Introducing Design Thinking (Conference Presentation)

December 4, 2011 //
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Hi Everyone! I apologize for the long delay in posting. I’ve been busy doing several conference presentations, including this one that I conducted in Singapore at Smart Healthcare World Asia 2011.

Note – While this presentation was specifically directed towards healthcare, I believe it can be generalized for ALL areas of society. The romantic worldview is screaming for attention in all domains.

IntroducingDesignThinking (Slides w/ Audio)

DEFINING DESIGN THINKING 

Design Thinking is notoriously difficult to define. When you look it up on the internet, there are a broad range of definitions and opinions on what exactly it is. To make things worse, the word thinking in design thinking has a tendency to become the focal point of the phrase.

People often describe design thinking as being only about thinking, but let’s not forget that the phrase also has the word design within it.  Design is notoriously difficult to define itself, but it includes the actions we make as we create new worlds for ourselves.

Design thinking, in other words, encompasses much more than our thinking abilities, it also encompasses how we act in the world.

DESIGN THINKING AS WORLDVIEW

Due to this broader scope, I believe that is better to frame design thinking as a worldview. A worldview is set of values and beliefs that human beings and communities of human beings possess that influence they perceive, interpret and, subsequently, act within the world.

Worldviews are often hidden from people’s awareness of themselves. This hidden dimension is what often makes them so difficult to articulate, and so easy to confuse with one another.

As I speak to you about worldviews today, I’m going to be speaking to you in generalities, but I want to take a moment to digress and say that worldviews are not black and white. They are gray.  My use of generalities is to simplify the discussion and my communication of it, but it is not intended to be used as an ultimate truth.

DESIGN THINKING AS THINKING

To start off, we’re going to investigate what the thinking portion of design thinking and how it relates to two dominant worldviews that exist within society today.

MULTIPLE WORLDVIEWS 

While there are many worldviews prevalent within society, the two that are most relevant to our discussion today, and that I believe are particularly dominant, are modernism and romanticism 1.

MODERNISM

The modern worldview became a more dominant worldview with the enlightenment. Once humans had determined the course of the planets through Newtonian physics there was a new confidence and optimism in our ability to solve all of our earthly problems.

This worldview is strongly objective. It believes that humans have conscious and rational reasoning. We are driven by common laws, one of them being self-interest, and our behavior can be standardized and predicted once we find thoroughly understand those common laws. This has been the dominant influence over science for the past few centuries.

ROMANTICISM

The romanticist worldview began one to two centuries after the modern worldview. It was a reaction against modernism. Humans were not deemed to be rational, or driven by reason but rather had an inner subjective connection with the world that could not be easily explained. Humans are driven by empathy that is intuitive, unconscious, and irrational.

We are unpredictable and holistic with the rest of the universe and each other, possessing emergent behaviors that a reductionist approach can not find. This is the worldview that has dominated art and this is the worldview that DT is typically dominated by as well.

Interestingly, science is increasingly embracing this perspective as well within areas such as neuroscience, behavioral economics, and moral psychology.

OPPOSITE PERSPECTIVES

As you can see, these two worldviews are completely opposite from one another, and have been clashing for the better half of the last several centuries. Modernism, however, has ridden off of the success of traditional science and has been largely adopted by our applied disciplines including business, technology, and healthcare.

DESIGN THINKING AS ACTION

As I mentioned previously, worldviews also affect the way we act. Not only do we get different insights into our products and services based on different interpretations, we also get different actions.

A BROADER SKILL SET

People with a romanticist worldview are more likely to have a discovery-based skill set. To the romanticist, everything is subjective. There is no one solution that must be found, rather all solutions must be discovered and explored.

People with a modernist worldview are more likely to have a delivery worldview 2. To the modernist, there is only one definition of truth and one ultimate solution. This solution must be discovered by weeding out the incorrect options.

