Leeds Town Hall, Urban OutlawThe NHS Citizen Team has just finished two intense days at a workshop in Leeds. This workshop was the end of our three-month sprint, to test, refine and redesign the vision for NHS Citizen. The purpose of the workshop was to work with existing collaborators and people new to NHS Citizen to learn lessons from the sprint and to agree what the key questions are for the next sprint.

Each member of the NHS Citizen team committed to writing a quick reflection on some of the lessons they will be taking away from Leeds. Here are mine. All of the reflections will be collected onto the NHS Citizen blog.

It’s all too complex

1. The detail in the NHS Citizen vision document is important, but it is far too much. Even people who have been to a number of our events have not fully understood how the system will work.

2. We now have the basic NHS Citizen system structure in place. We have to move from abstract designing to practical testing. Our Assembly Meeting test (see below) showed just how valuable this can be.

3. The views and opinions of citizens are central to the whole vision of NHS Citizen – for me they infuse the whole system. But apart from the name of the system, citizens and their role are hidden our text for many of the people who read it.

Working openly is the only way to design complex systems

4. Yet again our methodology of working in the open and testing elements of the system with collaborators has proved its worth. The way we were proposing to run the Assembly Meeting demonstrated that it would fail in its intent. The relatively spectacular failure, and in the subsequent discussions about why it failed afterwards, have given us a clear steer about how to redesign it.

We want NHS Citizen to contribute to collaboration not confrontation

5. The failure of the Assembly Meeting brought into starker relief the tension between the different types of accountability. Mixing hard accountability, with the Board being formally held to account by citizens in an Assembly Meeting, is totally at odds with our desire to develop a system for genuine co-production and collaboration.

6. To put it another way, hard accountability, with Board members sitting in front of citizens in the Assembly Meeting, will reinforce a ‘parent-child relationship’ (as someone in Leeds put it). It risks reinforcing not only the alienation of citizens and patients from the Board, but also the Board from patients and citizens.

Time is a precious resource and a tight constraint

7. However, it demands far less time from the Board. Turning up for a couple of hours to sit in front of the Assembly Meeting is a very different prospect to spending two intensive days working collaboratively with a group of citizens and patients to develop shared solutions to shared problems.

8. We are moving at breakneck speed because of the timetable required by the Board for designing a fully working NHS Citizen system. This means that we are only able to finish preparing materials for workshops, for example, just before the event itself. This stops us providing materials (such as hand-outs and slides, for example) in accessible formats. We have absolutely must find a way to carve out more time to do this.

9. The workshops themselves are also very packed. Rewriting the vision document late into the evening of the first day of the design workshop is important because it means we have a sense of progress. But we have to acknowledge that it is impossible for some people to contribute to this. We have to communicate better that the rewrite is not the definitive end, but just another stage in an open process.

Webcasting is essential to openness, but….

10. The webcasting of all of our workshops is a vital element of working in the open and bringing in voices of people who can’t be physically present at the workshops. However, it does present some hard constraints about what can be done in the room. The Assembly Meeting test should have included participants stepping into different roles, and us totally changing the set-up. But the camera positions, and the difficulty of webcasting table discussions made the impossible. This reduced the usefulness of the test, both for us, but I suspect for a good number of participants as well.

Hearing from everyone

11. We still didn’t manage to create an environment where everyone felt able to contribute. Too many of our plenary discussions included contributions from the same voices (ours included). The contributions were valuable and important, but there was more richness there that we need to pull out.

But it really isn’t all negative

12. I am by nature keen to learn from mistakes, this can lead to reflections like this sounding very negative. Notwithstanding what I’ve written above, I thought this was a fantastic workshop.

13. Despite point 11 above (it is always possible to do better), we had a wide diversity of voices and views that have contributed significantly to our thinking. The lessons I am taking away will affect not just the practicalities of how NHS Citizen ultimately works, but the look and feel, and even the philosophy lying behind it.

14. Everyone who was present (both physically in Leeds, and online) worked so hard and so thoughtfully. The NHS Citizen system was not given an easy time, but it was done in such a constructive and thoughtful way it was truly inspiring.

15. For the Assembly Meeting test three NHS England managers volunteered to role play being board members sitting in front of the assembled citizens. They had a hard time of it, both in role and a bit out of it, and all live streamed. They did it with great humour and dedication. I’m constantly amazed by the risks that the organisation and individuals within it are taking to make it work.

Finally, thank you to everyone who took part in the workshop. Your good humour and dedication was also evident and has really moved NHS Citizen on considerably.

Picture credit: Urban Outlaw