Design (re)Thinking Health Systems
Posted: May 10, 2013 Filed under: design thinking, knowledge translation, public health, systems thinking | Tags: design thinking, gigamapping, global health, health and wellbeing, health systems, Julio Frenk, knowledge translation, public health, science, system dynamics, systems thinking, visual thinking Leave a comment »
How might we design health systems to promote health and wellbeing and not just treat illness and disease and manage infirmary and chronic conditions? What if health systems were about health?
If we were to apply design thinking to health systems, what might be do?
In a previous post, I suggested that knowledge translation is too important to be trusted solely to health professionals, partly because they have largely failed to take up the charge. Taking a step back — a systems thinking perspective — one realizes that to design better knowledge translation, we need to design better health systems.
Julio Frenk, Dean of the School of Public Health at Harvard, believes this too. In a 2010 paper published in PLOS Medicine, Frenk comments on the state of health systems and examines how we might re-think them in light of global health challenges.
Health systems are the main instrumentality to close the knowledge–action gap. To realize this potential, it will be necessary to mobilize the power of evidence to promote change. Yet all too often reform efforts are not evaluated adequately. Each innovation in health systems constitutes a learning opportunity.
Frenk’s article is an invitation to engage in systems and design thinking about health. Both approaches invite pause to consider what the problem is in the first place. For design thinkers, problem scoping is the first step.
For systems thinkers this is akin to setting the boundaries around the problem.
Once we set the boundaries and find the appropriate problem, we then frame it appropriately for design. Problem definition is something often over-looked or under appreciated, but is the core of effective problem solving and design.
If I had an hour to solve a problem I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions – Albert Einstein
Health systems are typically defined in light of professional services and policies aimed at making the sick well. They are essentially illness and disease (sick care) systems. This conceptualization, still dominant in the professional and policy discourse in many Western countries, places medicine at the centre of health services with the allied disciplines working alongside, but rarely ventures its gaze beyond the institutions of care or the conditions such institutions are designed to treat.
Frenk, writing in PLOS Medicine, suggests its time to expand our view of what makes a health system if we are to truly promote and sustain global health and see three key points as provoking such re-thinking:
First, health has been increasingly recognized as a key element of sustainable economic development [1], global security, effective governance, and human rights promotion [2]. Second, due to the growing perceived importance of health, unprecedented—albeit still insufficient—sums of funds are flowing into this sector [3]. Third, there is a burst of new initiatives coming forth to strengthen national health systems as the core of the global health system and a fundamental strategy to achieve the health-related Millennium Development Goals.
In order to realize the opportunities offered by the conjunction of these unique circumstances, it is essential to have a clear conception of national health systems that may guide further progress in global health.
Frenk offers some suggestions:
Part of the problem with the health systems debate is that too often it has adopted a reductionist perspective that ignores important aspects. Developing a more comprehensive view requires that we expand our thinking in four main directions.
First, we should think of the health system not only in terms of its component elements (like human resources, financing, hospitals, clinics, technologies, etc.) but most importantly in terms of their interrelations. Second, we should include not only the institutional or supply side of the health system, but also the population. In a dynamic view, the population is not an external beneficiary of the system; it is an essential part of it.
It’s important to note the mention of the role of the population and its dynamical impact on the system. As populations change dramatically in their composition and form of residency within countries, including a greater movement to urbanization, so too will the myriad factors that influence health systems. The people are the system and thus it will change as populations change. While Frenk lists this as one point of many, it is a radical departure for reductionists or those who see health systems as being about care, not people.
A third expansion of our understanding of systems refers to their goals. Typically, we have limited the discussion to the goal of improving health. This is, indeed, the defining goal of a health system. However, we must look not only at the level of health, but also at its distribution, which gives equity a central place in assessing a health system. In addition, we must also include other goals that are intrinsically valued beyond the improvement of health. One of those goals is to enhance the responsiveness of the health system to the legitimate expectations of the population for care that respects the dignity of persons and promotes their satisfaction. The other goal is fair financing, so that the burden of supporting the system is distributed in an equitable manner and families are protected from the financial consequences of disease.
Frenk’s third challenge is to affirm the very point of health systems at all.
While not explicitly speaking of systems thinking or design thinking, there is much that both fields have in common with Frenk’s argument. Design thinkers might ask: What have we hired our health system to do?
Frenk argues that our health systems must go well beyond just making gains in measured health outcomes towards dignity, respect and social justice.
Finally, we should expand our view with respect to the functions that a health system must perform. Most global initiatives have been concerned mainly with one of those functions, namely, the direct provision of services, whether they are medical or public health services. This is, of course, an essential function, but for it to happen at all, health systems must perform other enabling functions, such as stewardship, financing, and resource generation, including what is probably the most complex of all challenges, the health workforce.
Frenk did not identify specific solutions, but did pose some key questions for health systems design.
If we were to take this challenge up as designers and systems thinkers, what might we do? Here are some suggestions for inquiry:
- Consider new definitions of health like the one posed in the British Medical Journal that emphasizes looking at the social and environmental influences on health beyond just the absence of physical symptoms. Further inclusion of a psychology of human flourishing might add to this definition.
- Map out a new system visually with people at the centre, not professionals or institutions. What does that look like? Tools like a Gigamap might provide the kind of multi-media, multi-sensory visual way to conceive of the interrelationships that make up health system. System dynamic models can help this out as well.
- Engage people across this system to validate this map and co-create possible future models that could serve to shape discussion at multiple levels and mobilize civil society to support healthy environments.
- Create small scale, safe-fail / fail-forward, prototypes of small-scale innovations that can be tested, developmentally designed, and rapidly re-developed as needed to start shifting the system as a whole.
Designing health requires designing health systems. Applying new thinking and envisioning a system that is dynamic, comprised of people and just institutions is a start.
Photo: Bartolomeo Eustachi: Peripheral Nervous System, c. 1722 shared by brain_blogger used under Creative Commons Licence
Hacking the Classroom: Beyond Design Thinking
Posted: April 6, 2013 Filed under: design thinking, education & learning | Tags: creativity, design, design thinking, education, hacking, learning, theory Leave a comment »
Design Thinking is trending is some educational circles. Edutopia recently ran a design thinking for educators workshop and I attended two great workshops at SXSWedu 2013 on Design Thinking:
Design Thinking is a great skill for students to acquire as part of their education. But it is one process like the problem-solving model or the scientific method.
