:59):
Because actually, digital isn'talways the answer.
And when we are thinking aboutwhat we're doing in health, we
need to think about the outcomewe're trying to achieve.
And that outcome is never goingto be achieved just by a digital
thing.
It's just one part of helping usto deliver stuff for patients
and for the front line.
(10:20):
So whilst our user researchersare mainly within the digital
area of NHS England, I thinkthat's a legacy thing of where
we've grown the capability.
There is a lot of what we dothat can inform everything that
we do with patients.
And actually, I think almostlike the next step is to be
(10:41):
working much wider than that andworking with our other
colleagues and other researchersacross the business to
collaborate on that end-to-endservice and understanding what's
happening out there.
SPEAKER_00 (10:52):
And how does the user research approach fit
alongside the kind of patientinvolvement side of things?
SPEAKER_01 (10:58):
They are...
two separate things, but theyare both really important.
Our user researchers, they doresearch with different people
every single time they go and doresearch.
They're new members of thepublic, they're new
professionals that we've notworked with, interviewed,
observed, tested our stuff with.
And that's really important.
(11:19):
I actually, outside of work, I'ma patient rep also.
And so I have, I almost haveboth hats and Both things are
really so important because thatpatient voice in our sort of
more senior strategic decisionmaking, bringing that patient
voice into that is reallyimportant.
So you've almost got two sidesof it.
(11:41):
You've got a lot of the detailin terms of our product and
service design and developmentfrom user research, the insight
from that.
And then you've got the patientreps who are experts at
representing that patient voicein a room, probably where the
stakeholders and the decisionmakers are trying to make the
(12:02):
decisions and making them attuneinto the patient voice there.
So they work together and I'vegot close relationships with our
patient voice and patientinvolvement groups.
I think where they're reallyimportant, I think, It's
slightly different as opposed topatient voice and patient reps,
but working with local communitygroups, particularly community
(12:22):
groups working with people whoface the most barriers to
accessing service or have lowertrust in public services, that's
where that patient reps andpatient voice are really
important and really powerful.
SPEAKER_00 (12:36):
So your user researchers, when they're doing
the broader discovery researchfor projects, rather than the
kind of more tactical, makingsure that the things are working
type of research, when it's thatearlier doors discovery
research, the insight that comesout of that must be really
useful and relevant to patientreps as well.
SPEAKER_01 (12:52):
The insight we get from discovery has wide
relevance and wide information.
Like I say, it doesn't justfocus on the digital, it focuses
much wider.
So that discovery information,absolutely.
It's not just the patient reps,actually.
It's almost helping to be thevoice of all the users that are
out there.
(13:12):
As a patient rep, I have livedexperience of one particular
aspect of being a patient and Ican advocate for that and I can
talk about that.
The value that often comes fromthe research we do with users is
that we get a much wider, variedspread of lived experience to
bring into those discovery portsand give a balance of the
(13:34):
different needs of a widevariety of lived experiences.
SPEAKER_00 (13:38):
One of the things we can experience sometimes is that
research can be quite siloed.
So you'll do research on aparticular problem and it will
be for a particular team tosolve a particular challenge.
actually there's always insightthat comes out that's relevant
to other teams and maybe it'sother user research teams, but
it might be other teams, forexample, patient reps.
Have you managed to solve thatas a problem inside the NHS?
SPEAKER_01 (14:00):
So there are two things about that.
I think there are two aspects tohow do you enable everyone to
have access to the insights thatyou're generating and make sure
that we're not working in silosacross the business.
I mean, organisations are...
just by the fact of the wordorganization.
They're always going to organizethemselves in some way.
And those ways they organizethemselves are always going to
(14:23):
be some sort of silo.
I just think we're never goingto break all the silos down.
But I think there's two things.
One thing is probably core tothe way I operate, actually.
It's people.
So everything you do is aboutpeople and people enable
everything to happen.
