In Books

Design for Care

We Tried to Warn You

Team Design

Systemic Barriers to Effective Societal Response to Terrorism

“Organizational learning must concern itself not with static entities called organizations, but with an active process of organizing which is, at root, a cognitive enterprise. Individual members are continually engaged in attempting to know the organization, and to know themselves in the context of the organization. At the same time, their continuing efforts to know and to test their knowledge represent the object of their inquiry. Organizing is reflexive inquiry.” (Argyris & Schön, 1978, 16–17).

Systems Thinkers Toronto turned out a dozen people last week for a demonstration the new SDD dialogue management software and a discussion of dialogic design practice, which can be seen as an embodiment of organizational and social system cognitive organizing.  I teach a basic form of the methodology in my Systemic Design course in OCAD University’s Strategic Foresight and Innovation graduate program. As a core practice of the Institute for 21st Century Agoras these methods have been developed from Christakis and Warfield’s Interactive Management over the last decade. The formal events are recognized and certified as Co-laboratories of Democracy).

The unique contribution of the software is in guiding a group of stakeholders to map out the influence relationships among structured statements in a dialogue. The logosofia system (and the new Cogniscope 3) are slowly replacing the aging CSII software. However, learning the software is not a path to practice, its merely an embodiment of the method which is learned in the course of performance in the Arena (Christakis’ term for convening Co-labs in high-stakes, multi-stakeholder engagements.)  While it usually takes years and mentorship to become a lead facilitator, we are making the engagements themselves more affordable and accessible. Between the Future Worlds Center and the Agoras Institute, we are designing and convening streamlined hybrid sessions that are more accessible to everyday citizens and civic groups. Such a hybrid design-led approach is shown in this opening presentation for an engagement in Berlin.

In our Toronto-based Systems Thinking community of practice we held a walkthrough of the software in a simulation, but holding a real dialogue on the barriers to effective action on global terrorism. Walking through the process of a Dialogic Design Co-laboratory with a dozen participants, we hosted the question of “What barriers do we anticipate that, if addressed in the next 5 years, will most effectively resolve issues of global terrorism?” 

We quickly ran through the following steps in simulation:

  • Triggering question (TQ) formation
  • Nominal group – responses to TQ
  • Entering responses into logosofia
  • Clarifubg statements upon entry
  • Selection of highest priority challenges
  • Structuring – Voting on relative influence
  • Mapping and final dialogue

I wanted to share the kind of deeply-thought responses that emerge when we take a more systemic approach to structured dialogue and attempt to focus attention on sources and motivations rather than manifestations and grievances:

• Attention to terrorist acts is disproportionate to the impact.
• Youth lacking healthy source of epic meaning.
• Psychological force of prior harms unreconciled.
• Inhibition within liberal democratic culture to take necessary steps to effectively eradicate perpetrators.
• Cultural ignorance of the roots of colonialism.
• Disappearing state monopoly over public values & communication.
• (Dictionary of definitions) Lack of agreement of definitions acts of terrorism
• Isolation of moderate groups of same ethnicity or faiths
• Cultural or political compulsions to escalate retribution
• Inequitable access to systems of education (polarization)
• Degrowth process of global economic forces (inequitable dist of wealth)
• Lack of true globalization (arbitrary geographic identities)










As you can see its a shallow map, as we didn’t have the time to include and map out all responses – this was a trial run, and the first round of responses. But the seriousness of the setting and the clarity of process in SDD reinforces a more thoughtful approach that brings forth group attempts to reach source issues that are also personally meaningful to the author proposing the issue.

Finally, the discussion yielded by the dialogic design trial brought serious reflection to the fore.  Here the predominant reasoning was that “terrorist acts” are the means to achieve other strategies. They have little to do with Islamic ideology, but leverage the fear factor associated with the unknown of cultures and “the other,” keeping the press at work reinforcing our notions of the fearsome other. The deepest drivers in the relational network, even in this quick run, show that unreconciled prior harms (blowback) and our own “cultural ignorance of the roots of colonialism” have deep causality with a deeply alienated young demographic in the originating cultures. If such a tool could be used for serious policy design, we might stand a chance of recovering our cosmopolitan values of an evolving human civilization, instead of living in a decades-long state of constant siege resulting from selfish policy choices at the hands of our own elected fanatics 13 years ago.

