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Service Design, Applied

Design Thinking combined with Salesforce Platform is powerful.


Ian H Smith

Digital Innovation is best when all stakeholders participate. This means adopting Three Design Principles: a 'Meaningful Journey' - underpinned by 'Fierce Reduction' and 'Progressive Disclosure'.

When delivering cloud technologies as a Service Enablement Layer, I focus on the 4Ps: People; Process; Platform; and, Participation. This is where Design Thinking means all stakeholders are engaged in the work and where people are placed at the centre of Service Design, executing faster.

As the opening of the Nightingale Hospital at the ExCel London proved, when a compelling need emerges, executive leadership in the NHS steps up and amazing things are possible - in days. However, when it comes to the mission-critical support processes behind the frontline heroes of doctors, nurses and social workers - digital innovation must - and can go faster.

What matters most is solving 'Wicked Problems' [1]. These are problems that are characterised as difficult, somewhat near-impossible to solve because of incomplete, contradictory, and changing requirements - or, as with COVID-19, a totally unexpected but truly disabling 'Black Swan'

However, the quest for improvement could be something seemingly mundane, yet generating deceptively high costs - e.g. labour-intensive, paper-based GP surgery or mail-based hospital appointments. These latter challenges are the 'quick wins' that a Service Enablement Layer can be applied to - and often, the best place to start. 

Eisenhower Meets Churchill

As with the Nightingale Hospital during the height of the COVID-19 crisis, a World War II-like spirit was present at this time in UK government and NHS. With a sense of urgency in mind, it is worth remembering two great leaders from USA and UK: Dwight D. Eisenhower and Winston Churchill. As illustrated in the infographic below, when looking at Wicked Problems in the NHS and pursuing Quick Wins, we could combine Eisenhower's 'Urgent/Important Matrix' with the label that Churchill pinned on important memos during World War II: 'Action This Day'.

If we combine Eisenhower with Churchill we have the foundation for both the prioritisation and the intent that can apply with a cloud platform-based Service Enablement Layer to achieving Quick Wins and solving Wicked Problems - in the NHS - or in any organisation - large or small. In simple terms, this means breaking this down into smaller elements and then applying a sense of urgency on a clearer set of problem-solving activities.

Digital Silo-Busting

Let's take notable examples of Wicked Problems facing the UK NHS and adult social care today: Eliminating (or at least, significantly reducing) bed-blocking.

To quote Rittel and Webber [2] : "every Wicked Problem can be considered to be a symptom of another problem". This is certainly true for the first four Wicked Problems noted above. Not least of these interdependencies is the 'silo effect' of each stakeholder organisation - and citizens - who are important actors in health and social care. This silo effect is everywhere in the public sector and we are focused on breaking through these boundaries in meeting each Wicked Problem.

As illustrated in the infographic above, the Wicked Problem of bed-blocking is caused by the silo effect among all of the stakeholders in what should be a coherent 'Social Care Value Chain' - moving from Hospital Discharge to Ongoing Care Executed. In turn, as Rittel and Webber have stated, the bed-blocking becomes a root cause of another Wicked Problem: namely, increasing bed capacity during and beyond the COVID-19 crisis.

One Platform, Many Apps

With cloud technologies, I take advantage of a readymade technology that allows the non-programmer ('Citizen Developer') to rapidly create forms-based cloud apps, without writing code - which is sometimes called 'No-Code' or 'declarative programming'. This is in contrast to 'Code' or 'imperative programming' - where programmers make use of a variety of languages to create cloud apps in this more traditional, slower approach to digital innovation.

No-Code innovation usually results in cloud apps being published 10x+ faster through declarative programming, when compared to the ground-up, imperative programming approach. This is especially relevant where the solution to the Wicked Problem is inherently based on what might be described as a combination of 'forms' and 'workflow', optimised as a 'Meaningful Journey', to execute a particular process or task.

For example, the third Wicked Problem of Delivering Equipment to NHS hospitals or home care environments (Itself, a root cause of bed-blocking) may be addressed through everyone in the supply chain sharing an app - and done so in days and weeks - not months and years.

Getting Started

And now let's think about solving every other Wicked Problem that can benefit from a forms-based app shared within and beyond the boundaries of your organisation. It starts with applying Design Thinking in five steps, iteratively: Empathize; Define; Ideate; Prototype and Test.

What follows from Empathy Mapping and an insightful Define capture of the Wicked Problem is the rapid creation of a new cloud app, through the Ideate, Prototype and Test steps executed in days and hours - not weeks and months.

Of course, in these challenging times, a strong financial case is a must for engaging in Design Thinking to apply digital innovation to Wicked Problems within a NHS Trust, CCG, ICS or AHSN. In order to find the first Quick Win, let's apply the Urgent/Important Matrix inspired by Eisenhower and a sense of urgency inspired by 'Action This Day' memos from Churchill in World War II.

What matters is keeping things simple and in the first two steps of Empathize and Define. I apply the 'Urgent/Important Matrix' to prioritise the focus for problem-solving. to quantify a compelling business case to achieve the first Quick Win. 

As illustrated above, a series of online Design Thinking Workshops - often just 1-hour sessions - can take the prioritised problem-solving comprising: 'Current State' ('As-Is'); 'Future State' ('To Be'); and, ROI Model ('The Case'). When looking at the different between Current State and Future State, the 'Basis of Decision' becomes a tangible difference between the financial difference of these 'States' and, the 'Cost of Delay' or 'Cost of Doing Nothing' calculated and validated by stakeholders.


1. Churchman, C. West (December 1967). "Wicked Problems". Management Science. 14 (4): B-141–B-146. doi:10.1287/mnsc.14.4.B141.

2. Rittel, Horst W. J.; Webber, Melvin M. (1973). "Dilemmas in a General Theory of Planning". Policy Sciences. 4 (2): 155–169. doi:10.1007/bf01405730.

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