So by having things like thecommunity practice that we've
developed at Clark, probably 150members at the moment the user
(14:44):
research community practicewhere we are sharing we are
doing show and tells we're doingthings like that so there's that
more about how do you get peopleto work together to communicate
to surface their knowledge toshare their knowledge and
there's other communicationthings like really active slack
channel little things like thatwhere someone can do a shout out
but one of the things we haveinvested in and i know thousands
(15:05):
have died on the hill of thisand i don't want to use the word
i am going to use the word theidea of a repository of research
knowledge i do hate that word ineed to call it something else
but i think we've called it i'veactually called it user research
finder so let's sack off therepository word user research
finder and we've actually usedai technology to develop a user
(15:25):
research finder where people canquery what do we know about this
And we've got our user researchuploaded into it and people can
do that.
It's in a private beta at themoment and we're just
redeveloping it further.
But things like that, whenyou've scaled to the scale that
we are, are actually reallyimportant to have people
different ways and differentmechanisms for people to
(15:46):
communicate and accessknowledge.
SPEAKER_00 (15:48):
I love the way that you dropped in.
We've actually used AI todevelop this kind of research
tool.
Actually, that sounds like anincredible thing.
Can you tell me more?
Can you say more about whatyou're doing with AI and
research insights?
Because that's the first timeI've heard of someone using AI
to organise research insights.
SPEAKER_01 (16:04):
Yeah, it's just a language model that you can use
to interrogate our userresearch?
I think people use the word AIand they think it's this big
mysterious thing and I thinkit's a lot of people are talking
about it and be in the futurebut it's a large language model
that we've used and it's got afront end that's built from
(16:24):
using our prototyping kit aspart of our NHS service manual
and we've worked with people whoknow about this stuff and to be
able to build this thing And weare just testing it out and
making sure it works foreverybody.
I think one of the challengeswith it is you don't want to
just suck in absolutelyeverything.
You want to make sure it'srobust user research.
(16:46):
So that's the challenge ofmaking sure it's pointing to the
right information sources.
SPEAKER_00 (16:51):
So essentially, you've got a big pile of
insights that have come from allthis research that's going on
all the time across the NHS.
then you've got a layer that isdoing the same thing as chat GPT
in terms of the organising andthe filtering of that content.
So you can go in and you can aska question about a research
topic that you're about to diveinto and see what the system
already knows.
(17:12):
Is that right?
SPEAKER_01 (17:13):
Yes.
SPEAKER_00 (17:14):
That's amazing.
That is moving things forward sofast.
SPEAKER_01 (17:18):
I mean, we're cautious about it because
obviously we're developing thisin a user-centered way.
We are iterating.
We are trying to break it.
We want to make sure that itworks for user researchers, but
it's not just a user researchtool.
It's a tool for anybody whowants to find out about the user
research that we're doing.
Like you say, other researchersacross the organization that
(17:38):
aren't necessarily working inuser research.
SPEAKER_00 (17:40):
People will come to researchers with a brief, won't
they?
They want them to find somethingout for the tool or the service
that they're developing.
SPEAKER_01 (17:47):
Yes.
The amount of times I get asked,what do we know about this?
Because I've had a userresearch, you should know about
every single bit of researchthat is going on across the
whole organisation.
But when you've got 130 userresearchers who are going out,
every single day they're doingresearch or consolidating
evidence or planning research.
(18:07):
Every single week...
There are people in our userresearch lab conducting user
research.
There are people outside,on-site doing research.
I have a decent brain, but Icannot tell you about every
single piece of research thatwe're doing or every single
insight that we've gained fromthat.
We need something like that tobe able to interrogate.
(18:30):
It's really about knowledgemanagement, isn't it?
It's not about...
Just about user research, it'sabout good knowledge management.
And I think it's a proof ofconcept that we've got.
And once we know that it worksreally well, we will talk about
it more widely and people canlearn from what we've learned
because we're not here to holdon to good things that can help
other people to do their job.
SPEAKER_00 (18:51):
And would it be in a model that could be shared with
other NHS departments or othergovernment departments?
SPEAKER_01 (18:56):
I think theoretically, yeah.
SPEAKER_00 (18:58):
Great.
Tell me a bit more about thework you've been doing to
involve excluded groups inresearch and why that's
important.
SPEAKER_01 (19:06):
I can't claim to be the person that's done it, but I
can tell you what we're doing interms of our user research
capability.
A lot of this started by acollective of people a few years
ago during the pandemic whoWe're just like, we need to do
more about exclusion in healthand care and in human-centered
design in health.
