‘Shoes Off Design’: Face-to-face vs remote engagement in Human Centred Design

While designing an app for parents with children between the ages of 0-2 in Liverpool, we booked a prototype testing engagement session booked with parents at a children’s centre. Personally, this was one of my first sessions working with the company and I didn’t really know what to expect. So with devices ready and a notepad in hand, I entered the room ready to give everyone a formal greeting and reel off a mental script about the app and what it does. To my surprise, sat down on the floor already were the mums and dads with their kids, playing. At this point it only seemed natural to join them, so the shoes came off and we sat down for a play and a chat about the product.

The important thing about this story is that it’s all about getting comfortable with our users. We didn’t want to come across as the ‘techy’ interviewer guys, coming in to talk in detail the ins and outs of a new app. Instead we formed a real connection with the parents (and their babies) and got some awesome engagement and feedback out of it.

Whatever field you are in, the HCD (Human Centred Design) process naturally has one common denominator: humans! Talking, interacting, laughing, creating – it is so important to be engaged with somebody in order to better understand their needs.

Digital product design involves interfaces and their specific elements which are governed by a huge variety of different users: older, younger, male, female, public and professional. With such a wide range, the success of these interfaces is hard to determine without meaningful engagement with individual users. You can find data to support any group of users but every one is unique, so real engagement is key.

Different stages of the HCD process require different sessions and approach. For example, in the discovery stage, a session may be more about asking lots broad questions and allowing for people to talk openly to gain a wide array of answers, but always pertaining to the project scope. Questions and cues can be used in tandem, such as “in an ideal world how would tech help you?” followed by “can you elaborate on this?” prompts. We should always try to dig deeper and ask ‘why’ to really gain the motivations behind the insight. Further down the line in the development stage where testing prototypes are concerned, it could require setting up tests such as A/B, or a ‘show me, tell me’ session, with certain stricter navigation for users to follow, as we have assumptions at this stage which need to be tested. Preparing the right session for the right process stage is key.

What does meaningful engagement look like normally, and does it differ during these testing times? How can we adapt to still produce products that will add significant value to a user, and one that they will love? This article will cover the importance of getting stuck in with users both face-to-face and remotely, comparing ways and techniques in which we can gain meaningful user interactions and insights.

Face-to-Face Engagement

At Damibu we are firm believers in the importance of the engagement sessions we host. As previously mentioned, each stage of the HCD process requires a slightly different approach, whether it’s 1-1 interviews, focus groups, co-creation or product testing.

It’s important to make the most of being face-to-face with users when you have this luxury, to create a more personal experience, so the user feels acknowledged and listened to. This is because there are certain things that in-person engagement allows that remote does not (and vice versa). It’s important to recognise the value of things like bringing along snacks or treats for participants, being able to involve everyone in a group and creating fun activities for people, in order to help create a relaxed atmosphere. Some of the best sessions and insights we have had have been working with parents of young children, sat on the carpet chatting and playing – leading to really open and honest insights, which we couldn’t have gathered via secondary research: shoes off design, quite literally!

The relationships formed during these sessions are as important as the insights gathered. As designers we spend a lot of our time trying to get inside a user’s head, so face-to-face engagement is the chance to really get to know who you are designing for. We think of it as a great opportunity to form lasting relationships.

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Remote Engagement

How does this experience look remotely? Thankfully, technology allows us to keep the meaningful interactions the result from working with users. Things like video calls, online prototyping, screen sharing and session recording are all great tools which have allowed us the ability to facilitate. Yet, although the environment of a session can be replicated well, naturally there are still differences. Here are some things we’ve noticed about engaging remotely:


  • Being able to access more people than usual
  • Less crazy commutes
  • People are at home, so they’re a little less formal

Not so good:

  • Key visual cues missed that could have been used to direct the session
  • People scheduling like mad means they have back-to-back meetings, so are overworked and sessions have stricter timelines
  • Group engagement sessions are a little trickier as it’s harder to bounce off people, and again, read the rest of the group when one person is speaking

