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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 see what kinds of evidence relate to each mode of reasoning, as information objects used in practice.

   Design Reasoning                                                     Inputs and Objects

1. Craft-based, sharply honed intuition
2. Rules of thumb: heuristics
3. Best practices (case-based)
4. Design patterns
(modified to account for the current problem)
5. Qualitative rules of practice
6. Quantitative rules
7. Computer models
8. Mathematical models

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 you 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? Both?

Evidence-based design (EBD) is being reframed now, in different ways, in design education, research and practice. I’d say “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 doesn’t diminish creative or interpretive design approaches, but perhaps the 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

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 uncertaintly, 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 complementarymode 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.


Flourishing Cities: Toward an Ecological Governance

We held a participatory design workshop at Urban Ecologies 2015 (June 19) to test-run a process with the Flourishing Cities canvas, a system map for citizen co-design for planning future governance commitments and preferred future outcomes The Flourishing Cities framework adapts a design tool from the Flourishing Business Model, a planning system for constructing strongly sustainable business models. The design tool in both cases is a visual organizer for engaging stakeholders in co-creating values-centred operational guidance, in the Cities case, adapted for civil society engagement with urban planners and local governments.  This is based on research work developed from OCADU sLab Strongly Sustainable Business Model group as applied to the flourishing of cities and settlements.

As suggested by the “strongly sustainable” terminology, the normative commitment of the planning system is toward a fullY-integrated social system of an organization with its inclusive societal contexts, human participants, and the natural ecosystem.

A significant design challenge of our time is anticipating the relationships of multiple environmental and social problems as a complex system of nonlinear effects.  Consider how climate change debates stay mired in the unproductive positions of critique or techno-utopian solutionism. Climate change offers us the perfect example of a long-term complex problem system. We are largely arguing about symptoms and how to treat them, as the root causes (if not formal causes) of climate change are in trade, economic investment, and industrial subsidies from generations ago. As we face the consequent effects on human migration, energy, transportation, and urban planning, we remain largely unable to influence the politics of global capital. So even if Canada elects a more climate-friendly government after the disastrous Harper regime, South Asia and China’s development and climate impacts remain untouchable and arguably worse than our last 100 years of aggressive growth.

However, we cannot model or think about nonlinear and atemporal relationships very well, especially in deliberative groups and decision making processes. We need not only better engagement and dialogue processes for citizen deliberative problem solving, we require relevant tools. We are aiming to design a framework from the common language of business model tools, adapted for city and community decision making models.

This proposed visual model enables a participatory mapping of propositions, values, and preferences that might yield significantly better group decisions for sociocultural and ecological development and governance in any planning engagement. The frame for Flourishing is drawn from John Ehrenfeld’s decade of research and promotion of “sustainability as the possibility that humans and other life will flourish on Earth forever.”

The Flourishing Cities canvas is an experiment in creative engagement for constructing strong sustainability models for city and regional urban governance.

The presentation deck for the workshop (available in PDF).


The workshop in action. This was our first, and I (with the Strategic Innovation Lab) would be happy to develop custom Flourishing City workshops for planners or stakeholder groups. Contact me or join the SSMBG on LinkedIn if you’re interested in this developing area.

Learning from the Global Community of Dialogic Design

Co-Evolving SDD Practice

In several short years, many leaders and institutions now openly acknowledge the necessity for inclusive social transformation. We also now find stakeholders raising the concern that social change must be driven by participatory and democratic processes. We recognize the fact that our third millennium world needs new methodologies and new tools capable of harnessing the collective wisdom of people from all walks of life in order to protect its sustainability and foster up harmony into its evolution. The practice of Structured Dialogic Design is positioned as a powerful tool in this context.

A group of nearly 30 practitioners and scholars met in Limassol Cyprus for May’s international meeting not to revisit the history of the past 40+ years but to “create the history of the future.” The community of scientists and practitioners of the science of dialogic design has now expanded to include people from all parts of the world and a variety of languages and cultures. A dedicated community of scientists, students and practice leaders gathered for a week to deliberate on how to evolve SDD and retain its scientific credibility together with its cultural sensitivity.

As Yiannis Laouris states: “No claim is being made about the superiority of Structured Dialogic Design, even though there is substantial empirical evidence, from more than 1,000 applications in the arena, to this effect when dealing with the management of complexity.”














