Defining what “good” means when it comes to user experience design is difficult. In NHS England, all our work is measured against the NHS service standard and we use the NHS design principles to help make decisions about how to align our work with our values. While both documents are useful, I’ve observed teams struggling with a lack of clarity about how to put them into practice. It doesn’t help that we have many teams working autonomously, all trying to keep up in a fast paced environment. Inevitably, they need to make decisions about how to balance trade-offs and when to say that they’ve done enough to move on. In an attempt to provide better tools for operating in this environment, we’ve been experimenting with a few ways to provide better support and create shared understanding. Below is our new definition for what constitutes a good user experience, tailored to the context of healthcare.

A good user experience is...

Valuable

• It meets a user need that we have evidence for
• It produces the desired result for the user and the provider
• It has a value proposition that is clear to the user

Obvious

• It uses clear, direct language that the user understands
• It has an intuitive interface that makes it easy to understand how actions are performed
• It matches the user’s mental model, not the organisation’s

Efficient

• It helps the user reach their goal with as little effort as possible
• It provides the information needed to make a decision and nothing else
• It does not ask for information that has already been collected or is already known by the organisation
• It eliminates delays wherever possible and loads quickly

Predictable

• It relies on common components, patterns, and platform conventions
• It organises and describes similar things in the same way
• It behaves in a way that the user can predict so they know what will happen next

Generous

• It does not have dead ends or abandon the user
• It creates an impression that is calm, direct, and supportive
• It respects the user’s time and attention by being well made and precise in its execution

Empowering

• It drives user agency with active, personal, and direct language
• It makes it easy for users to feed back about their experience
• It does not diminish the user’s confidence in their own actions

Trustworthy

• It provides a reliable and consistent experience that delivers what it says it will deliver
• It is easy to verify the content and outputs of the service
• It is accurate and unambiguous

Safe

• It does not distress, endanger, re-traumatise, or harm the user
• It helps the user avoid mistakes, recover from errors, and undo actions
• It keeps the user’s information secure
• It is designed to meet all relevant safety standards (DCB0129 and DCB0160)

Accessible

• It provides a good experience regardless of permanent, temporary, or situational disabilities
• It is tested with people who have access needs
• It works on whatever device the user has
• It is designed to meet all relevant accessibility standards (WCAG 2.2 AA)

Inclusive

• It is tested with people from diverse backgrounds
• It gives users a choice about how they access a service and provides alternative routes to care
• It works for everyone

The ideas described above are aligned with the design heuristics with which most of the industry should be familiar, but the specifics have been refined to fit our context. Our primary challenge was figuring out how to incorporate ideas about patient safety directly into our guidelines. We have clinical safety standards that govern everything we do (like DCB0129 and DCB0160, which are named in the list above), but we wanted to go beyond a situation in which these are separate from our design principles. We wanted to bring design and clinical safety closer together so that we could reinforce ideas of clinical safety by design, namely, reducing the possibility of hazards before they emerge by weaving clinical safety into every aspect of the design process. For us, clinical safety isn’t a gate, it is the process.

Some of the criteria in the list are hard to achieve and there are a few that we consistently fail to live up to. That’s not good, but it is also by design. The list above is a declaration of intent, describing where we want to be rather than where we are. For example, stating that a user experience in the NHS must work for everyone to be considered good is an attempt to fulfil the NHS Constitution. Our team works on a mobile app, but not everyone in the country has or wants to use a mobile device, and so that criteria will be forever out of reach. By naming our ambition, we are trying to point at a worthwhile goal, one we can aspire to, and all progress in that direction is good. Just keep chipping away; better is better.

We’ve been trialing this list with our teams for about six months now. Over that time, we’ve refined it through a few rounds of workshops. We’ve also used it to run heuristic evaluations, develop research plans, and construct measurement frameworks. It is still early days but so far all of these applications appear productive.

It would be reasonable to ask whether we really need yet another set of standards. I’ve asked myself that more than once, and being a good Agile citizen, I’m completely open to binning the thing if it isn’t working. Right now, my current feeling is that our space is entirely too messy to not provide a clear distillation of our expectations and ideology. This is our current attempt. It is still a work in progress and I’m sure it can be improved. To that end, comments, critiques, and questions are all very welcome.

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