And that had a number ofdifferent aspects to it.
(19:27):
It included things that we'vedone to be more inclusive in
terms of our recruitment.
So we make our actual teams farmore inclusive and
representative of people withlived experience.
But one of the other focuses wasabout our user research
practice, the people we wereconducting our research with.
So we started to developrelationships with community
(19:49):
groups.
So in the same way that a lot oforganizations have contracts
with recruitment companies tobring in participants for user
research, why aren't weutilizing groups within the
community to do that?
Why aren't we reinvesting in ourcommunities, particularly those
communities who don'tnecessarily trust the NHS?
(20:10):
We know that.
People talk about NHS being atrusted brand.
It might be for the majority ofpeople, but actually there are a
significant number of people whohave had poor experiences of
government and the NHS, andactually that trust isn't
necessarily there for somepeople.
And we need to be hearing thosevoices.
(20:31):
We need to be listening.
And we need to be equally, asuser researchers, we need to be
reflecting on our practice inrelation to that.
So we have...
a number of community groupsthat we work with.
And we do co-design, we doresearch with them, but also we
work with them to understand howour practice impacts them and
(20:54):
where we need to improve as userresearchers.
And I think there's been somequite open and forthright
conversations about challengingsome of the privileges that we
have as individuals, which havereally helped to improve our
practices as user researchers.
So I think at one point peopletalked about accessibility and
how one in six of your usersshould have access needs.
(21:17):
With our research, what we'retrying to do is focus on those
groups who are most excluded,who face the most barriers to
accessing healthcare, because ifwe understand those barriers if
we work with those groups thenwe will actually make it better
for for everyone else that'swhat we're doing so we focus our
research not on the generalperson who finds it very easy to
(21:42):
navigate their way throughhealthcare systems or digital
systems or for whom it's so Alot of our products focus on the
average person, whatever thatis, and we make sure that we
recognise that there's no suchthing as an average person and
look at how we break down thosebarriers through understanding,
(22:02):
through evidence, the livedexperience of those people who
experience those barriers.
SPEAKER_00 (22:06):
One of the phrases I've heard you use before is
research vampires.
Can you tell me a bit more whatyou mean by that and how you
avoid being a research vampire?
SPEAKER_01 (22:17):
So I think this actually came from the work we
did with one of these communitygroups during covid and it's as
researchers any researcher userresearcher academic researcher
what happens is you go into acommunity or you go and do an
interview with someone you takethe research you take their
evidence take the informationthen off you go and that's it
(22:37):
it's almost you drain them ofthe information you drain them
at the knowledge and they don'tget anything back And so it's
that relationship that we'vebuilt up.
And Lisa and our team has workedreally hard at those
relationships and pulls us allup if we do anything that is
going to do anything at all thatwas detrimental to that
relationship.
And it's that that is really,really important.
(23:00):
So you're not just a researchvampire.
You are improving your practice.
You are going back to thosecommunities and working with
them, not just taking thingsfrom them.
Exclusion.
is a clinical risk and it's notenough just to make something
accessible we have an nhswebsite who you know which you
(23:21):
know we do research we design itwe try to make everything we do
is accessible everything canalways be better but we try to
build accessible products andservices and tests to make sure
they're accessible but ifthey're not inclusive then that
leads to clinical risk if ifyou're talking about a skin
condition and you only describethat skin condition about how it
(23:43):
presents on white skin that isnot inclusive and that actually
is a health inequality whichmeans that somebody whose skin
isn't white cannot identify whatthis might look like for them,
what might seem for them, and itcould be actually quite a
serious problem.
So it's a clinical risk if weare not inclusive in what we do.
(24:03):
So working with communitygroups, working with people with
lived experience is essential toensure that we are delivering
health services that actually dohelp to save lives.
SPEAKER_00 (24:16):
That sounds like an evolution of the usability as a
clinical risk, which was aphrase that I remember hearing a
few years ago being used in NHSEngland.
SPEAKER_01 (24:24):
It is.
SPEAKER_00 (24:25):
I love talking to you, Rochelle, because we go off
on these kind of paths and it'svery easy for one thing to lead
to another.
What I was going to get toearlier on in the interview was
asking you to zoom out a littlebit.
