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By Designdialogues, on February 27th, 2010
I find it interesting that so much is being said about design thinking now, so many years after it is was (probably) first floated as a term by Richard Buchanan (1992). In fact, Adam Richardson wrote so succinctly on this last year that I’ll just cite him instead of Richard.
We now tend to think of design thinking as embracing all that represents “new design.” But the 4 orders of abstraction Buchanan describes in Wicked Problems in Design Thinking are not actually what people mean today with respect to design thinking. Buchanan lists:
- Symbolic and visual communications
- Material objects
- Activities and organized services
- Complex systems or environments for living, working, playing and learning
Another 4-phase description of design thinking is GK van Patter’s Design 1.0 – 4.0 as described in numerous NextD articles and presentations. The four phases are more of a process model than the design of things represented by each phase.
The NextD framework of D1, D2, D3 is in essence a complexity scale. It is a post-discipline view that is process, not content focused. As a field of knowledge design is an amorphous time warp that exists across several time zones or paradigms simultaneously.
The NextD view considers the four phases as processes in “designing for” which are generally:
1.0 Artifacts and communications (traditional design)
2.0 Products and services
3.0 Organizational transformation (bounded by business or strategy)
4.0 Social transformation (complex, unbounded)
These are essentially ways of viewing the changes in design practice, as design thinking, from the designerly and not a business perspective. A design approach to organizational transformation is not a business approach, even if both call the process “design thinking.”
As the debates about design thinking continue among design practitioners, theorists and academics, and advocates of new business, I’m struck by two developments:
1. The re-emergence of design thinking as a frame and trend has emerged because of business influences, and not from the design disciplines. Design had largely set Buchanan’s foresight aside (did you hear a lot about Rittell’s Wicked Problems in the 1990′s?) But as business education noticed it was time for a change, they took cues from Boland and Collopy’s Managing as Designing. Major design firms (IDEO, Continuum) started engaging in business consulting as much as design work. This is not a bad thing, but we should acknowledge the close relationship between business and design here. The language distinctions of design thinking as process are now influenced more by business need than design invention.
2. Design thinking may Because design does not inherently own “design thinking”, and there is very little agreement among designers as to, precisely, what Design Thinking is and how it differs from design methodology. I trace design thinking to systems thinking, but there are real differences
In “Learning the Lessons of Systems Thinking: Exploring the Gap between Thinking and Leadership” (published last summer in Integral Leadership Quarterly) I traced design thinking directly to creative systems thinking:
“Many systems thinkers explicitly oriented their theories to designing, at least starting with Newell, Simon and Shaw’s (1958) The Processes of Creative Thinking. Ackoff’s basic principles-such as starting from an ideal envisioned outcome and generate scenarios for reaching that vision-fit many of the practices espoused by firms such as IDEO, Jump, and Redesign Research. We may have dressed up the methodologies and supported them with design research, but design thinking is indebted more to systems thinkers than to traditional (industrial) designers. (Which may explain why design thinking is, unfortunately, rarely presented with the “designerly” richness it deserves).”
Most of that article discusses why systems thinking, even though taught to managers for a couple of decades in seminars and articles, largely failed in its mission to enhance management as a practice. A true evolving systems view of commerce would have treated stakeholders and customers as inviolable participants in the network of sustainable and virtuous business.
Innovation consultant Bob Jacobson has expressed that recently “design thinking,” as a business practice, may have reached a point of snake oil marketing. I have noticed design theorists backing off from the conceptualization of design thinking because 1) they didn’t get ahead of the curve of the meme uptake, as GK van Patter indicates, and 2) the framework for design thinking has been degraded by its many opportunistic deployments, making it “all things to all people,” and 3) it generally does not describe what designers do.
While designers will share their views of design thinking, they do not generally approach design projects from a “thinking” perspective. I see the very notion as having been conjured and defended by non-designers for non-designers to more credibly borrow from the universal patterns of designerly action. The attempts of non-designers to appropriate the terminology without the craft diminish the perceived value of design’s contribution.
So if we’re hoping to bring transformation to the enterprise, designing still plays only a supplemental role anyway. Design thinking is viewed by most as primarily methodology (Problem framing, user focus, early field research, iteration, agility, contingency). It is not the substantive work of transformation. But our continued churn and recycling of “what it is” just points to the way our field valorizes itself and indulges its fads, as much as management thinkers do their fads.
