Zooming in, zooming out: Designing healthcare services with a systems thinking approach

It’s no secret that the NHS is under pressure. With an elective waiting list reaching 7.6 million and patient satisfaction at record lows, the strain on services and staff is undeniable. But as Health Secretary Wes Streeting has said, while the system may be under severe stress, it is not beaten.

Over recent years, the NHS has moved quickly on digital transformation. New technology and automation have been adopted at pace to keep services running in extremely challenging conditions. That progress matters. But technology alone is not a miracle cure. To deliver on the mission to improve the health of the nation, we now need to look closely at how these systems are used in practice and how they can be continually refined.

We can’t simply bolt digital services onto complex, long-established ways of working and expect them to work perfectly. The next phase of transformation is about improving how systems connect, how they support clinicians, and how they reflect real patient needs and behaviours. That requires a different lens.

Why healthcare is so hard to fix?

Digital transformation in healthcare is often fraught with misconceptions. All too often, digital is held up as the holy grail. There is a misguided assumption that if we simply deploy more technology things will improve.

However, when these products are built in isolation and fail to communicate, they don't fix anything; they add friction. Healthcare is exceptionally complex; it is a "wicked problem" where the system is not a single entity but a vast number of separate programme areas connected in messy, evolving ways. Instead of attempting the impossible task of making everything simpler, good design is about accepting this complexity and taking a holistic view.

Zooming in and zooming out

User-Centred Systems Thinking considers the interconnections in complex healthcare systems while focusing intensely on the needs, behaviours, and experiences of the people who use and deliver them. It sounds complex, but the goal is simple: create services that are easier to provide and better to use. We do this by constantly "zooming in and out":

• Zooming in: We look at the granular service pathway. What is the lived experience or “human feeling” of a patient in a waiting room or a doctor trying to log into three different systems?
• Zooming out: We look at the whole system or “systems thinking”. What are the technical, financial, and political constraints that make delivery hard?

By cross-checking opportunities at the user level against implications at the system level, we can identify impactful interventions that are both "rock-solid" in their technology foundation and empathetic in their human delivery.

Proof it works

AT NEC Digital Studio, we have seen this methodology work where traditional "big bang" changes often fail.

In our work with NHS England on Urgent and Emergency Care (UEC), we didn't start with code; we started with a shared understanding. By building visual maps of how IT tools and databases interact and creating "influence maps" of teams and organisations, we were able to generate a comprehensive overview of UEC services that now serves as a foundation for future system development.

Similarly, in Eye Care services, where a third of patients were waiting more than 18 weeks, we mapped the entire system across multiple Integrated Care Systems (ICSs). By tracing patient journeys and identifying the root causes of "pain points," we developed a national model that moves away from fixing individual problems in isolation and toward a sustainable, future-proof service.

Even in Remote Respiratory Screening, we used a "test and learn" culture. By running a small-scale pilot with 50 patients, we identified user preferences and safety protocols before scaling up to 1,000 patients, significantly reducing the risk of a "failed" large-scale rollout.

Systems thinking, human feeling

System efficiency matters, but in healthcare it cannot be considered in isolation. If a GP appointment overruns by seven minutes, and that extra time with their doctor makes an elderly patient feel less anxious and more likely to take their medication, that's a positive outcome. Those additional seven minutes have consequences though. They impact the next patient waiting to be seen and the clinicians managing an already busy day. This is the tension at the heart of healthcare delivery. When care is reduced to workflows, we lose the "human feeling" that should be at the centre of it all. Services designed around idealised processes, rather than real human behaviour, don’t remove pressure - they displace it.

The challenge is not choosing between system efficiency and human feeling. It is designing frameworks that allow both to cascade through the system, from policy to services to individual interactions, without creating hidden pressure elsewhere. This is why my upcoming fireside chat at the HETT Leaders’ Summit is called "Systems Thinking, Human Feeling." Too many digital initiatives fail at the point of use because they reflect process-led design rather than real-world behaviours. Poor design also actively widens inequality. If accessibility and inclusion are not built in from the start, digital services exclude the people who need them most.

Healthcare leaders need to shift towards "System Stewardship", actively monitoring and refining the system continuously so it can manage change and remain sustainable for the long term. This is not a one-off transformation exercise. It is continuous responsibility.

We have a real opportunity to improve how care is delivered. But technology only helps if it supports the people providing care and the people relying on it. That must be the test.

Let’s connect at the HETT Leaders’ Summit

Join me and Claire Dellar, Lead Product Manager and Accessibility Ambassador at NHS England, for our Fireside Chat:

"Systems Thinking, Human Feeling: Designing healthcare services that work better for everyone."
14:15–14:35 | Aire Suite, Level 1.

You’ll also find me at the NEC stand (A63) throughout the day. If you’re dealing with the challenge of designing more inclusive services, I’d welcome the chance to talk through how these principles apply to your specific context. You can also connect with me and book time directly via the HETT Connect app.

Finally, for a deeper look into our methodology and the case studies I’ve mentioned here, visit NEC’s online exhibitor stand in the app to download NEC Digital Studio’s latest white paper: "A Recovery Plan for the Nation's Healthcare."