In Books

Design for Care

We Tried to Warn You

Team Design

The Systemic Turn – RSD5 Theme Issue of She Ji

At OCADU we’re delighted to see the theme issue from She Ji featuring studies presented at the RSD5 Symposium (2016) within a year after the proceedings. Thanks to editors Ken Friedman and Jin Ma, we have an amazing set of 5 contributions in systemic design from several of the leading scholars in the discourse community. Thanks to the OCADU Strategic Foresight and Innovation student team of Pupul Bisht, Ian Prieto-McTair, Kashfia Rahman, and Macy Siu, we have their brilliant synthesis map featured on the cover art for 2017 Vol. 3, Issue 3.

Get the whole issue for free 

The opening editorial discusses the Systemic Turn emerging in design practice.

Connecting the Social, Technological, Ecological, and Practical

The twenty-first century challenges human societies, settlements, and economies. This era confronts us with continuous wicked problems on a planetary scale, and it has done so since the tumultuous century began. Since at least 2005, we have seen a series of new approaches to design, from transformation design to service design, from transition design to DesignX. Each approach addresses a range of critical challenges oriented to a point of view. Each approach trials practices and methods in search of the disciplinary confidence to address the macro-level problems that people everywhere face. Climate change, distressed migration, equitable economy, housing, public policy, and health care top the lists of shared complex problems that we face. As designers we genuinely hope that new approaches to design can transform some of these problems to a better future than we face today.

Systemic design considers these macro-scale issues from a different direction. Much like transformation design, systemic design bubbled up from the crucible of millennium problematics and higher-order design. But rather than claiming a purchase on problem solving—always a risky proposition—systemic design took a realist path. We do not always seek to “redesign the system.” We instead aim for aspirational change for service systems and societal projects through better-fit processes and practices that evolve change over time, seeking the right dynamic fit between intervention and readiness.

Systemic design has influenced design education, scholarship, research, methodology, and it has developed a design orientation which we might call “Design as a Whole Systems Practice.” The ultimate aim of systemic design is to co-design better policies, programs, and service systems with the participants in those systems. The methods and principles that enable systemic design are drawn from many schools of thought in systems and in design thinking. The objective of systemic design is to affirmatively integrate systems thinking and systems methods to guide human-centered design for complex, multi-system, and multi-stakeholder services and programs across society.



Synthesis Maps: Making Complex Systems Tangible

Gigamaps and synthesis maps look very similar as finished products. However they differ in their developmental processes. Both are rich images that visualize complex system problems, and both are used as design artifacts in similar domains (from health to public policy, from service experiences to social change). Both are used with stakeholders for advising, planning, and designing for social and systemic challenges (wicked problems).

  • Gigamaps are more “direct engagement in the relations of a system.” Sevaldson explains Gigamaps in a well-regarded paper and in RSD proceedings. Gigamaps employ a research through design (RTD) practice of engaging directly with a system problem and following the contours of the complexity as expressed in a design space.
  • Synthesis maps evolved from the SFI pedagogy necessary to train students in systems thinking and to learn both system formalisms and systemic design for complex multistakeholder problems. Synthesis maps are typically designed as communicative artifacts that translate multiple knowledge perspectives about social systems to illustrate the dilemmas and challenges within a complex system scenario.

Due to the coursework setting in which these are trained, often without access to direct stakeholders, we employ generative and ethnographic research to design. These are then “first phase” system maps that synthesize research, perspectives, and design problematics into coherent visual narratives that make sense to stakeholders knowledgeable in these domains. Our hope with student work is to demonstrate the possibilities of synthesis maps to reveal systemics and propose design of future options. These become proposals for continuing with in-depth stakeholder work such as published by sLab to date. They serve to communicate complex concepts visually for service design, and as descriptive artifacts for presentation in conferences and publications.

Synthesis maps are particularly effective in representing multi-level social systems such as are common in healthcare – indicating an outer boundary (e.g., national or provincial system), the service networks, agencies and specialized providers within a care context, for example. SFI student teams have also delineated sophisticated dementia journeys, evolution of health equity, and the developmental pathways of childhood obesity.

