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By Designdialogues, on March 27th, 2011 Congratulations to the OCADU team for winning the Rotman Design Challenge!
The team from our first year OCAD University graduate program MDes in Strategic Foresight and Innovation won the Rotman Design Challenge on Saturday, for a high-touch (not high-tech) proposal for Mayo Clinic for early disease prevention, Mayo Moms. Mayo Moms leveraged a known health issue (lack of breast feeding culture in US) with a well-framed solution (human-to-human network sponsored by Mayo) with a sophisticated research approach and simple yet spectacular graphical design values.
Our school’s team had only two weeks (those starting early had 3 weeks) and they beat 20 entries, with great finalists from U Cincinnati’s DAAP and school of business, Cal College of Arts, Case Western, and of course several great entries from Rotman.
The $1500 award and first place went to a 5-person team of:
- Jen Chow, team captain
- Martin Ryan
- Josina Vink
- Jessica Mills
- Phouphet Sivaphong
Look out for more great work from this program over the year.
Toronto , March 7, 2011 – Students from institutions across North America who are recognized for their groundbreaking work in design thinking will be coming to Toronto on March 25 and 26 to tackle a “wicked problem” in the second annual Rotman Design Challenge. This year’s Challenge is an international one, with a number of US graduate and undergraduate programs participating including the California College of the Arts, the Darden School of Business, the School of Visual Arts, the University of Cincinnati and the Weatherhead School of Management.
By Designdialogues, on March 17th, 2011 On Design Observer Bruce Nussbaum wants to fail Financial Times’ top 100 business schools.
Let’s Give an “F” to the FT List of Best Business Schools
OK, at least some of them. But it is hard to argue with their top 10 – Stanford has the d.school link, and Wharton is a top systems and organizational design school. We would push U Toronto’s Rotman and Case Western well up the list (even though Rotman scores pretty well overall.)
Let’s first clarify the purpose of management education. Getting past the “cool idea” phase of enhancing business education by integrating creative design, what is it that is being enhanced? The practice of management, finance, organizational leadership, or marketing? (It is marketing primarily, which has a long history with creative professionals in advertising, market research, and product management.)
When we consider creativity, design freedom, and inspired ways of knowing, the business disciplines are not where we usually look first. I appreciate that design and arts should be influential in the transformation of other disciplines. But why focus on just business? Since people employed as designers typically work in business environments and are subject to the strategies and decisions made by MBAs, the relationship can seem a little one-sided. Design continue to do more of the contribution to an enterprise that is largely defined by the MBA. Should designers also influence strategic decision making?
Bruce cites Facebook and Twitter as kinds of new examples for creative business design. And Groupon, which is 100% business model innovation and almost an anti-design service. But Twitter evolved from a technical RSS tool, and it still has no business model. Facebook was from the Bill Gates Harvard dropout model. Good business is about capturing and sustaining value and being “just innovative enough.” Good design is more planning than play, it is more intentional than something like Twitter, which was not exactly planned that way.
Is the transformation of business education really that different than for other education? Why not also fail engineering schools and computer science programs? Isn’t this where the tech inventions come from? Most successful startups and sustainable innovations were not started in the university setting. But why not encourage a startup model in non-business disciplines? Schools are testbeds and collaboratories. They should be places where learners are free to try and fail.
Bruce cites Facebook and Twitter as kinds of new examples for creative business design. And Groupon, which is 100% business model innovation and almost an anti-design service. But Twitter evolved from a technical RSS tool, and it still has no business model. Facebook was from the Bill Gates Harvard dropout model. Good business is very often not innovative, but about capturing and sustaining value and being “just innovative enough.”
Let’s go on. Why not fail social sciences? What contribution has it made to addressing or intervening in the underlying socially systemic problems creating turmoil in economies, governments, organizations, institution? If we could reinvent university systems we might see more creative impacts in every field of discourse. We don’t see much progress in institutional innovation and compared to the utopian 1960′s social sciences do not seem as invested in the Big Issues.
What do business graduates consider successful? Do people go to business school to become creative design-oriented leaders? Then why don’t we see former MBA’s in MDes programs then for a second Masters? (OK, at OCADU MDes in Strategic Foresight and Innovation, we are seeing a few MBAs and we’re doing our best to un-brainwash them!)