RSD4 – Relating Systems Thinking to Design

The RSD symposium series has been held each year for four years now, sponsored by AHO (Oslo School of Architecture and Design) from 2012-2014 and this year in Banff. Organized by a four-person team of co-chairs, a group of great reviewers and capable volunteers, we’ve kept the symposium intimate and lightweight, affording a memorable experience. We’ve had extraordinary keynotes, again this year and as the Proceedings for each year show. This year, as the last two years we held 36-38 strong presentations, with a focus on quality design-led research in systemic design. We had 8 workshops held across all 3 days, an experiment in varying the tempo and level of engagement throughout each day.

Although this year’s proceedings are still in process (we integrate papers, abstracts, sketchnotes and PPTs) we have videos and presentations from the keynote speakers to share. We have a tremendous trove of documentation and we’ll organize a compelling story over the next two months to renew the experience and learning.


The keynote videos are now available:

Don Norman – Can HCD Help with Complex Sociotechnical Systems?  

Ann Pendleton-Jullian – Designing for Emergence Working on Radically Contingent Problems.

Mugendi M’Riitha – Renewing Africa’s Quest for Sustainable Energy.   

Ursula Tischner  – “Crowd” based Systemic Design and Innovation for Sustainability

Lia Patricio – A Framework for Co-creating Service Platforms (PDF)

For 2016 (Oct 13-15) my school, OCAD University, will be the hosting institution in Toronto, affording an even larger response between our large university communities and easy access to global travel.

Please contact me if interested in supporting the event, connecting with your organization, or coordinating with other events during the week in October 2016.

Healthcare Design as Extraordinary Service

Lisa Norton, a professor in the School of the Art Institute of Chicago, conducted an interview with me earlier this year for Integral Leadership Review and also published it on her own Design Being.  Titled Healthcare Design as Extraordinary Service, its available both online and as a PDF article. Several paragraphs are included herein to bring this back home to Design Dialogues. She opens with:

Leveraging systems thinking, human-centered design, and information architecture, his Redesign Network serves the emergence of healthcare service systems capable of taking better care of human beings. By developing schemas for more comprehensive understanding of systemic conditions, Peter Jones is defining new intersections and innovation spaces in healthcare and information-intensive services. In the following interview, Dr. Jones shares first-person reflections and insights on patterns in organizational leadership and influence, as well as his hopes and concerns for the future of healthcare systems design.

Lisa writes: “In the developed world, every citizen is impacted on several levels by their proximity to or distance from, care services and health support. Design for Care reframes the objectified “patient” and “user” categories as health seekers. By reframing the patient role as health seeker and differentiating health seeking, (understood as ongoing and continuous throughout life) from information seeking, Design for Care makes space for a diverse range of individuals with multiple intentions. “These are patients receiving care for complex co-occurring illnesses, people improving their sleeping patterns, individuals struggling with the care needs of their family members. In nearly all cases, we have something in common – we are all seeking to improve health toward a felt homeostatic balance, the experience of a recognized sense of ‘normal’.”

I see two emerging thrusts in design for systemic change and sets of questions they suggest. One relates to clinical organizational change: How can we expand the functions of care within clinical organizations to enhance the design of service and the experience of care? How might design move from IT and other non-clinical services to the front lines? The other to health systems level: How can we design to engage and promote extraordinary care in our societies? How can we help clinicians move healthcare innovation from process improvement into a realm of “extraordinary service?”

Apparently I had a lot to say about organizational design and the relationship to new healthcare practices and new distributed models such as the ACO. Perhaps channeling Russell Ackoff’s Democratic Corporation here, I’m proposing a similar self-organizing approach of teams within (large span) hierarchies.

There are few truly flat organizations. The “hierarchy vs. network” theme is archetypal, but structure is not a solution. Networks are not flat by any means; they are lumpy and energized by power bases. Many hierarchies allow their departments to behave as if flat. Rather than characterizing by dichotomies, we might consider every system as a mix of structures, often shifting, but in slow motion. Large product companies often have vertical market segments and product lines that require separate teams and external networks, such as the large firm in We Tried to Warn You. And they are able to “learn lateral” when necessary, even in a traditional managed hierarchy.

In terms of systemic design within organizations I’ve advocated a planned combination of top-down and bottom-up strategies of soft system design. My approach connects front-line projects with broad organizational and community goals. Through structured dialogue and creative workshops, we can help stakeholders in management and in patient-facing services to discover a shared framing of goals, boundaries, and roles to align their projects toward preferred system outcomes.

