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NHS Choices: Defining customer tasks


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Creating a health task list for the NHS

The National Health Services (NHS Choices) website for England gets millions of visitors every month. It's an excellent, trusted and well-managed website. And this is an important, perhaps obvious point. Nobody sets out to create a customer-hostile website. Few people start a content project with the objective of making the language impossible to understand, or making the navigation confusing. Web teams don't set out to make life miserable for their customers. It just happens. The internal pressures and needs of the organization, the very act of doing your job on a day-to-day basis, make it easy to lose sight of the customer.

NHS Choices is determined to be a truly customer-centric website. And it is. However, like even the best websites it can always do a better job. So it asked Customer Carewords to carry out a task identification project to get a clearer sense of its customers' top tasks.

It was a fascinating project and the result was that there was a very clear top task that ran across every single segment of the population. It didn't matter if you were in Yorkshire or London, rich or poor, doctor or patient, someone with a long-term illness or a short-term one, a patient or caregiver, you had the same top task when you came to the NHS Choices website. (More about that top task later.)

A goal may have made you begin to change how you live but when you come to a website you have a task.


Before we could get people to vote on the tasks, we had to define them.

A good way to start identifying tasks is by examining your organization's objectives, strategy, mission statement and other information that articulates what the organization is about and wants to achieve. Why does the organization exist? What does it see as its purpose? Where does it want to go over the next 5 years?

Simple as these questions are, many organizations do not have ready answers. This was not the case for NHS Choices. It had a very strong customer-centric ethos, a service focus. Among other things, it had articulated a significant number of customer goals. It saw its customers as primarily the general public, but also wanted the website to help doctors, nurses and other health professionals. It tried to get into the shoes of an ordinary person, to see the world through their eyes. Here are some of the website goals that NHS Choices felt ordinary people had:

  • I'd like to be happier
  • I'd like to improve my family's health
  • I'd like to have more energy
  • Help me look after myself the best I can
  • Help me improve my chances
Here are some of the goals of doctors, nurses and other health professionals:
  • Give me information I can trust and refer patients to for further reading
  • Give me material that helps me explain and discuss things with patients
  • Give me material that helps me persuade patients to take responsibility for their health
  • Help me understand what patients think about our service
NHS Choices had these and many more goals, and they were an excellent source for the task longlist. However, goals must be translated into tasks because websites are about tasks. A goal may have made you begin to change how you live but when you come to a website you have a task; a task that when completed will help you further your goal. As a web professional, it's not enough to know that your customers have goals like "I'd like to be happier" or "Help me look after myself the best I can" or "Help me improve my chances". These are important goals but what can you do to the website on Monday morning in order to help people achieve them?

We need customer tasks. We need clarity. Some goals can be easily translated into tasks. You must make things very concrete and clear on your website because people search and navigate with concrete tasks in mind; tasks they want to complete. The more ambiguous you are about your customers' tasks, the more likely you are to put up lots of vague, meaningless or misleading information.

Sources for the task longlist

The first step in task management is to carry out a task situation analysis in order to understand the whole range of customer tasks that exist. I call this list of customer tasks the 'Longlist.'

The following longlist sources are specifically for a public website, but the basic approach to building a longlist works just as well for an intranet. (However, you can't really look at 'competitor' intranets, and using public web search statistics is not relevant from an intranet perspective.)