Inventing what becomes valuable is elusive and not a direct product of the linear analysis that an MBA needs to run the shop. So rather than fuss over MBAs, who have a world of choice at their command, why not consider the role of innovative thinking in early education? Andrea Kuszewski just wrote on this in the Scientific American blog You can increase your intelligence. Perhaps it makes sense to return the arts to underfunded elementary and secondary education, and to increase support for the arts, design, and liberal arts in a broadly-based transdisciplinary curriculum for younger learners. Then perhaps MBA students would already be creative upon entering their programs.
By Designdialogues, on March 1st, 2011 Why are neologisms sometimes effective, and sometimes not? Why do they work when they work?
Neologisms are plays on words that coin a new expression, usually as a mashup of ideas in current circulation. They work well because, like sound bites or advertising slogans, they compress the currency of our concerns into a memorable meme that travels between people and across boundaries. They tend to stick, and at their best, help us imagine new possibilities suggested by the mashup or phrase.
The term sustainism expresses an ideology of sustainability. This is one of several turns of phrase in play just today.
John Thackara, whose work I admire and advocate, tees up a critique on Design Observer: Ultra Modern. Disclosure: I have not read the book he skewers, Sustainism Is the New Modernism: A Cultural Manifesto for the Sustainist Era But I have the read comments on the review, which is about as third-order as you can get. And I’m intrigued by the reflexive fussiness of language rectitude that spills from the mediasphere.
In the spirit of McLuhan, I’m interested in the expression in the medium, and not the content, even though it probably matters. Thackara doesn’t particularly like the neologism sustainism, and I’m on board with his leaking boat metaphor:
The word sustain — whether attached to an ism, or an ability — speaks too much, to me anyway, of bailing out a leaking boat as it drifts towards a waterfall. It’s got to be done, but it’s not a joyful prospect.
Sustainism is rather like a butterfly collection. Many of its specimens are renowned, and some of them are beautiful — but they are also — how to put this delicately? — lifeless.
Almost all the comments agree with John, and they stick it to “sustainism” with increasing gusto. But the post is about the concept of elevating the sustainable to the level of “the modern.” Modernism was a secular aspiration across global boundaries. Our advanced societies strove for it, and arguably never really lived the vision it inspired. Does sustainability offer a similar aspiration?
But the word I turn upon is not the turn on sustaining, it is the other word of our era, manifesto. We don’t need another manifesto. (“We don’t need to know the way home – All we want is life beyond, Thunderdome.”) It is the unbearable lightweightness of manifesti that drops off the edge for me.
Perhaps we need another, better neologism, one that sticks and holds the attention of cynical citizens in a failed democracy. You know which one …
As the American way of life slips away, or is stolen by those now gaming all of its institutions, and the Arab street rises in country after country to “win their future,” any manifesto seems rather thin. They are written excuses from one’s mother for not actually being there in person to deliver on the action the manifesto claims to inspires. A good neologism is perhaps better for our attention-addled times. Like Truthiness. Fact-Free media diet. Democrat-ish.
There’s nothing wrong with coining a neologism if it suits the times and purpose. How else will we drive some variety in our waning vocabularies? Marshall McLuhan would be 100 this year, and he constantly coined new turns of phrase. As Jamie O’Neil said in the McLuhan Remix project:
McLuhan described “the medium is the massage” as a “collide-oscope of interfaced situations” i.e. a series of preexisting concepts that were juxtaposed and combined in interesting ways. His famous puns, aphorisms and neologisms served to open up new possibilities for his concepts because he realized that “precision is sacrificed for a greater degree of suggestion.”
Who are to judge really? If we trust the author, do we not all share in the interpretation of the new form? Why are we not all creating new verbal forms? Is it so crucial to always make perfect sense to the listener? We are being precious to insist on such icy clarity in a media ecology dominated by Twitterists.
I agree that sustainability is merely bailing out the boat, it is a (Herzberg) hygiene factor, not a motivator. Yet the boat must be bailed, and done before we can sail.
Two years ago at the Business as Agent for Word Benefit conference the group I ended up in spontaneously, synchronously, hit upon the same realization that sustainability was, well, like eating your spinach. In seconds we coined the term thrivability as a response. Like a gift of collective mind, no one person at the table of 8 could own it, it rushed forth. We went online to register the domain name, figuring the word was original. We were not the first. We got GlobalThrivability.com and placed a Ning site on it, which still exists, mostly inactively I”m sorry to say.
We found thrivability was also synchronously in play – that year – by now-colleague @NurtureGirl whose Thrivable site had just started up. From neologism to emerging cultural theme, words happen, in this case both suggestive and precise.
I dearly hope we are not in an era of sustainability in the way that we were – or were never – Modern. Yes, we need to be sustainable, we also need to pay our debts. Those are not new visions for humanity. But there is a neologism that might be a vision. The story of how it happened suggests there is more than weird coinage at work.
