Interview: Victoria Betton, PeopleDotCom, on the importance of people-centred design for digital transformation

We recently sat down for a chat with Victoria Betton, director at PeopleDotCom, for a discussion on the importance of people-centred design for digital transformation.

Victoria started by introducing herself and telling us a little bit about her background, explaining that she worked in the NHS for over 25 years in various patient and public involvement, innovation, strategy, corporate services and communications roles. “Before that, I worked for homelessness and mental health charities, and then I trained as a social worker,” she shared.

“In my last eight years with the NHS, I founded and ran a digital health consultancy called mHabitat, hosted by an NHS trust in Leeds; that brought together clinicians and service designers to help with human factors in digital transformation.”

After running mHabitat for eight years, Victoria went to work for a startup, before making the decision to set up her own company, PeopleDotCom.

“I wanted to carry on and develop the work that I’d been doing at mHabitat. I called it PeopleDotCom because it’s all about the people – that’s the bit of digital transformation that interests me most. I’m really fascinated by what gets in the way of successful digital transformation, and why the big hopes and aspirations for digital often fall flat or don’t quite achieve what they’re hoping to achieve. There are many different reasons for that, but one of the big reasons is that we don’t design with people; we don’t spend enough time understanding the problems they’re trying to solve, and we don’t engage people enough right from the get-go.”

Since the company started, it has worked mostly with the NHS, but also with national bodies, charities, and arms-length bodies, looking at design thinking, engagement and complexity.

“When we’re trying to make any change in a complex system, it’s really hard to do because there are so many moving parts,” Victoria reflected.

Co-creating change and transformation in the NHS

On making effective change in the NHS, Victoria noted that whilst co-design and coproduction are often talked about, it often seems that these elements of change are an afterthought or at “the bottom of the ladder” in terms of priority.

“If we have the resources and the time – which is a really tricky thing in the NHS – then we can do a really good job, but too often we rush to the solution and then get failure demand,” she said. “You then have to go and sort it out when it doesn’t work. So if you can create that time, space and capacity at the beginning, to really do your discovery and co-create with people, then you get much better results; but it’s not always easy to make that case.”

Victoria talked to us about a course that PeopleDotCom is currently running for digital teams on design thinking, which began at the Northern Care Alliance with focus on developing a training programme for their digital team.

“Out of that, we developed our digital transformation by design course, because we realised that whilst digital teams often want to bring people like me in to help them with discovery or help them with engagement, actually they want to learn how to do it themselves,” she explained. “That’s a much more embedded, sustainable way of doing it. So we’ve developed a whole range of different courses; our foundation course is a three-day course delivered over a period of weeks, where we introduce digital teams to everything from discovery and co-creation through to optimisation and generating evidence. Then we’ve also got an online course for individuals, which is six modules over six weeks, and we’ve had really good feedback from that. It’s very participatory, there’s lots of interaction and people seem to really enjoy it.”

Whilst digital teams are under a lot of pressure from the number of services requiring their support, Victoria acknowledged, there is a lot of work that can go into ensuring that something is embedded right from the beginning, which can help further down the line.

“We can help them take a step back and think about how they organise themselves, and how they might apply some of these methodologies to help them take a more systematic approach to digital transformation projects,” she said. “With this approach, you start with user research, understanding user needs, and then once you’ve really understood the problems that need to be solved, you can work with key stakeholders and end users to co-design.

“Once you’ve implemented something, that’s just the start – you then need to get those changes in behaviour embedded over time. So you do need to continue to work with teams to optimise, and you can take a user-centred design approach to that as well.”

With design thinking, Victoria continued, it’s key to take the time to really understand that problem that you are trying to solve, and avoid the tendency to “treat technology as a commodity like a product or service”, rather than thinking about it in its context.

“Thinking about it in this way helps you in developing your requirements, and it also helps you through your procurement process and your implementation,” she said. “Even though you have to spend more time on it at the beginning, that means you can go faster later on.”

Tackling challenges within the NHS

We asked Victoria for her thoughts on the main barriers to design thinking within the NHS. She said: “One barrier is just time and capacity, because everything is under so much pressure at the moment. One way that we work around that is the fact that we don’t take people out of services to come to us – we go and do the user research work in context, within services. That means we can observe what people are doing and how people are working.

“The other thing is that whilst user-centred design as an approach is well understood, it’s not as socialised and used within local trusts.  There are some exceptions – we’ve been doing quite a bit of work with Somerset, for example, and they’ve got an amazing user-centred design team that they are growing and developing.”

Victoria commented that her background was in quality improvement when she worked within the NHS, and noted the “nice overlap” between quality improvement and digital transformation, though she also acknowledged differences. “The digital element tends to focus more on ergonomics and usability, and QI more on the process side of things. I’m always keen to work with QI teams; the best projects are where we collaborate with both the digital team and the QI team. There are actually quite a lot of change capabilities within trusts, and if you can bring them all together you can do some really interesting work; but I think user-centred design is often the missing bit of the jigsaw.”

Victoria added that there is a need to find a way of giving trusts who are doing really good work in this area a voice to share their experiences and what they’ve been doing. She highlighted the need to create “really strong case studies”, encouraging the measuring of value, so that this can be shared with other people.

Looking ahead

On hopes for the future with PeopleDotCom, Victoria shared that she would like to continue work on the development of the digital transformation by design training course, “because we’ve just loved delivering it, and we get such good feedback from it”.

She added that the team has developed an “essentials” course for the wider staff group and hopes to start delivering that. “We’ve also been developing a series of masterclasses in things like systems thinking, and we’ve got a WhatsApp community and a six-weekly show and tell, so that people that have been on our courses can come and problem solve together. We’re building a community, which we’re really enjoying, and we want to be able to do more, and build on the foundation course to give people more tools and methods.”

You can find more course information here.

As a final note, Victoria shared a statement that she has put together with Ayesha Rahim, clinical lead for digital mental health at NHS England, encouraging people to stand up to discrimination following the recently publicised comments by Frank Hester. If you would like to add your signature to the statement, you can do so here.

Many thanks to Victoria for sharing her insights. Victoria also recently joined us for a discussion on women and health tech; you can find our write-up of the discussion here.