As I mentioned earlier, design thinking is associated with the romanticist worldview. Not surprisingly, design thinkers have a tendency to possess a discovery skill set. They focus on divergent ideas and solutions and are continuously exploring the solution space. Scientists, engineers and physicians, meanwhile, have a tendency to utilize the delivery skill set. They focus on convergent ideas and solutions and are often driving towards something tangible that can be implemented.

A MODERNIST WORLD

The impact of the modernist worldview on how we create our products and services can not be understated. Since the industrial revolution, we have embraced the modern worldview to such an extent that we have focused almost exclusively on the objective realities of technology, what is feasible, and on business, what is viable. This objective view focuses little on the subjective impact our products and services have on human beings.

A ROMANTICIST WORLD

In the last several decades, however, the romanticist worldview has been not so quietly interjecting itself via design, art, and, now, design thinking. It has demanded a world that is more balanced, more subjective, and more humane. One that represents the world of human desire via our cognitions, perceptions, emotions, and actions within our individual lives.

A CREATIVE WORLD

This interjection of the romanticist worldview via design and design thinking has increasingly led to a perspective where our products and services should be created as a harmonious balance between desirable, feasible and viable; a combination of business, design, and engineering thinking.  This perspective leads to a larger and more balanced perspective that integrates the objective and subjective; the modernist and the romanticist.

I really want to stress the importance of this balance, however, as it doesn’t always occur.  People who embrace a design thinking worldview, the romanticist worldview, can be just as dogmatic about their perspective as a scientist can be about the modernist worldview, demanding that new products and service focus exclusively on human needs.

A DIVERSE WORLD

Any dogmatic approach will severely compromise the potential and quality of solutions you can develop because diversity will always lead to better results.  One need only look at our diverse planet to see that diversity is what is necessary to create an adequate “fit” within the different contexts of our environment.

Worldviews affect the way we interpret our world. By utilizing these diverse perspectives, we get diverse interpretations about what the world is and what it should be. This leads to an increased number of insights into what our products & services should be and how they should work and helps us ensure that the multiplicity of contexts we are supporting are accounted for.

ENGAGING WORLDVIEWS

While diversity is great for deriving more innovative solutions, it can also cause conflict. As I mentioned before, these two worldviews understadn and act in the world in contradictory ways.

I believe that many of the conflicts that occur within organizations and societies are due to people not realizing they are approaching problem-solving, and the subsequent solution space, from these two completely different perspectives.

To make matters worse, we have a tendency to try and sweep this conflict under the rug because we all dislike conflict. It makes us uncomfortable. The key to successful innovation, however, is to disregard this fear and to embrace the differences. We must explicitly engage these two perspectives in a discourse with one another 3.

HEAR

This discourse begins with listening. We have to hear what our customers and industry experts, from both of these perspectives, are trying to tell us about their worlds. We can do this in a variety of ways such as observing them in our hospitals, having them test our products, reviewing the latest things they’ve created, and engaging them in a group conversation. This is what we typically call research, but it is research that is both qualitative and quantitative.

CREATE

Once we’ve heard and seen what customers and industry experts are doing, we synthesize their visions and our own into one and begin to bring that vision to life via prototypes and concepts. Ideally, we sustain our discourse with our customers and experts by co-creating these prototypes and concepts.

DELIVER

Finally, we deliver those prototypes and concepts by transforming them into tangible and concrete products and services. Again, we should maintain our discourse with our customers and experts by providing them with initial access to the new products and services and by continuing to ask for their input and advice. The individuals in our discourse can often become wonderful advocates for us 4.

RENEWED HEALTH

Having seen that DT represents a different worldview and how that worldview can help us derive a different set of solutions, we can now understand why it is important. DT, representing the romanticist perspective can fill a much needed void in our healthcare products and services that have been largely neglected and that aligns much better with how our patients view health.

Our current actions and thinking around health have largely been derived from the Modernist worldview.