Laouris and Christakis have emphasized for many years the critical importance of performance in the Arena, of citizen and stakeholder-level action resulting in sustainable, persistent outcomes. All evaluation of quality and effectiveness must be tested by its effects in real discourses and decisions. The Symposium was a necessary, all too rare meeting of the College, the community of practice and scholars.  However, immediately after the week-long meeting, a significance team stayed in Cyprus to plan and deliver five (5) back-to-back Colaboratories. That’s commitment to the Arena.

In my view of the modes and outcomes of practice, I can identify four contexts of Dialogic Design engagements:

  • College – The Community of Practice and scholars who sustain the scientific work, the theoretical development, the scholarly publishing.
  • Lab – The Lab context is the crucible for tinkering with new concepts, building methods upon theory, and the source of methodological innovation. As designers, we might also call this the “Studio” context, because its working with peers and informed stakeholders on designing processes and applications. Unlike the contemporary notion of Social Labs, I see labs as back-room workshops where designers and planners work with problem owners in building new engagement methods and designing better ways to manage and analyze dialogue and its artifacts.
  • Arena – The Arena is the center of engagement, the Co-lab, the place where stakeholders meet and deliberate in a context of communicative action hosted by a team of 3-4 SDD facilitators. SDD organizes a stakeholder designing process in which every member is empowered to decide and to take action in collaborative outcomes.
  • Agoras – Agoras are evolutionary dialogues disclosed by processes of dialogic design.  The new Agoras we speak of are spaces for citizen dialogue, in the continuity of places like the Future Worlds Centre in Cyprus or Design with Dialogue in Toronto. The are becoming possible online, with mixed-methods and staged temporality.

The included presentation was on the relationship of design and design principles to systems practice and SDD.

SDD offers a significant, developed theory base and unlike most systems methods, it is a validated and published method. Yet SDD was never developed as an integrated design methodology, it was formulated from the beginning as a powerful systems approach for multi-stakeholder deliberation and strategic decisionmaking in complex and high-risk domains. What would it take to reconfigure SDD as a design-led multi-stage process for collaborative foresight for social systems planning and design?

We might start by integrating design and research methods from underrepresented creative and social science disciplines, including strategic foresight, participatory action research, organizational design, and developmental evaluation. The pre-Definition and execution phases in particular can be considerably enhanced. Both the Discovery (preceding SDD co-labs) and Action Planning (following co-labs) have significant potential for mixed-method design processes. Today we typically customize a research and facilitation strategy for a client, but do not always measure or compare outcomes or publish findings.  The Cyprus symposium provided a venue for practitioners to share the magic of approaches learned in the Arena.



Service Design for Care Workshop

We have started a quarterly series of healthcare service design workshops at OCADU for stakeholder networks, health providers and health agencies.  With an explicit focus on service design and design-led research in healthcare, we hope to raise awareness of the practices and models for service design in clinical and community care settings.

Workshop 1 – Inspiring health movements in community networks:  Community network innovations

Dr. Rick Botelho, Family physician and U Rochester School of Medicine


Challenge:  How can we mobilize people within their local and extended social networks to socialize health learning and experience to improve population health in the community?

Description:  We address the problem of community health through the approach known as catalytic innovation, creating lightweight modes of peer learning appropriate for different types of social networks (online, neighborhood, community centres). To overcome the scarcity mindset in healthcare, patients become an integral solution to these complex problems. These peer-driven services complement professional services and build growing networks of peer learning and coaching for health improvement.

The Health Coaching Buddies learning process developed by Dr. Botelho represents such a convenient, inexpensive and accessible peer learning system. These processes aim to improve health behaviors such as self-care of chronic diseases, improving health literacy, reducing social isolation and enhancing personal happiness and social well-being. These innovations can be made widely available, using social media, online programs and mobile phones. They are designed to create meaningful learning experiences that aim to accommodate people’s particular worldviews, needs, preferences and life circumstances, instead of making people fit into a particular program, theory, clinical approach or setting.

Objective: The workshop will engage participants to think systemically about population and community health improvement and to design possible interventions for peer support. It will focus on the first two phases of a 3-phase process: inspiration and ideation (but not implementation).

Methods:  Workshop participants will learn how to:

  • Frame the complex social challenge (continuous sharing and promotion of health support in community level)
  • Identify innovation opportunities
  • Visualize and specify service concepts proposed by small groups of participants
  • Formulate, conceive or propose catalytic innovations for community health improvement

Workshop Outcome: Imagine transformational leaders, innovators, organizations and communities working synergistically to:

  • Proactively disseminate peer learning and coaching systems at all levels
  • Align leadership, professional and social movements
  • Build exponential heath movements