Month: January 2023

What does “working in the open” mean?

In Public Digital we often talk to clients about working in the open. We think it’s a key ingredient of successful digital transformation.

A poster from the Public Digital Office "Show the Thing"
A poster from the Public Digital Office “Show the Thing”

What is working in the open?

Working in the open means showing people the work you are doing, as you’re doing it. At a minimum this should be people within your team and people across your organisation. Even better is sharing publicly, with stakeholders outside your organisation who have an interest.

Working in the open is not just about demonstrating progress, but also talking openly about mistakes, changes, and things you’ve learned. It’s partly to support communications, to help you build a movement for change. But it’s also about good governance. It gives stakeholders a window onto your work that drives up quality, helps unblock, and manages your dependencies. Work in the open by being open about the work.

Typical examples of working in the open are as follows.

Hosting ‘show-and-tell’ sessions. A show-and-tell is a regular (every 2 weeks, say) open invite event. The team does a short presentation about recent progress, and allows time for questions at the end. Importantly the team does not simply give a status update but “shows the thing”. Such as prototypes, designs, research, or other lightbulb moments.

Working in the open: team show and tell
Working in the open: team show and tell

Publishing regular updates on the team’s progress. For instance by writing and publishing weeknotes. Or writing regular posts about more specific things as they learn them. This could be a set of insights from user research sessions. Or the logic behind making a particular choice about a technology.

  • NHS trust digital leaders Amy Freeman and Andy Callow both publish weeknotes.

  • NHS Digital hosts a series of blogs on transformation, technology, and design.

  • The Defra Future Farming programme blog.

Publishing code and documentation as open source. When a digital team is developing a digital service or piece of software they should code in the open wherever possible. Publishing code in public repositories helps teams focus on the quality of their code and documentation. It allows others to build or copy the work that has been done.

  • GCHQ’s internal Boiling Frogs research paper on software development and organisational change. If GCHQ can work in the open, anyone can.

  • NHS design and prototyping kit code repository.

  • The Government Digital Services’s code repositories.

Using workplace messaging tools. This is one of the simplest things you can do to help your teams work in the open more. Posting information in a ‘chatroom’ rather than sending an email switches the default visibility of a message from closed (only the people copied get it) to open (everyone in the channel or room gets it). This helps all the team know what’s going on, and allows the team to discuss important topics together. It also allows discussion to happen asynchronously without the need for a meeting.

Working in the open: chat rooms
Working in the open: chat rooms

Richard Pope has published a brilliant thread on twitter of some of the things teams publish in the name of working in the open & transparency.

How does working in the open help

Traditional methods of project communication typically follow these patterns:

  • Broadcast. The communications are one-way.

  • Hierarchical. Only the most senior people are allowed to represent the project.

  • Tightly controlled. Everything has to be cleared by a separate comms team.

  • PR-oriented. The objective is to spin what you’re doing to show it in the best possible light.

  • Big bang. One big press release when the work is ‘finished’.

These types of communications are often impersonal, inauthentic, and frankly boring.

Working in the open is typically low cost and has a number of advantages.

It supports better project communications because:

It builds momentum. Digital transformation is not only about technology. It’s also about changing culture, process and operating models. You won’t be able to do this in a silo. By working in the open, you can develop your narrative and bring people with you. It helps create momentum for change. Sharing what you’re doing little and often increases the chances people will engage, reaching wider audiences.

It’s 2-way. It allows your audience to interact and converse with you. It opens up a channel for you to receive feedback.

It is timely and relevant. Avoiding long comms clearance processes enables your communications to happen when the work does. This helps build momentum and keeps you on the radar of key stakeholders: decision makers or funders. Decision makers don’t like surprises.

It has more authenticity. Working in the open allows you to talk in the voice of the people who best understand the project. Helping people understand why you’ve made the decisions you have builds trust. Like your maths teacher used to say, show your working out.

It supports better project governance because:

It makes the service better. More eyes and earlier eyes on the service, product or project means it will get improved, more quickly and at lower cost/risk.

It is a window onto your world. It allows stakeholders a much clearer understanding of what the hell is going on than a Red/Amber/Green status report in 8pt Arial on a slide.

It manages dependencies. Legacy organisations tend to try and manage dependencies in large spreadsheets. This may allow one person (the owner of the spreadsheet) to understand dependencies. But this isn’t enough. Working in the open allows everyone to see what’s in flight, and identify and manage dependencies for themselves.

It helps you manage and persist knowledge. It enables you to build an open store of understanding and insight over time about how and why things have been done. This makes it easier for others to copy or pick up where you left off. It allows others to link to what you are doing and explain.

It supports capability building because:

It helps you hire. Digital professionals like to be able to work in the open. If your organisation can show that it works this way, you will attract more of the people you need. “I asked members of the audience to raise their hand if they wanted to work at GDS after reading one of its blog posts. 75 per cent of people put their hand up.”

It is democratic. Everyone on the team is empowered to showcase their expertise about what they’re doing and why. This builds confidence in communications skills. It helps everyone feel like they are contributing.

If you want to build trust, confidence, and learning, we suggest you work in the open.

Further guides

More advice on agile communications from Giles Turnbull.

More advice on weeknotes from Giles and Ben.

More advice on running great show and tells.

More advice on doing presentations.

