What is our “Standard of Care” for Design?

Designers and people in the caring professions may have different and valid ways to think about caring and systems. On the Wenovski design community a wide-ranging discussion involves the question of designing “systems that care.” I take a position that we can care for systems practices, but systems will not perform as caring agents. (We could talk about future robots and the “uncanny valley” of likenesses and human qualities, but robots are not what we mean by systems, or even organizations).

What is care and where does it show up in systems, by design or by emergence?

Care is a deeply-held value to people, but when services designers explicitly adopt a language of values, they risk demeaning that value with real customers. I’ll try to say why I think so. First of all, can systems care? It would be like asking “can we design systems that love?”

What is the standard of care for a service or an information system? Without the accompanying duty of care that the professions have to honor, it may be meaningless. Care is at once a social value, a value of being (B value), and a legal term. So could it be unethical to profess a value such as care when it is not measurable or evident in the outcomes of the service?

Physicians are required to determine the standard of care for a patient condition. Unless we are designing medical devices that perform as actors in a medical system, designers are not held to meeting that standard. That diminishes our standing in the health professions.  So how should we profess to meet a standard of care?

While my job usually requires meeting standards of technology design, my philosophy is humanistic. My impulse is to reframe perspectives on systems and services as actors in (human) networks, and to dig into where caring actually shows up.

Claudio Ciborra’s last publication,  The Labyrinths of Information: Challenging the Wisdom of Systems, (2003) talks about the ways in which systems have a social life the evades our best intentions. While designers may wish to infuse a humanist intent, the social history of systems shows that they become bent toward instrumental tools and can produce outcomes we did not intend. For one, Ciborra cautions against the notion that we can “design in” qualities we believe will be perceived per the intent of design. He notes how “drift” and technique and adapted uses change any system toward often-unforeseeable outcomes. Heidegger’s Gestell, (which also emerged in Jacques Ellul’s Technique) is raised to examine how a system tends to level experience. wherein everything available becomes a “resource available to yield.” He describes a move from the rational systems approach to one committed to “Xenia,” or hospitality.

So can we host systems and social design practices with our stakeholders, moving from efficiency to care in the process? Can we actually do this? Ciborra leaves this chapter incomplete, without an example of such caring. It remains to be seen.

Let’s start with a definition of care that hold us to a higher standard. If we don’t consider care a B-value, a uniquely human and non-embeddable value, we may risk diminishing the quality of real care in our lives. Perhaps we can design contexts for integrated social systems that require the performance of human care, as in healthcare systems. But following Ciborra’s line, its clear to me that, over time, the stresses on and drifting of the health system form a context where care becomes a deliverable, and less of a human value.

We also mean very different things by Care today. When doctors speak of “delivery of care,” they mean the full complement of health treatments and services they personally oversee that represent caring for the patient.   It is like the value of Justice, that may mean one thing to judges and another to laymen. As designers, or at least in my case as a designer/researcher, I use the definition owned by the stakeholder I’m designing for, and not what I’d like them to adopt.

I think terms like “Customer Care” are atrocities of language and diminish the value of real care. Yes, they “mean well,” but I know of no service that even comes close to meeting a standard of care. People may care, but the service does not perform care. Shoshana Zuboff’s notion of the individuated consumer in the Support Economy, perhaps setting a  standard in services. We need to set a higher bar for the conditions of care, a new “standard of care.”

Care must be evidenced in constant acts of kindness, empathy, and situational intervention. Unless we are in a hospital, care is what people do when they work around the institutional rules to help us. It is not people doing their job to answer our questions when having trouble with our mobile phones. Care might be selected by careful hiring, and modeled by behavior and rewarded in organizational values sustained by ongoing dialogue. But in the design context, we might ask ourselves and our stakeholders:

  • Who is caring for the participant/customer/user here, at this point?
  • What is the standard of care for this situation?
  • How do we encourage humans in the system to take the courage and trust to express care?
  • Where is care perhaps not meaningful or necessary?
  • Where does the participant bring their caring to the scenario?

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