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Memo to NHS

Design Thinking drives immediate cost-savings in COVID-19 crisis.


Ian H Smith

In this deep economic recession caused by the COVID-19 pandemic, the UK National Health Service (NHS) has, more than ever before, a compelling need to save money from everyday processes. Digital innovation and 'Service Design' can identify the most important and most important areas where cost-savings can be made.

This is inspired by a combination of Eisenhower and Churchill: the Eisenhower Urgent/Important Matrix - underpinned by the WWII message Churchill attached to memos: Action This Day.

For example, how much does each NHS Trust or Board or GP Practice waste of portage stamps (never mind the related admin. costs) in sending out appointment letters - when text messaging to patient's mobile phones would improve the process? The answer is: a very significant amount of money wasted. And so the process goes on.

Design Thinking, Applied

'Design Thinking' is simply a people-oriented way to solve problems. Often, in digital innovation we apply Service Design to create new or improve existing tasks and processes. But is Service Design really delivering fast enough for your organisation? Are you up against resistance to change?

I believe that Design Thinking is a powerful, pragmatic way to enable digital innovation.

In the five-step, but iterative Design Thinking model, as originally created by the Hasso Plattner Institute of Design at Stanford University (, getting the initial (and then, recurring) 'Empathize' step right, gives you a much better chance of a better-validated, prioritised 'Define' step that follows. See infographic below.

Defining Design Thinkers

Design Thinkers are both designers and non-designers: but what they all have in common is being inherently curious, empathetic, challenging, non-judgmental and open-minded.

With digital innovation, a lack of clarity about technology choices can lead to ineffective translation at the 'Ideate' step, and leads to avoidable failures when moving to subsequent 'Prototyping' and 'Testing' steps - and then iterative the process

Equally, tech bias can create closed-mindedness, acting as an inhibitor to curiosity and exploration. To adopt a ‘beginner’s mind’ is actually helpful to solving problems with digital innovation: to look at business challenges in new ways – with all stakeholders.

Design Thinkers recognise that concepts of being ‘right-brain creative’ or ‘left-brain logical’ are better explained by creative and logical thinking taking place together. In some ways, a cold corporate culture may have a lack of a collective ‘Limbic System’ (low emotions), whereas Design Thinkers tend to exhibit strengths in this area: high-levels of curiosity and ability to communicate and ask the right questions.

In applying 'Empathy Mapping', as described below, Design Thinkers need to embrace three key attributes: 'Immerse'; 'Observe'; and, 'Engage'. The rewards from this is the discovery of both explicit and implicit needs: often resulting in unexpected solutions and outcomes for Service Design and digital innovation.

Immerse means experiencing what the user experiences.
Observe means observing user behaviour in the context of their lives.
Engage means interact, interview – all in short intercept encounters.

Starting with Empathy Mapping

Every organisation that employs two or more people is political. When we think about large, mid-sized or small enterprises, or public sector or non-profit organisations, the reality is, when you want to apply digital innovation, to change processes for the better, there's always barriers to contend with. Resistance to change is as alive and well today as it was with the Luddites resisting automation in the English 19th century textiles industry, and no doubt, historians will point to many cases further back, and since.

So, when we consider how to better apply digital innovation we must recognise that politics are in play. Often, the automation or even reimagining of tasks and processes requires a consensus to be built among people who, may not know each other, or may mistrust each other, or even be adversaries. We must face and defeat these realities, if Service Design is to succeed.

To enable consensus-building around problem-solving, we should start with the first step in Design Thinking: Empathize. And from this step, apply Empathy Mapping.

Design Thinkers embrace the three basic questions: 'What?'; 'How?'; and, 'Why?'. The ‘What?’ becomes observable facts; the ‘How?’ is all about emotional responses; and, the ‘Why?’ becomes the inferences drawn. All of this builds a picture, as the process moves iteratively through the five steps of Empathize, Define, Ideate, Prototype, and, Test.



Through a series of open workshops, Empathy Maps can be built using simple tools, such as 'sticky notes' to let each stakeholder write down and talk about the four things that make up their human reaction to a particular challenge, process or task: 'Say'; 'Do'; 'Think'; 'Feel'.

As the facilitator unpacks the findings from Empathy Mapping, a three-column list can generate output as:

User ________ Needs ________________ because _____________ (Insights)

Overcoming Other Barriers to Innovation

Empathy Mapping, when applied to the broadest number of stakeholders, will always help to overcome the political constraints within one or more organisations undertaking digital innovation. But it's worth spending time considering the broader cultural issues that persist, even in the most modern of organisations - and crucially, how to overcome such barriers to innovation and change.

The late Sumantra Ghoshal talked about the barriers to innovation and change over 25 years ago. He called it the '4Cs: Compliance; Constraint; Contract; and, Control'. As with much that comes from Business Schools, it has more focus on defining the problem, than the solution, but again, referring to Empathy Mapping above, this is a highly-effective way to overcome these barriers to innovation and positive change.

Ghoshal recommended that Discipline, Stretch, Trust and Support as the counter sentiments or cultural values to the 4Cs, describing this further as:

Compliance (overcome by Discipline)

Planning systems, budgeting systems, financial systems are all examples that can be related to Compliance. The opposite are embedding norms of self-discipline where trust and ownership is given to employees.

Constraint (overcome by Stretch)

The strategy created by top management that boils down to the frontline person can be seen as Constraints. Stretch however is when management creates a set of values and an ambition that invites and inspires employees to get the maximum out of themselves.

Contract (overcome by Trust)

Everything is described as a Contract: your job is a personal Contract, your relationship with the company is a Contract, and the budgets are personal Contracts. While it should all be about trust. Trust the employee to get the job done.

Control (overcome by Support)

The relationship with management exists to Control each other. While the primary role of management should be to help the employees succeed by giving support and guidance.

Engaging in Mutual Value Discovery

When we bring Design Thinking to digital innovation, and pursue Service Design. we need to ensure that there are "Measurable Value Outcomes' attributed to the effort. This simply means being constantly aware of a need for financial justification to maintain momentum in executing digital innovations. What matters here is making sure that all efforts are prioritised around the 'must haves' versus the 'nice to haves'.

What we are doing here is making sure that we create a 'Progressive Disclosure' of Value Created as a 'what-if', when comparing 'Current State (As-Is)' with 'Future State (To-Be)', as a tangible consequence of applying digital innovation to a particular task, set of tasks or process, that we explore through Empathy Mapping. This must be updated at every step of Design Thinking.

If this is being conducted in an environment where the 4Cs are strong, the Empathy Mapping must be consciously set to granulating the changes (and therefore, the perceived risks) to the smallest possible phases, faster.

In engaging the broadest possible set of stakeholders into Service Design, and combining Design Thinking with digital innovation, this must result in a 'Mutual Value Discovery' agreed between the 'supplyside' and the 'buyside' for digital innovation. Here, this means creating 'ROI Models' that quantify both the 'Economic Basis of Decision' attributed to Service Design, and a more intangible, but still important 'Emotional Basis of Decision' - relative to the Measurable Value Outcomes.

What results in the earliest stages of Mutual Value Discovery is Cost of Delay and Cost of Doing Nothing, applied to any number of standalone or interdependent tasks or processes - and the what-if decisioning to invest in Design Thinking and digital innovation engagements. This is crucial to counter the 4Cs and any instinct to delay or avoid commitment to change that comes with digital innovation.

Delivering the Results

Simple, effective Design Thinking is at it's most powerful, when combined with digital innovation on a No-Code Platform, such as Salesforce Lightning Platform. Read my recent blog post entitled Design Thinking and Salesforce to learn more.

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