The Complexity Challenge
Posted: June 30, 2011 Filed under: complexity, systems thinking | Tags: complexity, contemplative inquiry, education, learning, mindfulness, organizational change, simplicity, systems thinking 2 Comments »Before acting in a manner consistent with complexity principles, people need to understand what they are, how they are different from other systems, and what it means for their work. With mainstream education, professional practice so geared to linear forms of learning this bodes poorly for building better systems thinkers.
“Let’s just throw some social media at it” is a variant of an expression I often hear in my work in health communications consulting and training. Organizations seeking to use the new tools and media employed by Facebook, Twitter, and YouTube genuinely want to “get in the game” and use them effectively. Where things get problematic is when I tell them that social media is principally about building relationships and that extends to organizations: you need to relate and therefore act according to how you build relationships.
Just as no one (at least no one I’ve met) would consider drawing up a flowchart and showing a prospective mate the planned trajectory of their dating relationship with milestone targets and deliverables, no organization should think that they can just shovel content to people and expect their audience to relate better to them.
At first one might attribute this to a lack of understanding of social media, but that is only a small part of it. Empathy is another. But the third and perhaps biggest reason is a fundamental lack of understanding of complexity and what it means.
The seductive nature of the “best practice” and the prescription for change in 5,7, 10, 12 or whatever easy steps is something that is endemic in our society. These forms of thought suggest a linear trajectory of events, suggest an ability to control for externalities and parse out their impact, and provide a prescriptive solution that removes much of the worry about unknowns. But H. L. Mencken’s often quoted phrase (which I’ve used often) suggests the folly in this.
Simplicity is another way to get around complexity. It is something sought, but rarely achieved in its application to the lived reality of the human condition, and although much discussed it hasn’t been widely achieved as a means of policy effectiveness. The reason lies with the nature of complexity itself and its resistance to reductionism. Evidence from biology through psychology (see previous links for examples) points to the considerable problem that science has with applying linear modes of thought and inquiry to complex systems.
The problems here are multifold and complicated, if not complex.
1. Our education system is designed for linear, progressive modes of learning not discovery and non-linearity. We sit kids (and adults) in rows, we talk at them, we present material front-to-back. In short, we don’t design education for learning, but for knowledge transmission. Complexity is all about learning. Every situation has a degree of novelty to it that presents new challenges and what happens today might not be the same thing that happens tomorrow even if much is similar. Teaching to discover, adapt, play and risk is something our system doesn’t do well. How can we expect complexity and systems thinking to thrive when the muscles used
2. It’s more convienient to think in dichotomies than spectrums. As I’ve written previously, spectral thinking is something critical to many of the issues we face in complex systems. Good/bad, strong/weak, X/Y lose their meaning in complex environments where there is a. Of all the dichotomies that work, only Ying/Yang comes close. But its a more difficult concept to grasp that maybe things aren’t all one way or the other, that there is use in even something that isn’t well constructed. This problem (and the ones that follow) are tied to the first one: education and learning systems are not set up for this. We are primed for either/or thinking. Think in criminal justice terms how easy it is to demand harsh punishment for criminal acts without considering that the perpetrators are human too, even if their behaviour is unacceptable.
3. Our decision-making tools are ill-equipped to handle ambiguity. Health care is a great example of how badly we do at complexity thinking. Consider the systematic review, often viewed as the gold standard for evidence for adoption into healthcare organizations. If it has a good systematic review, then the chances that we will see that evidence translated into practice is good, right? No. Surprisingly, even systematic reviews of systematic review use shows a mixed bag in adoption. Systematic reviews are designed to reduce ambiguity, but (for those on human social systems at least) they only illustrate how much there is. A systematic review only looks at the evidence created, it doesn’t include all those questions that were never asked, never funded for inquiry, or couldn’t be structured in a manner that fits the criteria for a good review. It is, by its design, reductionistic in its approach to complexity.
4. Our institutions are resistant to complexity. Complexity takes time, nuance, and relationship development; all the things that screw up plans. You can’t plan a relationship, but you can anticipate some things. You might even be able to use scenario tools and strategic foresight methods to anticipate what might happen, but you can’t plan it. John Lennon is right:
Life is what happens when you’re busy making other plans
While we plan, the complex systems move along. We can plan and fail, fail and plan, or plan to fail and work build the strategic foresight to know what to do with these “failures”.
