In Books

Design for Care

We Tried to Warn You

Team Design

Information Empathy at the Touchpoints of Care

A well-attended roomful of IAs, designers and strategists awaited us Saturday for the first World Information Architecture Day – I was in DC at Sapient’s Arlington auditorium, with Dan Brown (@brownarama) and great folks from the National Cancer Institute. Dan led off with a talk on collaborative design teams, based on his book Designing Together.

I closed the day with a new talk based on care-centered information design guidelines in Design for Care.  One of the themes in the book is that information (content creation) must be developed as if it were a care practice. Caregivers and people in all health-seeking situations rely simple search access to internet and trusted institutional content – and because of the complexity of healthcare situations and the emotional concern of health, very little critical assessment may occur. The rapid-pace context of mobile interfaces compounds this issue. We cannot pretend to have solved it – in fact, it seems like we’re only now discovering the real complexity of health information as communicative care.

I retell the story from nurse Theresa Brown’s recent New York Times Opinionator,  Lost in Clinical Translation. She sums up perfectly why we must curate, edit, and design better information resources for clinician use and patient communication. The patient’s quote drives home the point:

“When the medical team came to her room, they discussed her situation in detail: the problem itself, the necessary course of anti-coagulation treatment and the required blood tests that went with it. To me, just at the start of my nursing education, the explanations were clear and easy to follow, and I felt hopeful they would give my patient some comfort.

After the rounding team left, though, she turned a stricken face to me and deadpanned, “Well, that was clear as mud, wasn’t it?”

What know what we ought to do, and it will be expensive. Medical evidence translated for the range of clinical occupations and contexts of care is hard enough. Translating the translations so that health-seekers understand what they need to act on is going to be a significant challenge.

What can we do? There may be hundreds of touchpoints of care in a health-seeking experience. Issues ranging from caring for Dad (see the presentation) to conferring with specialists need different content, images, and evidence support. Real questions and concerns are answered today by dense clinical resources (even the well-structured or the hyper-advertised and segmented WebMD. There are hundreds of clinical information sites, but most “patients” or health-seekers will stay with what  they know and understand – whcih may be insufficient to inform.

Should designers embrace a duty of care? Perhaps, following the classic Mayeroff definition of care, do we pursue aims in our work that help people “grow and feel cared for.” Guidelines for helping to grow should include:

  • First, do no harm.  Due diligence to locate errors, ensure correct usage and meaning in context, and accuracy of measures and terms.
  • Anticipate the information journey of health-seeking. People may have a months-long journey of treatment, testing and learning.
  • Ensure health-seekers understand in their own language and terms, where possible (Unless you have a captured market, you do not have “users” – we can never know who our content readers really are).
  • Start to design services around information touchpoints. Some touchpoints of care – Discovering about a condition, a diagnosis, a treatment – have physical service links as well.
  • Design for multiple channels – websites, print media, patient handouts, apps. But don’t rely only on mobile apps – go responsive. Health seekers have bigger issues to deal with than finding your app – and they are not likely to be loyal to more than one or two major brands.
  • Design responsive services for help seeking – use email responders and humanized (nurse-informed) call centers.

Systemic Design – An Emerging Interdiscipline

So we might ask, is there a definable field and practice of systemic design? With Jeremy Bowes, we teach a course in system titled Systemic Design in the Strategic Foresight and Innovation program at OCADU.  We believe systems thinking to be one of the core “thinkings” for the SFI program (design, business, and futures thinking, “surrounded” by creative systems thinking). Over the 5 years of teaching the program and producing futures and strategic design studies for agencies and clients, we have found systemic design becoming one of the most differentiating and persuasive competencies, both in its underpinning theory and social technologies.

We’ve been making the invisible college of this practice a lot more visible. Working with Birger Sevaldson at AHO, Oslo for the last few years, we’ve coordinated curriculum and methods and have exchanged workshops to develop systems thinking methods in strategic design and service design. At first, this was a typical international faculty and research collaboration, funded generously by Norway and the Oslo School of Architecture and Design (AHO).

