Tag: healthcare

design thinking

Leadership & Design Thinking: Missed Opportunities

on February 26, 2019

A recent article titled ‘The Right Way to Lead Design Thinking’ gets a lot of things wrong not because of what it says, but because of the way it says it. If we are to see better outcomes from what we create we need to begin with talking about design and design thinking differently.

I cringed when I first saw it in my LinkedIn feed. There it was: The Right Way to Lead Design Thinking. I tend to bristle when I see broad-based claims about the ‘right’ or ‘wrong’ way to do something, particularly with something so scientifically bereft as design thinking. Like others, I’ve called out much of what is discussed as design thinking for what I see as simple bullshit.

To my (pleasant) surprise, this article was based on data, not just opinion, which already puts it in a different class than most other articles on design thinking, but that doesn’t earn it a free pass. In some fairness to the authors, the title may not be theirs (it could be an editor’s choice), but what comes afterward still bears some discussion less about what they say, but how they say it and what they don’t say. This post reflects some thoughts on this work.

How we talk about what we do shapes what we know and the questions we ask and design thinking is at a state where we need to be asking bigger and better questions of it.

Right and Wrong

The most glaring critique I have of the article is the aforementioned title for many reasons. Firstly, the term ‘right’ assumes that we know above all how to do something. We could claim this if we had a body of work that systematically evaluated the outcomes associated with leadership and design thinking or research examining the process of doing design thinking. The issue is: we don’t.

There isn’t a definition of design thinking that can be held up for scrutiny to test or evaluate so how can we claim the ‘right’ way to do it? The authors link to a 2008 HBR article by Tim Brown that outlines design thinking as its reference source, however, that article provides scant concrete direction for measurement or evaluation, rather it emphasizes thinking and personality approaches to addressing design problems and a three-factor process model of how it is done in practice. These might be useful as tools, but they are not something you can derive indicators (quantitative or qualitative) to inform a comparison.

The other citation is a 2015 HBR article from Jon Kolko. Kolko is one of design’s most prolific scholars and one of the few who actively and critically writes about the thinking, doing, craft, teaching, and impact of design on the people, places, and systems around us. While his HBR article is useful in painting the complexity that besets the challenge of designers doing ‘design thinking’, it provides little to go from in developing the kind of comparative metrics that can inform a statement to say something is ‘right’ or ‘wrong’. It’s not fit for that purpose (and I suspect was never designed for that in the first place).

Both of these reference sources are useful for those looking to understand a little about what design thinking might be and how it could be used and few are more qualified to speak on such things as Tim Brown and Jon Kolko. But if we are to start taking design thinking seriously, we need to go beyond describing what it is and show what it does (and doesn’t do) and under what conditions. This is what serves as the foundation for a real science of practice.

The authors do provide a description of design thinking later in the article and anchors that description in the language of empathy, something that has its own problems.

Designers seek a deep understanding of users’ conditions, situations, and needs by endeavoring to see the world through their eyes and capture the essence of their experiences. The focus is on achieving connection, even intimacy, with users.

False Empathy?

Connecting to ideas and people

It’s fair to say that Apple and the Ford Motor Company have created a lot of products that people love (and hate) and rely on every day. They also weren’t always what people asked for. Many of those products were not designed for where people were, but they did shape where they went afterward. Empathizing with their market might not have produced the kind of breakthroughs like the iPod or automobile.

Empathy is a poor end in itself and the language used in this article treats it as such. Seeing the world through others’ eyes helps you gain perspective, maybe intimacy, but that’s all it does. Unless you are willing to take this into a systems perspective and recognize that many of our experiences are shared, collective, connected, and also disconnected then you only get one small part of the story. There is a risk that we over-emphasize the role that empathy plays in design. We can still achieve remarkable outcomes that create enormous benefit without being empathic although I think most people would agree that’s not the way we would prefer it. We risk confusing the means and ends.

One of the examples of how empathy is used in design thinking leadership takes place at a Danish hospital heart clinic where the leaders asked: “What if the patient’s time were viewed as more important than the doctor’s?” Asking this question upended the way that many health professionals saw the patient journey and led to improvements to a reduction in overnight stays. My question is: what did this produce?

What did this mean for the healthcare system as a whole? How about the professionals themselves? Are patients healthier because of the more efficient service they received? Who is deriving the benefits of this decision and who is bearing the risk and cost? What do we get from being empathic?

Failure Failings

Failure is among the most problematic of the words used in this article. Like empathy, failure is a commonly used term within popular writing on innovation and design thinking. The critique of this term in the article is less about how the authors use it explicitly, but that it is used at all. This may be as much a matter of the data itself (i.e., if you participants speak of it, therefore it is included in the dataset), however, its profile in the article is what is worth noting.

The issue is a framing problem. As the authors report from their research: “Design-thinking approaches call on employees to repeatedly experience failure”. Failure is a binary concept, which is not useful when dealing with complexity — something that Jon Kolko writes about in his article. If much of what we deal with in designing for human systems is about complexity, why are we anchoring our discussion to binary concepts such as ‘success’ and ‘failure’?

Failure exists only when we know what success looks like. If we are really being innovative, reframing the situation, getting to know our users (and discarding our preconceptions about them), how is it that we can fail? I have argued that the only thing we can steadfastly fail at in these conditions is learning. We can fail to build in mechanisms for data gathering, sensemaking, sharing, and reflecting that are associated with learning, but otherwise what we learn is valuable.

Reframing Our Models

The very fact that this article is in the Harvard Business Review suggests much about the intended audiences for this piece. I am sympathetic to the authors and my critique has focused on the details within the expression of the work, not necessarily the intent or capacity of those that created it. However, choices have consequences attached and the outcome of this article is that the framing of design thinking is in generating business improvements. Those are worthy goals, but not the only ones possible.