  1. Organization strategy: Analyze corporate philosophy, vision and strategy statements. What does the organization want to achieve over the next 5 years, and specifically what does it want to achieve on the Web? It is very important that you link your website strategy to the overall strategy of the organization. This seems obvious but strangely many websites are disconnected from core organizational aims and objectives.
  2. Stakeholder interviews: Talk to key people within the organization and find out what they think the purpose of the website is. What do they think the customer's top tasks are? What do they think the top tasks should be?
  3. Examine existing website: A good way to start is to copy level 1 and 2 of the website classification into the longlist. Another good source is the site index.
  4. Analyze top search terms: Do this by:
    • a. Analyzing data from the website search engine. Try to get the top 100 search terms over a 12 month period.
    • b. Google Adwords: https://adwords.google.com/select/KeywordToolExternal. Enter important words and phrases so as to see how people are searching for them. For example, when we tested for "flu" we noticed that the following terms were particularly searched for: flu symptoms, swine flu symptoms.
    • c. Google Trends: http://www.google.com/trends. If you want to do deeper research and compare search word trends over several years, then Google Trends is the place to go.
  5. Most visited webpages: What were the top 100 most visited pages on the website over the last year? (For a smaller website, the top 50 would be enough.)
  6. Competitor or peer websites: A minimum of four to six should be analyzed for tasks, particularly at the homepage level.
  7. Relevant media: Are there magazines, specialist industry websites, associations, etc.?
  8. Customer feedback: What are the most common customer inquiries and complaints? Talk to support, help and sales staff to get this sort of data.
  9. Customer research: Are there surveys or other research that show what tasks customers come to the website to complete?
  10. Customer interviews: For a large project, I recommend doing 10-20 customer interviews. These interviews don't usually uncover new tasks outside those already discovered as a result of analyzing the sources above. However, interviews are great for getting a feel for how the customer thinks. And they can show you how tasks are carried out, which is often faster and more concrete than a mere description. Make these interviews very short (about 15 minutes), using the following format:
  • Brief introduction
  • What are your top three tasks in this area?
  • Can you please visit the website and try to complete one of these tasks? (You can do these interviews remotely using screen-sharing software.)
It's not a good idea to have a task name that is very heavily associated with one particular demographic.

Duplicates and category-specific tasks

We collect tasks in a spreadsheet with the following headings:
  • Tasks: This is where we place the task word/phrase
  • Duplicates: This column contains task phrases that are very similar to each other.
  • Class: This is the broad classification that the task phrase fits into.
  • Source: This is where we got the task phrase. For example, "Top 100 Search Results".
  • Internal Source: This identifies the person who put the task on the list. (Sometimes a number of people will be involved in the research process.)
As we assemble a longlist we may enter words that are exact duplicates or near duplicates. In the following NHS Choices longlist we see that "Women's health" was found on the BBC health website and on webmd.com.

NHS choices longlist

We would immediately delete one of the "Women's health" entries. Now, what we have left is:
  • Women
  • Women's health
  • Women's health information
At this early stage in the process, we don't need to delete any of these, but at some stage we would probably have to choose one and delete the others.

A larger point here is whether we should have a task connected with "women" at all because women are a category or segment of the population. If we do, shouldn't we have "men's health" and "children's health", as well as "old people's health"? Think ahead to how this word will be used in navigational links. Isn't "women's health" very vague and catch-all? It's not really a task but a whole collection of tasks.

It is easy to fall into the trap of the organizational unit and departmental view of the world


Thus, where possible, we create neutral tasks that are not specific to an audience or demographic. (They need to work for women, men, etc.) Here are some examples:
  • Appointment reminders
  • Avoiding and preventing disease
  • Basic facts about conditions / diseases
  • Best place to go for help (GP, emergency, clinic, walk-in centre, pharmacist)
These tasks could be important to both men and women. We let the voters decide.

Duplicate tasks

The list of tasks in the preceding table has been marked as a duplicate of "appointment." However, if you analyze them you'll see that there are two distinct tasks:
  • Book an appointment online
  • Appointment reminders
The following tasks are all essentially the same and need to be merged into one:
  • Let me book an appointment
  • Make an appointment
  • Request an appointment
As you do your task longlisting you will begin to get a sense of how popular or important a particular task is. This is because you will keep coming across it. It will be:
  • In the top level of your website classification
  • On competitor websites
  • In the top search results
  • In the most downloaded pages
  • In the top help desk queries
One of the most important things the classifications help you do is divide the list into smaller chunks.


Applying task classifications

Classifying tasks is a way of grouping them to make it easier to get to the final Shortlist. Classifications do not need to be exactly right because your customers will not see this list of classifications when they vote; they will only see a randomly ordered shortlist of tasks.

