A New Information Architecture for NHS.UK - UX Scotland 2018

@sophiedennis
This is for everyone 
A new IA for NHS.UK
Sophie Dennis, NHS.UK Transition Strategy Lead

@sophiedennis
Mission
Create a new information architecture
for the NHS website that will provide a
solid platform for the service over the
next 5-10 years

@sophiedennis
Richard Pope
@richardjpope
7:28 pm - 13 Dec 2015
..it should be a warning in the civil service induction pack "at
some point, you will ﬁnd yourself saying 'we're mostly ﬁxing
the basics'"
https://twitter.com/richardjpope/status/671772934554451968
We’re still at the start of our journey

@sophiedennis
The NHS is an idea of  
unparalleled humanity

@sophiedennis
A society where no sick
person is denied medical
aid because of lack of
means

@sophiedennis
We believe…
Technology has the ability
to reach a huge volume of
people, mirroring the
universal and egalitarian
ideal of the NHS

@sophiedennis
We believe…
People shouldn’t have to
understand the health
and care system to get
the help they need

@sophiedennis
Alleviate
Pressure
on health and
care services
Increased
patient
knowledge,
conﬁdence
and control
Better
outcomes
for
patients
We believe…
= =

@sophiedennishttps://twitter.com/Julie_raw/status/966426604762214400
poster often seen in NHS clinics 
THE FIGURES MAY BE WRONG!
No photos please

@sophiedennis
50m visits month

Over half a billion visits a year

78% mobile

26m visits to beta.nhs.uk

Most visited condition 
stomach ache, 2.5m visits

Most used tool 
BMI healthy weight calculator, 8.9m starts

Content syndicated by 800 partner sites
and apps including 200 NHS organisations
It’s big

@sophiedennis
It’s really diverse

from  
how to treat a blister
to  
am I having a heart attack?

from  
how to have a better sex life
to  
being diagnosed with HIV

from  
ﬁnding a late-night pharmacy
to  
choosing a new GP

@sophiedennis
Diverse content is needed to
meet different clinical,
practical and emotional
needs

@sophiedennis
The domain is
complex and opaque

@sophiedennis@sophiedennis
Song
Artist
Album
Chart
A simple domain model 
“an abstract expression of a real-world system”
Domain models create robust
information architectures because
they map how things work in the
real world to users’ mental models

Condition
Clinician
Treatment
Symptoms
Side Effects
PrescribesDiagnosed by
Causes
which are
Isn’t this how health works?
Service
Location
Organisation
employed by
can be seen at
delivered by

the stomach ache < > stomach cancer problem

Clinician
Condition
Treatment
Symptom
Stomach Ache Indigestion
Constipation
Appendicitis
…
Stomach Cancer !!! OMG !!!
Symptom

Clinician
Condition
Treatment
Symptom
Stomach Ache Indigestion
Constipation
Appendicitis
…
Stomach Cancer !!! OMG !!!
Symptom
Doing this safely
requires curation

@sophiedennis
Self-care and pharmacy
1

@sophiedennis
When to see a GP…
2
1

@sophiedennis
How to tell if it’s an
emergency
3

Some other things it might be
- but don’t self-diagnose
4

@sophiedennis
For some symptoms, emergency
care is most important
1

Is is safe to even try automating
this with a content model?

What if users’ mental models
are not how the system works?
One NHS? No:
• 207 clinical commissioning groups
• 135 acute non-specialist trusts
• 17 acute specialist trusts
• 54 mental health trusts
• 35 community providers
• 10 ambulance trusts
• 7,454 GP practices
Source: NHS Confederation, 2017 nhsconfed.org/resources/key-statistics-on-the-nhs

@sophiedennis
Do the hard work to join
up services so it’s easy for
people to navigate them

@sophiedennis
Direct people to action-
oriented information and
tools so they can make
better decisions about
their health and care

@sophiedennis
Become people’s preferred
ﬁrst port of call to
understand, access and
manage their health and care

@sophiedennis
Our information architecture provides the fundamental
organising principles of our service. It is how people:
1. Understand what the NHS website is for and what it offers
- placemaking 
2. Know where they are and where else they might go  
- orientation and wayﬁnding 
3. Get to their destination  
- navigation
1
2
3

The house we have The house we want
Encyclopaedia
Magazine
Directory
Campaigns
The preferred start point for patients’ digital health interactions
Joined up content, services and tools that form  
coherent, end-to-end user journeys
Knowledge, conﬁdence and control to make better decisions  
about your health and care
Our organising principles
All the best
bits of the old
house, plus