One of the reasons concepts like ‘failure’ apply to so much of the business literature is that the outcomes are framed in binary or simple terms. It is about improvement, efficiency, profit, and productivity. Business outcomes might also include customer satisfaction, purchase actions, or brand recognition. All of these benefit the company, not necessarily the customer, client, patient, person, or citizen.

If we were truly tackling human-centred problems, we might approach them differently and ask different questions. Terms like failure actually do apply within the business context, not because they support innovation per se, but because the outcomes are pre-set.

Leadership Roles

Bason and Austin’s research is not without merit for many reasons. Firstly, it is evidence-based. They have done the work by interviewing, synthesizing, commenting on, and publishing the research. That in itself makes it a worthy contribution to the field.

It also provides commentary and insight on some practical areas of design leadership that readers can take away right away by highlighting roles for leaders.

One of these roles is in managing the tension between divergent and convergent thought and development processes in design work. This includes managing the insecurities that many design teams may express in dealing with the design process and the volume of dis-organized content it can generate.

The exemplary leaders we observed ensured that their design-thinking project teams made the space and time for diverse new ideas to emerge and also maintained an overall sense of direction and purpose. 

Bason & Austin, HBR 2019

Another key role of the design leader is to support future thinking. By encouraging design teams to explore and test their work in the context of what could be, not just what is, leaders reframe the goals of the work and the outcomes in ways that support creativity.

Lastly, a key strength of the piece was the encouragement of multi-media forms of engagement and feedback. The authors chose to illustrate how leaders supported their teams in thinking differently about not only the design process but the products for communicating that process (and resulting products) to each other and the outside world. Too often the work of design is lost in translation because the means of communication have not been designed for the outcomes that are needed — something akin to design-driven evaluation.

Language, Learning, Outcomes

By improving how we talk about what we do we are better at framing how to ask questions about what we do and what impact it has. Doing the right thing means knowing what the wrong this is. Without evaluation, we run the risk in Design of doing what Russell Ackoff cautioned against: Doing the wrong things righter.

A read between the lines of the data — the stories and examples — that were presented in the article by Bason and Austin is the role of managing fear — fear of ‘failure’, fear from confusion, fear of not doing good work. Design, if it is anything, is optimistic in that it is about making an effort to try and solve problems, taking action, and generating something that makes a difference. Design leadership is about supporting that work and bringing it into our organizations and making it accessible.

That is an outcome worth striving for. While there are missed opportunities here, there is also much to build on and lead from.

Lead Photo by Quino Al on Unsplash

Inset Photo by R Mo on Unsplash

behaviour changeeducation & learningsystems thinking

Learning fails in bad systems

on August 28, 2017

2348137226_2d6536745e_o_Edits.jpgEnormous energy is spent on developing strategies to accomplish things with comparatively little paid to the systems that they are being deployed in. A good strategy works by design and that means designing systems that improve the likelihood of their success rather than fight against them and this is no truer than in the effort to learn on the job.

 

A simple search of the literature — gray or academic — will find an enormous volume of resources on how to design, implement and support learning for action in organizations. At an individual level, there are countless* articles on personal change, self-improvement, and performance ‘hacks’ that individuals can do to better themselves and supposedly achieve more in what they do.

Psychology and related behavioural sciences have spent inordinate time learning how individuals and organizations change by emphasizing specific behaviours, decision processes, and data that can support action. A close inspection will find that relatively few strategies produce consistent results and this has to do less with execution, skill or topic and more with the system in which these strategies are introduced.

To illustrate this, consider the role of learning in the organization and how our strategies to promote it ultimately fail when our systems are not designed to support it.

Knowledge integration: A case study

Consider the example of attending a conference as a means of learning and integrating knowledge into practice.

Surajit Bhattacharya published a primer for how to get value from conferences in medicine, pointing to tips and strategies that a medical practitioner can take such as arriving a day early (so you’re not groggy), planning out your day, and be social. These are all practical, logical suggestions, yet they are premised upon a number of things that we might call system variables. These include:

  • The amount of control you have over your schedule week-to-week.
  • The availability of transportation and accommodation options that suit your schedule, budget, and preferences.
  • The nature and type of work you do, including the amount of hours and intensity of the work you perform in a typical week. This will determine the amount of energy you have and the readiness to be attentive.
  • The volume of email and other digital communications (e.g., messages and updates via social media, chat, project management platforms) you receive on a daily basis and the nature of those kinds of messages (e.g.urgency and importance).
  • The amount and nature of travel required to both attend the event and the amount you had prior to attending the event.
  • The level of rest you’ve had. Sleep amount, timing, and quality all factor into how much rest you get. Add in the opportunity to engage in an activity like walking, exercise or stretching that one might do and we see a number of factors that could influence learning performance.
  • The setting. The lighting, air quality and air flow, seat arrangement, room acoustics, and access to some natural light are all factors in our ability to attend to and engage with a learning event.
  • The quality and format of the content and its delivery. Speaker quality, preparation, content and overall performance will all contribute to the ability to convey information and engage the audience.
  • Food and drink. Are you eating the kinds of foods and beverages that enable your body’s performance? Do you have access to these foods and drinks? Are they served at times that suit your body?
  • Your level of comfort and skill at engaging strangers. This matters if you’re more introverted, dislike small talk, or are not energized by others.

These are all platform issues: those in which motivation and energy can be channeled to focus on and engage with learning content. The fewer of these factors present the greater the energy expenditure needed on the part of the learner.

Learning within systems

W. Edwards Deming noted that most of the issues of performance in any organization were due to processes and systems (estimated to be up to 85% or more) rather than individual employees. While Deming was referring largely to manufacturing contexts, the same might be said for learning.