So now what? Being aware of these things is a start, but making systems change is really the key. Making change is about questioning the way we have been taught to learn, and what our assumptions are about the universe are. Learning the difference between a simple, complicated, complex and chaotic system and the means to identify when those systems present themselves (and how they often change) is another. This means finding like minds, sharing stories, and building networks. It means creating space for relationships — even in our linear planning models if we must keep them (or better yet, get rid of most of them) — and considering what kind of returns we get from paying attention, being mindful of our systems, and what kind of things contemplative inquiry might offer that simple, detached data analysis does.
These are starting points, but not all of them. Addressing the challenge of complexity is, ironically or perhaps appropriately, complex. But the challenge of dealing with the negative outcomes resulting from overly simple approaches to dealing with complexity will ultimately be far more so.
Creating Campires For Innovation and Knowledge Translation
Posted: June 21, 2011 Filed under: complexity, environment, innovation, knowledge translation | Tags: campfire, collaboration, communication, complexity, design, intimacy, knowledge translation, meditation, storytelling Leave a comment »A campire has been a beacon for human life for centuries and may provide the ideal analogy and literal tool to engaging people in creating new things. The opportunities for it to shape our thinking and actions is enormous.
The campfire is a place where we go for warmth, intimacy, safety, light, food and inspiration. As camping season comes upon us in the Northern part of the Americas, it seems fitting to consider the ways that the campfire might be used to stoke the sparks of imagination and flames of passion (pun firmly intended).
Metaphors and analogies are commonly used in systems thinking and complexity science to illustrate concepts that are, on their own, relatively complex and awkward to describe literally. A campfire provides both a metaphor for bringing people together, but also a literal tool that could be used more effectively in work with groups struggling to innovate, collaborate and contemplate together. From a design perspective, campfires and the social system that they create around them provide an opportunity to enhance intimacy quickly, allowing for the potential to explore issues in ways that are more difficult to do in other settings.
Consider some of the following properties of the campfire.
Lighting has been found to have a strong environmental effect on many behaviours and moods, and the type of inconsistent light that is thrown by a campfire is similar to that which induces relaxation and intimacy (PDF).
It can be argued that storytelling has been our most powerful vehicle for sharing what we know throughout human history. Research on narrative effectiveness has found that emulating the environments created by a campfire (PDF), the close-in, small-group, open dialogue sharing kinds of spaces, leads to more effective communication in business contexts.
The sensory richness of a campfire — the smell of wood and smoke, the crackle, the sight of sparks and flame, the feeling of heat — all create an environment that differs from much of what we are used to, provoking psychophysiological stimulation that has been associated with learning outcomes. Research linking environmental design and architecture has explored the phenomenon of sensory richness and how modern designed environments reduce this and (potentially) limit learning. (See program example here).
Another quality of a campfire is that it creates space for meditative inquiry. Anthropologists and psychologists have speculated that it was the campfire and the meditative rituals that it created that led modern humans to separate from Neanderthals. The focus on something like a fire draws attention away from the chaos of the world and channels into a circle that is generated through the campfire.
One of the benefits of a campfire is the circle that it creates. Leadership scholar Meg Wheatley, Christina Baldwin and Ann Linnea reflected on their use of the circle and how it has been used historically as a means of creating a common space where participants are on more equal footing with one another as a means of leadership promotion. In a circle, everyone can (usually) see everyone else and no position is held as more important than others, which privileges all participants and not just some.
Lastly, the campfire creates not just internal peace, but social intimacy as well. Indeed,modern social media has been compared to the campfire (PDF) in its ability to potentially replicate the focused, shared space that a campfire occupied for much of human life. For the reasons listed above, the social media effect is likely limited, but nonetheless the metaphor may partly hold in light of a lack of alternatives.
In practice, lighting a chord of wood in the middle of an urban setting might be problematic, but it is worth considering for those of us looking to create those social spaces where people can gather. Taking a break and leaving town might be worth doing as well. Failing that, what are the campfire-like spaces that we can create with what we have.