Finally, Bruno Latour makes a clear point about the shift toward a humility and care in design in his 2008 speech, A Cautious Prometheus. Latour can be controversial, and this position is as divergent from methodological design thinking as one could imagine.
“As a concept, design implies a humility that seems absent from the word “construction” or “building”. Because of its historical roots as a mere addition to the “real” practicality, sturdy materiality and functions of daily objects, there is always some modesty in claiming to design something anew. In design there is nothing foundational. It seems to me that to say you plan to design something, does not carry the same risk of hubris as saying one is going to build something.”
The problem with design thinking may be the hubris that merely designing something is more than enough! There are no design thinking formulas for transformation. Latour’s notion of “care” and “entanglement” suggests that we must live in and with the very lifeworlds of our clients and organizations. My view is that transformative work leads us to become insiders committed to the worlds we care about. Design becomes secondary, a skill, that supports larger commitments to the world. And this may be the biggest difference between “Design 1.0 and Design 4.0.”
By Designdialogues, on February 11th, 2010
Thomas Goetz in Wired Magazine highlights Alexandra Carmichael and her decision tree for health decisions, along with 2 other scenarios. Alexandra is the founder of the CureTogether open source health research community. CureTogether is an innovative service that facilitates finding effective ways to address health concerns by active participation by people living with certain conditions, especially those resistant to conventional treatment regimes, such as chronic pain. (She is also an active and inspiring member in the Design for Care community, which is why I noticed and had affinity for her scenario).
Goetz’s article on decision trees (methods of structured decision analysis) suggests that they are an effective tool making better everyday health decisions. The reasoning is essentially based on the assumption that better health is a matter of inputs and outputs, which can be mapped and judged to determine a preferred course of action. Better inputs – food, exercise, lifestyle decisions – lead to better outputs, which are improved health measures and a healthier experience of life. Wired online even provides a decision tree mapping tool you can try.
Alexandra’s story is the most interesting and complex, of course. Here’s the decision tree they worked up for her, a lovely if simplified diagram:
I have to admit I found decision trees too be too neat and simple in my work as a systems consultant (analyst) in the mid-90′s. You learn in AI and knowledge elicitation that cognitive representations can be simplified, but if you over-simplify you lose the human texture of real life. Decision trees are retrospective constructions, not prospective. They are applied in a prospective way in the article, but they were not actually used for these case decisions, so their application is speculative.
When people are in the middle of a life decision, they often go by gut choice (Frank Kozik’s realization that he could lose his teeth if he kept smoking did not require a tree). What we call gut decision is based on dealing with the complexity by sensemaking – working through plausible narratives in the face of a changing situation. Alexandra’s seems like the latter, a sensemaking, not decision making situation.
Here’s why they don’t really work in these situations, and I quote from the article:
“Alexandra Carmichael spent a decade looking for a diagnosis. It took her another two years to determine the best treatment options.”
Decision trees are typically used to express the variables in situations characterized by regularity, such as computer programming and healthcare treatment decisions (both of which call the trees algorithms). Decision trees are applied retrospectively, based on observations from past experiences that are expected to hold with regularity in future applications of the same logic.
So if it took Alexandra two years just to explore treatment options, do you think she would be using a tree at the time to map out those options? Probably not, even if she wanted to. Long-term decisions take a long time because of the time necessary to trial and experiment with different options, to evaluate the trade-offs for each option, and to update that learning experience with all the other life learning that co-occurs and makes the process messier along the way. I would imagine that Alexandra, and the other two cases as well, made their actual life decisions based more on sensemaking.
So while decision trees could be used to describe prospective, anticipatory decisions (such as at least two of those in the article), they are not the best tool for the way people reason about the future. For one, by the time you’d have the information available to make the decision tree, the best path would be obvious because of what you learned over time. Two, important decisions are more complex than input-output. Over time people change their valuation of different options, they do not balance evenly on a simple flow diagram. A process more like dialogue (e.g., sensemaking) is what we often see – individuals talking with others who had similar experiences and judging the variables in personal terms. Three, people are quite poor at reasoning about prospective situations, about unknown futures. Attempts to simplify the process by reducing it to a pathway may help, but I would argue would not actually aid in a significant decision. Because an actual “decision” is not a simple act in time. It will often be a mix of actions and options that are kept open until or if needed. Again, that’s classical sensemaking.