In 2012, we exchanged workshops and ideas, and held the first symposium on the interrelationship between systems thinking and design action (RSD1). In 2013,with Harold Nelson and Alex Ryan we planned a larger symposium and invited global participation – free of charge – to the Relating Systems Thinking to Design 2 symposium. We had over 150 register for 6 (also free) workshops and 30 paper presentations, and witnessed the start of possibly a new framing of an interdisciplinary practice area.

As typical in the design fields, we called this discipline by different names. Birger leads a popular graduate program at AHO in Systems Oriented Design. This program is strongly design-led, studio-based, and highly integrative.

I conceived our program as Systemic Design, as the course is strong on systems theory and method, and the application to design is more emergent. Harold Nelson likes to remind us that all good design is essentially systemic. And the systems community (ISSS, IFSR, etc.) generally understands design as more of an outcome of systemic practices.

Yet in actual design practice, systems thinking and design thinking are not mutually influential. The evidence for this appears in the design and the systems literature, where very few papers explicitly develop this relationship. It is insufficient and unsupportable to (today) claim that these are performed well in practice, as that’s not the case. Systemic work requires skills and budgets that most design firms just don’t have for their client projects. The theoretical basis for systems-level research is not taught at design schools, and at most or best, one course. For the most part, (in practice) we give the “other” field we don’t know deeply some lip service and fake it well. (There are a small number of exceptional firms that work in this intersection, and they are not IDEO).

There’s too much value at stake to fuss around. The original leaders in the systems movement are not getting replaced at the same rate they are leaving us, the fervor and force is not following generations yet. The final statements from Ackoff to Warfield and other thinkers have been urging us, over the last decade, to connect systems principles and methods to the complex societal problems that are imminent and critical. But perhaps the next movement will be practical, co-created, and design-led.

Systemic Design effectively captures this emerging movement in design. We believe it possible for systems thinking and design praxis to develop the foundations for new, interrelated practices. This synergistic relationship will launch a new generation of systems-oriented thinkers empowered with the creativity and perspectives of design thinking. As educators and researchers, we also seek better theoretical foundations and rigor in design thinking.


Sketchnotes by Patricia Kambitsch, Playthink

What binds systems-related theories and practices together with design approaches may be the desire to reintroduce systems approaches with design toward a more effective integrated praxis, becoming more useful to designers (and stakeholders and clients) than evidenced by past applications. This implies the reshaping and design of systems approaches and the related practices so that they are better integrated into design processes.

The health seeker: The natural return to “normal”

The health seeker is any person aware of his or her motivation to improve his or her health, whether sick or not. Health seeking is the natural pursuit of one’s appropriate balance of well-being, the continuous moving toward a person’s own centre and recognition of “normal” health. For some, normal is just not feeling any symptoms; for others, it may be achieving the physical performance of an Olympian. (Definition from Design for Care, FAQ)   Either way, health seeking is a process view based on both behavior and one’s inner experience of “storing health,” it is not an identity.

There were several reasons for insinuating a new label. I needed a way to identify a person-centred view of care that embraces the full lifecycle of an individual and their circles of care. But we can’t say “person” all the time as a referent – and “patient” I like to reserve for the technical, clinical meaning only. And in a design book, I felt it was important to guide product-level designers away from “users” and user-centred.

The health-seeking impulse is also a systemic concept. Health seeking represents a motivation to restore balance, and is homeostatic in nature. I tend to disagree with the concept of “optimal” health, a concept which, from a person-centered and systems view,  seems to overreach the human condition. An individual cannot ever reach or measure optimal, but we do recognize our own “normal.”

To optimize a function means to engineer its relationship to the environment to maximize its success in all known or preferred states.  Optimizing ignores the real world complexity of many functions of a person, and presents health more as a engineering concept (where an optimal target can be defined and met as a benchmark). Research and experience shows people “seek normal,” even if normal for some is high performing and for others is merely comfortable. The reference should be with the person, not objective measures associated with an optimal state. That’s the system model chosen for the book.