Designers, health promoters or anyone seeking to bring together ideas while working in complex spaces may wish to give this more thought — or meditate on it, which might (as it has done before) spark a new evolutionary shift attributed to the campfire.
Complexity and Innovation: Lessons from elBulli
Posted: June 3, 2011 Filed under: complexity, innovation | Tags: complexity, creativity, innovation, restaurants, service industry Leave a comment »Good chefs know a lot about innovation in complex environments as they prepare meals for their customers. We can learn a lot from watching what they do and how they do it.
There is a renaissance in the food industry that is underway where local, seasonal foods and attention to regional specialties are replacing a homogenous generic set of flavours and dishes. Yes, we still have our fast food chains, but traveling to different cities in North America, it is refreshing to see that difference is beginning to replace the same-old-same-old. While there are arguments to made for how local food positively impacts flavour, economic development, sustainability and environmental responsibility, one positive is not efficiency. Cooking local, organic or ethically all add layers of complexity to meal planning and preparation as certain foods are simply not alway available and some require serving in very small windows of time.
For these reasons, chefs and their kitchens are ideal case studies for innovation and complexity.
Perhaps nowhere is this more true than at elBulli, the restaurant often considered to be the best in the world with its chef, Ferran Adria, considered to be the best as well.
Chef Adria was recently interviewed for the Harvard Business Review where he spoke of the innovation process at elBulli and how that applies beyond the kitchen. In that interview, he places a high value on the concept of creativity and how it is nurtured through teamwork. When asked about how this collaboration and creativity produces innovation, Adria replies:
First, if it opens a new path, and second, if it excites you.
That second part is what excited me (after opening a new path, so I guess this interview was innovative!) is the emphasis on personal engagement. Yet, this engagement also requires collaboration with others who think differently. Complexity requires exposure to diverse perspectives to address issues sufficiently and to this end, Chef Adria clearly advocates for going beyond the discipline:
It’s also very important to be connected to other disciplines: the world of art, of design, of science, of history. When an architect designs a building, he has to work with engineers and people in new technologies. It’s the same in cooking. We need experts in other fields. We turn to science, for example, to explain the “why” of things. Exploring and getting to know things is fundamental to ensuring that you don’t shut yourself off in your own little world.
The other key ingredient in this chef’s innovation pantry is focus and attention. Through the interview and others I’ve read of him, I see great attention towards the craft of cooking and keeping mindful attention on the task and doing it with a team.
It’s like any work. You need concentration and professionalism. And it’s very important to have passionate people with their own imagination. I’m the boss, and I pick the best team. We have 40 people in the kitchen and five managers with a great deal of focus. Everyone participates. And you create an environment that gives them space and the sense that they’re taking part in something very important. You can only improve the ones who are already good; you can’t do anything with the bad ones. Talent and capability lie with the person, not with the teacher.
The last point is worth noting too: teachers aren’t everything. I’ve been critical of our teaching environments and the way we structure formal learning as being too teacher and curriculum-centred and not creativity centred.
Finally, Adria emphasizes taking time to learn and integrate. Even when a famous restaurant that is open only 6-months a year, the creative pressures are still too much. More is needed. So, elBulli is closing. When asked why, Adria stresses the following:
The pressure to serve every day doesn’t offer the kind of tranquillity necessary to create as we would like. For the model we’ve had, six months a year was sufficient, but our new format will require a different focus. The most important thing is to leave time for regeneration. It’s important to “oxygenate” ourselves a bit—to let ourselves recycle and to adapt our vital and mental rhythms to a new set of demands.
In the health sector, we do the opposite: cram as much in as possible, despite the health implications.
So perhaps there is even more we can learn from the restaurant business and its lessons for innovation. Time to start cooking.
** Photo Cooks in an Italian Restaurant Kitchen, 1959 from Seattle Municipal Archives
The Momentum Problem in Developmental Design and Evaluation
Posted: June 2, 2011 Filed under: complexity, design thinking, evaluation, innovation, systems thinking 1 Comment »Developmental projects evolve at a pace that suits them, but what happens when the speed and pattern of this process collide with the other projects in life?