Much Ado About MOOC
Posted: February 8, 2013 Filed under: education & learning | Tags: design thinking, disruptive innovation, education, innovation, learning, MOOC, Peter Thiel, teaching, university 1 Comment »
It’s fair to imagine that one of the 2013 ‘words of the year‘ will be MOOC (which is not really a word, but an acronym that stands for Massive Open Online Course). It seems that everywhere you look in the higher education and professional development space we are seeing MOOC’s talked about and debated.
HBR editor Eric Hellwig, writing for the HBR blog, reported on a recent panel on MOOC’s held at the recent World Economic Forum in Davos with leaders like Bill Gates, Peter Thiel and Larry Summers. His report reflects the exuberance of the MOOC and the techno-deterministic spirit of much of the discourse on these tools:
The advent of massively open online classes (MOOCs) is the single most important technological development of the millennium so far. I say this for two main reasons. First, for the enormously transformative impact MOOCs can have on literally billions of people in the world. Second, for the equally disruptive effect MOOCs will inevitably have on the global education industry.
One of the panelists was Stanford professor Daphne Coller, the co-founder of Coursera, one of the largest MOOC providers offering more than 200 courses to millions of students worldwide. Coller has convinced top faculty at leading universities to provide high quality digital courses through Coursera for free and the result has surprised her.
We’re at 2.4 million students now. The biggest lesson I’ve learned on this is I underestimated the amount of impact this would have around the world. I really didn’t envision this scale and this impact this quickly.
Disrupting Education
Of these panelists, Peter Thiel may be the most controversial. He has spoken at length about the need to revamp education and sees technology and platforms like Facebook as a means to do it. (It’s worth noting that Theil was also an early investor in Facebook). He points to the multiple roles that education plays well beyond learning and suggests that when we go beyond that goal we start creating false economies of value within higher education:
You have to ask yourself, ‘What is the nature of education as a good?’ Ideally you want it to be learning. But it also functions as insurance. Parents will pay a lot of money for insurance against cracks in our society. Education as insurance has something to be said because it connects to the economy. You know computer science, you can get a job. But education also functions as a tournament. You do well if you go to a top school but for everyone else the diploma is a dunce hat in disguise. People need to understand what they’re trying to do? Is it insurance? A tournament? Learning?
Among Thiel’s biggest concerns is with the current educational system’s ability to support the kind of innovative thinking needed to make technological and scientific breakthroughs. So steadfast is he in the belief that some of the best minds are rotting in traditional classrooms that he founded the Thiel Fellowship, a scholarship fund to support promising young entrepreneurs in dropping out of school to pursue their ambitions of making social impact.
Thiel is disrupting education by taking learning away from the educational institutions charged with providing it. MOOC providers are seeking to develop a business model that puts them in the drivers seat of education and learning, drawing potential revenues away from traditional educational institutions. This will no doubt add to the pressures that universities and colleges are already facing as they rationalize ever more of what they do.
Education For All, Learning For Whom?
Free online learning of the calibre provided by Stanford University, Caltech, Harvard University, University of Toronto, MIT, and the Santa Fe Institute for anyone, anywhere sounds like a dream come true.
In some ways it is. In others, it’s an illusion.
This comes back to the metrics we use in evaluating the impact of education and asking what its point is in the first place. What do we mean by learning and are we serious about it?
It’s been suggested that less than 10 per cent of those enrolled in a MOOC complete it. And of this 10 per cent, it isn’t clear what they learn, how well they learn it, and what kind of application (if any) that content is made to issues away from the course. Online courses with video tutorials, self-organized learning and largely uni-directional teaching bring together the best of former teaching methods like instructional TV, self-help, and classroom lectures.
The problem is that this ‘best’ isn’t particularly effective. A 2000 meta-analysis of distance instructional methods found:
There does not appear to be a difference in achievement between distance and traditional learners. Of the ten instructional features that were analyzed, only three had an impact on student achievement. These three features were type of interaction available during a broadcast, type of course, and type of remote site. There was an insufficient number of studies to ascertain whether or not the education level of the distance learners effected their achievement in the course (Machtmes & Asher, 2000).
While this review was done before widespread Internet use, the methods included reflected the same list above with one- or two-way audio and video. The studies were also done on programs that were designed for credit, not voluntary non-credit courses. Research on motivation will show that optional programs are far less likely to engender behavioural shifts than those that are mandated.
So who then is benefitting from MOOC’s? We don’t yet know, but it is likely those with time to attend to the content, high levels of intrinsic motivation (< PDF), the technological tools to succeed, and the environment that is ready to support integration of content into practice. That’s a tall order.
We are in the early days of MOOC’s and its too soon to tell how successful they will be. However, theoretically there is relatively little reason to expect that they will produce the kind of results worthy of hyperbole — at east not with those already accustomed to alternatives. To offer a MOOC from a world-class university to a learner somewhere in the world where education is but a distant dream achieves a great deal. But to transfer MOOC’s to replace more interactive and engaging methods — usually face-to-face — and expect great learning is a bit implausible.
Yet, with what we are offering now to students in the form of large classes, disconnected curricula, and didactic instruction MOOC’s offer an attractive option. What it loses is the experience of learning that is not packaged in a class. This means a change to campus life, the informal and serendipitous learning that comes from being in the same physical space interacting with each other, and may seriously limit the use of thinking and creative tools that design thinking and applied creativity demand. (for a detailed look at MOOC’s and the modern university check out Nathan Harden’s essay in the American Interest).
There is much ado about MOOC’s, but is this a Shakespearian tragedy in the making for learners?
Photo credit: iStockPhoto used under license.
The Job Market Metric In Education
Posted: December 30, 2012 Filed under: design thinking, education & learning, evaluation, innovation | Tags: complex systems, complexity, contemplative inquiry, continuing medical education, design thinking, developmental evaluation, disruption, education, educational design, evaluation, foresight, jobs, journalism, learning, learning organization, mindfulness, path dependence, professional education, resilience, teaching, university 2 Comments »
Post-secondary and continuing education is continuing to be rationalized in ways that are transforming the very foundation of the enterprise. Funding is a major driver of change in this field: how much is available, when it flows, where it comes from, what is funded, and who gets the funding are questions on the minds of those running the academy.
