The Care Contextual Initiative

Context

Nourish's accessibility standards covered contrast, touch targets, and the WCAG basics - the physical and environmental conditions of using the platform. What they didn't cover was cognitive load: the mental and clinical conditions someone's actually making a decision under, in the middle of a medication round, a safeguarding conversation, or any other high-stakes moment of care. Two different problems, routinely designed as if they were one.

My role

As Head of Design, I identified and named the gap, then built Care Contextual Patterns as its own discipline - distinct from, and complementary to, accessibility. Not a solo initiative: designers across squads contribute to a shared pattern library, with me setting the standard and holding the cross-squad view of where it applies.

Constraints

This must work across a multi-product platform with squads at different levels of maturity, not just one team's roadmap. Regulatory deadlines already locked in on the calendar has given the work a forcing function rather than open-ended runway, and the users it needs to serve isn't limited to care professionals - it directly includes people calling on care, whose needs don't show up in a typical accessibility audit.

What we did

Defined the pattern library's scope through research and cross-squad discovery rather than starting from a solution. This means, cognitive load and information hierarchy as related to in care settings, crisis-mode interfaces for urgent and safeguarding moments, patterns for neurodivergent users, language-diversity considerations across first- and non-first-language speakers, and journeys for people calling on care rather than only the professionals delivering it.

Testing will run with real users who have accessibility needs rather than proxies. This will also be a partnership with engineering and PMs, whose input will contribute to shaping and prioritising journeys across the platform.

Outcome

Codified a platform-wide governance model that ensures 10+ squads are designing for high-cognitive load with clinical consistency, removing the ‘interpretation gap’ between product areas.

Reflection

The leadership lesson here was realising that Care Contextual Patterns only means anything because our designers across squads also vouch for it, from their different product areas and viewpoints.

My job wasn't to mandate a standard, but to make the case for one clearly and consistently enough that we’d have internal and cross-functional buy-in across the board. That's the only version that survives contact with actual delivery pressure.