If you're thinking back aboutthe work you've been doing over
the last few years in NHSDigital and NHS England, How
would you summarise the bigproblem that you've been trying
(24:45):
to solve through your work?
SPEAKER_01 (24:47):
Probably the way to summarise what we're trying to
do is, I guess, put the humaninto digital in health and care.
The health service as a whole,it is all about people.
It's all about humans.
You talk about patient-centeredcare.
And that is a real solid part ofhow our health practitioners
work.
Then when you start introducingtech, that kind of seems to be
(25:08):
forgotten.
And it seems to be laggingbehind.
And you're almost trying to fitthe user, the human, the people,
the patient, the healthprofessional.
You're trying to fit them to thetech that you're deciding to
deliver.
and not considering the contextof use of that or the actual
underlying needs.
I guess the problem we're tryingto solve is how do we inject
(25:30):
that human into how we deliverhealth tech.
SPEAKER_00 (25:33):
And from your perspective, why is this a
problem worth solving?
SPEAKER_01 (25:37):
Well, health is literally a matter of life and
death, isn't it really?
The work that we're doing.
And digital is part of that.
The human, the people...
That's a core part of health.
And the context of use of allour digital products and
services, it's in patient homes,but it's in GP practices, it's
(25:59):
in hospitals, it's in ourcommunities.
And if something doesn't work orsomething goes wrong here or
something falls through the gapor leads to delays in care...
At best, that's something thatmeans that someone's going to
wait a bit longer to get sometreatments or health and care.
But at worst, it's literallypeople being too ill to get
(26:19):
well.
The reason why this is worthsolving is that we can help to
save lives.
Human-centered design is allabout, I've talked about moving
barriers to accessing healthcare, but it's also removing
barriers to delivering healthcare.
And if we've got really poortech where our health
professionals are having toThink about workarounds on
(26:40):
paper.
I've seen this in practice.
I've seen it in context.
Or systems that take too long toget into the information that
they need to be able to workwith a patient or takes any
amount of time from patientcare.
One minute of time away frompatient care is a minute wasted
in the NHS.
And if you think the amount ofpeople who work in the NHS who
(27:00):
take one minute of their timeaway that we don't need to,
that's a pretty unethical thingto be doing.
And if tech is doing that, Ifthe products we're delivering,
we're not making sure doesn'tadd extra burden or don't take
away that time, then we'reworking unethically and we
really have to be thinking aboutwhat we're doing in health and
(27:22):
digital and tech to make surethat doesn't happen.
SPEAKER_00 (27:25):
We've done work across the NHS where we see
people struggling with sign-insto multiple systems that take a
very long time to load uppatient data.
And once you combine all thosethings, it's almost such a
spaghetti of systems andprocesses.
You can just see a point whereactually it's not possible to do
any patient time in the futurebecause it's all tied up with
using services and systems.
SPEAKER_01 (27:45):
I once described health tech in relation to
spaghetti.
It's actually somebody that Iwas working with who talked
about being spaghetti.
And I elaborated on it and sortof said, actually, it's not just
that it's multiple plates ofspaghetti and they're all joined
up and what happens is you starteating them and what you realize
is you can't just eat one plateyou need to eat all the plates
(28:07):
and so you're going to be sickbut then you've got someone
outside quite frankly knockingon the window going oh i could
make pasta okay and they look atit from the outside and go yeah
what are you worried aboutwhat's the place yeah i can make
pasta i'll solve it all Andthat's how it feels in health
tech to some extent.
SPEAKER_00 (28:25):
And there's someone in there who's, actually, we
haven't tried that sort of pastabefore.
That would be really tasty.
Let's have some of that in themix.
SPEAKER_01 (28:30):
Yeah, but you always need to have the pasta there,
otherwise you actually can'tfunction.
That's the other thing.
You always have to have the liveservice.
It's not like you could just,you might want to burn it all,
but it's not like you could justset it all on fire and start
again.
SPEAKER_00 (28:42):
So thinking about the problem you're trying to
solve is how to make the digitalside of the NHS more human.
How many barriers or whatbarriers did you experience in
trying to solve this?
SPEAKER_01 (28:53):
Oh, shed loads.
SPEAKER_00 (28:56):
And I imagine a lot of them are still there.
Does it feel solved?