Over my past 5 years at Mayo, however, we’ve learned from hundreds of research studies that our patients have evolved beyond this modernist perspective and view their health through the romanticist lens.

HOLISTIC HEALTH

Patients view their health as being far more holistic than their providers. Health is about living a full, and rich, life. This life is one that is more than the absence of disease. It is about flourishing in multiple areas such as my job, my family, and as an individual.

COMMUNITY HEALTH

Flourishing is not only about helping each of us as individuals. It is also about cultivating and promoting flourishing throughout the community. Patients know that health goes beyond our physical bodies and is embedded within our environment.

As healthcare providers, our patients want us to be community activists. How are we helping create a healthy community. Health is more than medicine and treating disease. It is about promoting wellness in our grocery stores and on our streets. It’s about community planning and community politics.

 FRIENDLY HEALTH

As we help our patients flourish, they don’t want it to be treated like participants in a scientific study. They don’t want the cool and distant doctor that observes their patients, analyzes their symptoms, runs diagnostics, and prescribes treatment.

They want you to know them at an emotional subjective level. They want you to be involved in their lives and know who they are. They want you to be their friend.

COMMITTED HEALTH

Our patients don’t want us to monitor their physical progress and development. They want us to be committed to their personal growth; their mental, physical, and even spiritual development. They don’t want us to focus only on their weaknesses, they want us to focus on their strengths.

How are you making your patients stronger? How are you taking the best of them and making it even better? Are you acknowledging how far they’ve come? 

CARING HEALTH

Ultimately, our patients want us to genuinely care about them. To care about someone is to have a relationship with them, and they want a relationship, a real relationship, with their providers. Healthcare today is not about caring in their eyes anymore.

What happened to the doctor that knew them? That knew their community and their children? What happened to the word care in healthcare?

A DIFFERENT RELATIONSHIP

Our patients want a fundamentally different relationship. One that is no longer about their physician having full control over a limited aspect of their health. The want to have a dialogue with their physician, an ongoing conversation about their health and about their life.

Support for the unilateral relationship with a physician is over. It is time for healthcare to embrace a bilateral relationship and commitment with our patients. 

DEEP HEALTH

In summary, the relationship our patients want is a deep, personal, relationship. One that is about commitment, friendship, community, and growth.  Many physicians I’ve spoken to about this have immediately said “impossible” or “too difficult”. Excuses I often here are that is is too emotionally draining or too time-consuming. My response to that is twofold:

  1. This type of excuse is driven by fear. We are increasingly afraid to have emotional relationships with others. Yes, it is difficult to make these types of connections with people that are sick or dying. It is also, however, rewarding. The deepest relationships are the most meaningful.
  2. It has been done before in this field and is being done in others. There was a point in time, not too long ago, where physicians made house calls. They knew their patients, and they knew their community. They depended on both for their survival every day.

We can bring this type of relationship back to our patients. We can create a system that no longer thinks of our patients as machines that can be standardized and controlled, but one that instead thinks of our patients as the emotional, relationship-driven, and empathetic people they are.

 

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Shifting service to spiders; a new strategic direction

May 29, 2011 //
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The “pull” internet

The power of the new web 3.0 paradigm to be a game-changer in multiple areas has been spoken about a lot lately. One of those areas has been called “The Power of Pull”.  In his book “Pull”, John Hagel discusses how the future promises to be one where people will no longer have to actively reach out to gain information and services, as the services will, instead, come to them. In effect, they’ll be “pulling” these intimate, and personalized, services and information to themselves in an automated fashion in any location at anytime.

Spiders and bees

The pull paradigm reminds me of the information foraging model created by Peter Pirolli and Stuart Card from Xerox PARC. In this model, the ways humans search for information is compared to the way animals forage for food. The authors note two different animals, in particular; spiders and bees.