By Designdialogues, on February 16th, 2011 (This piece is concurrently posted at the first Healthcare Experience Design conference site, where I’ll be speaking April 11.)
Patients are not users, and people are not (yet) patients until under a doctor’s care. Where does the user experience of health actually live?
Healthcare is systemic at every level of observation, and traditional user-centered design will tend to under-scope that system’s complexity. As with an emergency physician treating a cardiac arrest, but having to ignore multiple chronic diseases causing the attack, user-centered design is unsuited (by method) to fix what ails the system. Design teams will treat symptoms but fail to resolve root causes of systemic health and care problems.
We are faced with a double difficulty – of learning the language of healthcare and medicine and then to intervene. Designers must enlarge their methods toolbox and vocabularies to enable a more powerful range of options in systems and services design. Being able to carefully distance from the medical frame, designers can start making a difference by considering creative connections inaccessible within the patient and service model.
Designing for the Health Journey
Healthcare is characterized by multiple stakeholders (from consumers and patients to clinical staff, from administrators to insurers), multiple services (from primary care to academic institutional networks), and multiple sectors of services (from clinical practice to insurance and government).
The first design challenge is that we don’t find a definitive “user” in these complex systems of practice, in the institution. (If designing consumer websites or insurance products you can skip this part). If we design for one class of persona, we leave out another class. We cannot design for physicians, nurses, patients equally. Today’s major providers of electronic health records systems are a perfect example – by attempting to serve every constituent with a comprehensive database, they serve none well.
So who and what are we designing for? We are designing for situations that have few common workflows, with widely dispersed information, multiple and competing vendors, no integration, and weak systems protocols. This leaves us very limited ability to design at the service and systems level.
Leading with Experience
With a wide variety of stakeholders and problem owners, healthcare has no common voice, no conventional “user” base, and no system owners. Currently, design/research professionals are often isolated from each other by working in narrow bands of problem scope defined by a technology (e.g. electronic health records or device design), by media (online health publishing, social media, Health 2.0) or by an institution (electronic records, clinical informatics).
Rather than demonstrating leadership in the last decade, HCI and UX design have barely kept pace with the changes in the healthcare field at large. We have come late to the party, and are finding ourselves boxed-in by fixed infrastructures of large vendor services, EMRs, and fragmented IT systems. The dedicated design professionals in the field are doing great work, but where are human factors or experience designers actually positioned? Even in innovative institutions like Cleveland Clinic, the “patient experience” roles are not led by experience design professionals but by clinicians. They are the equivalent of the Customer Experience role which has become a staple of marketing. While at first it may seem that’s a good thing – we are all focused on better patient experience after all. However, my years of experience in product and service design informs my gut that the power of such a marketing-focused role can tend to overwhelm the more nuanced, interpretive, cognitive and affective responses from people served by healthcare services and informatics. Also, while patient focus is important, in designing for whole system impact, every constituent must be considered. The PX role can suffer the same blindness as UCD by over-focusing on one constituent.
The idea of the Chief Experience Officer was formulated by our field probably a decade ago – and being such a good idea, it may be championed by the same professionals that lead most of the decisions in healthcare, medically trained professional staff. Yes, it is fair to ask whether we are ready to lead in such roles. It is time we did. As conductor/author/educator Benjamin Zander calls for - we can lead “from any chair” – the chair we’re in today.
First take a reality test. There are few nationally-recognized design advisors or even industrial engineers leading in healthcare service. Publications are dominated by physicians and informatics specialists, who often focus work on tightly-scoped, feasible research agendas fitting the mandates of their institutions. Conferences are structured around medical or educational disciplines (societies and colleges), technology (Health 2.0), technology-oriented research (Medicine 2.0), and disease specialization.
Given the complexity of systemic issues, the compelling urgency of narrow-focus concerns, and the dedicated roles of stakeholders, individual designers and institutional teams are often unable to design solutions to address root causes or to scale applications across institutions or practice areas. Will Design for Care address or even hope to fix these concerns? (You’ll have to stay tuned …)
(An excerpt from Design for Care, in blog form)
By Designdialogues, on February 4th, 2011 Architecture, interior design and clinical devices have adopted evidence-based design (EBD) and these fields actively contribute to its development through major projects, journal articles, and conferences. Evidence based design is a rigorous design equivalent to the careful application of scholarly evidence in informing care decisions. It is a healthcare term of art and has meaning in that sector. It is not the gathering of user data as research “evidence” to inform design decisions in digital design. EBD generally involves:
- Reviewing current and retrospective research literatures to identify precedents, mature findings, and prescriptive guidance from relevant studies.