I would like to hear from people about their own decision stories. Here’s my story that occurred while reading this very article:
I have to admit I don’t rush to read Wired or any magazine, but let them pile up for leisurely lunch reads. In fact, I was sitting in a walk-in clinic in Toronto waiting for my first-ever doctor’s appointment after becoming a Canadian resident in March. In fact, I had saved Ontario the burden of covering a cyst removal by having my US dermatologist do it last week when in Dayton. So my decision tree was: rapid infection + known doctor + easy appointment outscores Wait for return to Canada + free + new doctor. Again, in real time I would not use an algorithmic approach. The decisions are made by the necessities of emergence, the quality of certain breakdowns, and the need to fit life’s other goals in place with a mundane travel schedule.
Sensemaking is not just for the everyday health seeking situation. It is even more critical for expert decision making, although this is only now beginning to be recognized, in medical disciplines that are characterized by what they like to call evidence-based decision making. In my research on clinical informatics, I’ve found that residents and trainees use a decision-tree approach to diagnosis and treatment decisions. They have to – they cannot afford to take chances and have to “go by the book.” Senior clinicians, on the other hand, have a huge repertoire of experience and do not need to look up decision models. Their experience is most helpful for the unforeseen and complicated situations that trainees cannot and would not address. And if a situation is challenging to an expert, do you think they will be able to resolve it by using a decision tree? If the problem is not canonical, it needs to be addressed in the unfolding complexity of discovery and iteration. In short, experts rely on sensemaking, which is also called “expert judgment.”
From a health informatics perspective, these observations are in line with Gary Klein and other decision making researchers in cognitive engineering. Essentially, the more expert a decisionmaker is, the more variables they will have to consider, and their model becomes a lot more web-like and dynamic than a decision tree. Because experts have such a large repertoire of prior situations to draw from, their decision processes are more like pattern-matching (what Klein calls Recognition-Primed Decision making). They don’t step through branches of consequence, they just ‘know” from experience. When breakdowns occur and new situations arise, the “making sense of things” that follows leads to what looks like a decision, but should be seen rather as the output of a sensemaking process. I also think people can “make sense together” aided by well-designed resources and ubiquitous access to information. Sensemaking for clinical problem solving is the point of the Interpretive Collaborative Review.
By Designdialogues, on February 9th, 2010
Are EHRs (Electronic Health Records) Error Inducing Machines?
Thanks to Brady Anderson on the Design for Care community site who alerted us to Dr. Christine Sinsky’s “eNirvana – Are we There Yet?”
I believe we are “not yet there.” As long as the Medicare specification known as “meaningful use “criteria ignores design, usability, and the propensity for foreseeable error, we are not even close. The key quote from Sinsky illustrates the problem from the point of care and clinical use:
While Google Desktop Gadgets make access to information as unfettered as possible, HIT systems often sequester individual tidbits of information at the ends of nonintuitive labyrinths, with needless hurdles along the way. Clinicians need clear access to priority information, not an obstacle course. As an EHR user, I have to keep a thought in mind until, five clicks and two screens later, I can find related information. Then, I have to park all of this developing thought for four more clicks, three screens and a slow download until I get to the screen where I can take action. Repeat this process for dozens of tasks per patient and you have an environment that facilitates error and inefficiency.
However, in terms of her design process recommendations, I’d take issue with the Big Box brand names she recommends EHRs should listen to:
So let’s get Google on it, and bring in a Toyota mindset while we are at it. Toyota understands the need for lean, streamlined workflow. Toyota understands that even a minor unnecessary step that causes worker fatigue or extra time is a problem. Many steps in HIT are redundant. They cause worker fatigue and monopolize time.
No, please – Google’s information interfaces are wretched, even if they have the bomb back end. They are engineers with no design sense. The better example is actually Microsoft, as much as I used to dismiss them. They have done their homework on usability, reliability, and information integration. Google relies on goodwill and monopoly – they are becoming the new Microsoft.
