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Designing for users: the role of user-centredness in test and learn

This article is included in our book, Adopting the practice of test and learn. It was written by Dr. Saw Nwe.

You can download a PDF version of this book, or visit this page to request a printed copy.

Every change in organisations, whether at the system level or the service level, impacts human behaviour, experiences and outcomes. All the groups involved - including the internal teams who deliver services and the external service users who use them - have their own goals, challenges and needs they're trying to meet when interacting with the service. These are user needs.

At its core, test and learn is a user-centred approach to change. It embeds user-centred methods at every stage and demands that teams make decisions based on what they learn about users, prioritising meeting those needs and driving the right outcomes for users.

When decisions are grounded in real evidence - rather than assumptions - about what users need, we can make changes that solve the right problems.

From “responding to demand” to “meeting needs”

In my work as a doctor delivering health services in the NHS and a consultant working with public and private organisations, I have repeatedly observed how organisations respond to change. The innate response is to add more: more process, more layers of governance, more tools, more complexity.

Over time, the service swells. It becomes a beast of its own, becoming harder to navigate for both people working inside it and those trying to access it. Ultimately, it pushes the organisation further away from the human needs of the people it was designed to serve.

As a result, services become confusing or inaccessible. Staff feel overwhelmed, people feel underserved. This shifts the system into firefighting mode: reacting to problems rather than preventing them. We see failure demand rise, leading to poor outcomes at an individual level, organisational level and at a wider systemic level.

Organisations are meant to respond and react to change. But when rising demand is seen as a pressure to be managed, it can trigger a sterile, aseptic approach to change that prioritises process over people and control over curiosity.

Instead, a test and learn approach and the user-centredness it mandates forces organisations to shift their mindset to: “What are our users trying to achieve, why, and how might we help them achieve it?”.

Take a generic application service, in which users submit application forms with the goal of getting approval. If the service consistently receives a high volume of incomplete applications, the organisation might try to control the problem by imposing processing targets on the service teams. But a user-centred approach compels the organisation to understand why users aren’t completing forms correctly in the first place, and strives to fix that problem. It could be due to unclear instructions, inaccessible content or poorly designed user interfaces.

How test and learn helps organisations be user-centred

Test and learn involves teams starting with just enough insight from initial user research to take action by building early prototypes. Those prototypes are then tested with users in real contexts, enabling teams to gather insights from what they see, hear and measure. With each cycle of testing and learning, their understanding of users deepens, informing decisions and shaping interventions that lead to better outcomes.

As such, the process brings to light the real, lived experiences of people affected by change - experiences that often get buried under layers of process, governance and urgency. It makes the invisible visible. It rebuilds empathy which can fade as complexity grows. And it reconnects siloed teams to the core purpose of change: who it’s for and why it matters.

When accompanied by fast feedback loops, the user-centred practices embedded throughout test and learn help organisations to:

  • Learn if a theoretical idea leads to intended outcomes in practice

  • Understand user behaviour and responses to change

  • Surface unintended consequences early

  • Validate what works - and stop what doesn’t

Critically, this approach helps organisations test risky assumptions and de-risk high-stakes interventions on a small scale - before investing in a large scale roll out.

Case study: transforming post-referral processes in Nottinghamshire’s Safeguarding Hub

Public Digital used a test and learn approach in our work with Nottinghamshire’s Multi-Agency Safeguarding Hub (MASH) to help the service identify and support children’s needs earlier, before crisis or escalation of needs.

We brought together a multi-agency team with deep knowledge of the service, including those who deliver and access it day to day. Using a user-centred, test and learn approach, we helped the team understand the problems, test ideas and iterate them based on what they learned in real time - all within a high-risk environment.

One issue we prioritised was streamlining the team’s process between receiving referrals and taking action. Previously, a single MASH officer recorded and passed referrals to a social worker, adding multiple back and forth processes between teams. Instead, we tested a system in which a multi-agency team - including a MASH officer, social worker, police officer, nurse and education adviser - triaged and assessed referrals together in real time.

This led to faster information sharing, holistic assessment of needs, and quicker support. In one case, the team assessed a referral about a pregnant woman and concerns for her unborn child. The new system enabled the team to immediately put safeguarding measures in place, including arranging a mental health check-in at her midwife appointment the next day. Previously, that level of coordination would have taken days.

This was just one example. The team continued testing and learning to scale their approach - and the more they did, the more they learnt about their users.

The cost of not being user-centred

Many leaders feel they don’t have time or investment to be user-centred.

But in reality, they don’t have time not to be. When change (policy, service, product) is implemented without understanding user needs and testing solutions in real-world context, it can lead to costly rework later down the line. Designing blindly in this way can result in duplicated effort, loss of trust and poor outcomes - for both users and for the organisation.

In healthcare for example, user-centredness has a direct impact on patient safety, experiences and health outcomes. An online patient portal might give users immediate access to their clinical letters or test results. While it is important for patients to have access to their health records, a lack of user-centred approaches in product design, or failing to test and learn with real users, can have unintended consequences. Patients might read distressing diagnoses without context, or receive blood results without clinical interpretation, leading to anxiety and confusion. This creates failure demand as patients call for clarification or submit complaints, straining already stretched resources and trust.

The cost of not being user-centred can be harmful at an organisational level too. One NHS Trust implemented a voice recognition software assuming it would replace administrative support. Staff were cut to make a case for investment, but the technology didn’t deliver intended results in practice. Clinicians were left to face the direct consequences of duplicated work and increased workload, and an investment in an unusable solution that didn’t meet users needs. Had the organisation taken a user-centred, test and learn approach - testing with one group, learning and then scaling or stopping - it could have avoided these human and organisational costs.

Everyone plays a role in user-centredness

A test and learn approach - and its process of continuously understanding and designing for user needs - enables organisations to adapt and respond to change before reaching a crisis point.

It’s an approach that works because it recognises that considering user needs isn’t a luxury or a tick box exercise, or just a problem for design teams. Instead, everyone has a role in positioning users at the centre of decision making and prioritisation, and in doing so, delivering better outcomes for the people they serve.

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About Dr. Saw Nwe

Saw is a Principal Consultant at Public Digital, where she combines her clinical experience with her expertise in user-centred service design to help clients transform outcomes for users. She has worked with clients including the Nottinghamshire Children Safeguarding Partnership and NHS Digital Mental Health.

Saw previously worked as an NHS clinician in primary and secondary care, and holds a Masters in Healthcare and Design.