Healthcare practices are very resilient, they are trained and standardized so that many clinicians can be interchangeable and perform well under a range of conditions. Changing clinical practices, workflow or procedures requires strong evidence and a clear argument, retraining and evaluation. It’s the same thing when introducing a new EMR or IT system. Healthcare organizations are designed in a sense to resist change; they hold strong norms of practice due to the constant demand to serve their communities. Therefore when consultants (and designers) want to promote innovation and change and they don’t live and work inside healthcare – hospitals or practices – their proposals will likely fail. We are not all on the same team. Clinicians have a primary duty as caregivers – what is our duty of care to the caregivers? Perhaps as designers we can see possibilities those working in the domain cannot, but that doesn’t give a mandate for change from the outside.

Healthcare is risk-averse by design. It is (in Jane Jacobs’ terms) a guardian moral system, as opposed to a system of commerce or trade. Most consultants, designers and IT people come from companies with a commercial moral system, and their operating values may be inherently at odds. Is it ethical for “us” to advocate they act like creative entrepreneurs? Technology interventions can have the effect of embedding a foreign values system, and once embedded, received without consensus.

In my experience, creative competencies can be established within organizations in a developmental way, but preferably not through direct “culture change” initiatives. Cultures change when internal practices reflect new values within ways of working. These practices, habits really, become communicated and valued across departments and enable significant improvements in complex work processes. I don’t believe that my role as a systems designer is to change culture however, it’s a designerly arrogance to believe we can change cultures as outsiders. We haven’t personally done that work in our own organizations, and even when I have, it was in an insider’s role of peer-led stewardship, not as a hired consultant. So how can we pretend our process design is the answer to complex sociotechnical work challenges? The best we can do is to facilitate dialogues and help internal teams design strategies for near and longer term transformations.


Fear and Loathing of Evidence in Design Research

Some of the gaps in practice are starting to show between design-led everything and design research. Don Norman has been advocating an evolution in design thinking and education with a stronger role for evidence. Recently, Don articulated a scale of levels of rigor in design practice, ranging from designerly intuition to math and engineering models. I have added “inputs” to this list so that we might consider what kinds of evidence relate to each mode of reasoning, as we might see evidence as information objects, discovered in research and evolved through practice.

   Design Reasoning                                                     Inputs and Objects

1. Craft-based, sharply honed intuition                           Design materials and repertoires
2. Rules of thumb: heuristics                                             Principles as heuristics, canonical types
3. Best practices (case-based)                                            Inducing patterns from cases, formalized insights
4. Design patterns                                                                Patterns adapted, catalogued and applied in new cases
(modified to account for the current problem)
5. Qualitative rules of practice                                           Observations and claims from social science & ethnographic modes
6. Quantitative rules                                                            Data, formulae, observations and summaries from probability samples
7. Computer models                                                            Inputs to modeling identified and defined from cases and statistical reference
8. Mathematical models                                                     Abstracted information, parameters and statistics

While I might agree that 6-8 are conventionally more “rigorous,” they are in some was less evidence-based in design practice. In presenting evidence toward critical design decisions, quantitative evidence counts. However, good design practices will have identified design options using qualitative and iterative abduction well in advance of statistical tests, which are typically evaluations of a small set of options determined through prior user/human research. Statistics aggregate observations from a thinner set of observations, and abstracts the evidence away from the source, from the people or settings of use. This is why usability evaluation in situ remains such a powerful form of evidence, as I’ve found a single situation in context to be more convincing to sponsors and engineers than a large scale user survey. Type of evidence at the stage of design is more crucial than rigor.

Whether or not you agree with these, there seems to be a split at 5, where design patterns are not direct evidence-based (inferred from observation) What do we really know about evidence-based design? Is it a developing design practice trend, or more of a mode of design research that drives design decisions? Is it premature or perhaps overstating the case, perhaps we might find more agreement if we described models of “designing from evidence?”

Evidence-based design (EBD) has already been reframed, in different ways, from architecture, design education, research and practice. EBD is not a thing, yet. It’s not what we think it is. This is not a monolithic practice that threatens design traditions.  In practice, understanding the contributions of science and standards of evidence contribute to better design decisions in any complex sociotechnical system. Evidence is not a passive construct, it requires a process of data collection and interpretation. Collecting data about or during a design inquiry doesn’t diminish creative or interpretive design approaches.

But perhaps another concern is more that a turn toward evidence alters the balance of power designers have worked so hard in the last decade to achieve. Design thinking and co-creation practices have been endorsed as powerful allies in business and social innovation, and perhaps in some ways a strong evidence approach competes with co-creation. I would suggest this is a necessary return to balance of the reality of the purposes of design thinking – to ensure effective and desirable products and services are developed based on an honest appraisal of the humans in the social systems of use. These are customers, end users, organizations, marketplaces. Evidence returns some power to the reality of current needs and functions, perhaps at the expense of conducting longer, more experimental projects. However, in domains such as healthcare, public service, and many high-risk applications, the necessity for not just managing costs, but employing systemic design to drive down costs while serving constituents is one of the main drivers inviting design practices into these otherwise forbidding arenas.