And I’m not sure Toyota’s lean or other processes are representative of the high-reliability processes needed in healthcare. Redundancy and multiple touchpoints are effective in HRO systems; We need to make sure busy clinical staff don’t miss things. Clinical work requires attention to distributed cognition as much or more than individual.
Attention Overload and the Overabundance of Healthcare Information
The usability gap is not just with EHRs of course. The web does not automatically make things better. Every informatics vendor in healthcare services has a different interface, a different information model, and different applications for their resources. Where a patient can use the Mayo Clinic, Web MD, e-Cleveland Clinic, Everyday Health, and so forth, doctors have dozens of specialized resources available online through the hospital’s library or intranet. But they may be too busy to use the resources available.
These days I actually find fewer and fewer senior physicians (that I speak with) using smartphone for clinical information. Typically I hear they use “ePocrates” or another drug search tool, but that’s it. Doctors, like most professionals, are overwhelmed with data and with packaged information as well. My current book chapters (the ones I’m writing now) are dealing with these issues. Residents, even senior residents, are in training and will use online resources more. Senior clinicians are not using the plethora – and there is quite a plethora – of resources as much.
Where is all this going?
It will get worse first. The next 3 years will see a shakeout of everything in the professional marketplace. I can already get the clinical handheld version of Medscape as a free app on the iPhone – and maybe residents would use that. But the mere provision of “easy to use” clinical information on the web and phones is not the problem. I would not be surprised to see a revolt of some sort, a lockdown of apps in the institution so that a small number of preferred resources are used.
The VA medical centers have done this for some time on their CPRS menu for CDSS (Clinical Decision Support). Clinicians need only focus on a few supported resources, although new ones can be requested and installed at different centers (or regional VISNs).
The medical literature is even worse to navigate. Senior medical experts and clinical researchers have an increasingly difficult time getting to the articles that matter. Publication inflation and the proliferation of less-than-citable journals have allowed for a huge growth of mediocre research that clutters attention and bandwidth.
For two years or so I’ve been working on a process with U of Toronto’s Dr. Peter Pennefather to address this problem. We call this system the Interpretive Collaborative Review, which is currently a rough prototype. The ICR process is designed to guide collaborative profiling, scoring, and recording of jointly perceived significance associated with online publications. The goal is to make explicit a group’s perspective and understanding of the value of claims presented in these publications.
We address the problem of an overabundance of published and Internet accessible health science research information. The overloaded research ecosystem presents a major challenge for identifying a subset of that information for adequately informing specific healthcare choices. This challenge is further complicated when accounting for varying or multiple perspectives in the governance of those choices.
We consider this a problem best resolved by collaborative sensemaking (for more, see prior post).
By Designdialogues, on February 2nd, 2010
Design with Dialogue, our Toronto community of practice, is moving into its 20th month of regular sessions at OCAD’s Strategic Innovation Lab. Our new website shows current and upcoming events, and we’ll update the archives from the old site soon enough.
We are making new connections between dialogic group communication, design problem solving, facilitated consultation, and sensemaking.
Recent posts have perhaps tipped any reader to what I believe to be pressing concerns. While I have opinions and ideas about open innovation, the viability of the iPad in healthcare and educations, creating new ecosystems for local innovation, the marriage of systems thinking with design practices, and so forth, I’m not sure I’m contributing to solutions discussing what’s popular.
I’m more interested in how committed collectives of people – as in organizations and mixed stakeholder groups – might find breakthroughs in problem understanding and collective action. The practices of sensemaking (Dervin, Klein, Weick) are called for to manage these complex situations, but do we know how to make sense together? Technologies of dialogue are necessary to bridge the distance between an individuals’ perspective and collective agreements for wise action.
Can this be done online, people ask. My first response is, why? Are our situations not serious enough to call for taking the time to engage in person? Do any of us really believe that crowdsourcing leads to better sensemaking? To borrow the sorry monkeys on typewriters analogy, will a million people typing answers to questions online (devoid of context or their commitment to act) create a Shakespeare of solutions? Will people online somehow arrive at a better sense of a shared situation than 12 committed stakeholder who are willing to act on their own decisions?