The concept of developmental evaluation and developmental design resonate with a lot of people working in social innovation, public health, and international programming. The reason is that, despite the wealth of planning frameworks available and the logic that is embedded within them, the world doesn’t really work according to plan.
As Colin Powell once said (paraphrasing another famous military leader):
No battle plan survives contact with the enemy
While we may accept this as common and expected among our programs, it doesn’t make adapting to these circumstances any easier. And, true to complexity, the more elements added to this mix, the more unpredictable and non-linear things get.
For developmental evaluators, this non-linearity and complexity is part of the job, but when you’re working on multiple projects, that job becomes more challenging to do. When you are a program manager responsible for budgets, ensuring that you have the right staff, accounting for the delays and system dynamics associated with your program delivery is an enormous undertaking and can by itself shape the program that is actually delivered. One can’t justify keeping a staff member on to wait for things to happen; most of the time that person is found other things to do in the interim. However, those “other things” lead to a fragmented attention on what is going on with the program.
Multiply this by manyfold, and you have a truly complex problem affecting a complex program.
What does this mean for a developmental design and evaluation? My motivation for writing this post is to solicit ideas and stories about this problem set and explore some potential solutions. While I personally struggle to maintain the focus and momentum on projects that have extended lags, unpredictable or spontaneous patterns of activity, I know that many of those lags are partly affected by those running the programs having other things on their plate. Its a compounding problem. One person experiences a delay, occupies time with other things that take them away from the project, which create further delays with other elements of the program and so on.
From a design standpoint, this is less problematic. These delays can spur creative reflection and action towards generating a product if the time away from action is used for such mindful attending to ideas.
For developmental evaluation, this is slightly more problematic as the event-process-effect links that we seek to connect together become harder to disentangle. Non-linearity doesn’t mean that there is no such thing as cause and effect. It is just that there are consequences arising from events that are nearly impossible to trace back to a single “cause” (which may not exist), but nonetheless, something does happen that sparks other things. The more one can attend to such things, the better quality the evaluation.
Yet, I argue that the very complexity of the programs require more not less attention when doing evaluation lest we become simple storytellers. We offer more than that. But to do that well requires a sustained level of attention to the dynamics and what we might call paying attention to the silences to glean lessons from non-action that might have significant impact on our programs. This also requires not “filling the time” when things are quiet, but remaining active. Anyone who practices mindfulness meditation knows that non-doing requires a lot of work!
This sounds nice, but how practical is it? And how do we set benchmarks of sort to evaluate the silences and justify such active work in times of quiet? Or do we simply ride momentum like others and hope that we can pick things up when the momentum is high?
Photo Speed of Sound by Ana Patricia Almeida used under Creative Commons License from Flickr
Branded Knowledge: Does This Make Sense for Health?
Posted: May 23, 2011 Filed under: complexity, knowledge translation | Tags: brand, branding, complexity, health, health care, knowledge translation, marketing, public health Leave a comment »Commercial products relying heavily on branding to entice their purchase and use in a crowded marketplace. Is this something that the health sector should consider and, if so, what might it look like?
I’ve just spent a rare free weekend in Chicago walking around, taking in the sights, and doing what a lot of other people do when they travel to another country or city: shop. It is hard to avoid some shopping when down in the Loop on Saturday or Sunday as that is what much of Chicago’s core is made for. The same can be true of most major centers, if you exclude the office buildings that are often semi-vacant on weekends.
A brief tour of many of the shops, from the discounters (Filene’s Basement, TJ Maxx, and Nordstrom Rack) to the mid-range stores (Macy’s) to the higher end department stores (Nordstrom) and the many boutiques, one is easily amazed by the abundance of goods on sale. But what intrigued me as I stood and watched what was around me was that many of the branded goods available at all of these places (including many of the boutiques) were the same. Big names in fashion were at all of them. And the products themselves were virtually indistinguishable from one another except for 1) price and 2) seasonality.
The first is perhaps the most obvious, but as one who is not as attuned to the seasons in fashion beyond the warm-weather/cold weather distinction as many, it the second part that I find most interesting. What makes last year’s $150 pair of Lacoste sunglasses worth $25 this year is nothing other than its seasonality. In other words, they are last year’s model and no longer as coveted.