The Gigamap technique was developed by BIrger Sevaldson of the Oslo School of Architecture and Design, who we have collaborated with since 2011 in the development of systemic design methods and the RSD conference series. Observations of the AHO Gigamap Gallery shows their process develops a strong architectural and descriptive approach to complex projects, which are pursued through studio work using a research through design (RTD) process. The SFI maps have been developed in half-term courses guided by design-led field research and extensive secondary source references to build descriptive system maps as a mapping of territory for systemic design of the social systems of concern. We also develop a core systems theory or methodology within the SFI maps as a means of pattern and leverage. Because the process we teach is developed more as a synthesis of evidence and is informed by theory, our process is better considered as a Synthesis Map.

A recent synthesis map was created by an sLab team for the SSHRC-sponsored Canadian Governance in the Digital Era, with the resulting map (here reduced in size), published in the March 2015 issue of Canadian Government Executive. The map draws on both foresight and system thinking models within a horizon scan of trends, values and weak signals for future innovation patterns.

How Might Canadian Governance Be Transformed in the Digital Era?
(cc 2015) Kelly Kornet, Goran Matic, Peter Scott, Jill Sharrock, Stuart Candy, Peter Jones, Patricia Kambitsch, Greg Van Alstyne.



Synthesis Maps from CanIMPACT | Mapping the clinical cancer system

The CanIMPACT project (Canadian Team to Improve Community-Based Cancer Care Along the Continuum) is a multidisciplinary pan-Canadian program studying how to improve cancer care to patients in the primary care setting. Funded by the Canadian Institutes of Health Research for 5 years (2013–2018, Grant no. 128272) the project was led by Dr. Eva Grunfeld, Director of Research at U Toronto’s Dept of Family and Community Medicine.  For the CanIMPACT synthesis map project, our sLab team (Jones, Smriti Shakdher, Prateeksha Singh).  Two synthesis maps were prepared to reflect the discovered insights from the multi-year investigation, a clinical system map and a patient-centred map informed by the CanIMPACT Patient Advisory Council. The resulting maps were published (a first for a system map method) in Current Oncology and presented at the first Canadian Partnership Against Cancer (CPAC) conference, and MedicineX 2017.

Jones, P.H., Shakdher, S. & Singh, P. (2017). Synthesis maps: Visual knowledge translation for the CanIMPACT clinical system and patient cancer journeys. Current Oncology, 24 (2), 129-134.

Synthesis mapping produces high-quality representations of insights drawn from research evidence,
It presents visual models of systemic patterns discovered through multidisciplinary observations, and
It communicates to stakeholders and interested observers the processes, interventions and possible strategies and policy interventions in a complex system.




















CanImpact Synthesis Map: Canadian Clinical System of Primary Care in the Cancer Continuum






















CanImpact Synthesis Map: Patient Experience of Primary Care in the Cancer Continuum
A Relationship-Centred View of Breast and Colorectal Cancer Survivorship

(PDF copies of both maps are available by selectness the image, (c) 2016 Strategic Innovation Lab.)

Studies from the CanIMPACT project have been published in the same issue as a special edition guest edited by Dr. Grunfeld. The summative workshop at which the maps were presented, with conclusions and recommendations, is found online at NLM and Current Oncology:

Discussion of the “two solitudes” or disconnected practices of primary care and oncology are described in Eva’s second article in the same issue:

The Current Oncology article presents a simplified summary of the design action research process we used in developing the synthesis maps in the CanIMPACT project. These steps would be representative of an evidence-driven approach, and while not all synthesis maps are models of system knowledge from evidence, it is a well-suited technique for a range of complex knowledge problems in healthcare, medicine, community and mental health, education, social policy, and other institutional and policy sectors.