Redecorate
Replace the wiring and plumbing
Refit a couple of the bathrooms
 
but still fundamentally the same house
Build a big extension 
Knock-through the whole ground floor
Build a cinema in the basement… 
 
completely different house
We’ve mainly been doing this Next we need to do this
Our transformation journey
All the best
bits of the old
house, plus

@sophiedennis
Our existing information
architecture leads to fragmented,
confusing user journeys

Live WellHealth A-Z Care & Support Health News
Services  
near you
Home
Sexual Health
STIs
1.  
Might I have
an STI?
1
Google Search
Start Here

Services  
near you
Home
Gonnorhoea
Thrush
Sexual Health
Chlamydia
STIs
1.  
Might I have
an STI?
1
2. 
What might
it be?
2
Google Search
Start Here

Services  
near you
Home
Gonnorhoea
Thrush
Sexual Health
Chlamydia
STIs
3.  
It’s probably Chlamydia.
What do I do?
3
1.  
Might I have
an STI?
1
2. 
What might
it be?
2
Google Search
Start Here

4.  
Where can I get a
Chlamydia test?
Services  
near you
Home
Gonnorhoea
Thrush
Sexual Health
Sexual Health
Clinics
Chlamydia
STIs
4
3.  
What do I do?
3
1.  
Might I have
an STI?
1
2. 
What might
it be?
2
Google Search
Start Here

4.  
Where can I get a
Chlamydia test?
Services  
near you
Home
Gonnorhoea
Thrush
Sexual Health
Sexual Health
Clinics
Chlamydia
STIs
4
3.  
What do I do?
3
1.  
Might I have
an STI?
1
2. 
What might
it be?
2
5
5. How do I protect
myself in future?
Google Search
Start Here

4.  
Where can I get a
Chlamydia test?
Services  
near you
Home
Gonnorhoea
Thrush
Sexual Health
Sexual Health
Clinics
Chlamydia
STIs
4
3.  
What do I do?
3
1.  
Might I have
an STI?
1
2. 
What might
it be?
2
5
One journey 
3 out of 5 site sections
5. How do I protect
myself in future?
Google Search
Start Here

@sophiedennis
We mainly support  
one information seeking ‘mode’

@sophiedennis
Information seeking needs in healthcare
1. Target seeking  
Looking for speciﬁc information. “Known-
item” search behaviours: I know what I
want and how to describe it.
3. Orienting  
Getting up-to-speed with a complex (and
possibly distressing) new topic. Not really
sure what I need or where to start. “Berry-
picking” search behaviours 
4. Exploring 
Iteratively adding to understanding of a
topic. Building a mental model. “Berry-
picking” search behaviours.
6. Evaluating  
Choosing the best option from a range.
Comparing options to make an informed
choice. Eg treatment options, local health
services.
8. Keeping up-to-date  
Ensuring understanding of a topic is current
1
2
3
4
5Inspired by:
Donna Spencer, Four Modes of Information Seeking and How to Design for Them
Marcia Bates, The Design of Browsing and Berrypicking Techniques for the Online
Search Interface 
Dan Ramsden (BBC), A Model for Navigation & Information Seeking
✔
✘
✘
✘
?

@sophiedennis
Our content and information architecture
needs to better support the range of
patients’ information-seeking needs -
including their changing emotional state and
cognitive capacity - over the course of their
healthcare journey

BEFORE  
“health encyclopedia”. Structured as a linear
journey for target-seeking behaviours
nhs.uk/conditions/type-1-diabetes
Turns out this is not the most important
stuﬀ someone just diagnosed with Type 1
Diabetes needs to know

AFTER  
Practical, actionable advice 
 
Supports orienting and exploring, and reflects
different needs at different stages of patient journey
beta.nhs.uk/conditions/type-1-diabetes
Newly-diagnosed ‘orienters’ can quickly
find the most important things without
being overwhelmed.
1

Those who are ready for more detailed
information can still find it easily
2
AFTER  
Practical, actionable advice 
 
Supports orienting and exploring, and reflects
different needs at different stages of patient journey
beta.nhs.uk/conditions/type-1-diabetes