SPEAKER_01 (28:59):
Oh God, it's never going to be solved.
I think, okay, when we, and Imean we, because it isn't just
me that's helped to make it morehuman.
And when we first set out onthis journey, we came in and if
just from a user researchperspective thinking about that
people like what's your jobisn't that what i'm doing or i
(29:20):
got told you're here to tick abox for a gds assessment or
you're here to tell the stuff wealready know or there was that
sort of barrier where peoplefelt it was a threat some people
maybe for their roles their jobor whatever because yeah
anything new or seemingly new,people will say it's not really
(29:41):
new, or it feels like a threat.
So I suppose that's Barry fromthe start, but once you almost
start delivering, you get peoplewho see the value.
So it was about starting small,starting in one area.
So the area that first kickedoff working in a user-centred
way, was real human-centred way,was when we moved what was the
(30:03):
Choices website to the NHSwebsite that we see today.
And that's where it started outand people saw the value.
They saw what was happening.
They saw that actually peoplewere talking about this in a
really positive way.
And even if you're someone thatwas adverse to change, or
someone that actually wasn'tnecessarily on board.
If you were someone who maybelooked over and thought, this is
(30:25):
something that people aretalking about, I'd better get on
the bandwagon.
You've got some people who maybe more resistant going, yeah,
this is a way we should beworking.
And then they started seeing thevalue and other people see the
value and demand gets more andmore.
But I think the point at which Ithink it really matters open the
(30:45):
floodgates was during thepandemic because this was a time
where nobody had experiencedthis before it was really
ambiguous situation there werelots of people who were working
in this new area but they had tomake lots of decisions and they
had to do that in a context thatwas constantly changing where
(31:09):
the policies hadn't even beenwritten and we had to constantly
flex ourselves.
And what was really apparent isthat this was something where
human-centered design and userresearch excelled.
It gave senior decision-makersthe ability to almost de-risk
their decisions because it gavethem just enough information to
(31:30):
enable them to make some sort ofdecision with some sort of
evidence.
And it meant that we could beflexible.
We flexed the product.
We flexed the service reallyquickly.
We turned things around reallyquickly.
It's where our design system andservice manual came into its own
because you could quickly spinup things using it.
And I think that really didsolidify that working in this
(31:52):
way actually helps us to deliverwell, deliver faster, deliver
more robustly, more efficiently.
I think really shone through andmade some people who maybe were
more sceptical or not on boardreally stand up and listen and
realise the value of this work.
SPEAKER_00 (32:10):
At the same time as being a really stressful
environment, it must have been areally exciting environment to
be working inside the NHS duringthe pandemic.
SPEAKER_01 (32:17):
Yeah, it was really tough because people had
pressure of work that was goingon, the rapidity of it, the very
short notice of actually whatneeds to be delivered that week.
And sometimes that was actuallyannounced in the press before we
even knew about it.
But there was a huge reliance ontechnology and it being remote
(32:38):
access to care and we werespinning up new products and
services within days and it wasan unsustainable pace I would
say but what happened was partsof the organisation that really
need to work together tocollaborate had to and were
forced into a situation wherethe only way to deliver was to
do that and to some extent Ilook back now and go we did it
(32:59):
then we could do it now we hadYou said design folk, policy
folk, operational folk, allworking together to deliver an
outcome.
And that's exactly how we shouldbe working.
That's exactly how we should beworking moving forward.
And that was the real hugebenefit and value in COVID was
actually just working in thatway because we're forced into
(33:22):
doing it.
Because that's the only way wecould deliver for the country
and deliver that rapidly was ifwe actually did collaborate so
closely.
And I think...
That's where we need to bemoving to on a more permanent
basis now.
SPEAKER_00 (33:36):
It's interesting because we talked earlier about
user research being used in thecontext of other disciplines and
other challenges.
And actually what you're talkingabout there is that discipline
collaborating closely withpolicy.
And that's an area that we'veworked in a bit ourselves and
just feels like the right way ofworking because there's the
insight, what should we do aboutit as an organisation?
SPEAKER_01 (33:55):
Yeah, absolutely.
And almost, I think the policywas being developed by
developing the user-centeredproducts because there was no
policy.
And so as you're designing whogets access to tests, how do we
develop the test system?