Bees are active foragers. They send out scouts to find new food and develop complex communication systems to share and notify each other about the new food. They also engage in this active pursuit daily. Spiders, on the other hand, are passive foragers. They build a web, and then sit back and wait for food to come to them. The new pull paradigm within web 3.0 is basically a shift from providing information and services to bees to providing information and services to spiders.

Businesses are all bees and no spiders

What I find fascinating is how few businesses are strategically prepared, or have even thought, about this shift. I’ve worked in multiple industries over the years, and  amazingly, the majority of companies have business and product strategies that are all about the bees. McDonald’s, for example, does a great job at fitting into the active bee’s lifestyle. They are right there, in the middle of the flight path, saying “here I am to meet your needs”.

Healthcare also, has primarily supported bees. An injured bee has had to actively seek out their healthcare provider at that critical time of need. This has been a critical mistake on the part of healthcare, as the majority of patients I’ve talked to are spiders and not bees. They are not actively engaged with their healthcare provider, nor are they actively seeking them out. Yet, they should be and they do need help.

Supporting spiders

As the web 3.0 paradigm changes technology to better support spiders, businesses will need to be prepared with strategies and tactical operations that support spiders. Otherwise, they will have a product channel that can support spiders, but an operational end that can not.

Apple, in a way, has already begun to support spiders, as has Amazon. They are great examples of what a spider strategy can look like, but they, too, have work to do to fully meet the spider’s needs (we still have to pursue these services, but the level of effort is minimal. Sort of a bee-spider hybrid).

Social spiders, not solo spiders

One area that concerns me about the new pull-based internet (web 3.0), is that the temptation with this new paradigm is to automate everything and eliminate human beings from the equation. The spider metaphor, unfortunately, reinforces this as spiders are often thought to be self-sufficient loners. Spiders, however, are NOT all independent hermits. Several species of spiders are incredibly social, forming giant colonies.

In the research we’ve done, we’ve noticed that people absolutely do not want to be interacting with machines and only machines. People don’t trust machines and don’t find experiences with them to be fulfilling. When dealing with our spider strategies, we need to think social and not solo.

It’s about relationships

Ultimately, the new web 3.0 paradigm needs to be about businesses reaching out to people and taking every opportunity they can to put them in touch with another person. The automated, mechanistic, version of web 3.0 will only make us more inhumane and alone, but  the power of pull can also be used to create deeper, more committed, and more caring relationships between people, their families, and their service providers.

A return to the small town community

In our past, our service providers were our friends. The town doctor and town bartender knew us and cared about us. A new strategy for social spiders that is based on deep relationships can return us to those lasting connections. That’s true, valuable, and humane service at its finest.

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Categories featured, leadership, web3.0

The Holy Grail of Healthcare Design

May 23, 2011 //
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Simplifying complexity – the virtue of a great model

Throughout my career, modeling has always been one of my favorite activities. There’s a certain pleasure that one feels in taking an incredibly complex set of research data, organizing it, re-organizing it, and re-organizing it some more until you stand back and have that “aha!” moment –  that moment of clarity where a pattern starts to emerge. The complexity seems to dissolve before one’s eyes, and solutions instantly start to come to mind.

When I worked at Corel, for example, it truly was amazing to see how a seemingly complex photography application really boiled down to a simple set of core activity domains (create, edit, share, organize). A good design research group typically has the luxury of being able to create one really solid framework or model that simplifies a complex experience so that a company department can benefit from it for years.

A simple model simply won’t happen

Healthcare, however, is different. Complex doesn’t even begin to describe how difficult and knotty a healthcare experience model or framework can be.  I’ve discovered during my time at Mayo that the reality is there isn’t a single framework or model that you can use to describe a healthcare experience. Not even two. It takes multiple interdependent frameworks to even scratch the surface. And that’s not simple at all.

The models themselves often end up being so complex that business leaders, designers, and other team members look at you with that blank stare of hazed confusion, even when making their best efforts to support you.