Consider our example from earlier about the conference. We’ve already outlined the factors that could contribute to learning at the conference itself, but let’s extend the case further to what happens after the conference. After all, a surgeon, engineer, computer programmer, law clerk, or carpenter isn’t going to practice her or his craft at the conference; they’ll do it when they return to regular work.

Now consider what our attendee encounters after they have made the trip home to apply this newfound learning:

  • A backlog of emails, phone messages and other correspondence that has either been left untouched, scantly attended to, or fully managed. In the first case, the backlog might be high and requires a considerable amount of time and energy to ‘catch up’ on upon return, however at least the learner was fully present to perform the many activities suggested byBhattacharya in the earlier article. In the second case, there is a higher than usual amount to attend to and the learner might have been selectively disengaged from the learning event. In the third, the learner returns to usual life without a backlog but may have sacrificed considerable attention toward the usual correspondence than actually learning.
  • A backlog of meetings. Scheduled meetings, calls or other events that require a co-presence (virtual or physical) that were put off due to travel are now picked up.
  • A backlog of administrative tasks. Submitting receipts and conference expenses, regular accounting or administrative tasks are all things that either was left untouched or, in the case of submitting expenses, unlikely or impossible to do until the trip has returned.
  • Fatigue. Sitting in a conference can be exhausting, particularly because of the conditions of the rooms, the volume of content and the break in the routine of every day (which can be energizing, too). Add in any travel issues that might arise and there is a reasonable chance that a person is not in an optimal state to take what they have been exposed to and apply it.
  • The usual organization processes and structures. Are there are opportunities to reflect upon, discuss, and process what has been learned with others and spaces to apply those lessons directly with appropriate feedback? How often have we been exposed to inspiring or practical content only to find few opportunities to apply it in practice upon our return in enough time before the details of the lessons fade?

It’s not reasonable to expect to have optimal conditions in our work much of the time, if ever. However, as you can see there are a lot of factors that contribute to our capacity to learn and the required energy needed to take what we’ve been exposed to and integrate it into our work. The fewer of these situations in place, the greater the likelihood that the investment in the learning experience will be lost.

An organization or individual requires a platform for learning that includes systems that allow for learners to be at their best and to provide a means for them to take what they learn and apply it — if it’s valuable. Otherwise, why invest in it?

This isn’t to say that no good can come from a conference, but if the main focus is on actual learning and the application of knowledge to the betterment of an organization and individual why would we not invest in the platform to make use of that rather than discarding it.

Rethinking our systems

When I was doing evaluation work in continuing medical education I was amazed to see how often learning events were held at 7 or 8 am. The rationale was that this was often tied to shift changes at hospitals and were the one time of day when most physicians were least likely to have other appointments. This was also the time when physicians were either highly fatigued from a night shift or having battled traffic on their commute to work or were planning the rest of their day ahead — all circumstances when they might be least focused on actually learning.

This choice of time was done for scheduling purposes, not for learning purposes. Yet, the stated purpose of continuing education was to promote learning and its various outcomes. Here, the strategy was to expose medical professionals to necessary, quality content to keep them informed and skilled and doing it at a time that appeared most convenient for all is an example of an idea that had logic to it, but ultimately failed in most regards.

How? If one looked at the evaluation data, typically the results suggested this strategy wasn’t so bad. Most often post-event surveys suggested that the overall ratings were consistently high. Yet a closer look at the data yields some questions.

For example, the questions asked to assess impact were things like: did the presenter speak clearly? or did the presenter provide the content they said they would? In most cases, participants were asked if the speaker arrived on time, presented what they said they would, were intelligible and whether there was a chance the learner might find useful what was presented. It had little to no bearing on whether the content was appropriate, impactful or applied in practice. This is because the system for evaluation was based on a model of knowledge transmission: content is delivered to a person and, assuming the content is good, the lesson is learned.

We know this to be among the weakest forms of moving knowledge to action and certainly not something suited to more complex situations or conditions, particularly in health systems. This is still what prevails.

Design for learning

If you’re seeking to promote learning and create a culture where individuals across an organization can adapt, develop, and grow learning requires much more than simply sending people to conferences, hosting seminars, providing books and other materials or watching some instructional videos. Without a means to integrate and promote that new knowledge as part of a praxis, organizations and individuals alike will continue to get frustrated, lag in their efforts to anticipate and respond to changing conditions and will ultimately fail to achieve anything close to their potential.

Designing for learning is as much about a curriculum as the context for how that curriculum is delivered and how learners are set up to engage with it all in their organizations and everyday lives.

*This is literally the case because the volume of new articles being published daily is so high.

If you’re looking to create learning systems in your organization, visit Cense to explore what it can do for you in shaping your strategy and evaluation to support sustainable, impactful learning for complex conditions. 

Image credit: “Platform” by Martin L is licensed under CC BY 2.0

 

knowledge translationsocial systemssystems thinking

When More is Less: The Information Paradox

on September 22, 2016

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There is a point at which information ceases to increase knowledge and understand and begins to undermine it, creating a paradox. When information on nearly anything is more abundant than ever the choices we make about how to engage it become more important than ever. 

The Information Age has been described as the period where industrial production was replaced by knowledge production as the key driver of social and economic benefit for society. Underpinning the thinking behind the information age (and the digital revolution that accompanies it) is that having more information, more access to it and improved tools to use it to solve problems will improve life for everyone. Presented with a choice to have access to more information or less people will almost always choose more.

More information leads to more options, which equals more choice and more choice is about freedom and that is seen as an inherent social good derived from the capitalist system, which further leads to better choices, more freedom and greater happiness overall. At least, this is what we’ve been led to believe and Barry Schwartz explains this quite eloquently in the opening of talk embedded later in this post.

This is the theory of change that underpins information theory as its played out in modern capitalist societies. It’s also the source of many of our modern paradoxes and problems.

