The role of standards in a fragmented ecosystem

I’ve been thinking about the role of standards, and how they can help in the complex sector I’m working in — that of health in England.

But first some history…

I’m a Product Owner and I’ve previously had experience in the public sector where the work I did on standards (and governance) contributed to a £400M enterprise meeting its legal and moral obligations. This meant hitting all its digital ‘sales’ targets of more than £200M a year (of a complex education product with a ‘sales value’ of c £15k completed over 6 years), and as part of that keeping up to 200,000 active customers (by which I mean students) happy.

The numbers are dwarfed by health (a workforce of 1.5 million that serves 50 million people, and a national website that has 50 million sessions a month) but what I learnt from my previous experience was the value of standards that could be measured against achieving hard targets. Heck, we could measure customer flows on a dashboard, track conversion rates, satisfaction scores, retention rates and balance cost against benefit moderately easily.

And standards supported all of the above. So….

What do we mean by standards in health?

For the last 6 months standards have been talked about a lot. I’m comfortable talking about data standards (I supported early linked data work in the 2000’s at, and did early work for authentication and identification systems for the 200,000 students (or 2 million alumni) back in the day — including security issues, and I guess today I’m most comfortable talking about standards that support the design and build of an excellent (and inclusive) user experience.

In November, at the Health Product People gathering, @hadleybeeman talked about emerging thoughts on the different levels that you could think about standards. On the train ride home I did a doodle that I’m sure didn’t accurately reflect Hadley’s talk but which I found useful to try and rationalise our work against.

Different levels of standards

I have a great deal of empathy around things that touch on culture and behaviour — such as procurement, or HR policies that foster agile ways of working, and recently I’ve started doodling again to try and help conversations about what ‘standards’ could cover. This ranges from what may be ‘binary’ or ‘on-off’ standards — such as TCPIP, or some of the harder edge of security and encryption — to things that may be mandated (e.g. use national identifiers such as the NHS number or National Insurance number), to things which become accepted, or ‘hoped for’ norms because the hard work has already been done — such as the newly emerging NHS login.

Then there’s standards nearer to my day job — those which focus on user needs, that enable inclusivity, but also that help meet the needs of the organisation.

I have a theory that says public sector organisations only exist to meet a user need, therefore meeting user needs meets business needs. If they don’t the gap is just ‘waste’. So when we talk about user needs I don’t have any problem with talking about business needs in the same breathe. The two should be aligned.

Anyway, back to the doodle. The one below suggests there’s a range of standards that range from ‘binary’ to ‘measurable but subjective’.

When you’re working in an ecosystem such as health I think we need to understand that range of standards because doing so may help us think about adoption. This may include ‘mandating’, but it might also include just showing ‘what good looks like’, or doing the hard stuff to make it simple for others. Like releasing a front-end library and health content standards (which we did recently).

A range of standards from binary to subjective

How might it work in health?

There’s been a lot of talk in the last week (and maybe for much longer) about the ‘people > processes > tech’ construct and I think it’s important to see it in that way; people always come first.

This matches something we’ve been talking about in relation to a service standard for health, and by that I mean a ‘guiding north star’ that helps us know what good looks like. This would be centred on user needs, that makes people think about the end to end service, and that makes people think about what’s needed to build and run that service. It would also challenge people about how to measure success, and something that guides the right technology choices (which should liberate, not restrict).

Our hypothesis talks about a service standard for health that acts as a companion to Gov, and this guiding north star would be atop a ‘pyramid of content’ that contains advice and guidance, relevant examples and case studies in health to help teams deliver the right thing. The doodle below attempts to capture this thinking.

An image showing a health standard might act as a companion to Gov, atop a ‘pyramid of content’

The idea being it would build on the excellent work of Gov but which helps deal with the more problematic areas in health, which includes things like clinical risk, interoperability (across fragmented health systems) and measuring health outcomes.

We’re going to keep working on our hypothesis as we believe that a service standard tailored to health, which acts as a guiding north star, will help teams across health deliver better services, more efficiently.

And soon hopefully we’ll share more widely our hypothesis for a service standard.

Let me know what you think. This stuff isn’t easy…