At the centre of the focus of this funding issue is the job market. Training qualified professionals for the job market in various forms has been one of the roles a university has played for more than a century. Now that role has become central.
Let’s consider what that means and what it could do in shaping the various possible futures of the university. This second in a series looking at the post-secondary and continuing education focuses on the metrics of jobs.
“What are all these people going do?”
The employability of graduates is now the holy grail of education industry statistics. Earlier this year I was sitting on the stage at an academic convocation with a senior colleague staring out at a sea of soon-to-be-graduates when he leaned over and asked the question quoted above. Staring at a sea of masters and doctoral graduates numbered in the hundreds and knowing that this ceremony was held twice per year, the question stuck and remains without an answer.
Maybe there were enough jobs for that cohort, but this process gets repeated twice each year at universities around the world and each year that I’ve been a professor those numbers (of graduates) seem to go up. Some of our programs in the health sciences are admitting three times the number of students than they were just ten years ago. There is much demand for education (as judged by departmental applications), but are there jobs demanding this kind of education in its current form?
Yes, the Baby Boom is moving into an age of retirement and increasing needs for health services, but do we need to graduate 80+ Physical or Occupational Therapists to meet this need this year? Do we need a few dozen more epidemiologists or health promotion specialists to add to the pool? How about psychologists or social workers: how many of those do we need? The answer from my colleagues in these fields is: We don’t know.
Chasing the Wind
Jobs are a red herring. It’s one thing to have a job, but is it the job that you trained for? (And is having that job even a reasonable goal?) Being employed is not the same as building a career. What if you were trained perfectly for a job that no longer existed? Imagine a Blacksmith in the 20th century or a Bloodletter. These questions are not asked, nor is much asked about quality of education relative to the pressures of recruitment, cost-cutting and educational rationalization. Most of us don’t know what quality education is in real terms because we are measuring it (if we are measuring anything at all besides jobs) by standards set for the jobs of the past, not the future (or even the present?).
“Skate where the puck is going, not where it’s been.” – Wayne Gretzky
Jobs are living things and very few in 2013 will resemble what they did even 10 years ago. The citizens of the developing world are entering this rapidly changing job market ready for change (See also McKinsey Global Institute report on future of work in advanced economies) because they don’t have the old ways to rely on. They are primed for change and if professional education is to meet the needs of a changing world, it needs to change too. It means getting serious about learning.
If education is rationalizing itself to focus more on jobs, then it also needs to get serious about clarifying what jobs mean, defining what ‘success’ looks like for a graduate, and whether those jobs are designed for where the proverbial puck is now or for where it is going.
Disruptive Learning / Disturbed Education
“The Only Thing That Is Constant Is Change -” ― Heraclitus
I’ve pointed out that learners have an uneasy relationship with learning principally because it means disrupting things. This is a topic I’ll be covering in greater depth in a future post, but if one considers how our social, economic, and environmental systems are changing it is not unreasonable to call this the age of disruption .
Change in complex systems is often logarithmic, not linear. It may be massively punctuated like a Lévy Flight or it could be closer to a random walk. In environments with a change coefficient that is large the level of attention must be more fine-grained than 5-year reviews. It requires developmental evaluation methods and learning organizations, not just conventional approaches to generating and assessing feedback. It requires mindful attention and contemplative inquiry to guide a regular reflective practice if one is to pay attention to the subtleties in change that could have enormous impact.
For example, if journalists and news media waited every five years to assess the state of their profession, they would have missed out on Twitter and come late to blogging, two of their (now) powerful sources of competition and tools of the trade. Some have waited, which is why they are no longer around. Metrics for journalism education today might consider the amount of exposure and proficiency in social media use, digital photography, use of handheld tools for communication, and real-time reporting skills. Metrics of the past might focus on newspapers and radio broadcasting. Which mindset, skillset and toolset would you rather be trained in today?
Questions for educators, learners (and evaluators):
Whether health sciences, journalism, human services or any field, what might some questions be that can help determine the role of job training in professional education? Here are five starters:
1. What is the state of your profession right now and are you training people for existing in this state? Are you preparing people for the next evolution?
2. Where is your field of practice going? What are the possible futures for your profession in the next 5, 10, and 20 years? Will it still exist? Are you a blacksmith looking for more horses in the automobile age or Steve Jobs waiting to attract people to a new graphical user interface?
3. Is your mindset, skillset or toolset in need of re-consideration? Does it still do the job you’ve hired it to do?
4. What do people need that your skills can help with? What unfilled needs and expectations are there in the world that your mindset, skillset and toolset could solve?
5. What would happen if your field of practice disappeared? How else could you apply what you know to making the contribution you wish to make and earn a living? What other skills, tools and ways of thinking would you need to adapt?
Design thinking can greatly help shape the way that one conceives of a problem, works through possible options, and develops prototypes to address the needs of the present and the future. Foresight methods help lay additional context for design and systems thinking by providing ways to anticipate possible futures for any given field. Lastly, knowing what the state of things are now and how they got to where they are now can help determine the path dependencies that education may have fallen into.
We can’t change what we don’t see and better foresight, hindsight and present sight is critical to better ensuring that education outcomes are not imagined, but based on something that can actually improve learning.
Evaluating Social Innovation For Social Impact
Posted: November 15, 2012 Filed under: complexity, design thinking, education & learning, emergence, evaluation, knowledge translation, systems thinking | Tags: design, design thinking, developmental design, developmental evaluation, evaluation, evidence, Helsinki Design Lab, knowledge exchange, knowledge translation, research design, research methods, social impact, social innovation 1 Comment »
How do the innovation letters line up?
Earlier this week I has the pleasure of attending talks from Bryan Boyer from the Helsinki Design Lab and learning about the remarkable work they are doing in applying design to government and community life in Finland. While the focus of the audience for the talks was on their application of design thinking, I found myself drawn to the issue of evaluation and the discussion around that when it came up.
One of the points raised was that design teams are often working with constraints that emphasize the designed product, rather than its extended outcome, making evaluation a challenge to adequately resource. Evaluation is not a term that frequents discussion on design, but as the moderator of one talk suggested, maybe it should.