Systems of influence: The case of the ePatient

I’ve stopped going to health-related hackathons and design jams altogether for the simple reason that one can almost always guarantee that one third or more of the solutions generated will be some form of app or information-focused tool. These well-meaning, creative tools are part of a consumer health movement that is all about putting information in the hands of patients with the idea that putting information in the hands of patients is the key to empowerment and better health outcomes, except they rarely lead to this promised land.

Few are better at explaining — and indeed living — this reality than Dave deBronkart or ‘e-Patient Dave’ who has been a tireless advocate for better information tools, access and engagement on health for patients. His Ted Talk captures the spirit of the movement nicely.

With all due respect to the positive sentiments around what the ePatient movement is about, it is based on a series of assumptions about health systems, patients and health itself in ways that don’t always hold. For certain patients, certain conditions, and certain contexts having more information delivered in the right format is indeed empowering and may be life saving as deBronkart’s story illustrates. But what’s often missing from these stories of success are the many layers of assumptions and conditions that underpin information-driven healthcare.

A few years ago I interviewed a patient who spoke about his experience with health care decision-making and information technology and his response was that having more information didn’t make his life much better, rather it made it even more complicated because with more access to more information he had more responsibility related to that information.

“I don’t know what to do with it all and there’s an assumption that once I know (this health information) I am in a position to do something. I don’t have the foggiest idea what to do, that’s why I am going to see (the health professionals) because that is what their job is for. They are the ones who are supposed to know what is to be done. It’s their world, not mine.”

This case is less about deferral to authority, but about resources (e.g., knowledge, skill, time, networks, etc..) and expectations around what comes with those resources. When you are unwell the last thing you want is to be told you have even more work to do.

The assumptions around personal health information and decision-making are that people have:

1) access to the data in the first place, 2) time, 3) information gathering tools, 4) knowledge synthesis tools, 5) skill and knowledge of how to sift, sort, synthesize and sense-make all the information obtained (because it may be in different formats, incomplete, or require conversions), 6) access to the people and other knowledge and skills required to appropriately sense-make the data, 7) the resources to act on whatever conclusions are drawn from that process, 8) a system that is able to respond to the actions that are needed and taken (and in a timely manner), 9) the personal willpower, energy, and resolve to persist through the various challenges and pushback from the system to resist the actions taken, 10) social support (because this is virtually impossible to do without any support at all) and 11) the motivation and interest in doing all of this in the first place.

Dave deBronkart and his peers are advocating for patient engagement on a broader level and that includes creating spaces for patients to have the choice as to what kind of information they use or not. This also means having choice to NOT have information. It’s not about technology pushing, but having a choice about what to access, when and how. That’s noble and often helpful to those who are used to not having much say in what happens, but that, too has problems of its own.

The paradox of choice

Barry Schwartz’s work (pdf) doing and synthesizing research on consumer decision-making puts truth to this lie that more choice is better. Choice options add value only to a certain point after which they degrade value and even subvert it altogether. The problem is that choice options are often ‘all or nothing’ and may be addictive if left unconstrained as we’ll see below.

Schwartz addresses the matter of decision-making in healthcare in the above video and points to the shifting of responsibility away from experts to everyone. Perhaps it is not surprising that we are seeing an incredible backlash against expert-driven knowledge and science in a way that we’ve not seen in over a hundred years. This is at a time when the public has access to more scientific data — the same data that scientists and other experts have — through open data and open access scientific publications to validate the claims by experts.

As discussed in a previous post, another feature of this wealth of information is that we are now living in what some call a post-truth political climate where almost anything goes. Speaking on the matter of science and climate change former Alaska Governor and Vice Presidential candidate Sarah Palin suggested that, when compared to Dr Bill Nye (the Science Guy and a rocket scientist — yes, a real rocket scientist ), she is as much of a scientist as he is.

Why have science when you can have opinion?

Distracted driving on the information superhighway

Recent data from Canada shows that year-over-year growth in smartphone use at 24% to over two thirds of the population with 85% reporting some form of mobile phone ownership. One of the key features of modern smartphones is the ‘always on’ nature of their tools and alert systems allowing you to bring maps, address books, a digital library, video and audio telephony, and the entire Internet in your pocket.

The distractions that come from the tools meant to deliver information are becoming crippling to some to the point of distancing us from our humanity itself. The title of a beautiful, sad piece in New York Magazine by Andrew Sullivan put this into perspective: I used to be a human being. (We will come back to this in a future post.)

But even if one still feels human using information technology, its a different experience of humanity than it once was. Behaviour change writer and coach Tony Schwartz (I’m not sure if he’s related to Barry), writing in the New York Times magazine, noted how his use of information technology was affecting his ability to, ironically, glean information from something simple as a book.

One evening early this summer, I opened a book and found myself reading the same paragraph over and over, a half dozen times before concluding that it was hopeless to continue. I simply couldn’t marshal the necessary focus.

He goes on to explain what is being exchanged for the books he had aspired to read:

Instead of reading them, I was spending too many hours online, checking the traffic numbers for my company’s website, shopping for more colorful socks on Gilt and Rue La La, even though I had more than I needed, and even guiltily clicking through pictures with irresistible headlines such as “Awkward Child Stars Who Grew Up to Be Attractive.”

We can laugh at the last bit because most of us have been online and lured by something we thought was impossible or ridiculous and had to inquire about. Link bait is not new or particularly clever, but it works. It works for a variety of reasons, but largely because we need to inhabit the same space to work as well as to play. The problem comes when these worlds cross-over into one another.

For example, I recently was shopping for a safe (no, it’s not to store my non-existent millions, but rather protect hard drives and enhance data security) and wanted to return to a story I’d read in the Guardian for a different blog post. As I returned to pull the URL for this I found the page looking like this:

screen-shot-2016-09-21-at-7-25-06-pm

All of a sudden I am confronted with shopping choices amidst a quest for a URL.

