Four Weeks to Alignment
NHS clinical interoperability at Oracle. A stalled multi-million-pound programme. A room of executives. 2 hours.
- Leads discovery
- Facilitates and convenes
- Makes ideas tangible
- Regulated sector
- Where
- Oracle Industry Lab, for the NHS
- When
- 2025
- My role
- Senior Service Designer and Programme Manager
- Themes
- FacilitationDiscoveryIdentity and accessExecutive alignment
4 weeks
from stalled to operational showcase
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01Situation
An NHS interoperability programme worth millions had been stuck for months. 3 organisations, 3 sets of systems, and nobody holding a shared view of the patient journey.
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02The move
I designed the identity and access surfaces for the clinicians and administrators who actually live in the system, then ran a single Lightning Decision Jam that put 10 or more executives in front of the same picture.
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03Result
The room went from scattered to aligned in about 2 hours, and the programme went from stuck to a working, operational showcase in about 4 weeks.
The Lightning Decision Jam, playable
Problems, votes, questions, ideas, votes again, then the matrix. Rebuilt so you can run it yourself.
The situation
So this was at Oracle, in the Industry Lab, and I was often the person brought into programmes that had lost their way. The one I point to most is a multi-million-pound NHS clinical interoperability engagement.
The short version of interoperability is this: getting different health systems, built by different people at different times for different organisations, to actually share what they know about a patient. So that the person in front of a clinician is not a stranger every time.
When I came to it, it was stuck. Different organisations, different systems, no shared view of the journey. It had the particular heaviness of a programme that everyone agrees is important and nobody can move.
What I did
The core of the work was identity and access. The governance surfaces. The unglamorous plumbing that decides who is allowed to see what about whom. I designed those surfaces to take administrative friction out of the way for the clinicians and administrators who actually live in the system all day, rather than for the people who buy it.
But the thing that actually unstuck it was not a design artefact. It was a room.
I ran a single intensive Lightning Decision Jam that took a group of executives from scattered to fully aligned in about 2 hours. The trick, as always, was not a better argument. It was getting everyone looking at the same picture of the same problem at the same time, so the disagreements they did not know they had surfaced and got resolved in the open rather than festering across weeks of separate meetings.
The hard part
A room of senior people who have been politely disagreeing for months. Clinical leadership with one priority, operational leadership with another, engineering with a third. The temptation is to let the biggest voice decide. I did not.
I designed the session so that the ranked list made the call, not any one person. Silent ideation first, so quieter voices were not drowned out. Problem framing before solutions. Impact and effort, voted blind, before anyone argued their favourite.
Outcome
From stuck to a working, operational showcase in about 4 weeks. And a room of senior people aligned in about 2 hours, which, in a programme like that, is worth more than any document.
What I took from it is that the cost of a stalled programme is almost never technical. It is that nobody has made the whole thing legible to the people with the authority to move it. Make it legible, and the movement often follows faster than anyone expects.
The lesson
You do not argue a stuck programme into motion. You put everyone in front of the same picture.
How I found out .
Each method, and why I chose it.
WhyPeople say in private what they will not say in a workshop. The session only works if nobody is ambushed and I already know where the real objections sit.
The people it had to work for.
Composite and anonymised. Needs and frictions kept, names removed.
Persona 1 of 4
The ward clinician
Works across 3 organisations in a week. 3 logins, 3 sets of permissions, 1 patient in front of her.
- Needs
- She needs to see what the last team knew about this patient, in 1 click, not 3 phone calls.
- Friction
- Access that takes 3 phone calls, so she rings a colleague instead and the record stays incomplete.
Written on the
inside cover
- Everyone agreed it was important. Nobody could say who owned the journey between organisations.
- The surfaces had been designed for the people who buy the system, not the people who sign into it 40 times a day.
- The disagreements between executives were real, specific and had never been in the same room at the same time.
- Once the ranked list existed, the argument stopped. The list decided, not a person.
What was actually on the wall.
The maps, papers and notes that did the work.
Most of this is under NDA, so each piece is described rather than shown.
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LDJ board
12 problems, 3 How Might We questions, 8 ideas, 2 rounds of dots, 1 matrix. Photographed, then redrawn for this site.
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Clinician IDAM blueprint
5 lanes, 6 stages, line of interaction and line of visibility. Anonymised version in the exhibit.
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1-slide decision summary
The 3 things the room agreed, with owners and dates. The only slide that mattered.
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Showcase script
The patient and clinician journey the lab now walks visiting health leaders through.
What changed, and what I keep.
- 2 hrs
- from scattered to aligned, 10+ executives
- 4 weeks
- from stalled to an operational showcase
- 1
- shared picture of the journey, where there had been none
- 3
- decisions made in the room, each with an owner and a date
- The showcase became the lab's lead demonstration for visiting health leaders, so a stalled programme turned into the thing the lab shows first.
- The clinician and administrator journey became the reference for the next phase of discovery, which was scoped and resourced on the back of it.
- Across the same Oracle chapter, a shared service design toolkit and templates for a 13-person design community cut design sign-off times by 30%.
- 01 You do not argue a stuck programme into motion. You put everyone in front of the same picture.
- 02 The list decides, not the loudest person. Design the session so that is true.
- 03 Problems first, questions second, solutions third. Skipping a step is how rooms end up ranking the wrong thing.
I would have run the session in month 1, not month 3. I waited until I understood the programme well enough to design the right anchors. 2 weeks of interviews would have been enough.