Employing the right sessions at the right stage of the process may be the same for both in-person and remote engagement, but the techniques used to gather insights now have to be adapted. Things like not being able to greet with touch, pick up visual cues as easily, or bring snacks for users mean that we have to find different ways to create the right atmosphere, which does offer food for thought about ways to overcome these remote barriers. This can be as simple as more of a chit chat to start with; finding similarities like working from home as that’s something most of us have in common right now (and how we find out how busy they are); the obvious weather questions; surveys and quizzes; or video sharing. These are all fun ways of creating the right environment for interaction remotely. It may be different but there is still a huge number of ways to get creative in your approach.


It’s easy to dissect each way of working and the specific differences, but ultimately both face-to-face and remote engagement require the same facilitator behaviours to achieve the same great outcomes. Rather than ‘specifics’, it’s key to think more about ‘generals’: putting a user at ease, showing enthusiasm and involvement, or facilitating a really well prepared session which has been tested to avoid hitches. You can have a great meeting hundreds of miles away from a user and still feel closer than in a poorly done session when you’re sat a metre away. So whatever the literal distance, don’t design from a distance!


How to sell to the NHS

So you’ve got a widget that’s ready to go and you want to ‘sell to the NHS’…

Don’t ‘sell to’ but ‘tender for’

All public bodies abide by strict rules regarding how they spend public money. If the cost of any project amounts to more than £181,302 (February 2018) it must go out to public tender. This value is called the Official Journal of the European Union (OJEU) Threshold. Purchase processes for anything under this value will change according to which public body you’re dealing with. However, even below this threshold there’s a lot of pressure for public bodies, such as NHS Trusts and Clinical Commissioning Groups (CCGs), to open projects for a public tender process.

The benefit of a tender process is that the buyer has, 1) already decided that they want a solution to their problem, and 2) has already set aside money to pay for it. Of course, this might not work for innovative products. If they don’t know that there’s a solution to their problem, then they might not go out to tender for it. However, there are increasing requests for ‘expressions of interest’, to review the possibilities around a particular problem.

Even if you’re not considering tendering, it’s always interesting to keep an eye on the regional tender portals, such as ‘The Chest’, the North West’s Local Authority Procurement Portal.

Don’t ‘sell to the NHS’ but ‘sell to a NHS provider’

Many companies have a widespread belief that it’s required to sell direct to a trust or a CCG, however sometimes it’s actually easier not to go directly to the NHS. There are providers to the NHS whose commissioning rules aren’t as strict, so you could instead go to a healthcare provider servicing the NHS.

This could get you in easier, with less commissioning rules, and it would provide you with a test case. In many cases, once you get to know the workings of the NHS, you may find it’s the providers that are the perfect purchasers of your solution.

On the other hand, you may have an idea or a widget that, with a bit of research, will be ready to ‘sell to the NHS’…

Don’t ‘sell to’ but ‘partner with’

Another route is to partner with an NHS organisation via a grant-funded project from UK Research and Innovation or similar initiatives. You’ll find NHS organisations are happy to partner with you and even happier if you can pay for their services. In some cases, such as SBRI Healthcare, projects can come with a partner from the start. If your targeted grant doesn’t come with a partner, there are programs and organisations, such as the Innovation Agency, one of the 15 Academic Health Science Networks (AHSNs), that will help you link in to the NHS to find one.

In either case, if you’ve got a widget ready or you’re going to develop one, nobody’s interested in your technology – they’re only interested in what your technology can do for them.

Don’t ‘sell the tech’ but ‘sell the benefits’

You will need to put your solution in a context that somebody in healthcare will understand. Google ‘NHS Business Case’ to find an NHS Business Case template on the old National Innovation Centre website. This format is a well-known way of putting a business case to NHS trusts. The sections’ content applies whether you’re selling to the NHS, a provider, or asking for a grant, so in either case filling in the Business Case won’t be a waste of time.