Information wealth: A Faustian bargain to knowledge poverty?

“We willingly accept the loss of concentration and focus, the division of our attention and the fragmentation of our thoughts, in return for the wealth of compelling or at least diverting information we receive.”

Tony Shwartz’s comments above and below point to what we know about how information works in our brain. We can try and resist, but the evolutionary reasons we pay attention to things and the biological limitations we have to processing it all are most likely to trump any efforts to resist it without substantial shifts to our practices.

Endless access to new information also easily overloads our working memory. When we reach cognitive overload, our ability to transfer learning to long-term memory significantly deteriorates. It’s as if our brain has become a full cup of water and anything more poured into it starts to spill out.

I wish I had the answers to what these are. Schwartz, has proposed a digital vacation. As beneficial as it was for him, he was also willing to admit that it’s not a perfect strategy and that he still spends too much time online, too distracted. But, its better.

Comedian Louis C.K. has taken to ‘quitting the internet’ altogether and, in a touching moment of reflection (as he often does with wit), notes how it has improved the relationship with his daughters.

It’s these relational aspects of the new information technology and how it impacts our world that concern me the most and creates the most troubling paradox: the tools that are designed to bring us together might just be making it harder to be together and pushing us apart from each other and ourselves. This is what I will look at in the next piece in this series on paradox.

Image credit: Information by Heath Brandon used under Creative Commons License and by author

 

 

art & designcomplexitydesign thinkingevaluationinnovation

Defining the New Designer

on August 8, 2013

Who is the real designer?

It’s been suggested that anyone who shapes the world intentionally is a designer, however those who train and practice as professional designers question whether such definition obscures the skill, craft, and ethics that come from formal disciplinary affiliation. Further complicating things is the notion that design thinking can be taught and that the practice of design can be applied far beyond its original traditional bounds. Who is right and what does it mean to define the new designer?

Everyone designs who devises courses of action aimed at changing existing situations into preferred ones. – Herbert Simon, Scientist and Nobel Laureate

By Herb Simon’s definition anyone who is intentionally directing their energy towards shaping their world is a designer. Renowned design scholar Don Norman (no relation) has said that we are all designers [1]. Defined this way, the term design becomes something more accessible and commonplace removing it from a sense elitism that it has often been associated with. That sounds attractive to most, but is something that has raised significant concerns from those who identify as professional designers and opens the question up about what defines the new designer as we move into an age of designing systems, not just products.

Designer qualities

Design is what links creativity and innovation. It shapes ideas to become practical and attractive propositions for users or customers. Design may be described as creativity deployed to a specific end – Sir George Cox

Sir George Cox, the former head of the UK Design Council, wrote the above statement in the seminal Cox Review of Creativity in Business in the UK in 2005 sees design as a strategic deployment of creative energy to accomplish something. This can be done mindfully, skilfully and ethically with a sense of style and fit or it can be done haphazardly, unethically, incompetently and foolishly. It would seem that designers must put their practice of design thinking into use which includes holding multiple contradictory ideas at the same time in one’s head. Contractions of this sort are a key quality of complexity and abductive reasoning, a means of thinking through such contradictions, is considered a central feature of design thinking.

Indeed, this ‘thinking’ part of design is considered a seminal feature of what makes a designer what they are. Writing on Cox’s definition of design, Mat Hunter, the Design Council’s Chief Design Officer, argues that a designer embodies a particular way of thinking about the subject matter and weaving this through active practice:

Perhaps the most obvious attribute of design is that it makes ideas tangible, it takes abstract thoughts and inspirations and makes something concrete. In fact, it’s often said that designers don’t just think and then translate those thoughts into tangible form, they actually think through making things.

Hunter might be getting closer to distinguishing what makes a designer so. His perspective might assert that people are reflective, abductive and employ design thinking actively, which is an assumption that I’ve found to be often incorrect. Even with professionals, you can instill design thinking but you can’t make them apply it (why this is the case is something for another day).

This invites the question: how do we know people are doing this kind of thinking when they design? The answer isn’t trivial if certain thinking is what defines a designer. And if they are applying design thinking through making does that qualify them as a designer whether they have accreditation or formal training degree in design or not?

Designers recognize that their training and professional development confers specific advantages and requires skill, discipline, craft and a code of ethics. Discipline is a cultural code of identity. For the public or consumers of designed products it can also provide some sense of quality assurance to have credentialed designers working with them.

Yet, those who practice what Herb Simon speaks of also are designers of something. They are shaping their world, doing with intent, and many are doing it with a level of skill and attention that is parallel to that of professional designers. So what does it mean to be a designer and how do we define this in light of the new spaces where design is needed?

Designing a disciplinary identity

Writing in Design Issues, Bremner & Rodgers (2013) [2] argue that design’s disciplinary heritage has always been complicated and that its current situation is being affected by three crisis domains: 1) professionalism, 2) economic, and 3) technological. The first is partly a product of the latter two as the shaping and manufacture of objects becomes transformed. Materials, production methods, knowledge, social context and the means of transporting – whether physically or digitally — the objects of design have transformed the market for products, services and ideas in ways that have necessarily shaped the process (and profession) of design itself. They conclude that design is not disciplinary, interdisciplinary or even transdisciplinary, but largely alterdisciplinary — boundless of time and space.

Legendary German designer Dieter Rams is among the most strident critics of the everyone-is-a-designer label and believes this wide use of the term designer takes away the seriousness of what design is all about. Certainly, if one believes John Thackara’s assertion that 80 per cent of the impact of any product is determined at the design stage the case for serious design is clear. Our ecological wellbeing, social services, healthcare, and industries are all designed and have enormous impact on our collective lives so it makes sense that we approach designing seriously. But is reserving the term design(er) for an elite group the answer?