Online, we can facilitate socially-recruited responses to focus questions, we can collect commentary and clarifications, we can publish our synthesis and findings. But can we perform collective sensemaking? If so, where is the research suggesting this? I think this matters, because if effective collective decision making requires the understanding acquired by sensemaking to result in high-leverage shared action, we might stop fooling ourselves that the efficiency of “everything online, all the time” will achieve our goals.
By Designdialogues, on January 9th, 2010
Part II. Human-Scale Tools for Change
While many authors recently warned of the consequences of an ideology of unfettered growth, including Ronald Wright, Jared Diamond, George Monbiot, and Thomas Homer-Dixon), philosopher/priest Ivan Illich warned us 40 years ago. He foresaw a collapse of the post-industrial economy, which did not happen then. Illich proposed that autonomous, creative citizens take responsibility for creating the tools that might regenerate a civilization for real human needs and purposes. Perhaps both, breakdown and a creative civilization, are happening now.
As with the Club of Rome (1969) and their Limits to Growth (1972), Ivan Illich was right – but at the wrong time. Those who remember the 1970′s may recall that alternative publications at the time (I have all the old Co-Evolution Quarterlies) treated the mid-70′s as if the apocalypse was happening then. Perhaps it always seems that way. As Dayton’s (now Austin’s) Troy Campbell sang on 2004′s American Breakdown, The World Keeps on Ending – every generation reinvents their desire the end the problems they inherited before the problems end the generation. Yet this time there is something different, something truly timely in Illich’s Convivial Tools notion.
I can only conjecture on how the breakdown of industrial society will ultimately become a critical issue. But I can make rather firm statements about the qualifications for providing guidance within the coming crisis. I believe that growth will grind to a halt. The total collapse of the industrial monopoly on production will be the result of synergy in the failure of the multiple systems that fed its expansion. This expansion is maintained by the illusion that careful systems engineering can stabilize and harmonize present growth, while in fact it pushes all institutions simultaneously toward their second watershed. Almost overnight people will lose confidence not only in the major institutions but also in the miracle prescriptions of the would-be crisis managers. The ability of present institutions to define values such as education, health, welfare, transportation, or news will suddenly be extinguished because it will be recognized as an illusion.
Ivan Illich (1973) Tools for Conviviality
John Thackara revived a conversation for Tools with brio at the CHI 2004 conference in Vienna. With Bill Buxton, they presented an unscheduled dialogue they called “A Convivial Conversation” to intrigued conference participants. As I recall they debated their fairly polar perspectives on the possibilities and consequences of ubiquitous, cheap flat screen display panels in the public sphere. They both made convincing cases. Thackara’s is the case that would be expensive to ignore, if he and Illich turned out to be “more right.”
What Happened
Even if you cannot recall (and I can’t), it is clear that in 1973 few – if any – individuals were prepared to make the call that IT would become the great engine for new growth in the next decade. Society was not even yet mourning the loss of manufacturing and the blue-collar middle class the declined with it, because that had not happened yet. Even if Illich did not foresee the forestalling of the American breakdown granted us by 25 years of IT-fueled growth, what Ivan got right was that constant, increasing growth largely serving a managing elite was unsustainable. Crashable, and in a big way.
What economists, sociologists, and visionary editors (like Stewart Brand) also missed was the possibility that long waves of growth and destruction have their own cycles. Although both Kondratieff (1925) and Strauss and Howe’s Fourth Turning called the collapse for soon after the millennium, and not in the 70′s, most people missed those memos, as they were making other plans. Although long wave patterns are not provable hypotheses, they are empirically supported by the evidence they refer to in their models. While all models are biased, the biases that you accept make a difference in the real world.
The 1970′s saw the creative destruction of the first industrial economy. But it was a preview of the larger economic changes that could occur when the IT revolution completed its cycle of automating efficiencies, first by replacing rote work and then destroying administrative employment. Take a look at the figure on the Kondratieff page. We are living in that end phase of the growth cycle right now. We don’t know what’s next, and you’re living in happy times if you believe the Kurzweil post-human Singularity will somehow save us. You should really disbelieve anyone who says they know what happens next.