Below is a sample of the classifications used for NHS Choices.
  1. Alternative
  2. Causes / risk factors
  3. Find services / experts
  4. Live well / healthy living
  5. News
  6. Symptoms
  7. Tests / diagnosis
  8. Treatment
You can see how they were applied in the following table:

NHS classes

One of the most important things the classifications help you do is divide the list into smaller chunks. A longlist for a large website can be anything from 500 to 1,000 initial tasks. Even when you eliminate exact duplicates and words that are clearly irrelevant, you still might have between 400 and 500 tasks. That's an awful lot of stuff to go through. You will certainly need to run through the whole list a number of times in order to get a feel for it. However, trying to manage the entire list and bring it down to a shortlist is an almost impossible task. If you keep going through a very big list again and again you run the risk of developing list blindness. You need to break the list up into chunks. That is what the Duplicate and Classification columns are for.

The following is a sample of what was classified as Treatment in the NHS Choices shortlist. By having the ability to focus only on the tasks in a particular class, you will be able to understand your list much better. You'll be able to really zone in and see things with greater clarity. And, of course, if you have misclassified something it should stand out from the rest of the tasks in that class.

NHS treatment

In an earlier version of the task list we had the phrase "healthy living". We ultimately deleted it from the list but we introduced a class called "Live well / healthy living". Here are some of the tasks we came up with in this classification:
  • Change your lifestyle (fitness, weight, smoking, drinking)
  • Dealing with stress
  • Diet, food and nutrition
  • Find out how healthy you are
  • Learn how others changed their lifestyle
  • Living with a condition / disease

Grouping / amalgamating tasks

Next, we aim to reduce the number of items in the longlist by grouping them. For example, let's look at a task that ended up on the final NHS shortlist as:
Diet, food and nutrition


This task was actually the result of examining tasks such as:
  • Eat Healthy
  • Food & Nutrition
  • Food & Recipes
  • Food and a condition / disease
  • Healthy nutrition guide
  • What to eat / not to eat
Remember that the actual words you choose for your tasks are incredibly important. When I worked with a consumer electronics company, we changed the words "Find a dealer" to "Buy / Shop locator" and doubled the amount of visitors to the online shop as a result. Sometimes you'll know amalgamation should occur but you'll still want to carry out tests to find the most powerful word. Thus, when I did the tourism task identification project I left in both of these tasks:
  • Deals
  • Special offers
These are in essence the same task but I wanted to know which resonated most with the customer. Based on my experience with many shortlists, I knew that I would ultimately amalgamate these words. "Special offers" resonated far more than "Deals". This was particularly so within the European, Australian and New Zealand markets. However, in the US, while special offers still got the biggest vote, deals was not far behind.

An interesting thing to understand here is that practically nobody searches for "special offers", while millions search for "deals". I have found over the years that the words people search with are often just a hint at what they really care about. They don't always tell the true and total story, and that's why you shouldn't exclusively depend on the words people use when they search to help you understand what their tasks are. (There are some good examples of this in the Microsoft Office case study in Chapter 10.)

The ideal task tends to be at level 2 of the classification-not too general and not too specific.


What is a typical task?

A typical task is what I would call a level 2 classification task. A level 1 classification task is what you will see on the homepage or in the classification at the top of the homepage on many websites. It's a classification like:

  • About us
  • Products
This is generally too big, too macro. It's not really a task, but rather a group of tasks. One way of checking if a task is too big and all-embracing is to ask yourself the following questions:
  • If this gets a big vote what are we going to do?
  • What things are we going to improve?
  • What specific aspects of the website are we going to focus on?
At the other end, if you choose too many micro tasks it will be difficult to keep the shortlist under 100. Also, a particular micro task may not get a good vote because it is too specific a task. This sort of micro task is generally what I think of as a level 3 or below task. For the NHS Choices task identification we decided that the names of diseases and conditions (cancer, diabetes, etc.) would be too micro as tasks and that instead we should use task descriptions such as "Basic facts about a condition / disease". Another reason we did this was because, like the demographic-related tasks (women's health), disease-related tasks are only likely to get votes from those specifically interested in those particular diseases.

