NHS Digital is the information and technology partner to the National Health Service. In the words of Owain Davies, Lead Product Owner at NHS Digital, it is “just one part of one of the country’s best-known institutions”.
When Davies took up his role in September 2016, he and his team set out to digitally transform the web presence of the NHS, which has the vital job of catering to hundreds of thousands of NHS workers and patients alike.
NHS Digital embodies a number of apparent contradictions: it is both professional and patient-facing, and although its websites carry primarily content and resources, they are structured and behave more like ecommerce websites. Above all, Davies stressed, the NHS “isn’t here to sell you something” – its mission is simply to help people get to the information that they need as quickly as possible.
At Festival of Marketing 2019, Davies explained to a packed room on the Digital Transformation stage how his team transformed and modernised the NHS’s online customer experience, making its information as accessible and discoverable as possible, and what results they have seen so far from their efforts.
NHS Digital: Before the transformation
Prior to its transformation, NHS Digital was made up of very disconnected content spread across four different websites (or as Davies described it, “Four websites in a trenchcoat pretending to be one website”) and more than 120 transactional sites. Information was divided into confusingly-labelled categories, and users didn’t know how to find what they needed from the website.
The NHS Digital website in August 2016
NHS Digital needed to be able to satisfy a wide range of different goals and balance a number of competing priorities. Its user groups include IT professionals, NHS managers, healthcare professionals and patients; these might manifest themselves in 20 personas, and one website can’t possibly focus on all of these at the same time.
Additionally, patients and professionals access NHS web content in different ways, with 80-90% of patient traffic coming from mobile devices as patients Google their symptoms on mobile, while professionals are far more likely to be accessing resources on a desktop computer.
The website had a huge number of PDFs – around 12,000 by Davies’ estimation – which needed to be recreated as searchable, accessible web content. The NHS Digital content management system (CMS) also had some 600 different users, which led to content of wildly varying quality being published. This was cut down to about 20 people (including the core team) – everyone else was required to go through an authorisation process to publish content.
This wasn’t a hugely popular decision within the organisation, but it allowed them to focus on bringing all of NHS’s web content up to standard before they opened access back up again.
Going back to basics
Davies and his team started their work by going back to the basics of good digital customer experience: starting with user needs, and designing content that is simple, helps the user complete their task, and links together.
The team took a “task focus” to designing website usability and defined “red routes” on the site: user journeys that you don’t want to get in the way of and will do everything to bring to the fore.
Certain pieces of advice that might be considered best practice for website design or content didn’t always apply to NHS Digital: for example, there was no point including images that didn’t serve a purpose. Stock images of smiling nurses, while they might look aesthetically pleasing, would get in the way of users completing a task, so the team didn’t include them.
Accessibility is usability
The NHS Digital team has carried out a huge amount of work to make their web presence more accessible, particularly between April 2018 and October 2019. They set out to make sure everyone could use their sites – whether that might be someone with a screen reader, or a person with a broken arm who couldn’t move their mouse properly.
“Accessibility is usability,” Davies told the audience. “Everything that we did to improve accessibility also made the website more usable.”
To do this, they tackled both the technical infrastructure of the NHS web presence and its content. “Content is often overlooked in accessibility,” Davies noted – people will talk to the developers of a website and tell them to improve accessibility, but not consider the content that goes on it.
The team initiated a drive to switch from documents to web content, cutting the 12,000 PDFs down to just a few hundred, and converting the rest into web content. This had benefits for SEO and completion of designated “red route” tasks.
They also ensured that NHS content designers knew how to design content accessibly and carried out user testing for different tasks, making sure they could still be completed if, for example, the user couldn’t see the screen.
When creating content, the team aimed for a reading age of eight years old for the patient-facing website, and eight to 12 years for the professional websites. “We’re quite used to talking technically, so making sure we talk in a simple way is quite a challenge,” noted Davies. If there is a technical term that needs to be used, they will use it, but make the rest of the content as non-technical as it can possibly be.
Bringing the content to the user
A “lightbulb moment” for the NHS Digital team came when they realised that the NHS’s websites acted more like ecommerce websites than content websites. The aim was not to make the user spend as much time on the site as possible, but to allow them to find what they needed and complete a journey.
The team set about “bringing the content to the user”: redesigning the site around the user, rather than making the user find things on the site. A regular reader of NHS blogs would find recent blogs listed on the homepage the next time they returned to the site, while someone who checked their NHS Mail regularly would be guided in that direction.
Good journeys, noted Davies, might not involve your site at all – while most businesses would consider a lack of click-through from a search results page to be a failure, for the NHS, if a user can get an answer from a rich snippet on Google, “so much the better”. The team implemented schema.org extensively across NHS websites, and made sure its metadata was optimised for both robots (e.g. search spiders) and people.
Not everything about the ecommerce model was suited to the NHS: for example, ecommerce websites are interested in cross-selling and enticing customers to add more to their baskets. For a task-focused user, “cross-selling” needs to add value to their journey – they aren’t interested in browsing around the site, but information on completing a related task might be very useful.
The team looked at merging content and finding ways to link different journeys together. Domain expertise was incredibly valuable in achieving this: the NHS has teams working on every product and service, which provided an insight into which tasks were interrelated and could be usefully linked up. They carried out a great deal of user testing and ran experiments to discover whether, for example, someone who looked at the NHS news page would be interested in reading blogs.
Automation also exposed some useful opportunities for working out how things linked together, although for the most part, said Davies, the team will manually curate experiences for users based on personas.
The accessibility work that NHS Digital carried out wrought an amazing transformation on the NHS web presence. According to an audit of the NHS’s compliance with WCAG (Web Content Accessibility Guidelines), between April 2018 and October 2019 the NHS went from 36% of webpages that had no priority accessibility issues to 100% of pages having no priority issues.
The percentage of webpages that passed the ‘AAA’ standard for web accessibility – the highest standard possible – rose from 53% in April 2018 to 98% in October 2019, with 100% of webpages meeting the ‘AA’ standard, and 90% of pages meeting the ‘A’ standard.
Daily users of the NHS’s websites have risen from 15,000 per day to 26,000 per day – but pages per visit and time on site have both gone down. Again, this is something that would be a negative for most businesses (particularly content websites) but for NHS Digital, it means that what they’re doing is working – people are getting to their goal quicker.
NHS Digital has also experimented with emerging technology like chatbots to help users carry out tasks on their websites. However, Davies stressed that companies should make sure they have the basics in place before they attempt something more advanced like a chatbot. “The biggest problem is that your data isn’t structured enough; there’s no point trying to get to those places if you haven’t done simple things,” he said. Once data has been structured, then the bot can make it useful to the user.
Above all, Davies’ advice to companies who might be digitally “behind the curve” and just beginning their transformation was to start with the basics: “Do content well, do usability well.” These are the important components of a modern digital customer experience – and only once those are sound can companies afford to branch out into more advanced digital experiences.