I can’t agree more.
Design and Evaluation: A Natural Partnership
It has puzzled me to no end that we have these emergent fields of practice aimed at social good – social finance and social impact investing, social innovation, social benefit (PDF)– that have little built into their culture to assess what kind of influence they are having beyond the basics. Yet, social innovation is rarely about simple basics, it’s influence is likely far larger, for better or worse.
What is the impact being invested in? What is the new thing being created of value? and what is the benefit and for whom? What else happened because we intervened?
Evaluation is often the last thing to go into a program budget (along with knowledge translation and exchange activities) and the first thing to get cut (along with the aforementioned KTE work) when things go wrong or budgets get tightened. Regrettably, our desire to act supersedes our desire to understand the implication of those actions. It is based on a fundamental idea that we know what we are doing and can predict its outcomes.
Yet, with social innovation, we are often doing things for the first time, or combining known elements into an unknown corpus, or repurposing existing knowledge/skills/tools into new settings and situations. This is the innovation part. Novelty is pervasive and with that comes opportunities for learning as well as the potential for us to good as well as harm.
An Ethical Imperative?
There are reasons beyond product quality and accountability that one should take evaluation and strategic design for social innovation seriously.
Design thinking involves embracing failure (e.g, fail often to succeed sooner is the mantra espoused by product design firm IDEO) as a means of testing ideas and prototyping possible outcomes to generate an ideal fit. This is ideal for ideas and products that can be isolated from their environment safely to measure the variables associated with outcomes, if considered. This works well with benign issues, but can get more problematic when such interventions are aimed at the social sphere.
Unlike technological failures in the lab, innovations involving people do have costs. Clinical intervention trials go through a series of phases — preclinical through five stages to post-testing — to test their impact, gradually and cautiously scaling up with detailed data collection and analysis accompanying each step and its still not perfect. Medical reporter Julia Belluz and I recently discussed this issue with students at the University of Toronto as part of a workshop on evidence and noted that as complexity increases with the subject matter, the ability to rely on controlled studies decreases.
Complexity is typically the space where much of social innovation inhabits.
As the social realm — our communities, organizations and even global enterprises — is our lab, our interventions impact people ‘out of the gate’ and because this occurs in an inherently a complex environment, I argue that the imperative to evaluate and share what is known about what we produce is critical if we are to innovate safely as well as effectively. Alas, we are far from that in social innovation.
Barriers and Opportunities for Evaluation-powered Social Innovation
There are a series of issues that permeate through the social innovation sector in its current form that require addressing if we are to better understand our impact.
- Becoming more than “the ideas people”: I heard this phrased used at Bryan Boyer’s talk hosted by the Social Innovation Generation group at MaRS. The moderator for the talk commented on how she had wished she’d taken more interest in statistics in university because they would have helped in assessing some of the impact fo the work done in social innovation. There is a strong push for ideas in social innovation, but perhaps we should also include those that know how to make sense and evaluate those ideas in our stable of talent and required skillsets for design teams.
- Guiding Theories & Methods: Having good ideas is one thing, implementing them is another. But tying them both together is the role of theory and models. Theories are hypotheses about the way things happen based on evidence, experience, and imagination. Strategic designers and social innovators rarely refer to theory in their presentations or work. I have little doubt that there are some theories being used by these designers, but they are implicit, not explicit, thus remaining unevaluable and untestable or challenged by others. Some, like Frances Westley, have made theories guiding her work explicit, but this is a rarity. Social theory, behaviour change models and theories of discovery beyond just use of Rogers’ Diffusion of Innovation theory must be introduced to our work if we are to make better judgements about social innovation programs and assess their impact. Indeed, we need the kind of scholarship that applies theory and builds it as part of the culture of social innovation.
- Problem scope and methodological challenges with it. Scoping social innovation is immensely wide and complicated task requiring methods and tools that go beyond simple regression models or observational techniques. Evaluators working social innovation require a high-level understanding of diverse methods and I would argue cannot be comfortable in only one tradition of methods unless they are part of a diverse team of evaluation professionals, something that is costly and resource intensive. Those working in social innovation need to live the very credo of constant innovation in methods, tools and mindsets if they are to be effective at managing the changing conditions in social innovation and strategic design. This is not a field for the methodologically disinterested.
- Low attendance to rigor and documentation. When social innovators and strategic designers do assess impact, too often there is a low attention to methodological rigor. Ethnographies are presented with little attention to sampling and selection or data combination, statistics are used sparingly, and connections to theory or historical precedent are absent. Of course, there are exceptions, but this is hardly the rule. Building a culture of innovation within the field relies on the ability to take quality information from one context and apply it to another critically and if that information is absent, incomplete or of poor quality the possibility for effective communication between projects and settings diminishes.
- Knowledge translation in social innovation. There are few fora to share what we know in the kind of depth that is necessary to advance deep understanding of social innovation, regularly. There are a lot of one-off events, but few regular conferences or societies where social innovation is discussed and shared systematically. Design conferences tend towards the ‘sage on the stage’ model that favours high profile speakers and agencies, while academic conferences favour research that is less applied or action-oriented. Couple that with the problem of client-consultant work that is common in social innovation areas and we get knowledge that is protected, privileged or often there is little incentive to add a KT component to the budget.
- Poor cataloguing of research. To the last point, we have no formalized methods of determining the state-of-the-art in social innovation as research and practice is not catalogued. Groups like the Helsinki Design Lab and Social Innovation Generation with their vigorous attention to dissemination are the exception, not the rule. Complicating matters is the interdisciplinary nature of social innovation. Where does one search for social innovation knowledge? What are the keywords? Innovation is not a good one (too general), yet neither is the more specialized disciplinary terms like economics, psychology, geography, engineering, finance, enterprise, or health. Without a shared nomenclature and networks to develop such a project the knowledge that is made public is often left to the realm of unknown unknowns.
Moving forward, the challenge for social innovation is to find ways to make what it does more accessible to those beyond its current field of practice. Evaluation is one way to do this, but in pursuing such a course, the field needs to create space for evaluation to take place. Interestingly, FSG and the Center for Evaluation Innovation in the U.S. recently delivered a webinar on evaluating social innovation with the principle focus being on developmental evaluation, something I’ve written about at length.