When applying for grants, you must make clear how your idea is aligned to national policy in the NHS. For example, if you’re doing something related to GP surgeries, you have to explain how and why it links to the GP Forward View or another relevant policy.

If you’re going directly to the NHS, you need to remember that to get to the stage where someone is assessing your project, you need to have already done all of your testing and you would have already passed all of the hurdles related to referencing national policy. This means, that you have to adjust your applications: text that you have previously written for a research and development grant may not be suitable for an NHS trust tender or proposal.

It could work, but if you join everyone else in saying, ‘we support the 5 Year Forward View’, then you won’t stand out. It’s best to point out the benefits which the reader can naturally match to their policies. For example, the Cheshire and Merseyside Sustainability and Transformation Plan focuses on prevention and children’s health. When writing about an innovation which addresses this, you could say specifically that this will prevent children using GP surgeries. Concentrate on those particular issues and what benefits they can bring.

So you’ve got your innovation, you’ve written your Business Case and you want to start ‘selling’ into an NHS organisation…

Don’t ‘sell to the NHS’ but ‘sell to a person’

The first thing you need to do is to find a ‘sponsor’. This would be somebody who might not have direct control over the money, but will have control or a strong voice in your solution’s clinical area within the organisation. For example, a Children’s Clinical Lead within a CCG, if this is what your product refers to. Your sponsor will be prepared to vouch for and promote your product within their organisation. A sponsor is vital when ‘selling’ innovation.

In the world of innovation, you often have to ‘sell’ the problem before you can even start to think about selling the solution. This takes time, energy and tenacity. There needs to be a strong emphasis on patient involvement in innovation. As much as your product can be clinically relevant and viable, it must have patient feedback behind it too. If you have no access to patients, your sponsor – given the right ethics sign-off – may be able to help you. First-hand experience and continuous evaluation are essential.

However, it’s very doubtful that your sponsor can just buy your product. They’ll have to fill in a certain amount of paperwork – how much depends on what your product costs. If it’s £5,000 then it might be 2-3 pages, but if it’s £100,000 then it will be a much bigger process. However, if a sponsor has to spend two weeks doing it for one innovation but only a day for another, then they’re going to spend less time but more promotional energy on the latter. This is where a well written Business Case comes in. A well-structured Business Case can give the answers your sponsor needs for their paperwork.

So everyone wants it, but there’s still a problem…

Don’t ‘sell to’ but ‘tender for’

Yes, we’re back to this one. Even having gone through all of the above, you’re still left asking for money from a public body. Not only does the paperwork increase as the cost goes up but also the ‘strictness’ of the acquiring process – each NHS organisation has different levels of power and ownership of budgets.

If you’re selling a product for £1,000 then a senior staff member may be able to sign it off. However, even at, say, £5,000, a head of department might need to get two or three verbal quotes, and at £50,000 they might need three written quotes. Also, even though the formal OJEU Threshold for public tendering is £181,302, many public bodies have policies that demand public tendering at a far lower level.

So, in the end, you’ll probably end up tendering anyway.

Finally, don’t ‘sell’

Generally, clinicians don’t like being ‘sold’ to. Working with the NHS should be seen as a partnership for the good of patients. Anything you produce should have full and true patient involvement throughout. Co-create during development; user test during prototyping; and evaluate during delivery. In the long run, this will deliver a far better product that the NHS will want to take advantage of.


Working with Damibu has been both great and really interesting

“Working with Damibu has been both great and really interesting, Kate and John have been extremely helpful and professional whenever we have worked together. They have happily met with us on numerous occaisions so we can both share what we do and what work we are currently working on and discuss how we can work together”


Jessica Anderson, 
Digital Health Team, PSS

“The sessions applied the human centred design process”

“The sessions applied the human centred design process and the way in which they engaged with the particular group of service users was admirable, this was always carried out with patience and empathy”

Anna Richards, 
Betsi Cadwaladr University Health Board