- Prioritizing and balancing the literature basis with primary data collected from actual patient data, subject matter experts, and professional observations.
- Advancing theories and hypotheses to support observations and structuring evaluations to test outcomes of design decisions (e.g. architecture, facility design, wayfinding, room design).
- Measuring outcomes following implementation and assessing theory validity and any gap between observations and hypotheses.
How are other design disciplines positioned with respect to evidence? Does it make sense for UX and experience design to adopt evidence-based principles, especially in healthcare?
Other design fields are not in the same risk position as architecture and device design. It doesn’t help UX to make claims for evidence that cannot be supported by (some type of) peer review. Design trade publications and user experience blogs show growing interest in EBD. Unfortunately the typical claims being made for (largely qualitative) evidence are not helping the UX field gain credibility (in healthcare anyway).
Except for (relatively) few domain-focused specialists and industrial design firms, most claims to evidence-based design are not supported by the necessary level of research, transparency of sharing data and findings, and multidisciplinary skills. If EBD is claimed in low-risk or non-critical applications, it is probably not really EBD. Most projects (e.g. websites) do not require this standard of research design. When lives, liability, and (tens of hundreds of) thousands of dollars are at risk, the due diligence of quantified measurable evidence is necessary to ensure the decisions are supportable.
The assertion that a firm employs evidence-based design should not be made in a healthcare context without being able to justify a validated research and design process and to endorse personnel capable of leading such a project. If we honestly consider the maturity level of evidence-based design in UX and service design, based on known and published literature, a charitable assessment would be Level 2, Repeatable (pegging it to the SEI Capability Maturity Model):
| Level 1 – Initial (Chaotic)It is characteristic of processes at this level that they are (typically) undocumented and in a state of dynamic change, tending to be driven in an ad hoc, uncontrolled and reactive manner by users or events. This provides a chaotic or unstable environment for the processes.
Level 2 – Repeatable
It is characteristic of processes at this level that some processes are repeatable, possibly with consistent results. Process discipline is unlikely to be rigorous, but where it exists it may help to ensure that existing processes are maintained during times of stress.
Level 3 – Defined
It is characteristic of processes at this level that there are sets of defined and documented standard processes established and subject to some degree of improvement over time. These standard processes are in place (i.e., they are the AS-IS processes) and used to establish consistency of process performance across the organization.
Level 4 – Managed
It is characteristic of processes at this level that, using process metrics, management can effectively control the AS-IS process (e.g., for software development ). In particular, management can identify ways to adjust and adapt the process to particular projects without measurable losses of quality or deviations from specifications. Process Capability is established from this level.
Level 5 – Optimizing
It is a characteristic of processes at this level that the focus is on continually improving process performance through both incremental and innovative technological changes/improvements. |
I’ll provide an example from a current project – Procedures Consult, an online multimedia training and learning management system used for learning medical and surgical procedures, an Elsevier Health product. While not actually designed as an EBD product – we have no consistent access to internal outcome measures – the design process was rigorous and repeatable. The processes used to design and evaluate Procedures Consult were developed over time with multiple (many) field observations and interactive trials. The test protocols were standardized and applied in institutions in Columbus, Boston, Philadelphia, Cleveland, and repeated for every new feature set.
The design and evaluation process is also Defined (Level 3), meaning that other products and projects have reused the process and protocols and the process can be improved across the organization. Can a design consultancy help an organization improve its capability maturity? Of course – but a long-term relationship is necessary if the shop is already just at Level 1, or if working with a product team and not senior product management. The process change and benefits are not seen with one project or one release cycle. Evaluation procedures and skills and standards for user evidence are established over time, not in one product. Learning must be documented and shared across the organization, requiring trials with new products and communicating best practices between shops.
Evidence that Counts
EBD is one of many methodologies that should be understood and used in appropriate settings. Not every software interface or health website requires the same methodology, or not every institutional project requires such a robust approach. However, meeting the consensus on evidence does support publication, which advances the credibility of design and its contribution to health science.
