Mapping an NHS Sexual Health Service

The NHS sexual health service in Manchester recognized the need to enhance the quality of care for the trans and gender diverse (TGD) community. Acknowledging the importance of co-design, they committed to improving services in collaboration with the TGD community to ensure more inclusive, responsive, and effective healthcare.

Our challenge was to gather meaningful insights from a diverse group of health practitioners and TGD service users. Facilitating discussions across such a broad range of participants required a careful, inclusive approach—creating a space where all voices felt heard and valued while navigating the complexities of healthcare experiences and perspectives.

Creating a safe enough space in this context meant fostering an environment where both TGD service users and health practitioners felt able to share openly—acknowledging that absolute safety is complex, especially in discussions about healthcare experiences.

We focused on setting clear facilitation agreements, using trauma-informed approaches, and balancing structured dialogue with open reflection. By recognizing power dynamics, validating lived experiences, and ensuring participants had control over their level of engagement, we built a space where trust, honesty, and meaningful collaboration could emerge.

Through thoughtful facilitation we used a journey map - a visual map of the journey from the perspective of the user -  as a tool for capturing and framing discussion around the experience of a service.

By identifying HMWs from the board we were able to collate them into themes. This helped the group distill the vast information collected into 5 areas of opportunity

Using the journey map input we synthesised the data into problem statements and How might We’s.

This format gave the NHS team a practical and actionable outcome of the activity and input from the participants

Breaking the Ice

During our initial alignment sessions, engagement was low, with only one or two participants speaking out of a group of 15+. To encourage participation in my first design session, I started with small breakout groups, which helped break the ice. This approach made a noticeable difference—more participants turned on their cameras and engaged in discussion, creating a more open and interactive space.

The Format

Using a journey map as a facilitation method proved highly effective for gathering insights and sparking meaningful conversations. The two key prompts—“What would move you forward?” and “What moves you backward?”—helped participants articulate their experiences and identify actionable opportunities for improvement.

Practical Considerations

Rather than allowing participants to work directly on the board, we opted for a transcribing approach due to varying levels of tech confidence and the types of devices being used. While this required more facilitation effort, it ensured that everyone’s contributions were captured and included in the process.