Developmental evaluation is one approach, but as noted in the webinar : an organization needs to be a learning organization for this approach to work.
The question that I am left with is: is social innovation serious about social impact? If it is, how will it know it achieved it without evaluation?
And to echo my previous post: if we believe learning is essential to strategic design we must ask: How serious are we about learning?
Tough questions, but the answers might illuminate the way forward to understanding social impact in social innovation.
* Photo credit from Deviant Art innovation_by_genlau.jpg used under Creative Commons Licence.
How to recognize Design Thinkers
Posted: October 31, 2012 Filed under: design thinking | Tags: complexity, design, design thinking, Roger Martin Comments Off
Since R. Martin and others hijacked the term 'designthinking', there is an ongoing dispute. Two thought worlds exist and possibly these can be united by laying bare the essential characteristics of a 'design thinker'.
Thought worlds
Design thinking frames the verb 'design' as a specific cognitive activity in order to solve problems and is discerned from other ways of thinking such as decision making.
Design Thinking: Thinkers, Science and Practice
Posted: September 6, 2012 Filed under: design thinking, systems science, systems thinking | Tags: AIGA, Bruce Nussbaum, community of practice, design, design education, design research, design thinking, DMI, education, evaluation, experiment, metacognition, practice, psychology, research, social innovation, systems thinking, William Storage 1 Comment »
If to think and be aware of those thoughts (to think about thinking) is a defining feature of what it means to be human, why is it such a challenge to think about types of thinking? An answer to that question might help explain why design thinking is so difficult to translate into action and scholarship and why it continues to be the recipient of intense criticism and boosterism.
The other day a colleague reminded me of an essay on the demise of design thinking that I commented on in an earlier post . The post by William Storage adds further to the growing list of critiques of design thinking and ends this way:
In short, Design Thinking is hopelessly contaminated. There’s too much sleaze in the field. Let’s bury it and get back to basics like good design. Everyone already knows that solution-focus is as essential as problem-focus. Stop arguing the point. If good design doesn’t convince the world that design should be fully integrated into business and society, another over-caffeinated Design Thinking book isn’t likely to do so either.
Storage is right to argue that another book will not convince people of the merits of design or design thinking (which is different), but I can’t imagine it is just because of its merits. There appears to be something that troubles people with picking up metacognitive concepts.
Thinking about (Design) Thinking
Metacogntion is thinking about thinking and concepts like design thinking and systems thinking are, at their most basic, about the thought processes involved in contemplating systems or design. What commentators like Storage and Bruce Nussbaum are railing against is how this more sophisticated concept of design thinking (design metacognition if you will) has over time become synonymous at best, but a wholesale replacement at worst with a set of tools and creativity exercises.
Here we see the gap between the methods and their methodology.
Systems thinking, having had a few decades jump on design thinking seems to be faring better in that its common use is treated more as a metacognitive exercise than just a method, but only slightly. Why does adding thinking to something make it so difficult to communicate?
There is a reductionist push towards making thinking — design thinking, systems thinking, critical thinking, visual thinking — into a discussion of methods and tools. The concern, not unfounded, is that concepts like design thinking is pitched as a set of very simple techniques to provoke innovation while being stripped of its genuine innovation potential and reflective capacity, ironically removing the “thinking” part of the approach. These tools are manifest expressions of thinking and facilitators of it, but they are not thinking on its own.
The business and evidence of thinking
Maybe this is our fault for not putting thinking into the development of these concepts from the start. For example, the field of design suffers greatly from a lack of scholarship and theory around its methods and approaches. Designers are a practical bunch and seek to create and build things over theorizing and submitting their own processes to research. There are notable exceptions to this of course, but overall it is safe to say given design’s pervasiveness in our world that we know relatively little about it.
Systems thinking (as it applies to human systems) is in a different position, almost an opposite position. Whereas design thinking has come from a long history of practice with little formal research supporting it, systems thinking has emerged largely from academia and has far less empirical support for its applications to social affairs.
Another issue is economic. The drive for innovation-led market advantages in many fields is pushing anything to support such activity — something design thinking can do — into high demand. Markets abhor vacuums so they get filled and early markets favour the swift and bold, not necessarily quality. As my doctoral advisor once told me when I was hesitating on publishing my research: “people remember the first, not necessarily the best“.
Thus, we have entire business enterprises founded on teaching people design thinking without much depth in their process or intellectual foundations to support their work. They are out there in spades and contributing to the reasoned distrust, frustration and dislike of design thinking by many who could be its biggest advocates. Whether that’s hopeless or not remains to be seen.
Where to?
So what is to be done? One option, that taken by Bruce Nussbaum, is to consider design thinking a failed experiment and seek alternative terms and concepts that capture the essence of what it does to improve innovative thinking, but in a manner that is less distorted. The challenge here is that, even if a new term does supplant design thinking, what is to prevent that concept from being co-opted and distorted as well with the same innovation-related market drivers in place?
Some argue that by formalizing design thinking into accredited programs, designations, certificates or degrees can assure quality just as we’ve started to see creep into the field of evaluation,. This presumes that have an empirically supported or widely agreed definition of what design thinking is and what are its core competencies. It also presumes we have the faculty with these skills and in positions to train people using methods tested to produce specific outcomes. Neither of these is true at present. This is the equivalent of suggesting that artists must have art degrees. Some artists do, but many do not and there is little to distinguish the difference in quality of the work between them.
A third option, the more complicated one and the most flexible, is to consciously build a community of practice around design thinking aimed at improving the scholarship, research and communications about design thinking to enable the wider world to learn about it, debate it, and apply it. This is already starting to form through such venues as the Design Thinking LinkedIn group and the Design Thinking Network. To that end, we could see a tremendous opportunity for professional organizations such as DMI and AIGA to contribute to this by opening themselves up to the wider community in the focus of their events and training options. By increasing commitment from those doing design and design thinking to education and contemplative inquiry into their craft we are naturally developing a field of practice that forms an attractor basin for better thinking and action.
