Saturday 23 July 2011

Top of the class?

Yesterday saw the publication of the Socitm report that informed a discussion group entitled ‘How good is your hospital’s website’, at the NHS Web Futures ’11 event.

The report is:
“...a mini survey of the usefulness and usability of nine high profile, city-based hospitals in England... [which] assessed how easy it was to complete five common tasks likely to be high on the priority list of every patient...
“The survey revealed a distinct lack of customer focus likely to leave patients and visitors struggling to find this key information.”
Before you read the mini survey of NHS hospital websites in full, I’ll declare my interest, which is that ‘my’ hospital, Southampton General (part of SUHT) came out rather well.

I have mixed feelings about this. It’s all very well being the model pupil but if you and your small selection of classmates are all dressed in shades of ‘must try harder’, and some of the kids you consider the cleverest (such as Imperial or King's) are excluded from the rankings, then it’s a strange victory.

On the other hand, I viscerally support the principle of focusing on the user experience, rather than giving in to internal politics or lazily building everything around corporate structure. I agree we have a lot to learn from web best practice in general, and from each other.

Socitm didn’t carry out this survey for their own amusement; there’s a suggestion that they could facilitate a programme of review, learning and networking for the NHS similar to Better Connected, from which local government websites benefit.

Why might we want this?

An external source of validation might:

  • provide new qualitative and quantitative measures of success;
  • instil a healthy sense of competition and enable benchmarking;
  • give less experienced web teams a basic roadmap and some good examples to follow;
  • gain recognition for the work carried out by web teams and add weight to negotiations for resources (in local government, CEOs and elected members are rather interested in Better Connected scores);
  • create economies of scale: for example, if the review questions were based on evidence of user requirements, it would save individual Trusts repeating the same basic research.

What do we have to lose?

I've got some questions:

  • How much would it cost to sign up to the process? (Though what price a poor website?)
  • Is it valid to have objectives set for us by an external body?
  • Might some organisations become lazy and reliant on the service? It would not solve all our problems for us – there’s still hard work involved.
  • What if one size doesn’t fit all? Some websites might fail to meet very specific and valid local requirements while they are busy trying to meet nationally-agreed, but less locally-relevant, criteria.
  • What ‘teeth’ does this review have? Council websites haven’t improved solely as a result of benchmarking. Many other factors been important, notably government requirements for certain services to be provided online, and mandatory submission of links to certain content to the central DirectGov hub.

A taste of things to come

Events like NHSWF are rare opportunities for NHS webbies to meet, share and learn. Should we go down a route similar to Better Connected, with perhaps an ‘official’ (DH-sponsored?) flavour, it might be the shape of things to come.

The report summarises the model of good practice and ‘top tasks’ tested in the survey, but a few points leapt out from the ‘How good is your hospital’s website’ discussion, facilitated by John Fox:

  • The importance of being able to find particular top tasks direct from Google – how many of us focus on menus and the homepage, and neglect SEO?
  • The fact that some very pretty websites were actually impossible to use. They can fool your stakeholders but fail when you are a patient or visitor.
  • It’s particularly important - and difficult - to prioritise user experience if you are a Trust with multiple distinct hospital buildings or sites.
  • Sometimes we overlook the basics. We mustn’t get blinded by our specialist knowledge and forget that many really don’t know or care about, for example, the difference between primary and acute services.

In reality

It was disheartening to note defeatism among some website managers.
 “I would like to, but you don’t know how strong and influential those people are”
Maybe I’ve just been lucky to work in two public sector environments where I’ve had a supportive boss, been encouraged to innovate, and always felt able to put forward a reasonable argument for change.

Partly it must genuinely be due to issues with corporate culture, personalities and politicking, but partly I think websites in some NHS organisations just don’t have enough weight, by which I mean expertise, evidence, experience and resource. Might a national comparative survey and support service help?


  1. There is plenty of open source material on user centred design of websites, and the ISO standards are good. There are plenty of societies and communities that talk about these problems for free for those that are interested. Organisational change could be supported by ISO TR 18529:2000 Ergonomics of human system interaction - Human-centred lifecycle process descriptions (2000).
    The problem for the NHS (compared to say Amazon) is 'follow the money'. Patients and users pay but their financial say is very indirect. HCD can't fix that.

  2. Good stuff :) glad all the hard work is paying off..