Some have argued that elitism in design is not a bad idea and that this democratization of design has led to poorly crafted, unusable products. Andrew Heaton, writing about User Experience (UX) design, suggests that this elitist view is less about moral superiority and more about better products and greater skill:

I prefer this definition: elitism is the belief that some individuals who form an elite — a select group with a certain intrinsic quality, specialised training, experience and other distinctive attributes — are those whose views on a matter are to be taken the most seriously or carry the most weight. By that definition, Elitist UX is simply an insightful and skilled designer creating an experience for an elevated class of user.

Designing through and away from discipline

Designers recognize that their training and professional development confers specific advantages and requires skill, discipline, craft and a code of ethics, but there is little concrete evidence that it produced better designed outcomes. Design thinking has enabled journalists like Helen Walters, healthcare providers like those at the Mayo Clinic, and business leaders to take design and apply it to their fields and beyond. Indeed, it was business-journalist-cum-design-professor Bruce Nussbaum who is widely credited with contributing to the cross-disciplinary appeal of design thinking (and its critique) from his work at Newsweek.

Design thinking is now something that has traversed whatever discipline it was originally rooted in — which seems to be science, design, architecture, and marketing all at the same time. Perhaps unlocking it from discipline and the practices (and trappings) of such structure is a positive step.

Discipline is a cultural code of identity and for the public it can be a measure of quality. Quality is a matter of perspective and in complex situations we may not even know what quality means until products are developmentally evaluated after being used. For example, what should a 3-D printed t-shirt feel like? I don’t know whether it should be like silk, cotton, polyester, or nylon mesh or something else entirely because I have never worn one and if I was to compare such a shirt to my current wardrobe I might be using the wrong metric. We will soon be testing this theory with 3-D printed footwear already being developed.

Evaluating good design

The problem of metrics is the domain of evaluation. What is the appropriate measurement for good design? Much has been written on the concept of good design, but part of the issue is that what constitutes good design for a bike and chair might be quite different for a poverty reduction policy or perhaps a program to support mothers and their children escaping family violence. The idea of delight (a commonly used goal or marker of good design) as an outcome might be problematic in the latter context. Should mothers be delighted at such a program to support them in time of crisis? That’s a worthy goal, but I think if those involved feel safe, secure, cared for, and supported in dealing with their challenges that is still a worthwhile design. Focusing on delight as a criteria for good design in this case is using the wrong metric. And what about the designers who bring about such programs?

Or should such a program be based on designer’s ability to empathize with users and create adaptive, responsive programs that build on evidence and need simultaneously without delight being the sole goal? Just as healthy food is not always as delightful for children as ice cream or candy, there is still a responsibility to ensure that design outcomes are appropriate. The new designer needs to know when to delight, when and how to incorporate evidence, and how to bring all of the needs and constraints together to generate appropriate value.

Perhaps that ability is the criteria for which we should judge the new designer, encouraging our training programs, our clients (and their asks and expectations), our funders and our professional associations to consider what good design means in this age of complexity and then figure out who fits that criteria. Rather than build from discipline, consider creating the quality from the outcomes and processes used in design itself.

[1] Norman, D. (2004) Emotional design: why we love (or hate) everyday things. New York, NY: Basic Books.

[2] Bremner, C. & Rodgers, P. (2013). Design without discipline. Design Issues, 29 (3), 4-13.

complexitysystems thinking

Marketing the Narrative of Complexity

on July 6, 2012

Sunset 2007-1Complexity, by its very nature, is not a simple concept to communicate, yet it is increasingly becoming one that will define our times and may be the key to ensuring human survival and wellbeing in the years to come. If society is to respond to complex challenges the meaning of complexity needs to be communicated to the world in a manner that is understandable to a wide audience. This is the first in a series of posts that are looking at the concept of complexity and the challenges and opportunities with marketing it to the world.

Across North America this week the temperatures are vastly exceeding normal levels into ranges more akin to places like India or East Africa. The climate is changing and regardless of what the causes are the complexities that this introduces require changes in our thinking and actions or human health and wellbeing will be at risk. To follow Einstein’s famous quote:

“We can’t solve problems by using the same kind of thinking we used when we created them”

Many U.S. States are suffering hurricane-like after-effects from a Derecho that hit last week, knocking out power at a time when temperatures are into the high 90’s and low 100’s. Derechos are rapid moving hot air systems that are difficult to predict and can only be anticipated under certain conditions. The heat wave combined with the lack of air conditioning and supplies left 13 dead, maybe more. The heat wave is continuing and is expected to last throughout the weekend.

But this post is not really about the weather, but the challenges with complexity that it represents and how we need to be better understanding what complexity is and how to work with it if we are to survive and thrive in the years to come.

Blog interrupted

It’s ironic that this post was delayed by blackout. I live in Toronto, Canada and we have a remarkably stable power supply, yet last night and through this morning I was without power  due to suspected overheated circuits attributed to high air conditioning use, shutting down my Internet and everything else with it. In many parts of the world, this kind of blackout is commonplace and a fact of daily living, but not here…yet. This fortuitous bit of timing illustrates the fragility of many of our systems given the reliance on power to fuel much of what we do (e.g., cooking, food storage, Internet, traffic signals, lighting, etc..).

Virtually all of the infrastructure of modern life (here and increasingly globally) is tied to electricity. If you’re interested in imagining what would happen if it all shuts off, I’d highly recommend reading The World Without Us by Alan Weisman. Weisman uses a complexity scientist and futurists’ tool called a thought experiment to craft a book about what New York City would look like if humans suddenly disappeared. The book illustrates how nature might take over, how the underground subways would flood and collapse because of the millions of litres of water needed to be pumped out of it each day, and how certain human-built structures would decay over time (some far faster than we might hope).