Some further suggests to this point:
- Follow what psychology did after the American Psychological Association President George Miller suggested they “give away psychology” to the world. Psychology was once an elitist, opaque field of therapy and science and now is widely taught, incorporated into nearly every human-centred discipline, and is founded on a strong scientific and practice base. Democratize design thinking.
- Enlist creative professionals from fields like environmental studies, public health, social work, and education into the design thinking fold beyond traditional design disciplines. Get those living the spirit of Herb Simon who are out there trying to actively change current conditions into preferred ones — the social innovators, the public servants, the entrepreneurs of every stripe — to contribute their stories and insights on design thinking and get those into the public sphere for debate and dialogue.
- Fund and support more research programs beyond examples of my own modestly-supported Design Foundations project , which has sought to study design thinking by interviewing those experts that do it and the literature on its practice across disciplines. And rather than proclaim design thinking’s success and power, prove it and document it.
- Evaluate the programs that teach it, the processes used and determine what works, under what context, and document what happened along the way so we can learn more and be better at advocating for the power of design than simply proclaiming its worth.
Let’s contemplate more, study more, and reflect more about design thinking and maybe we’ll become better design thinkers.
What are your thoughts? Comment below.
Marketing Metaphors of Meaning in Complexity
Posted: July 17, 2012 Filed under: behaviour change, complexity, marketing, systems thinking | Tags: Bruce Mau, complexity, Dave Snowden, design, design thinking, empathy, marketing, metaphor, narrative, public health, public policy, Rory Sutherland, storytelling, systems change, systems thinking, TED, tobacco control Comments Off
Metaphors and storytelling are ways to navigate through complex, inter-related ideas in a way that brings coherence and delight to them in narrative form. Stories are not just for children, but a serious tool for bringing complexity to life, making it accessible and usable to a world that can benefit from learning more about it.
Have you ever found yourself curled up in bed with a book that you can’t put down or found yourself up much later than you’d planned because of a TV program or movie you got caught up in? Ever have the same experience with a piece of academic writing? How about a technical report? I’ll bet the answer is yes to the former examples more than the latter (if there is a yes at all to the second two). Books — mostly, but not always, fiction books — magazine and newspaper, articles, poems and even blog posts thrive on a narrative that takes you a journey even if you don’t know the destination. That narrative, if its engaging, has consistency, a tone, a flow and a ‘texture’ that makes it enriching. It is perhaps the reason why so much scholarly writing is so dull: the texture is rather dry and lacks appeal.
Not all scientific articles require such appeal. Indeed, the standardized methods of reporting experiments can be very useful in interpreting results and deriving meaning from complicated interactions. Yet, this application of the standard model of writing from science to other areas is perhaps taking scholarly work to places it didn’t need to go. Or perhaps it is preventing us from going places we need to go.
In terms of complexity, one of those places it needs to go is into widespread discourse on public policy, health promotion, and social program planning. Storytelling and metaphors are one vehicle.
Making metaphors and embodied cognition
A recent Scientific American blog post by explored the role of metaphors in some depth, bringing attention to some of the early work of psycholinguist pioneers George Lakoff and Noam Chomsky in looking at the role of embodied cognition, a concept where a metaphor actually gets integrated into the body (literally or figuratively). In the column Samuel McNerny looks at the history of the idea and the use of metaphor, drawing on interviews, literature and recent research.
As Lakoff points out, metaphors are more than mere language and literary devices, they are conceptual in nature and represented physically in the brain. As a result, such metaphorical brain circuitry can affect behavior. For example, in a study done by Yale psychologist John Bargh, participants holding warm as opposed to cold cups of coffee were more likely to judge a confederate as trustworthy after only a brief interaction. Similarly, at the University of Toronto, “subjects were asked to remember a time when they were either socially accepted or socially snubbed. Those with warm memories of acceptance judged the room to be 5 degrees warmer on the average than those who remembered being coldly snubbed. Another effect of Affection Is Warmth.” This means that we both physically and literary “warm up” to people.
Metaphors like “warming up” are therefore representations of real phenomena that become figurative in certain scenarios. McNerny adds:
The last few years have seen many complementary studies, all of which are grounded in primary experiences:
• Thinking about the future caused participants to lean slightly forward whilethinking about the past caused participants to lean slightly backwards. Future is Ahead
• Squeezing a soft ball influenced subjects to perceive gender neutral faces as female while squeezing a hard ball influenced subjects to perceive gender neutral faces as male. Female is Soft
• Those who held heavier clipboards judged currencies to be more valuable and their opinions and leaders to be more important. Important is Heavy.
• Subjects asked to think about a moral transgression like adultery or cheating on a test were more likely to request an antiseptic cloth after the experiment than those who had thought about good deeds. Morality is Purity
The challenge for complexity in social life is coming up with the right metaphor and finding one that is embodied within the systems we seek to influence.
Telling systems stories
One of the best examples of the use of storytelling and metaphors to explain complexity comes from Dave Snowden of Cognitive Edge with his humourous, insightful look at order and the art of organizing a children’s party.
What Snowden does is anchor something new (complexity) in a familiar frame of reference (a children’s party). While this is not something that directly translates to how we operate social organizations such as “warming up” does to explain relations between people, it offers something close.
Anchoring the novel in the familiar. Childhood is the one universal we adults all share. Travel the globe and watch children interact and you’ll see patterns repeated everywhere. Emotion is another universal: joy, fear, anger, contentment, curiosity, and such are all platforms that can be used to create and share stories about our world. For those of us working in communities, we need to understand what universals exist in those realms. This means paying deep attention to the systems we are a part of.
In short: systems thinkers may need to be participant observers to the systems they wish to influence and learn about the big and small things that drive them.
As systems are large, complicated and complex, it is unreasonable and perhaps impossible to know everything necessary to successfully navigate through it and maneuver the leverage points necessary to create responsible, sustained systems change. To do so, we need to enlist others and that means getting complexity into the minds of many operating in the system and not just a few ‘systems thinkers’.
We need to get better at telling stories and marketing metaphors of meaning.
Learning storytelling from marketers
Marketing is largely about identity and stories about identity. Marketers want to influence what you do (choose, use, purchase, etc..) and how you experience what you do when you do it. To do this, they know the importance of design and the stories to accompany that design. Design, when done well, is partly about creating empathy with those who are to benefit from the products of design and the best products out there are ones that apply empathy and guide behaviour at the same time. Steve Jobs and his design team led by Jonathan Ive were (are) famous for doing this at Apple.