Most systems I’ve designed have included both types (or multiple methods) of design research. Certainly when working with development teams and product managers, the “harder” evidence – user data – is always more convincing than generative or conceptual design cases.

There’s been a long tradition of evidence-based design in healthcare, based in studies of environmental design and architecture in facilities and care practices. Its major proponents have been doing safety and systems-oriented research and intervention since the early 1980’s, and if you search “healthcare design” these are the precedents that show up. (See the venerable Center for Health Design) CHD studies have made a huge difference in quality of care and patient safety over the last 30 years. Design enhancements such as in-room artwork, access to natural scenery and living plants have resulted in decreased length of stays, improved service experience, and other softer outcomes, such as lessened anxiety. We can measure these things and make a convincing case for expensive and significant facility changes (to make any change to hospital environment is expensive, as it must be durable and repeatable option for all patient rooms or locations). The now-current knowledge that “single patient rooms lead to better health outcomes” is both patient-centred and evidence-based. But hospitals would never accepted the expense of essentially doubling the number of rooms based on patients preferring it. They do measure hard outcome data, and outcomes are a major design criterion.

Evidence is not necessarily a positivist position, even if the tradition of EBD tends to be so. Evidence is merely “based on data” as opposed to expert judgment or collective agreement, which are interpretive modes. In fact, collecting interpretive data from users, rigorously, is evidence. Patient narratives are a type of evidence. If we don’t collect data, we’re at significant risk of interpretive risks in making design decisions that affect safety, human welfare and finances. So just as scientists argue about the meaning of data, so ought we.

Evidence and its alternatives are not an either/or proposition. In fact, there is no “or” to be found. There is little risk of epistemological contamination by adopting the value proposition for evidence in design.

In systemic design there needs to be a balance of methods and perspectives, as complex systems (at least) are many-sided and many-functioned operations which no one person can understand in whole. Every contribution to knowledge helps.

In healthcare, the trend that is balancing evidence-based care is patient-centred care. But very few organizations have produced meaningful approaches that all understand as patient-centred. There’s pretty good agreement around “levels of evidence” and research standards, there’s almost none for patient-centred care. The definition of PCC seems to be getting fuzzier, not clearer, as more stakeholders adopt a patient-centred view, and then are stopped by the uncertainty, perhaps, of how to best implement the value in real care setting.

PCC is not patient experience, or patient satisfaction, PCC is interpreted very differently between clinical professions, and differently across institutions.

Are some hospitals advocating a trend “away” from evidence and toward “patient centricity” when they don’t agree what that is? And when they get closer to it, PCC may tend to blow up the business model and workflows.

Unless design thinkers make a culture out of evidence, it will become a complementary mode driving research, and helping designers make “unassailable” design proposals in complicated and risky situations.

If non-clinicians actually look at how the evidence behind medical practice is treated, they’d realize that no expert “lets the evidence decide.”

The reliance on clearly established precedent and the “literature” is a starting point for clinical decisions – diagnostics, medications or surgical therapies are complex decisions and require the best known answers before expert judgment is applied. The risks are too high not to. Yes, in hospitals residents execute much of this and they don’t build long-lasting personal relationships. They are residents. But nurses, who have championed patient-centred care and tend to practice it philosophically even if it’s not standardized, demonstrate in many ways affective and interpersonal qualities we associate with PCC.

Certainly clinicians who actually work in healthcare are not going to wish away evidence supported decisions anytime soon. When we seek to deliver design value at organizational and social/policy levels, we’re dealing with high degrees of complexity and the difficulty of sustaining a presence long enough to make a difference. Gaining agreement on courses of action is critical in these domains. Evidence helps us build the case for stakeholder agreement, especially across strongly contested views and positions, where power is involved or people have possible losses.

But service design and whole system (integrated IT and process) design require both evidence-based and x-based. And I’d like to hear more of what those other “x’s” are, because I never saw a conflict between research-led design and exploratory design. They are usually different stages, but I will say that in corporate work I’ve found you rarely get paid to explore. In design school our students usually want to just explore and save evaluation for “later in the career.”

If we want to be trusted to work with mission-critical services and integrated systems, we need to get beyond our own prejudices of what these categories might mean. We have to read studies, learn from scientific research and design research, from our peers and dialogues. And I would make a case for integrated methods and multi-perspectives.