It struck me that we do this in the health sciences all the time. If your reference list isn’t up to date, people question the sources and the validity of the findings. While probably appropriate for work in basic and clinical sciences, it seems less true for health promotion. It also seems less appropriate for areas where there is great complexity.
Brands also matter with regards to where something is published. A premium is placed on scholarly work that is published in journals with high impact factors over those that are in lesser-known journals. The underlying assumption here is that the more people cite something and the more we believe a source to be high quality the higher the quality the knowledge. The strength of the brand of sources like JAMA, Science, the New England Journal of Medicine and the Lancet exceed the rest of the health field.
While this respect for such “brands” sounds reasonable, there are many problems associated with it. Most notable among these is that they publish a certain type of knowledge in a particular format that adheres to particular models of discovery and rewards particular ways of expressing information. This has advantages, but it also creates path dependencies that shape knowledge itself and restrict the sharing of other forms of knowledge. In doing so, there is some assumption that the “best” knowledge (i.e., that which fits with the brand) looks a certain way and fits a certain way.
An alternative is to create different brands, just as we see in the marketplace for clothing and other retail goods. Apple, once a brand favored by a small, but fervent group of supporters in the early 80′s, is now the world’s most valued brand. It was the small, scruffy underdog and now is the leader. The same might be said for other forms of knowledge. If we were to package health promotion into a form that had the same appeal as other sources, could we create a demand and cache for it in a manner that drew people to it? And would this be a good thing?
I’m not sure. But I do believe it is possible. A colleague of mine once did a study looking at factors that predicted uptake and citation of research knowledge in a particular domain by looking at study qualities across a number of dimensions including design, home institution, discipline and others. After all was considered only one factor predicted uptake: the study used an acronym. Yep, if you branded your study it was more likely to achieve uptake than if you didn’t. To my knowledge this data was never published, presumably because it was so embarrassing to us scientists as it provided evidence that evidence isn’t just what drives our work. Whether it holds over time is worth considering, but it does suggest that brands might matter.
Marketers and companies work hard to distinguish themselves in a crowded marketplace. In a world where there are literally tens of thousands of venues for publishing our findings that are chosen every week, the market is filled. And do we want to rely only on the big brands to fill our knowledge? If so, we run into the same scenario as I did shopping by seeing the same brand everywhere and, because of that, seeing its value discounted because there is so much of it and it expires quickly.
The comparison is not perfect, but neither is it outrageous. Could branding knowledge and knowledge translation be coming to an inbox, book, or library near you?
Creative Intelligence or Design Thinking?
Posted: April 13, 2011 Filed under: art & design, complexity, design thinking, innovation, research, systems thinking | Tags: creativity, design science, design thinking, research 4 Comments »
Design commentator Bruce Nussbaum shook up the world of design thinking this week arguing that it is a “failed experiment” and that Creative Intelligence is an appropriate term to replace it. What might this mean for design and its increasing role beyond its traditional boundaries?
Reading the blogs (and comments) at FastCo Design this week it would seem that anyone invested in design thinking might want to take cover. Design thinking apparently has jumped the shark and is, as Bruce Nussbaum claims, a failed experiment. In its place should be creative intelligence, a process that Nussbaum describes as:
I am defining Creative Intelligence as the ability to frame problems in new ways and to make original solutions. You can have a low or high ability to frame and solve problems, but these two capacities are key and they can be learned. I place CQ within the intellectual space of gaming, scenario planning, systems thinking and, of course, design thinking. It is a sociological approach in which creativity emerges from group activity, not a psychological approach of development stages and individual genius.
This proposal comes from a visible frustration with the way in which design thinking has been taken up as a tool with the critical component — creativity — left out in the cold.
Nussbaum’s rally against design thinking has not to do with its successes (in which he outlines many, including the widespread application of it to service and non-profit development), but rather where it becomes a barrier and where it fails to deliver:
But it was creativity that Design Thinking was originally supposed to deliver and it is to creativity that I now turn directly and purposefully. Creativity is an old concept, far older than “design.” But it is an inclusive concept. In my experience, when you say the word “design” to people across a table, they tend to smile politely and think “fashion.” Say “design thinking,” and they stop smiling and tend to lean away from you. But say “creativity” and people light up and lean in toward you.