Thought experiments take data from things that have happened already, theories, and conjecture and project scenarios into the future based on the amalgam of these. It provides some grounded means of anticipating possible futures to guide present action.

From present delays to future/tense

The Guardian asked a number of scientists working on climate about whether this current spate of extreme weather events is attributable to global warming. The scientists offered a range of answers that (not surprisingly) lacked a definitive statement around cause-and-effect, yet the comments hint at a deep concern. These anomalous conditions are starting to move further towards the end of the normal curve, meaning that they are becoming less statistically plausible to be caused by chance. What this means for the weather, for climate, for our economies is not known; all we have is thought experiments and scenarios. But the future is coming and we may want to be prepared by helping create one we want, not just one we get.

Unfortunately, we cannot wait for the data to confirm that global warming is happening or determine that we are contributing to it and to what degree. This is not just a weather issue; the same situation is playing itself out with issues worldwide ranging from healthcare funding to immigration policies and migration patterns. Interconnected, interdependent and diverse agents and information forms are interacting to create, emergent patterns of activity.

It is for this reason that weather patterns — despite being one of the most monitored and studied phenomenon — can’t be accurately predicted outside of a few hours in advance, if at all. There is too much information coming together between air flows, humidity, land forms, physical structure and human intervention (e.g., airplane contrails) interacting simultaneously in a dynamic manner to create a reliable model of the data. David Orrell’s book Apollo’s Arrow is a terrific read if you want to understand complexity in relation to weather (and more) or see his talk at TEDX on YouTube.

Two’s company, three’s complexity (and other analogies)

The above heading is taken from a title of another book on complexity and tries to simply point to how adding just a little bit of information (another person to a conversation perhaps) can radically alter the experience from being simple or complicated to complex. Just thinking about planning a night out with two people vs. three and you’ll know a little of what this means.

Analogies and metaphors are ways in which complexity scholars commonly seek to convey how the differences in conditions represent varying states of order. Brenda Zimmerman and others write about putting a rocket to the moon as being complicated and raising a child as being complex. One of my favourites is Dave Snowden‘s video on How to Organize a Children’s Party. One of the reasons we resort to analogies is that we need a narrative that fits with their experience. All of us were children and some of us have had them as parents so we can relate to Zimmerman and Snowden’s ideas because we’ve experienced it firsthand.

We haven’t experienced anything like what is anticipated from global warming. In the Americas, parts of Europe and Asia we are enormously fortunate to have entire generations that don’t know what it’s like to be hungry, have no healthcare, be without electricity, or have no access to safe water and proper sanitations. Stories about children’s parties might not bring these scenarios home. It is why Weisman’s book is so clever: it makes a plausible scenario fiction.

Science fact as science fiction

The role of fiction might be the key to opening the marketing vault to complexity. Scott Smith and others have been exploring how the use of science fiction helped pave the way for some of today’s modern technologies and innovations. By weaving together fantasy narratives and imaginations on the future, technologists have managed to re-create these tools for current life. Witness the Tricorder Project that seeks to develop the same multifunction health and information tool used by Dr. McCoy on Star Trek.

We are making headway with complex information as witnessed by the popularity of infographics and data visualizations. But there is much more to be done.

Complex problems require complex solutions. Artists, designers, scientists, marketers, journalists and anyone who can communicate well can play a role. Making complexity something that people not only know about, but want to know about is the task at hand. In doing so, we may find people reaching for and advocating for complex solutions rather than stop-gap, band-aid ones like buying a car with better fuel economy as the main strategy to combat carbon emissions.

It’s been done before. Marshall McLuhan wrote about esoteric, yet remarkably insightful and complex topics and became a household name in part to his appearance in Woody Allen‘s Annie Hall. Our media landscape is far more complex now (no pun intended) to think that a single appearance of any complexity superstar (if one existed) would change public perception of the topic in the same way that McLuhan’s did for his theories on media. Yet, Al Gore’s An Inconvenient Truth might have done more to get people talking about the environment than anything. And while Gore is not known for his witty storytelling, his slide show did a good job.

To begin our journey of marketing complexity we need to come up with our stories so that we can tell ones that are pleasant, rather than the ones that are less so. And if you want one that fits this latter category, I strongly recommend reading Gwynn Dyer’s chilling Climate Wars. Instead, let’s get closer to living what Peter Diamandis and Steven Kotler write about in Abundance.

The future is ours to write.

For more books and resources on complexity, check out the library page on Censemaking.

behaviour changeeHealthhealth promotioninnovationpublic health

Social Media and Health: Leaders(hip) and Followers(hip)

on May 18, 2012

Social media is finally catching on with healthcare, public health, and  health promotion. With a few recent articles published in the academic literature to rest on, academic health sciences has finally (and I might argue, begrudgingly) conceded that 900+ million users and $100B valuations (Facebook), and thousands of messages exchanged every milisecond (microblogs like Twitter and Sina Wiebo) might have some value for the public beyond entertainment.

If you note how long it took the health sector to start using the telephone as a serious means of engaging their patients or the public, this is lightning-quick adoption. Still, the barriers to adoption are high and the approach to using the technology is scattered. Indeed, just like the start of Internet-delivered telehealth (or cybermedicine (PDF), which has now evolved into eHealth), there is a mad rush to get liked, followed or some other metrics that most health professionals barely understand.

And that is part of the problem.

Meaningful Social Media Metrics

What is a meaningful metric for social media and health? A recently published article in Health Promotion Practice suggested four metrics that are taken from social marketing and applied to social media. These Key Performance Indicators (KPI’s) are:

  • Insights (consumer feedback)
  • Exposure (media impressions, visits, views, etc..)
  • Reach (# people who connect to the social media application)
  • Engagement (level of interaction with the content)

These are reasonable, but to to the uninitiated I would suggest a few words of caution and commentary to this list.