  • Domain and Literature Review A scoping review of the CanIMPACT study and its references was conducted. Continuous searches informed emergent questions for representing mapping decisions.
  • Expert Interviews and Content Analysis, with Visual Notetaking. The CanIMPACT qualitative study, the Casebook survey of cancer initiatives, and administrative data substudy reports were analyzed, guided by interviews with study area leads.
  • Knowledge Synthesis to Design Maps in Stages In collaborative sessions, maps were hand-sketched to represent salient findings drawn from content analyses. Peer Critique of Electronic and Print Maps Structured critiques of the maps were held with the CanIMPACT and PAC experts at key stages of map development.
  • Iterative Map Design The clinical map was developed first, in stages that adhered to the method. The necessity for a patient-centred map was discovered during the peer critique step.


Soft Service Design: Interventions in Complex Social Determinants

Design for Health (2017)

Design for Health – Published by Routledge May 2017,   Edited by Emmanuel Tsekleves and Rachel Cooper (Editorial overview of book and chapters)

Chapter 3:  Soft Service Design around the Envelope of Healthcare (Peter Jones)

Better alternatives to improving population health have been sought by healthcare policymakers and the front-line clinicians who see patients in everyday care settings. While public health experts and primary care clinicians recognize the significant effects on health from social determinant factors they have limited tools for addressing these causal factors in their patient’s lives. Systemic improvements to a population’s social ecology are considerable challenges from within the “envelope” of a healthcare system. The service design challenge I propose and aim to answer is that of, can we better intervene outside of and around the envelope of the healthcare system?

In mental health and primary care contexts, we find that systemic factors and social determinants (such as environment, housing, social lifestyle, food accessibility) account for a significant proportion of presented conditions that are treated as mental illness. The primary care and mental health systems are not structured or funded to address social determinants – as they do vary in every micro-context. A community activation approach might be better aligned to community-level needs and cultures.

Social determinants are embedded in a community setting, are multi-causal and interrelated, have indeterminate risk, and are not typically perceived by individuals as health threats. A community’s population and traditional primary providers have few resources for intervening or changing source social causes and contributing factors that diminish individual well-being. Without addressing these social sources and determinants through channels other than insured care delivery, their pervasive influence will persist and will continue to be accommodated as effects in larger healthcare systems.

A systemic design approach developed from the theories of flourishing mental health and flourishing societies has been adapted to identify and guide supports for socializing collective health. Flourishing entails individual and family health, the movement toward “a good life,” and ultimately the sustainment of human and all life. Toward these ends we present a framework for community-centred approaches to facilitate flourishing through the design of soft services. Current cases in university campus mental wellness, and peer health coaching are developed as models for eliciting design principles and approaches that have been effective in interventions in the social systems surrounding practices of care, outside the envelope in which the healthcare system operates.

The chapter presents a summary of the ongoing OCADU studies conducted from 2012-2015 by Peter Jones and SFI graduate students Adam Starkman and Karen Oikonen. A brief article on the soft service design approach to mental health was previously published in the service design journal Touchpoint.

The 4C Journey Map model and method were developed in the mental health study and advanced and refined in conference workshops, including RSD4 (Banff) and the Delight 2015 conference in Portland. The shown here was developed in this study. The sketch presents a service system mapping model .

The Four C’s refer to the mapping and design for Context, Constraints, Cues, and Communications. (Care is unique to healthcare contexts and not all maps).

The model has been adapted and evaluated in recent OCADU research by new SFI graduate Jyotish Sonowal for his MRP study, the Hospital as  Flourishing Business.

I cannot do justice to Sonowal’s work in this short piece, so I will encourage those in healthcare service design to download and read his contributions to this developing area.  Jyotish started with a hospital-based study evaluating the (by now) well-known Flourishing Business Model (Canvas) for clinical service models in a regulated public hospital. He further develops the study to cover:

  • The application of the Flourishing canvas as a process for serious stakeholder conversations for sensemaking in advance of service design.
  • The bridging of new business model thinking to service modeling, presenting the clinical service in its functional complexity using the 4C Journey map process.
  • The proposal of service design tools for engagement across the large organizational context of the hospital. Sonowal describes how to adapt the early design discussions to the concrete contexts of hospital front line managers.

















4C Journey Map for soft service design / inside and outside the healthcare envelope. (Click for full image, (c) 2017 J. Sonowal)