Nussbaum clearly struck a chord with many. Within hours of the article being posted, dozens of comments were posted to the site, with most favouring the cause of creativity over design thinking.
Frog Design‘s lead on health projects, Robert Fabricant, weighed on this issue as well with another FastCo Design post comparing CQ to Wile E. Coyote’s efforts to get the Roadrunner, speculating that CQ may not fare much better than design thinking in the long run if not applied strategically:
Creativity is generally viewed as an inherent quality within a person; there’s a notion that you find out early in life whether you are creative or not. How many times have you heard a business person say “I am not creative” in a meeting? The concept of “Creative Intelligence” (or CQ) extends that model by implying that our level of creativity can be assessed in a quantitative manner similar to an IQ score. By bringing creativity into the sphere of assessment, I fear that CQ will ultimately suffer a similar fate as Design Thinking.
Fabricant worries about the institutional co-optation of the term CQ much as design thinking was/has/is by many in the business world.
While I respect the efforts to extend the creative power of design beyond the confines of mere terms, the rhetoric of pro- or anti-design thinking has already left me exasperated. It is evident that many are dissatisfied with what design thinking hasn’t brought and how it has been used, but my concern is that we may be throwing the baby out with the bathwater and undoing the good it has done by claiming such things as it being “a failed experiment” .
I argue that it never had the chance to be fully implemented in the first place, nor have we ever raised it to the level where any scientist (behavioural or otherwise) could claim an experiment ever took place. I’m nit-picking the words because that is exactly what the design thinking critics have done, but in this case I am arguing for more research not a new term.
Design practitioners and scholars may wish to consider the answers to the following questions before closing the book on design thinking:
- What are the central theoretical foundations of design thinking?
- How does design thinking map on to what is known about how people change their behaviour? or organize in groups, teams and communities?
- In what ways does the science of complexity and system dynamics fit with the design process?
- What are the personality and delivery variables that influence an acceptable facilitated design process?
- What is “success” in a design thinking intervention?
None of these questions have been answered. Books have been written, talks have been given, and magazines fill themselves with articles on design thinking, yet in all my intellectual travels I have not found answers to these questions. As a behavioural scientist and emerging design practitioner myself, I would rather know these answers before making such claims to abandon the idea.
Further, the concept of CQ is, as Robert Fabricant noted, fraught with pitfalls ahead. Every time a new “intelligence” is introduced, the rush to assess it, measure it and teach it produces a wave of scholarship aimed at tree-loving rather than forest appreciation. Where I think design thinking could have gone further was not so much in instilling/harnessing/discovering creativity, rather in getting people to consider the systems that people fabricate to do creative work in.
It is perhaps ironic that in a week where design thinking is under attack in the social media world that FastCo Design’s parent, Fast Company, published an interview with one of the founding fathers of the concept, David Kelley of IDEO on designing better workplaces and workforces. In that interview, he frames design thinking in a process and outcome that is worth listening to for those interested in adding to the science of design thinking and how to make these better environments:
The main tenet of design thinking is empathy for the people you’re trying to design for. Leadership is exactly the same thing–building empathy for the people that you’re entrusted to help. Once you understand what they really value, it’s easy because you can mostly give it to them. You can give them the freedom or direction that they want. By getting down into the messy part of really getting to know them and having transparent discussions, you can get out of the way and let them go. The way I would measure leadership is this: of the people that are working with me, how many wake up in the morning thinking that the company is theirs?
I welcome more discussion on CQ and believe anytime creativity is bared for people to explore and nurture society benefits. But the risks of abandoning one idea without science to create a new one is that design’s influence itself might wind up the victim. Creativity is an old concept and many disciplines hold it as part of its central tenets and design risks losing the good in design thinking while reaching too far into creativity unless it has the science to back it up (see an interesting link between science and design in this month’s Metropolis magazine — that’s for another post)
Of the few that have managed to traverse this area between design, creativity, and science is Keith Sawyer at Washington University in St. Louis. Check out his books on the subject.
