I can’t tell you how often people have said to me “but you don’t understand, this topic is very complex”.

Tax is very complex. Pensions are very complex. Medicine is, of course, very complex. “You can’t just dumb it down,” people tell me, “you can’t make it simplistic”.

And there it is, the big word – simplistic.

Making things simple is hard work. “I didn’t have time to write a short letter, so I wrote a long one instead,” Mark Twain said. We’re trying to write a short letter with NHS.UK and don’t really believe in simplistic. And this is why ….

Health is a different animal

The first thing I learned on NHS.UK was that health isn’t government. The rules aren’t black and white as in ‘here are the tax rules, stick to them or you’ll get fined’.

Health, in comparison, seems rather colourful. There’s a whole spectrum of opinions about any given condition.

I admit, colourful makes me nervous but I can work with it.

Fundamentally, in digital health we’re dealing with this: people come to NHS.UK to understand what’s wrong with them and what to do about it. It’s our job to make that as easy as possible for them.

Acting on things isn’t always easy for users – let’s help them with that

The second thing I learned was that the NHS is a very complicated organisation.

To get to the right place, see the right person isn’t always easy. Patients we spoke to tell us there’s a lack of transparency about what happens when and where. It’s a bit like navigating a city without your GPS or even a map.

It’s not our job to explain to patients how the NHS works. But it’s our job to get them to the right place as quickly as possible. This can be a GP, a consultant or the pharmacy to treat themselves.

It’s also our job to tell them where they are at any given moment and what’s coming next.

Example 1: Tell me where I am

Screen Shot 2016-08-16 at 14.07.21

This is an image of our most recent prototype for hernia and hip replacement surgery. It came out of the need:

I need to know what’s going to happen from the day I get my surgery date to the day I go home.

To start with we wanted to do something really simple, test it, iterate it.

While this page doesn’t give every detail and each step is potentially more complex, it does provide an overview.

Some people might call it simplistic. I call it simple because it gives just enough information to understand the basics.

It also provides a timeline that people can take in within a few seconds. Even if they just read the headlines they’ll get the idea.

The page tested generally well:
 “It’s easy to navigate. All there in 6 steps.” (participant 128).
“Brief but covers it.” (participant 129).

This shows that sometimes colourful is just the wrong colour. Sometimes we must be black and white to guide people. That doesn’t mean we’re dumbing things down.

Users make emotional decisions – let’s help them with that too

The third thing I learned was that many decisions around health are emotional.

User needs like ‘make the pain go away’, ‘my child is ill what can I do about it now?’, or for depression ‘I need help with the first step’ show this.

Users want information fast and they can only take in so much.

This means it’s even more important to make things easy to understand and act on.

Example 2: Relating things to the user’s experience

Screen Shot 2016-08-16 at 12.28.00

Here’s our rashes prototype. Rather than giving users a long list of medical conditions to choose from, the page relates the information to the user’s experience: rashes with fever, rashes with itching etc.

Again, this isn’t simplistic. It’s a simple way of helping users navigate quite a lot of medical detail when they might feel stressed and under time pressure.

Simple means culture change

But there’s something else: simple also means culture change. Out there with our users and within the organisation.

When you make a serious subject like health or tax simple, there’s a suspicion that it’s not serious anymore. I’ve heard things like ‘but it can’t be that easy’ or ‘what are they not telling me?’.

However, over time people will get used to simpler information. They’ve done so in government, they’ll do the same in health.

The other thing is cultural change within the organisation. There’s of course the old debate over using words like ‘pee’ and ‘poo’ instead of ‘urine’ and ‘stool’. But there’s also the bigger  thing of ‘don’t take lots of stuff away, we’ll lose our users’.

Simplifying information doesn’t mean we’re taking stuff away. It means we’re structuring and wording it in a different way that’s based on user needs.

It won’t be perfect straight away

We still have more research and learning to do. For example, if people want a second, more detailed, layer of information and how best to present this to them. We want to test this with our next iteration of the hernia and hip replacement prototype.

Iteration is important. It makes more thought-through products. It also makes simpler products.

And that’s why we’re here – to make simpler, better products. It’s our job to take the pain of figuring things out away from the user. That we can do. For all the other pain we have fantastic doctors and nurses.

7 comments

  1. What a fantastic snap-shot of the work that goes into building clear, concise content – thank you.

    One of the hardest part of content generation is remembering that the user doesn’t necessarily have the benefit of the author’s knowledge and experience. Providing information in a way that is clear to someone who has very little or no prior knowledge of the subject is a challenge at the best of times. To do it with medical content makes it really interesting!

    Keep up the good work, we’re following the progression of this project with great interest.

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  2. Couldn’t agree more. Particularly when it comes to iteration. I’ve just started on the NHS England Clinical Entrepreneur Fellowship and iterative improvement is exactly what it is all about!

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  3. A fantastic insight Hinrich, thank you. As someone who works in an iterative agile development environment and who’s also undergone NHS surgery within the past year, I’m very interested in the sneak peek at your prototypes and to understand your ethos.

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  4. Comment from Carrie Barclay

    Really great read, thanks for sharing.

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  5. Comment from Jane Dunn

    The language used is important and I think you have explained it very well, as you mentioned many people will not have any knowledge or understanding of the procedural format. Please don’t forget that many do have knowledge and experience in medical care so a balance of mixed information is important so each person feels the info us for them personally and not a linear response

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  6. I’m currently working on an IA and content project for one of the many fantastic organisations that supply NHS with mental health care services. I’ve encountered similar things, the group believing everyone is unique (of course, they are) and that the issues are so complex that it’s impossible to provide content that meets everyone’s needs.

    I ran a collaborative design workshop to develop personas with empathy maps before doing an experience map for each group. They soon realised that although everyone’s specific problem is unique to their circumstance, the emotions, motivations for finding help, and feelings behind it are identical. 100 personas down to 1 and we got to move into some more creative work and have not got to an IA structure that will handle lots of opportunities to help patients.

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  7. Comment from Virginia Morrow

    Well done for a clear, concise and compelling read about creating copy that people easily understand. And I sympathise with you about the colourful complexities of health information. Never easy to talk about ailments in an accessible way. Really good piece!

    Reply

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