Firstly, the insights suggested by Neiger and colleagues “can be derived from practices such as sentiment analysis or data mining that uses algorithms to extract consumer attitudes and other perspectives on a particular topic” (p.162). While not incorrect, this makes the job sound relatively simple and it is not. Qualitative analysis + quantitative metrics such as those derived from data mining are key. Context counts immeasurably in social media use. It’s only in situations where social media is used as a broadcasting tool that gross measures of likes and sentiment analysis work with little qualification.

Even that is problematic. Counts of ‘likes’, ‘visits’, ‘follows’ and such are highly problematic and can be easily gamed. I am ‘followed’ on Twitter by people who have tens of thousands of followers, yet virtually no presence online. Most often they are from marketing fields where the standard practice is to always follow back those who follow you. Do this enough and pretty quickly you, too can have 23,000 followers and follow 20,000 more. This is meaningless from the perspective of developing relationships.

Engagement is the most meaningful of these metrics and the hardest to fully apply. This category gets us to consider the difference between “OMG! AWESOME!” and “That last post made me think of this situation [described here] and I suggest you read [reference] here for more” as comments. Without understanding the context in which these are made within the post, between posts (temporally and sequentially), and in relation to a larger social and informational context, simple text analysis won’t do.

Social Media Evidence: Problems and More Problems

One of the objections to the use of social media by some is that it is not evidence-based. To that extent I would largely agree that this is the case, but then we’ve been jumping out of airplanes with parachutes despite any randomized controlled trial to prove their worth.

Another article in Health Promotion Practice in 2011 highlights potential applications for social media and behaviour change without drawing on specific examples from the literature, but rather on theoretical and rhetorical arguments. An article published in the latest issue of Perspectives on Psychological Science highlights the current state of research on Facebook, which is timely given that its IPO is set for today. That review by Wilson and colleagues illustrates the largely descriptive nature of the field and offers some insight on to the motivation of Facebook users and their online activities, but rather little in what Facebook does to promote active change in individuals and communities when they leave the platform.

The answer to whether social media like platforms such as Facebook ‘work’ as methods of promoting change is simply: we don’t know.

Does social media provide support to people? Yes. Does it inform them? Yes to that too. Does that information produce something other than passive activity on the topic? We don’t know.

In order to answer these questions, health sciences professionals, evaluators, and tech developers need to consider not just followership, but leadership. In this respect, it means creating changes to the way we gather evidence, the tools and methods we use to analyse data, and the organizational structures necessary to support the kind of real-time, rapid cycle evaluation and developmental design work necessary to make programs and evidence relevant to a changing context.

As Facebook launches into its new role as a public company it is almost assured to be introducing new innovations at a rapid pace to ensure that investor expectations (which are enormous) are met. This means that today’s Facebook will not be next month’s. Having funding mechanisms, review and approval mechanisms, a staff trained and oriented to rapid response research, and an overall organizational support system for innovation is the key.

Right now, we are a long way from that. Hospitals are very large, risk averse organizations; public health units are not much different. They both operate in a command-and-control environment suited for complicated, not complex informational and social environments. Social media is largely within the latter.

Systems thinking, design thinking, developmental evaluation, creativity, networks and innovation: these are the keywords for health in the coming years. They are as author Eric Topol calls the dawning of the creative destruction of medicine.

The public is already using social media for health and now the time has come for health (care, promotion and protection) systems to get on board and make the changes necessary to join them.

design thinkingpublic healthsystems thinking

Diversity and Structure Meets Systems and Design Thinking

on March 2, 2010

 

The past few days I’ve had the privilige to speak to future healthcare leaders in the Health Organization Management Program at the Rawls College of Business at Texas Tech University. With every conversation I had with faculty, students, and researchers I was reminded of the value of diversity and the challenge that structure poses to encouraging the best aspects of diversity to emerge.

The positive side of diversity is that bringing together people from different backgrounds to bear down on a topic of shared interest in study (and practice) is an energizing experience. Last night I had the pleasure to speak to students who were getting their MBA’s with a healthcare focus. This group included pharmacists (and former deans), current physicians, training physicians, nurses, and even those who already had Masters degrees in other subjects like Public Administration. It was, by the standards of a usual healthcare education course, a pretty diverse audience. And as so often happens when diverse, engaged people come together, interesting conversation and learning happens.

The class was on systems thinking and its application to health care and public health and it provoked a series of discussions about how we too often structure our systems — particularly those in higher education and healthcare — to reduce the very diversity that leads to insights and engagement (the kind of thing we had last night). Because of issues of convenience, efficiency, and power (sharing or retaining) we often reject concepts that diverge from the norm, despite evidence or argument that they might succeed. An idea becomes habit and then soon is entrenched in what Jaron Lanier calls, ‘lock-in’. It becomes something we no longer question or we cease to challenge because it seems too hard to challenge.

A great example we discussed was the modern hospital. Hosptials are designed to reduce diversity in variation and service, create environments that support consistent ‘best practices’, and create a critical mass of service providers that is also efficient. While those ideas have some merit, they also embody an absence of systems thinking in their design at a fundamental level. Consider the very idea of putting all these people who are immunocompromised and often contagious together in one building. How wise is that?

Designing hospitals — or systems — like this suffers from a locked-in mindset that says healthcare needs to be delivered in large institutions for some of the reasons mentioned. It is so entrenched, that we don’t even consider that there could be many other ways to do this. Maybe some of those alternatives are more humane, safer and efficient. We don’t know, until we consider new ways of thinking and reclaim the diversity in the thinking that guides the structures we create.

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