**Photo entitled “Is the traditional business world at war with creativity?” by opensourceway used under Creative Commons license from Flickr
Design and Health Promotion
Posted: March 5, 2011 Filed under: complexity, design thinking, food systems, health promotion, public health, systems thinking | Tags: design, food security, health promotion, public engagement, public health, tobacco control Leave a comment »If everything humans create is designed then bringing design into the conversation about human health is imperative. It is a wonder that the world of health and that of design seem so far apart.
Seth Godin, the plain spoken entrepreneur and source of much personal inspiration, released a new book this week. It’s a non-traditional format being offered through Amazon and designed more for small-bursts of reading, linking and digital consumption than a traditional book. In Poke the Box and the accompanying (free) workbook, Godin demonstrates as he has many times before the power of generosity and knowing your audience — building relationships with them – as a key to success in turbulent times.
I mention him because his key message is that the world is changing fast and we have to adapt, change our business models, take risks, and do things different (and consciously) lest we have change thrust upon us. Seth’s message is: design your future or have it done for you.
Our health systems are in this state right now. I use systems in plural because the most common thing that people think of when I say that I work on issues of health is the health care system. I work in health promotion — that branch of public health that seeks to keep people healthy, prevent illness, and design ways to help everyone achieve their best. I use design here consciously, because much of what health promotion does is seek to shape the conditions in which health is created, maintained or compromised – even if that word isn’t used explicitly. Many of these are what are called the social determinants of health. These include one’s level of education, race, relative income, employment opportunities, and access to health care, among others.
Yet, design is a foreign concept in public health. To many of my colleagues, design is something related to product development or something to that extent. Even as public health begins to embrace art as a means of engaging people, design and design thinking remain somewhat unknown. This is in spite of the fact that much of what public health does is design-oriented; it is the conscious shaping of settings, conditions and human activity to promote health and protect people from harm.
I’ve often said that my course on health behaviour change is about training public health professionals on ways to overcome bad (unhealthy) design in our communities, policies, and programs.
What I have been seeking to do is introduce the concept of design to a wider audience within the health professions and have been pleased with the early uptake. Speaking with colleagues in a variety of public health areas, there seems to be a growing discontent with the way things are being done and how our programs and policies are being created. The idea of engaging the public is something not unfamiliar to public health, yet it is something done out of a sense of values and respect, and less about purposive design. What health promotion adds is its explicit statement of values, while design adds value through its conscious application of strategic planning to the creative process.
There is a growing movement of design for health, including: conferences devoted exclusively to this idea, the engagement of major design firms in the development of health care institutions, and international health programs focused on better design. While exciting, these initiatives focus on either health care or product support for health promotion and very little on the social development of healthful conditions.
While designers have taken to contribute to social determinants like education, there has been much less attention paid to the ways in which people learn, the sources of that knowledge, who accesses education in the first place, and the literacies required to fully benefit from modern information production landscapes. This is the domain of health promotion. It is also where we can make the most impact.
Consider something like tobacco use, where more than 500 million people alive today are expected to die from it. From the cigarettes themselves to the ways in which they are used, sold, regulated and marketed are all designed solutions.
We are on the cusp of major food price increases and potential shortages on a global scale. How we address these problems in ways that don’t exacerbate the gap between the rich and poor or create further unintended consequences is important. Without consideration of the ways we design our markets, our policies and the opportunities for people to engage in the decision making process, the creation of the solutions, and the discussion about what not just how such interventions can instill health we are losing an opportunity to get the best of design into health.
At the same time, we need design to go beyond simple end-user participation into true engagement with the public on a level that goes beyond strategy and tactics and more towards values.
Complex problems like chronic disease, health inequity, access to health care, civic engagement, global migration, and food security are ones that require a diverse set of perspectives, abductive (design) thinking, systems perspectives and ways to bring them all together. Design is a way to do that. Health promotion, rather than health care is the focus that will get us from treating problems to developing solutions.
** Photo – Health Sciences – by D’Arcy Norman (no relation) used under Creative Commons License via Flickr









