The growing pains of design leadership

Leslie Knope from the TV show Parks & Recreation

I’ve been in a design leadership position for nearly two years now. At its best, it’s a fulfilling role where the impact of your work (and that of your team and colleagues) can be seen at scale. At its less-than-best, it can be laborious, with levels of admin and political chicanery that you swore as a younger designer you would never sink to.

It’s interesting to reflect on how the role has evolved over the last year-and-a-bit. It feels more ‘official’ now, and I think this is commensurate with design as a profession becoming more established as a strategic organisational capability at the NHS. Basically, we’re starting to grow up. Since the investigative work begun by the multidisciplinary teams in the NHS Alpha and Beta phases, ‘designer’ is now on the NHS payroll, with gradings and levels of responsibility. We have a ‘Head of Design’, who is a clear-minded strategist with a cogent message about the value of design. It’s real.

Interaction design is seen as an essential part of the creation of healthcare tools and services for the public, and service design is making leaps and bounds as a means to orchestrate all the different offline and online parts of a person’s health and care experience. This work on public-facing services is having a ripple effect on more monolithic staff-facing systems, which may have previously been seen as Too Big to Change. But, as the NHS Long Term Plan now states, vendors of professional-facing services must “…meet usability standards to match those we expect in the rest of our lives.” There’s no excuse anymore. Indeed, it’s great to see colleagues working on staff-facing services using the new NHS.UK frontend and prototype kit, to try out new ideas quickly and cheaply.

But all this impact and recognition for design, comes with an overhead on those of us who are the organisational face of the profession. More expectations. More accountability. More demands on your time. More meetings. More “Dean, have you got a minute?”. Which is a challenge for those of us still finding our feet in a large organisation, whilst also making the transition from design practitioner, to design leader.

When you get to a certain point in your design career, you can go one of two ways. There’s the ‘artisan’ route. The design/web equivalent of an expert cabinet maker. Carefully-paired typefaces. Subtle and unique colour palettes. The most elegant of code. Always experimenting, and driving the medium forward.

Or there’s the leadership route. I joined the NHS to help redesign and prepare a 10-year-old website for the organisation’s future plans. But in doing so, I saw the huge opportunity for design to make an impact on health and care. I’d already been wondering how much longer I could feasibly be toiling over the design of my umpteenth ‘cog’ icon, when there were designers half my age (and salary) who could do just as good a job. So it was the leadership route that was the next step for me.

But that means letting go of certain things. Unless you’re superhuman (which I definitely am not), you won’t be able to keep up with design software, code, practical techniques, and such. You won’t be able to (or need to) get right into the design detail of your grid measurements, or class names. There will be practitioners in your team who are perfectly capable of doing that, and you will have to trust them, so you can look to other matters. Your instincts and experience as a designer will never leave you, but some skills will atrophy over time. And that’s fine.

What I’ve discovered is that much of my job is now about discovering and promoting a shared understanding of what a good outcome is (handy hint: repeatedly shouting ‘user needs!!!’ is not always the best approach to win hearts and minds). Whether that’s by agreeing new ways of working, presenting to other professions, or lobbying for a change in some internal policy or other, you need to be able to understand others’ motivations, and find consensus, in order to facilitate the kind of design influence you know will benefit the organisation and its users. But this is not easy, and I can think of plenty of situations where I could have handled things better in hindsight.

Driving better design in an organisation that is only just starting to get used to its place in the landscape, means challenging entrenched views, and sometimes having difficult conversations. Diplomacy and forging consensus will get you far, but at some point, it will be necessary to put your foot down, or escalate a matter, even if (especially if) it makes you unpopular. This is where the job is not easy. I’ve had a few sleepless nights before a looming meeting, and I’ve have had a few sleepless nights after unexpected conversations, where I’m thinking about how to address a situation. This is when you wish you could just retreat to Adobe Illustrator and noodle about with some icons. But that’s not what you are paid for, and it is not what your colleagues (or your users) need from you.

Making this transition from a practitioner to a leader is not straightforward. I’ve experienced plenty of growing pains, and still am. But learning how to do this, as the organisation learns with you can be very rewarding. When you get approached by someone you don’t know, who thinks they might need a designer? That’s progress. When you get asked to speak about accessibility at an event attended by lots of NHS seniority? That’s progress.

But you can’t just sit back and relax on that seat at the table you’ve been given. You need to keep advocating, keep worming your way into conversations. You also get to keep employing a skill any good designer has — asking ‘why’. Why have commissioners asked for this? Why isn’t there budget for that? Why isn’t there a user researcher assigned to this team? As someone who’s generally an introvert, being the annoying ‘why’ person is draining, but part of the job. If you don’t keep pushing, you’re letting down your team and profession, and ultimately, the users of the NHS.

Edit: I forgot to credit Ade Adewunmi for telling me on a design leadership course, “We don’t need designers who are also leaders; we need leaders from a design background”. This was a pivotal point in my thinking about my career. Thank you Ade, and Rebecca Kemp for running the course.

Lead designer. Personal website:

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