In an earlier post I mentioned the work of Rory Sutherland and his discussion of tobacco use as an illustration of the ways in which failing to empathize with a product user’s life can change the impact of policies and programs aimed to improve it. The case (made in the video below) is that there are some real, tangible benefits to smoking that get ignored when we aim to snuff it out (bad pun intended). For public health to enhance its effectiveness, we need to pay attention to these benefits and find ways for people to derive them in healthier contexts.
But listen to what Sutherland says not only here, but in another of his TED talks he points to ways in which small changes can have enormous consequences if done in a systems-forward manner (my term, not his).
What Sutherland does is not just provide good ideas, but tells good stories. Like Dave Snowden, he captures our interest and makes us want to think about concepts like behavioural economics and marketing just as Snowden inspires thinking about the differences between order and chaos.
Not all of us can be great storytellers or funnymen (and women), but we need to take this seriously if we wish to use complexity and systems thinking to advance change in our world purposefully, because massive change is happening whether we want it or not. The key is whether we will be telling stories in the future of how we helped shepherd change that helped us be more resilient and thrive or let these forces shape us in ways that caused unnecessary problems. It is, as Bruce Mau said, not about the world of design, but the design of the world.
Empathy: The Ultimate Design + Systems Challenge
Posted: July 1, 2012 Filed under: art & design, complexity, design thinking, psychology, social systems, systems thinking | Tags: complexity, contemplative inquiry, design, design thinking, empathy, mapping, mindfulness, perspective taking, psychology. social psychology, social determinants of health, social justice, systems thinking, visual thinking, visualization 4 Comments »
Empathy is a central feature of good human-centred design, yet is often practiced narrowly. Visualization with systems thinking and mindfulness are three additional features that can transform empathy from a simple tool to a vehicle for transformation by connecting us less to absolute problems and more to relative ones.
In today’s Globe and Mail newspaper online, the oft controversial columnist Margaret Wente offered an op-ed piece called I have ‘white people’s problems,’ and you probably do too. The column refers to an article in The Atlantic by Anne-Marie Slaughter looking at how women today still struggle to be successful at work, family and personal life simultaneously. Both Wente and Slaughter take pains to point out that they lead privilidged lives, yet that privilige does not shield them from experiencing social problems in a way that is both unique to their situation and widely shared by women across the social spectrum.
A read of the comments for both articles shows how much of a hot-button issue this is for people (Wente’s article had more than 700 comments within hours of being uploaded) and includes much discussion of the racist/non-racist/classist over and undertones to the content and topic. It might be tempting to rush in and judge these two articles for dwelling on the pains of a privileged few in light of problems of poverty, food insecurity, safety, sexual and gender-based violence, and absence of healthcare experienced by the greater number of people on this earth.
Yet, if we look at the issues as they are with less judgement we can see the reaction to these articles less as a battle of ideas, but an unconscious attack on empathy. There is this perverse pleasure for some in pointing out the arrogance, ignorance, or neglectfulness in others, but such criticism (sometimes falsely veiled as critique or critical thinking) often fails to deeply connect to empathy beyond the pale. How then do we promote empathy in such conditions?
Perspective Taking: It’s (Relative) Promise and Perils
As Micheal Marmot and others have shown consistently with evidence is that relative inequities, inequalities and health disparities are as significant or more so than absolute ones. Whatever challenges you face they are exacerbated by how you see yourself in relative position to those who deem closest to you. Saying: “it could be worse” works when you see your peers as worse off than you or your equal, but it doesn’t work as well when you’re surrounded by people you perceive to be in better shape. Thus, we have an issue that is both absolute and relative based on real and perceptive differences working simultaneously. In the case of Wente and Slaughter’s articles, most of us (the 95-99% not represented in these perspectives) see them to be in better shape and that has consequences for us and them.
Peter Coleman and faculty at the International Project on Conflict and Complexity have looked at how relative position and empathy fit together in the context of peace-building and mediation and have found that there are spaces where taking into account the lives of others can increase conflict, not dampen it. Of the many examples cited in their work (including Coleman’s recent book) is a decade-long initiative to build bridges between anti-abortion and pro-life advocates in the Boston area and how efforts to build empathy between these two foes often served to antagonize and create bigger gaps in position rather than closing them. These problems, often seen as intractable, represent about 5% of all the ones we face, but their effect is enormous.
Recent studies in social psychology have confirmed that bridge building requires more than just seeing the other side, it requires being heard (PDF – Bruneau & Saxe (2012), Journal of Experimental Social Psychology). A study by Kraus and colleagues (PDF) found that social distance can have an impact on the way that people empathize and the conclusions that they draw when trying to place themselves in the position of others.
Your Grief is Not the Same as My Grief
The above heading comes from a statement uttered in a group counselling context and has forever stuck in my head. It recognizes that we all experience things in a unique way, yet it was uttered in a spirit that suggests we can still come to share that experience in a manner that can build solidarity and connection.
This points to the ultimate design challenge: creating greater connection through empathy without widening social distance.
One might think this would be easier given that empathy is one of the principle tools of design, yet my experience suggests that designers might be more apt to identify this as important and have strategies to get to it, there is still much to be done. But as we all design for ourselves and some of us for others, imagining another’s perspective requires understanding both that another perspective exists and where in relation that perspective sits to your own. It is here that we need more than an empathic lens or a design lens, but a systems lens as well.
Visualization: Placing Empathy
Systems thinking provides cognitive tools for understanding entire domains and the relationships within it. Systems mapping takes these ideas and makes them visual by providing an architecture for that understanding. Visualization provides the means to connect these two worlds by providing a design sensibility with a systems perspective. The figure below illustrates this position.
Mapping the positions held or visualizing them allows an idea to be represented in a manner that invites dialogue and open comparison. Rather than keeping one’s perspective locked within their own mind, a visual representation allows both the individual and those who they seek (or we seek) to build empathy with the tools to better frame the position each holds relative to one another. Doing so goes beyond imagining what it would be like to walk in anothers’ shoes and actually sees it and allows us to test assumptions.