Why is healthcare so damn difficult to describe, so difficult to get one’s arms around? Because modeling healthcare is basically the same as modeling life. When you really start to think about it, healthcare impacts every single facet of every single moment of our lives. Health is life. And creating a model of every aspect of life is, well, pretty much impossible.

A model for life?

Even though it really is this complex, I’ve found there a few things a design team can do to still retrieve value out of healthcare modeling.

1. Think about personas as roles

Think about all of the different hats your personas may put on. A patient, for example, puts on multiple hats when dealing with their healthcare experiences. They may put on their traveler hat when coordinating their visits, put on their insurance agent hat when dealing with their insurance issues, or put on their lawyer hat should they run into legal problems. By looking at personas from the perspective of roles, you can help your team achieve better focus.

2. Develop different models for different audiences

Due to each healthcare model having so much depth, I’ve found it valuable to create different models for different levels of the organization. Provide a few 20,000ft view models for executive leadership, and leave the detailed, in-depth, models for the design team.

3. Develop models that focus on the different human factors

I find the 6 basic human factors lenses – cognitive, emotional, physical, social, cultural, and spiritual – are an excellent way of  capturing the critical essences behind a healthcare experience.  I find that using keywords for that essence, i.e. our experience is brilliant, compassionate, and humility, can be particularly effective as a model for executive leadership (as described in number 2 above)

4. Develop connective models

When you have several different models dealing with different contexts, it can be difficult to see the big picture. One thing that helps is a connective model. A connective model is a model that acts a bridge between models by filling in the gaps that disconnect them.  Although it may not simplify your overall story as much as you’d like, it can still provide much needed clarity to a work team. It is always useful to look at several models and try to see what threads, even if thin, may connect them.

5. Try not to build models based on sequence

Experience maps that show a particular, time-based, sequence are fairly standard in the experience design world. In healthcare, however, they can often confuse the issue rather than help it. The majority of people do not follow a specific path into a healthcare experience because their medical conditions can warrant a very different path through the system. A person who has suddenly lost their thumb will skip several steps that a person with diabetes will take. A person who has had diabetes for several years will go direct to a final step, whereas a new person will start at the beginning. A person with a severe case of asthma who is diagnosed with a lung infection will start their journey in a different place than someone with asthma alone.  A model with paths is a path towards confusion for your team.

These a few of the things that have helped my team successfully navigate this complex world of healthcare modeling. I’d love to hear what has, or has not, worked for you!

 

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Categories featured, healthcare

The Myth of the Outlier

May 23, 2011 //
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One of the interesting things I’ve observed working within healthcare experience design is something I refer to as the myth of the outlier. Basically, all patients believe that they are edge cases.

Everyone’s an edge case

Even though people clearly understand that when a certain pattern of symptoms are presented to their physician there is a higher probability of it being a particular illness, they will often believe that they are the exception to that probability. Not only does this sense of being the edge case extend to their diagnosis, it can also extend to their treatment.

Don’t trust the doctor

I realize that the medical field’s understanding of disease is particularly narrow in some regards and it can be correct to mistrust our doctors and their interventions in our health, but, overall, this distrust in diagnosis and the belief in the myth of the outlier is somewhat irrational. Medicine is based on science, and there is a lot of evidence to support many of our medical practices. Doctors are often right.

From a design perspective, this poses a daunting challenge. How do we help facilitate a sense of dialog between two people that both feel strongly they are “in the right”?   During user research, our patients often express that they  feel “spoken down to” and one of the reasons why is this basic lack of trust between patient and physician that the myth of the outlier fosters.

Re-establishing trust

Although re-establishing trust between doctor and patient is not easy, I do think we could try several options:

Decision Guide

Create a clear and concise decision guide where the doctor presents the same evidence and guidelines to the patient that they often use themselves to make a diagnosis. This gives the patient a feeling of empowerment over their health and can lead to a sense of rapport with their physicians

It can lead to difficulties, however, from a time perspective and also in instances when that type of information is not available. A lot of medicine is still based on wisdom and intuition gained via years of experience, and many patients are not satisfied with that answer.