What counts as evidence in medical practice, in scholarship, in care planning, and in design decisions differ significantly. Not only the types of evidence, but the definition of evidence, its collection, quality evaluation, controls, presentation, and publication differ between fields and applications. In most fields, a bad design decision will not aggravate morbidity and mortality. In healthcare, poor design sensitivity and insufficient evaluation can lead to harm. Just as in medical research, levels of evidence are defined, in healthcare design research, appropriate levels of evidence might also be suggested. In clinical decision making, available evidence ranges from randomized controlled trials to expert studies, including a variety of types of evidence (observations, imaging, measured variables) relevant to diseases, biological responses, and applications to procedures, interventions, public health. The UK’s National Health Service classifies levels of evidence as follows:
Level A: Consistent Randomized Controlled Clinical Trial, cohort study, clinical decision rule validated in different populations.
Level B: Consistent Retrospective Cohort, Exploratory Cohort, Ecological Study, Outcomes Research, case-control study; or extrapolations from level A studies.
Level C: Case-series study or extrapolations from level B studies.
Level D: Expert opinion without explicit critical appraisal, or based on bench research or first principles.
Since these levels of evidence are applicable to health care decisions, equivalent human-centered design evidence might be expected to relate to design decisions, which affect more than just patient outcomes. Design and experience research evidence must be defined to meet the needs of a wide range of different applications in healthcare. Some of these, we know well:
- Software user experience
- Interactive systems
- Medical devices
And for more complex or emerging applications, I would observe we do not have generally accepted units of analysis and evidence:
- Service systems
- Organizational and Administrative processes
- Work practices and workflow
- Wayfinding systems
For these applications there are fewer experience design studies to draw on. Traditional operational studies rely on “outcome measures,” but the measures taken often assume a causality between interventions and outcomes – a causality which may not exist in a complex reality.
Evidence by type – roughly from more to less rigorous – might include:
- Controlled human interaction experiments. Mixed method studies
- Patient observations, physiological measures, field experiment data
- Robust sampled ethnographic data, controlled usability interaction studies
- Small sample interviews, Hard case study, extrapolations from field research
- Expert opinion, Heuristic or multi-perspective assessment
Why does this matter?
If “everyone is a designer” and “everyone does research,” there is little hope for distinguishing a standard of ethical practice that might lead to reliable contribution to healthcare. With the huge growth of the Web and of people needed to build it, the user experience field has expanded well beyond the original human factors community that started the field. Many of us older guys were educated in experimental research at the post-graduate level, and worked on large scale information systems long before the Web. Early usability testing methods (at IBM, AT&T) were often conducted in accordance with experimental design standards and at least descriptive or inferential statistical support.
The widespread adoption of the label “user experience design” has glossed over many of original distinctive differences between practices, but research professionals constitute an ever-shrinking proportion of the field. While this merger perhaps gained broader acceptance, it may reduce credibility in high-hazard, high-reliability settings. A different “standard of care” is necessary when designing a system for clinical professionals, or patients, than for consumers.
The user experience field right does not have a single professional society or advocacy. There is no clearinghouse for agreement on validation of practices and standards. I actually think we have a legitimation issue regarding meaningful evidence and accepted, if not standard, measures for high-risk and complex applications. And as a long-time practitioner (my first million dollar usability lab project was in 1989), today I am not sure how these advances in practice are best contested and resolved. By followers on Twitter?
A self-assessment across design fields should be conducted by a panel of representatives from the primary design disciplines to clarify the standard of evidence, range of research methods, and a credible and ethical representation of the state of practice. This self-communication within the larger field of design and user experience disciplines is needed to communicate explicitly the expected value and values understood by practitioners in those fields.
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Re-visions by Peter Jones Design Dialogues invites you to examine ideas, new and old. Everything humanity creates is work-in-progress, and so is open to dialogue. Re-visions and re-views are welcome. Design Dialogues is for working out ideas, before they find their way into practice or in actual publications.
Innovators all face an urgent challenge to make the differences that must happen; there is no longer any status quo. Many of our trusted institutions & social contracts are now broken. Whether from fear or habit, our culture is not yet innovating democratically. We do not really know how to collaborate sufficiently to the task.
From healthcare to finance, politics to education, infrastructures & decision processes, we can & must reinvent our own futures. These social systems have evolved beyond their capacity to transform by management. Collaboration is insufficient - We truly need new ways of working, deciding, and organizing.
Of the many ways to collaborative intelligence, some demonstrably better than others. Dialogic design, based on systems thinking & design science, offers a validated way to create new understandings, design systemically, & act democratically on the deep drivers of a problem.
A community of practice meets for these dialogues in person every 2nd Wednesday in Toronto:
Art, science, and design are three ways of knowing, and in the field of action they inform each other. All modes must be recruited if we are to interfere & reinvent social systems. Your participation is required.
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