Power is perhaps the one remaining unsolved issue areas in the shared domains of design, systems, OD, and progressive management. Healthcare, like other public and social sector institutions (education, social welfare, government) is organized by what Jane Jacobs in Systems of Survival calls Guardian systems, the moral syndrome of ruling. As in government, the values of authority, prowess, rank, restraints on trading, and “deceit for the task” are important in these sectors, though we don’t like to admit it. Even democratic governments are not democratic in values or style, they inherit the mantle of the warrior class, which makes a living by “taking”. In some ways, business – even corporate America – is fairer and more open. In Jacobs’ model, business (or mercantile systems) tends to care about collaboration, honesty, results and of course customers – this leads to power toward winning joint ends and achievement, rather than winning process (or means) struggles. Power manifests in many ways – so in design processes, we adapt and deal with power issues in different ways, according to different environments.
Design practices tend to deal with power differentials obliquely, since designers tend to only have soft power, referent or expert. Since we are positioned externally to power centres, our influence isn’t a threat to legitimate power. We will eventually go away. And designers like to avoid conflict that isn’t creative.
Because I want to attract new audiences for Design for Care, (its an “early” book in the field), I pull many critical punches. I don’t want to give the impression to healthcare decision makers that designers want to “change the system” in ways that may appear naïve (or that might seem uniformed from a clinical point of view). These issues are highly contested within the spheres of legitimate medical power and decision making, so coming from a design text, its a sensitive balancing game to discuss these issues.
Yes, design practices can lead to interesting outcomes with power conflicts. We can structure design engagement to proceed over multiple iterations of research and mutual learning. We can build multiple team structures within organizations, and encourage a mix of disciplines, personal styles, and affiliations within each team. We employ forms of dialogue to get to creative tensions, which can relieve the social tension around power to decide.
Typically, we advocate design methods that lead to innovative (high novelty) outcomes with high degrees of agreement. The creative process itself references the common design theory of power, which is that “everyone is creative.” Therefore if we are inclusive and participatory, power differences are minimized. So we include a wide range of participants and seduce them with creative engagement to generate sufficient depth and breadth to maximize the outcomes of enhanced design outcomes, higher utility and social adoption.
However, in many collaborative and team decision processes power (especially between levels of hierarchy and top-dog disciplines) emerges as a significant dimension. In the chapter (8) on systemic design practices in healthcare institutions and systems, I suggest the dialogic design methods (as indicated in the influence map) from the Romanow Report case study.
Influence map generated by Cognisystem for recommended actions from the Romanow Report (Challenges in Canadian Healthcare)
Dialogic design been in continuous development since the 1970′s (Interactive management) and appears in hundreds of journal articles. We teach this practice to our Strategic Foresight & Innovation grad students. It balances in-session power dynamics and post-engagement power (deciding final outcomes) in several ways:
- We take “the whole system in the room” very seriously. That means the containing system for the organization, not just the organization itself, if possible.
- Set the expectations for democratic process, and frame the focus question, issues, and context very carefully. We spend weeks getting to the right question for a stakeholder engagement sometimes.
- Select stakeholders using a very disciplined rule of “requisite variety” to the outcome decision. Include diversity, all affected organizations and levels, and include those vulnerable to a bad decision
- Use a structured dialogue process that ensures principles of autonomy and authenticity are met. SDD has well-defined methods for ensuring this.
- Facilitate processes with an aim of neutrality. Ensure all participants recognize they are co-designers in the process, and share investment and ownership in the outcome.
- Have good sponsors and organizational brokers that mediate power relationships in advance of holding a workshop, and can mediate results in the org setting when we, the hired social design team, leave!
We might call the principle requisite access to power, since the value we’re seeking is not to minimize the strong but to give those with unequal access an equal chance for advocacy. We aim to ensure all stakeholders recognize their capacity to act on power within their responsibilities for action. Since all members of a dialogue have power, all forms of power should be ethically recognized, not neutralized. (Its the Reconciliation of Power in axiom #7 in our development of Dialogic Design Science).
Yes, design practice has practical ways to navigate power dynamics in stakeholder engagements and co-creation workshops, but design theory has very little to say about the influence of power. Power in the act and activity of design is a pervasive fact of life. Whether in product or service design (Design 2.0, which is in service to sponsors and product managers), organizational process design (Design 3.0, where the decision rights of managers hang in the balance), or certainly social transformation (Design 4.0) there are different modes of power, means to exert and follow power, and – if we choose – there are systemic design methods to both balance and emancipate requisite power to change organizations, societies, and worlds for the better.