From here, a contemplative approach to inquiry based on mindfulness can allow people to sit — literally or figuratively — with this data and envision the positions in new ways. Contemplating the meaning of what a particular perspective holds can enable a perspective taking that goes beyond seeing this head on and perhaps sees it from above, below, behind or inside and gets us away from our forward orientation bias.
By redefining the space in which the problem exists by literally creating that space on the page or screen we can better see beyond our current position to imagine how things previously deemed impossible might exist. Returning to the original example, this means seeing that one can hold much privilege and social advantage and experience the world in a manner that feels as violated, limiting and stressful as someone of lesser absolute means. It can also facilitate the reverse perspective. In doing so, this type of visualizing + empathy + contemplative inquiry has the means to take away much of the judgement and see things as they are without reducing or amplifying problems beyond their current context.
In doing so, perhaps we can better see us all as interconnected members of a system with pains and hurts and joys and skills rather than devote more energy that is necessary to judging others and less on making lives better for everyone.
The Hyberbole and Exaggerated Demise of Design Thinking
Posted: June 14, 2012 Filed under: design thinking | Tags: AC4D, critical thinking, debate, design, design research, design thinking, industrial design, Nigel Cross, wicked problems, William Storage 1 Comment »
Designing better design thinking
Design thinking is hot and under fire. Just as its miracle properties are misleading, so too are the claims that it is dead or dying.
If design thinking didn’t have something going for it no one would talk about it.
In a well-laid out essay on design thinking (and its timely death) William Storage points to the concept’s origins and proceeds from there to point to how it no longer serves a purpose given the panoply of voices arguing its merits.
He writes:
Design Thinking has lost its focus – and perhaps its mind. The term has been redefined to the point of absurdity. And its overworked referent has drifted from an attitude and guiding principle to yet another hackneyed process in a long line of bankrupt business improvement initiatives, passionately embraced by amnesic devotees for a few months until the next one comes along. This might be the inevitable fate of brands that no one owns, spawned by innovators, put into the public domain, and consumed by consultancies who prey on business managers seeking that infusion of quick-transformation magic.
A related discussion on the LinkedIn group devoted to design thinking on this very topic prompted a lively debate. The impetus from that discussion came from the topic of a panel discussion at next week’s DMI conference in Portland entitled: Is Design Thinking Dead?
Bruce Nussbaum’s oft-cited assertion that design thinking is a failed experiment was one of the higher profile critiques. He asserts that the experiment of design thinking has failed, whereas I argue that we haven’t even begun our research in the first place to make that claim.
Returning to Storage’s essay, he concludes:
Design Thinking is hopelessly contaminated. There’s too much sleaze in the field. Let’s bury it and get back to basics like good design. Everyone already knows that solution-focus is as essential as problem-focus. Stop arguing the point. If good design doesn’t convince the world that design should be fully integrated into business and society, another over-caffeinated Design Thinking book isn’t likely to do so either.
To the first part of this argument, I agree wholeheartedly. Any concept that catches fire as broadly as design thinking that lacks a definitive intellectual home is bound to be tied to the hype cycle (discussed here and here in past posts). I would suggest to anyone interested in design thinking that they follow anyone’s claim about the idea with a question: what do you mean by that term?
Where I have problems with Storage’s argument is in its implication that good design is its own merit and that its benefits are obvious. To this point, I disagree wholeheartedly. The same foolishness is applied to healthcare around use of good evidence: high quality evidence that is “self-evident” is rarely so and even then inconsistently translates into practice with ease. Were that the case, the field of knowledge translation in health wouldn’t exist and evidence-based practice would be a pointless term.
If the benefits of good design were that obvious, every intelligent manager, strategist, executive and front-line staffer would be working towards it. They don’t.
There is little indication that design thinking in a form that would resemble common practice exists in any of the sectors I work in (and no, use of sticky notes and a white board does not equate to design thinking by itself). There simply is not enough reflective and documented practice in design thinking to provide the kind of wisdom to separate out the “sleaze in the field”, yet that isn’t reason to throw the baby out with the bathwater. We do not have good research to either venerate or denigrate design thinking based on anything other than the popular use of the term and rhetoric.
Einstein, as he often does, provides words to consider:
The attempt to combine wisdom and power has only rarely been successful and then only for a short while. – Albert Einstein
The ideas that lay behind design thinking are powerful, yet the wisdom of the field has not yet flourished enough for us to abandon the idea on anything other than the immature notion that it is popular and therefore can’t possibly be serious. In an age where wicked problems are more commonplace, new ways of thinking, seeing and acting are being required of organizations seeking to survive and thrive and design thinking offers some prospects for how to navigate through this. Not all designers deal with wicked problems.
Which leads to my disagreement with Storage’s assertion that design thinking equals design. Designer’s regularly apply the kind of problem exploration and applied creativity that is central to design thinking, but they alone are not design thinkers. Were that the case, then the concept would have found little purchase outside of that discipline. His argument also implies that good design is evident, another point that I contest (and will save argument for another day). Good design is contextual and thus the standards that make it so must therefore be negotiable. It therefore cannot be claimed outright.
A “good” chair is dependent upon who is sitting in it, where it is placed, and the resources required to produce it and sustain it. By that argument, “good” design thinking may fall into the same lines. But unlike design, which has wisdom and experience broadly dispersed in society and different fields of practice, design thinking has no such equivalent. What is the evidence that it produces more useful or effective outcomes? What are its central theories? How is it linked to other fields of creative thought and action? Are there fields better suited to applying design thinking? What do effective practitioners look like? These questions remain either unexplored or poorly done so. The process of design thinking has received the treatment it deserves and it is that which has garnered the attention, admiration and scorn of the blogosphere and beyond — the space where the “over-caffeinated” books might sell.
Scholars such as Nigel Cross have done much to advance our understanding of what designerly ways of knowing might look like as practiced by leading designers. But few systematic examples exist outside of design contexts alone. This is changing and books like Wicked Problems by the group at AC4D provide one such example.
It is time to pull design thinking from the embers of hyperbole and placed under the microscope and macroscope of reflective practice and research. Once there, we might better comment on what this idea means for business, social innovation, human services and our overall wellbeing by pointing to something other than an exclamation mark to make our point.