How do we develop thevaccination system?
(34:17):
Who are we going to allow accessto book a vaccination or get a
test?
you're developing the policythat wasn't there and the user
research and insights you'regetting from that was helping
our policy colleagues to makethose decisions and it's almost
like that's we should never goback to working at that pace
with that much pressure in thatsort of way again because we
(34:38):
will burn every single personout but that joint working and
collaboration is something weshould try to keep from that
situation.
SPEAKER_00 (34:46):
We work in these product teams where you've got
various disciplines from tech,from content, from design.
If you could have a policyperson involved in that product
team as a way of working asstandard, it would move things
forward.
SPEAKER_01 (34:59):
Yeah, and I think there are some teams who do have
that, but I think it's in theminority and I think it's rarer
than it should be.
And I think it's not even justpolicy folk, it's the
operational folk on the frontline as well, the people who are
working in the context too.
the people who do theimplementation and the change
(35:20):
across the system.
That's really a trulymultidisciplinary team.
I think people talk aboutmultidisciplinary teams in a
sort of standard, whatever astandard product team is, a
product manager, a deliverymanager, design, content,
business analyst.
For me, the trulymultidisciplinary team, and
we're looking at this in termsof health, is about having those
policy folk in, operationalfolk, improvement folk.
(35:41):
That is where we really shouldbe moving towards.
SPEAKER_00 (35:45):
So you talked about there being, I think, five,
people when you joined theorganization five researchers
how have you gone from fivepeople up to 100 and how do you
find the right people andnurture the talent when you you
find those people
SPEAKER_01 (36:00):
yeah how did i go to five people to 130 that's a
really good question you startyou just start and you just
build it over time actually thisis probably where my background
in occupational psychology comesin quite well because a lot of
that was recruitment selectionassessment and career
development and organizationaldesign and organizational
(36:20):
development and organizationalchange and I think what happened
was I seized on an opportunityat this point I was I was a user
researcher and they brought insomeone to lead what they were
calling the digital deliveryprofession.
So develop the profession ofdigital delivery folks.
(36:40):
So that was product delivery,design, content and user
research.
And I basically contacted thatperson and spoke to them and
said, look, how can I help?
This is my background.
And having gone into the jobthinking, I don't want any more
responsibility.
I don't want any stress.
I don't want to be responsiblefor a team, people, department.
(37:02):
I couldn't help myself.
I couldn't help myself and tryand solve the problem.
I don't know.
I just saw stuff around me and Ithought we could do this.
We could do that.
I could do the other.
And so I spoke to this personand looked with them to look at
how we can expand it.
So it was about slowly growing.
But I think the key thing for mewas to first start off with what
are the core competencies we'reexpecting from people in user
(37:25):
research, making sure weactually had job descriptions
that were user research jobdescriptions not not not maxtra
project manager project managersare brilliant there's a
different job description for auser researcher but also
creating a career ladder forpeople so that when we got
people in there was somewherefor them to move through and
move up to i mean i created thecareer ladder that i moved
(37:48):
through i moved to senior imoved to lead and i moved to
head of it i was almost put therungs out in front of me as i
moved up from them actually andAnd then once you start
expanding, you need the tools,you need the infrastructure.
And there wasn't necessarilyfunding for that tools and
infrastructure.
So I almost got the communityitself to start looking at,
(38:08):
okay, what are the things weneed to develop?
What are the things we need todo?
And they led on certain aspectsof that.
And that sort of provided theproof that actually we need this
function.
We need this capability, whichled to a individual doing
research ops, which then ledexpanded when we realised
actually there's so much more wecan do, there's so much more we
(38:31):
should do I took advantage ofthe fact that I was given the
central UCD budget to look afterand we had some vacancies and we
could use that vacancies to dosome good work and I suppose I
just saw things that neededdoing and I worked out ways to
get them done and I got peopleon board and I got people on
side I think we had an execdirector that came in and we had
(38:54):
something in common so I got intouch with them and said oh and
by the way when was the lasttime you observed user research
and would you like to observesome user research and I spoke
to her about the work that wedid.
And then she advocated for us ather SLT and got me there to talk
to her directors about what userresearch was.
And I think it just gatheredmomentum and gathered momentum.