A visual presentation of the health seeker emerges in the views of a person’s full lifecycle as in the book’s persona Elena’s journey from care-giver to recovering a new normal following a significant series of clinical encounters:

Health Seeking 1.0


The health seeking journey situates the health seeker in a larger context where each stage of awareness results in (possibly, depending) a different encounter, a different outcome, and even a different circle of care. The journey shown here is not the sequence of supply-sided touchpoints of a service interaction, but the relationship of motivations to chosen touchpoints, leading to encounters and information resources. In this context, health seeking is rather like information seeking – an individual’s process for seeking resources and support to reach preferred outcomes.

Instances of health information seeking, as with the health concerns they reflect, are associated with a person’s experience of ill health. The health seeker is a person acting on the intention to pursue or sustain health, and health seeking is a purposeful activity that aims to restore or improve health.  This new, neutral term gives context to the full range of experiences a person encounters in the pursuit of a homeostatic balance of relative good health.

When any concern arises—whether it’s sleeplessness, an unusual internal pain, or a chronic condition—our perspective changes, our information activity becomes focused and intentional, and in some cases our identity changes. A personal mood shifts from the indifference of everyday health to that of relieving a concern. Health seeking begins in earnest. People may undergo a significant change in identity—from a nonmedicalized self to that of a patient or even of a disease sufferer.


Design with Dialogue: Framing Perspectives on Mental Wellness

An Innovation Town Hall on Mental Wellness

November’s Design with Dialogue invites a wide range of community members to explore the landscape of campus and community mental wellness, the innovation of responsive care, and enhancing health service. With seasoned facilitators and special guests we take on several big questions, as well as those brought to the dialogue in the DwD circle.

  • How can we move beyond the conventional views of mental health and learn from each other?
  • Are there innovations in community and social health that might enhance awareness and improve mental wellbeing?
  • What might we understand together to cultivate empathy and insight about the experience of emotional and mental health journeys?

The Health and Wellness Centre at OCAD University has pursued a positive, innovative course in engaging students and the campus in dialogues to understand experiences in mental health. Partnering with the HWC in this community-focused DwD, we join students, faculty, and community professionals in an exploration into the experience and struggles of mental health and the context of care and health services.

The Innovation Town Hall starts with several perspectives to learn about current, personal and critical issues in mental wellness and care.  Moving from whole group to small group, context stories and health awareness journeys are co-created and shared among groups.

Outcomes of this dialogue will help inform the Health and Wellness Centre’s service and will be considered for potential designs for service enhancement. Please register on Eventbrite for this special session.

Session Hosts

Peter Jones &  Andrea Yip

Andrea Yip, MPH is the Coordinator of Mental Health Initiatives at OCAD U and Ryerson University and is working to co-design a collaborative mental health strategy between both schools. Working along the intersections of art, social design and health promotion, Andrea is coordinates community-led initiatives that have human-centered impact.

Andrea is an advisor to the Canadian Commission for UNESCO and the Wellspring Centre for Innovation.  Twitter: @andrealyip

Systemic Design Symposium

Relating Systems Thinking and Design is a free and open symposium in Oslo, Norway over two days with a preceding full day with diverse workshops. The symposium is provided for free, and is open to accepted presentations and to invited and guest participants.

The symposium will take place at Oslo School of Architecture and Design for:

9th October: Workshops

10th – 11th October: Symposium

Purpose of Symposium
The emerging renaissance of systems thinking in design responds to the increasing complexity in all challenges faced by designers and transdisciplinary innovators. Our worlds have become too complex for linear and goal-driven management, resulting in hopelessly complicated social, economic, and political systems. The global demand for sustainability, democratic economies, and the emerging social arrangements for better education, employment, and development have become too complex for conventional thinking.

About 50 authors have contributed brief papers and presentations for the 2 day symposium in 5 theme areas derived from the papers themselves. New thinking in systemic design incorporates advanced design research, service design for complex systems, and emerging design theory informed by systems thinking.