What’s Happening Now
You also don’t have to believe James Howard Kunstler’s take, that we should learn to live off the land again. Along with systems theory, back-to-the-earth was a major theme in Brand’s old Co-Evolution Quarterlies. Stewart Brand himself shrugged off the possibility of re-ruralization for the new millennium in a recent NPR interview, and he appears to now be on the side of the “bright greens,” if not the Singularity movement. You don’t have to believe President Obama either, that recovery is imminent. (What are we recovering to?) Just observe for yourself, the evidence is available.
We may be in a services economy that generates value from IT-enabled constellations. But services have not yet generated the sustainable employment necessary to create and hold quality of life and cultural growth. Between these historical shifts, the leisure class we were promised 100 years ago never really got off the ground. The smartest among us today are also the hardest working people I know. Leisure and culture are hard won, perhaps.
Why a Convivial Response?
What does a convivial world even look like? Do we have any good examples? Copenhagen? Willits, California? Toronto?
Let’s return to what Illich called the tools for conviviality,http://redesignresearch.com/dialogues/wp-admin/post.php?action=edit&post=572&message=1 a process of human-scale cultural design. This means for us to “invert the present deep structure of tools” in order to “give people tools that guarantee their right to work with independent efficiency.”
I choose the term “conviviality” to designate the opposite of industrial productivity. … I believe that, in any society, as conviviality is reduced below a certain level, no amount of industrial productivity can effectively satisfy the needs it creates among society’s members.
Liz Sanders of Make Tools (former Sonic Rim, Fitch) represented Illichian design thinking to an IDSA conference in Cincinnati (also around 2004). She founded the new design firm on a convivial concept: that users in any service have the autonomy and desire to create their own concepts to express needs and desires for their world. She calls this generative design, a radically co-creative participatory design approach. Make Tools has people “making tools: or expressive projections of their wants, as a means for producers to create new tools in turn.
As designers and innovators, we are social tool producers. What Illich points to is that, while we may find our tools liberating or enhancing of our own autonomy, we may not foresee whether we serve any long-term social goals. When we serve our clients, are we contributing to more of the same? Where do we, as design “thinkers” grasp the reigns of ethical vision sufficient to effect, not abstract “change,” but just the conversations that change people’s minds? Do we even have the convivial tools of deliberative communication?
A convivial society should be designed to allow all its members the most autonomous action by means of tools least controlled by others. People feel joy, as opposed to mere pleasure, to the extent that their activities are creative; while the growth of tools beyond a certain point increases regimentation, dependence, exploitation, and impotence. I use the term “tool” broadly enough to include not only simple hardware such as drills, pots, syringes, brooms, building elements, or motors, and not just large machines like cars or power stations; I also include among tools productive institutions such as factories that produce tangible commodities like corn flakes or electric current, and productive systems for intangible http://redesignresearch.com/dialogues/wp-admin/post.php?action=edit&post=572&message=1commodities such as those which produce “education,” “health,” “knowledge,” or “decisions.” School curricula or marriage laws are no less purposely shaped social devices than road networks.
What are tools for scaling conviviality? We need tools for dialogue and making sense together. We need tools that create a culture conducive to communication and dialogue. We need tools we can share – literally, like Philadelphia’s Tool Library.
Let’s look at America. How do we save our neighborhoods from decline, enhance local transportation, bring local farming and food into small towns and cities? How do we use online tools effectively to promote real democratic change? How do we recover election integrity? How might we re-envision school systems and universities? Money and banks? Journalism and news? All of these are questions of conviviality. They all require people work together across ideologies and boundaries, intervene, document their work, make serious decisions, and propose alternatives to others in the community.
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A Peter Jones Publication Blogs have evolved into several popular forms - mine is an old-school online publication of written works in progress. While the topics range widely, they reveal my interest in understanding the emerging social meaning of technology in use, finding better ways of designing for knowledge and organizational practices, and progressive interpretations of systemic innovation.
The title is meaningful - I see design processes as dialogic. Not just iterative, but design as languaging, both verbal & visual. We co-create & co-interpret in shared languages. A dialogic orientation requires we discover and appreciate the perspectives of all participants in a socio-technical system. Dialogue is performative designing - it requires both discipline and improvisation, to enable emergence of new meaning in human systems.
We hold these dialogues every 2nd Wednesday in Toronto:
Realize that dialogue has occurred when speaking leads to a new state of mutual understanding, and right action arises. This is also the purpose of designing.
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