(39:17):
It was a great group of people,some brilliant people across the
community who wanted this tohappen, who worked together, who
collaborated.
The user research community inNHS England are, I don't know,
they're one of the best parts ofmy job.
supportive, skilled people whoknow so much about this work and
(39:39):
other work and I think it justsnowballed and gathered momentum
and I knew I wanted to be at apoint where user research was
embedded in our product teams.
Initially, my role working forthe person who's heading up the
digital professions was almostto bring people in, get a pool
(39:59):
of researchers and allocate themto places and almost like an
agency model.
And when you've only got a fewuser researchers, that's okay.
But really you need people whoare embedded in the products,
who understand the products.
And it'd be less about thepeople pulling research in But
the research, user research hasbeen in there to advise them
about what user research needsto happen.
(40:21):
Because I think by the timepeople think about user
research, sometimes it's almosttoo late and the time has
passed.
So I think I just saw a lot ofproblems to solve and I wanted
to solve them and I couldn'tstop myself.
SPEAKER_00 (40:34):
And what's it like now in comparison to when you
first started at the NHS andtied to that?
Do you feel responsible for someof that change and feel a bit
proud?
SPEAKER_01 (40:43):
I'm incredibly proud of the capability that we have
in NHS England, the userresearch capability.
I'm incredibly proud of thepeople that we have in it and
the people that have developedthrough that.
There are people who started offas graduate UCD folk who have
moved up for larger.
There are people who started offas associate user researchers
(41:05):
who are now lead userresearchers.
There are people who have goneon to other places to greater
things.
And it is...
I'm incredibly proud of everysingle person within that
community and what we haveachieved together as a
collaboration.
To some extent, we're victims ofour own success.
We still don't have enoughpeople to do everything we want
to.
But what I think is brilliant isthat it's no longer me
(41:29):
advocating for user research oruser-centered design.
It's no longer even just our URsor our UCD folk advocating for
it.
It's now got to the point whereI've been in meetings and
someone said something and oneof our directors has advocated
for working in a user-centredway or doing user research and
challenged other people in thatroom to work in that way.
(41:52):
That's when you've delivered onwhat you're trying to achieve,
when you're no longer the peopleor the person that's advocating
for it.
It's someone else and you don'thave to be in the room for
people to be advocating aboutit.
I remember Someone was tellingme about one of our clinicians
who I worked with in the veryearly days who was quite
skeptical about user research.
(42:13):
Then she saw how it wasidentifying clinical risk and
someone told me they were in ameeting with her and she was
challenging everyone in themeeting going, where's your user
research?
Why are you working in auser-centered way?
And I don't have to be in allthe meetings anymore.
I don't have to be the voicetalking about this in the
meetings anymore.
I think we still have ourchallenges.
(42:33):
It's not perfect.
It's not a utopia.
but there are more and morespaces in the organisation when
our researchers, our designers,our content folk don't spend
half their time advocating justto be able to do their job.
It's just part of the way theteam works.
And that I see as a hugesuccess.
SPEAKER_00 (42:54):
And what's next for you, Rochelle?
What's the next challenge thatyou're working on?
What would you like to moveforward?
SPEAKER_01 (42:59):
I think it's that thing I was talking about
earlier I think it's about howdo we bring the digital policy
and operational together to workat and understanding how we
deliver youth-centered servicesacross the NHS we can't deliver
out into the NHS we can'tdeliver services for the NHS
(43:19):
without working across digitalpolicy and operational and I
think that's where My passion atthe moment is in that space and
wanting to bring that togetherand look at how do we do that.
SPEAKER_00 (43:31):
Thank you so much, Rochelle, for taking the time to
talk to me.
I look forward to our nextconversation at some point,
whenever that may be.
Have you got anything that youwould like to close on?
SPEAKER_01 (43:39):
I think I would say, I say this a lot in relation to
my job, it's the closest I amever going to get to using my
skills and abilities to savelives.
And I don't think there's anyjob in the world that's more
valuable or better than that.
SPEAKER_00 (43:55):
problems worth solving is brought to you by
healthier the collaborativeservice design consultancy for
transformation in health careand public services find out
more about how we can help youdeliver user-centered change at
(44:18):
healthier.services
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.