Trigger
“She can’t manage
on her own any
more”
First contact
“What kind of care and support is
available to us?”
Users are often looking for information
in a crisis situation, in a highly
emotional state.
They do not know what they are looking
for yet.
People would ideally have one person
who would tell them what they need to
do and when. If it couldn't be one
person then the next best thing would
be having one place where everyone
sent them with well written information
and signposting to services.
LA assessment
LA determines how urgent and
severe the care needs are
LA check level of income and
decide whether to grant full or
partial care funding
Not everyone applies for LA
funding
Goal: find and arrange care and support for an old person (at home)
Task Model
How can
we get
help?
Cooking
meals
Day
centres,
activities
Befriending
servicesMedical or
psychological
treatments
Taking
medicines
Advocacy
Getting
up,
washing,
dressing
Shopping
Information
& advice
Cleaning
Transport
Decide we
need help
Planning care funding
Planning for future financial
commitments to funding care
Choosing care types
What kinds of care & support are required?
What kinds of care and support are available?
What is affordable?
What can be provided by informal carers?
What can be organised privately and what can be funded by LA?
Some users evaluate affordability of p
or fully privately care.
It is particularly important for care hom
funding where the costs are particular
Recommen
dations for
care
providers
How long
does it
take?
Talk to
professionals,
the council
Talk to
friends &
family
Arrange LA
needs
assessment
Apply for
LA funding
Gather
financial
info
LA
“Support
offer”
Personal
budget
Needs level
determined
by LA
Self-
financing
Accept
care
chosen by
LA
Home
adaptations
Council-
provided
Private
Informal
carers
Make
benefit
claim
Meal
delivery
Ineligible
for LA
support
Advised to
apply for
benefits
Support
for carers
What are
we entitled
to?
How much
does it
cost?
What do I
need to
know?
Understand the
process of arranging
care & suport
What is
available
locally?
Who will
provide
care?What type
of care do
we need?
What
types of
care are
there?
LA funding
decision
Apply for LA
funding
Needs level
determined
by LA
End user’s
opinion of
needs
Family’s
opinion of
needs
Locally
available
services
Choose care types
Affordability
Care needs
Domestic
help
Homecare services
& personal care
Community
support
Emotional
care
Gardening
Voluntary
sector
Care
provision
Professional
advice
Private
funding
top up
Benefits
received
(Attedance /
Carers
Allowance)
Urgency of
need
Conflicting
advice and
opinions
Price
Long-term
cost
What
happens if
private
funding
runs out
Long-term
affordability
Priva
top-u
fundi
Funding
responsibil
ities when
prices
increase
When LA
might
increase
funding
LA funding
available
Plan care
funding for the
long term
Orienting
Get up-to-speed quickly
- Primer, getting started guide, do
this first
- Guide to the system
- Signpost deeper understanding
Target-seeking
Evaluating
Exploring & evaluating
What funding options are there?
What works best for us?
- Outline available options, pros and
Exploring & evaluating
What care is available? What elements
do we care about?
What’s best for us?
Exploring & evalua
What are the options? What
What’s best for us?
Task models help us
understand people’s
information seeking
needs and behaviours
at each step in their
journey
And then design our
content and navigation
to support those
behaviours
If we can create task
models and IA patterns
for the main abstract
user journeys for
NHS.UK
We can then scale the
design patterns we’ve
developed to other user
journeys that fit the
same model
Task models help us understand and design
for the changing information seeking needs
across patients’ user journeys
www.cxpartners.co.uk/our-thinking/task-model-cheat-sheet-pdf
www.slideshare.net/JesmondAllen/the-lost-art-of-task-modelling

Type 3 
Small amount of content. Highly-focused.
Optional tasks pattern.
Type 2 
Orienting and exploring a topic. Structure
suitable for diﬀerent stages of health journey.
Our evolving suite of ‘hub’ layouts will help us
group and cluster content so people can orient
in and explore complex health information
Type 1

High-level topic cluster. Directional - get you to
the particular topic you need.

@sophiedennis
We also need to rethink our 
global navigation and information hierarchy

@sophiedennis
Card-sorting at scale with Taxonomics:
12 months
42,000 domains/websites
7 million search terms
c.4,500 “user goals”

@sophiedennis
The 340 most popular topic clusters in healthcare by
search engine demand. We can use this to prioritise our
work based on areas of largest need.
Analysis by Taxonomics

@sophiedennis
Deep dives into each topic shows where our content
doesn’t match how people search for information - their
existing mental models, and how they express their needs

@sophiedennis
A potential new information hierarchy,
ready to validate with users

@sophiedennis
Thank you
sophie.dennis1@nhs.net

A New Information Architecture for NHS.UK - UX Scotland 2018

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A New Information Architecture for NHS.UK - UX Scotland 2018