So, the ideal task tends to be at level 2 of the classification-not too general and not too specific. This, of course, is not always true-it's just a general rule. As you iterate through your task list, you will begin to get a feel for it. You will get a sense for its unity and wholeness. That's why it can take 4-6 weeks to get a longlist together and bring it to a shortlist. It's simply not something you can rush if you want to get it right.

The final shortlist

The final shortlist should be 100 tasks or less. We have experimented with lists of up to 150 and amazingly you will still get lots of people to vote and vote well. However, you will certainly lose a number of people because of the list length. 100 is a very long list-and I know it shouldn't work; I know it breaks all the rules-but a significant number of people will vote on a list this long.

Steps in finalizing the shortlist

Getting to the final shortlist is an iterative process. When the original longlist is about 500-600 terms, you need about five sessions lasting 2-3 hours each to examine and refine the list. In these sessions you should aim to include no more than five people. These people should have authority, experience, and a true feel and understanding for your customers.

As you bring the list under 200-preferably in the region of 150-it is of great use to bring a number of experts (three to five generally) through the list individually. Sit down with them and ask them to read over it. This will take about an hour. The following kinds of questions should be asked:
  • Are the tasks in the customer's language?
  • Is there anything missing?
  • Are there any duplicates that need to be merged?
The final shortlisting workshop is a very important event in the process. Its purpose is to finalize and sign-off the shortlist. Keep the following in mind:
  1. Avoid including more than five people. The conversations can get intense and the more people involved, the longer it will take to get consensus
  2. Make sure, if at all possible, that anyone who attends the final workshop has been through an earlier version of the list at least once and is genuinely familiar with the process. Otherwise, you could spend a lot of time educating one person about the method and process and thus waste a lot of time.
  3. Schedule at least half a day. For intense and difficult lists a final shortlisting workshop can often end up taking a whole day.
  4. Try to have your longlist at 150 tasks or less before going into the workshop. Otherwise you may not get to the final list in that session.

And the top task for health is …

"Check symptoms" is the top task on the NHS Choices website, whether you are a doctor or a patient, rich or poor, living in the North of England or the South, whether you have a short-term illness or a long-term one.

NHS top task

How to read the table

  • Tasks: This column lists the tasks in order of their votes, with the task with the highest vote at the top.
  • Total Vote: This column gives the count of the vote each task received. "Check symptoms" got a total vote of 1,387.
  • % of Total Vote 30,255: This column expresses each vote as a percentage of the total votes cast, which in this situation was 30,255. So, "Check symptoms", with 1,387, received 5% of the total votes.
  • Cumulative vote: This column adds the percentage votes for the preceding tasks together. For "Basic facts", it's 8%, which is the vote for "Basic facts" and "Check symptoms" added together. (There is rounding, so that total may vary slightly from the individual percentages.)
  • Cumulative carewords: This column adds the percentages for the preceding carewords (tasks) together. There were 86 tasks voted on in this particular survey, so each task represents 1.2% of the total. Thus, the first four tasks represent 5% of the total tasks voted on.
It's not a very long neck. 5% of the tasks get 15% of the vote, whereas we usually find that 5% get in the region of 25% of the vote. The top eight tasks got as much of the vote as the bottom 44, whereas usually the top five tasks get as much of the vote as the bottom 60. The top task, 'Check symptoms', got 1,387 votes, whereas the bottom task, 'Learn how others changed their lifestyle', got 59. The following table shows that while the neck may not be as long as usual, it certainly is consistent. The chart takes a sample at 25%, 50%, 75%, and 100% of the vote. The top eight tasks that had emerged at 504 voters (25% of the vote) remained at the top for the rest of the vote.

Percentage table

As you can see from the following table, 'Check symptoms' was the top task for all professional categories:

Proffessional category chart

There were a few areas where 'Check symptoms' was not the top task. It was fifth for males, with their top task being 'Book an appointment online'. The fourth task for males was 'Get medical records online', perhaps showing a greater desire for self-service and convenience among males than among females. For those over 55, 'Check Symptoms' was not the top task because, basically, they already know what they are dying of.

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The Stranger’s Long Neck

The above is an excerpt from Gerry McGovern’s latest book, The Stranger’s Long Neck




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