More advice on coding in the open.

This post was originally published on the Public Digital website on 21 January 2022.

NHS digital reorganisation: start by working in the open

The Department of Health and Social Care announced yesterday that NHS Digital and NHSX will be folded into NHS England. We have seen these kinds of reorganisations many times before, including in the NHS. All too often they are distracting, dispiriting and don’t deliver the intended benefits.

But that doesn’t have to be the case – providing you get off on the right foot. The reorganisation is not the story. What you do afterwards is.

We don’t know all the internal mechanics of the NHS. But based on what we do know, here are our suggestions for using this transition to build trust and continue the momentum gained during the pandemic.

  1. Work in the open by default. Start by publishing the names of who’s in charge, and what they’re responsible for.

  2. Make an unambiguous, technically literate statement explaining what this means for patient data.

  3. Deploy expert multidisciplinary teams (design, technology, clinical, operations) at all levels of decision making and delivery. Make the most of NHS Digital’s specialist capability in design and technology.

  4. Explain which platforms are needed across the NHS, based on a thorough look at what exists now.

  5. Show how this organisation change is meaningful by delivering something quick, visible and helpful to the system as a truly joint team. Such as an MVP platform for ICS websites, or new clinical calculation APIs, by next April.

  6. Use the practice of working in the open to manage dependencies and duplication, instead of relying on spreadsheets held by Programme Management Offices. Get senior leaders to publish weeknotes.

  7. Fix corporate basics to reduce friction for staff: make the website clear, put everyone on the same email system and directory, modernise the most important internal tools.

  8. Do less so you can deliver more. Use the change to stop doing what is no longer needed or isn’t delivering value.

Most important of all – don’t let this distract from the core mission of making the NHS better for everyone. We need it, especially this winter.

This post was originally published on the Public Digital website on 23 November 2022.

What good looks like for digital transformation in health

A banner thanking the NHS. Image by Red Dot from Unsplash and shared under their license.
A banner thanking the NHS. Image by Red Dot from Unsplash and shared under their license.

As part of our work with NHS Providers (supported by HEE and NHSX) on running digital board sessions for trusts, we often get asked, “Can you tell us what good looks like?”. So it was great to see that NHSX is working on this very question, and even better talking about it openly on social media.

When Trust leaders ask us this question they usually are coming from a place of “tell us what the latest technology is” or “paint us a picture of the modern digital hospital”. My response is always the same. We could do that, but is that really what you need?

Historically, digital advancement in health settings has been taken through a predominantly technological lens. The most obvious example of this is HIMMS. But I worry this approach has been pretty unhelpful overall, because as anyone with experience at the sharp end of digital transformation will tell you, it’s not just the technology but the culture, processes and operating model you need to worry about if you want to genuinely change. The risk of painting the picture of an internet-era clinic is that you are not giving a trust any tools to help them get there.

With that in mind, here are some thoughts about what good looks like.

  1. Having a clear mission everyone understands. Digital strategies that are 40 pages of shopping lists are hard to remember. Make it clear to people what you are trying to do, or they wont come on the journey with you.

  2. Relentlessly focus on your users’ needs. If you aren’t actively focussed on understanding and addressing the clinical, practical, or emotional needs (Ht Janet) of either patients, clinicians, or other staff people won’t use your services and you will never see any benefit.

  3. Talk about services not projects. Services start at go live, projects end at go live. Your digital services should be seen in the same way as any other service you offer- to be supported ongoing, iterated, improved. The NHS Service Standard has all the advice you need.

  4. Invest in skilled teams – with internet era capability covering not only engineering but product and design, and pair these with clinical and operational staff. Work together, don’t chuck requirements over the fence. And please please try not to design things without some design expertise!

  5. Use modern cloud based technology. Don’t lock into long contracts. Work with suppliers who want to collaborate with you as one team. Stop putting tin in the basement.

  6. Be agile. Focus on the minimum viable product based on valued delivered and iterate when you learn more. Minimum viable governance that is proportionate to the need. Show the thing, don’t hide meaning in 2″ inch-thick board packs.

As a board, be servant leaders. Take collective responsibility for your digital transformation, put it at the top of your agenda. Ensure you have the right technical knowledge in the room where it happens. Unblock things for your teams. Move authority to information not information to authority.

The title of this blog post is ‘What good looks like for digital transformation in health’ but the same principles apply in every sector. None of this is news. It’s all already in the Public Digital book, blog, and in other places like the digital maturity scale my colleagues developed with Harvard Kennedy School. Many of my formercolleagues and others all around in the health and care system have been saying similar things.

A common picture for what good looks like is beginning to emerge across the NHS. In some places, it is already more than just words – you can see it, and so can patients. But that’s not true everywhere. What comes next must be the harder discussion about what makes good so difficult to achieve, and so hard to scale. Because the answers are likely to be rooted in the topics that all too often fall into the ‘too hard to fix’ category: money and power, legislation and legacy, the rules and tools of the game.

If you’re interested in this work and want to continue this conversation you can find me @e17chrisfleming.

A banner thanking the NHS. Image by Red Dot from Unsplash and shared under their license.
A banner thanking the NHS. Image by Red Dot from Unsplash and shared under their license.

This blog post was originally published on the Public Digital website on 5 February 2021.