Transparency regarding physician results

We could choose to show true statistics about our physicians such as the number of cases successfully treated, patient satisfaction, etc. That level of transparency is something truly rare today, but it could be a huge benefit towards re-establishing trust with the patient regarding their diagnosis and treatment.

I’m not sure that many of our doctors would appreciate this type of honest assessment, but it is already occurring without their blessing. In a world where doctors are being rated on websites by more angry patients than happy ones, it could benefit them greatly to have an unbiased and professional reflection on how they perform.

Bargain

Yet a third approach I’ve seen work is bargaining. Many physicians will tell their patients to give their solution a try with the promise that if it doesn’t work, they’ll be open to other options. This can be effective if the rapport is already good within the relationship, and when the physician is proven correct, can lead to less myth following later on.

Peer sites such as patients like me

Instead of shunning social sites, doctors should use them to support their case. They could show their patients how their diagnosis aligns perfectly with other patients that are just like them.

What are your thoughts on the myth? Have you seen any effective design solutions for handling it?

(By the way, the myth of the outlier has HUGE implications for electronic algorithms as well. I’ll be discussing that in a future post!)

 

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Categories leadership

The Minimization of Compassion

May 23, 2011 //
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The Three Factors of a Great Healthcare Experience

I recently heard an astute co-worker say that great healthcare experiences at Mayo come down to 3 things: brilliance, humility and compassion.  I was instantly struck by how accurate, yet simple, of an equation this was.

When done well, here’s what these 3 look like:

Brilliance

The accurate and reliable medical diagnosis and treatment that a healthcare organization can provide.  At Mayo, this is particularly pervasive as we have some of the world’s leading physicians under our roof.

Humility

Every patient is treated with respect and as an equal, no matter how brilliant the physician may be. This humility extends throughout Mayo as an organization as well.

Compassion

Every patient’s struggle and hardship is acknowledged. Patients are listened to and supported through their trials of fear and doubt.

Brilliance Bias

As I think about this simple framework, what particularly amazes me is how much we have a tendency to focus on the brilliance factor over the other two when we design healthcare products and services.

This bias seems particularly noticeable when looking at medical information, patient education, digital products, and medical devices. These products and services are filled to the brim with statistics, symptom checkers, and other data driven interactions with a matter-of-fact tone behind their information and messaging that is sterile, crisp and concise.

Compassion in Crisis

Unfortunately, many healthcare interactions are a moment of crisis for the people experiencing them and this data-rich, clinically-toned, approach does little to provide them the comfort they desperately seek. I’ve felt saddened numerous times in user research sessions where I’ve seen people cry simply recounting the terror they felt when given a diagnosis and I felt even worse when they recounted how the tone, information, and data our products conveyed made the situation worse.

Take, for example, the act of measuring one’s blood sugar. We provide many tools and techniques to help with this laborious task – from reminders, to trackers, etc. Yet, as laborious as it may be, another reason why diabetics I’ve spoken with hate taking their blood sugar is that it is a reminder to them of what they see as a personal failure. It is an emotional issue for them and it is one that goes largely unaddressed.

The success of great healthcare experiences is NOT solely within their brilliance. Brilliance is an expectation that only helps people with their physical and cognitive needs. Compassion, on the other hand, is a differentiator that speaks to people’s emotional needs. The best physicians, coaches, and other healthcare professionals know how to relate to their patients in a compassionate way that helps them with their profound, and volatile, emotions and it is those interactions that people remember the most.

 

Categories featured, flourishing, healthcare

Conference Presentation – People ARE the Product

May 23, 2011 //
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Below are my conference presentation slides with a transcript from the healthcare experience design conference. I typically ad lib these, so it’s not a direct match-up. I may have left a few points out and added a few others. Hope you enjoy. Feel free to post questions in the comments section, and a big thanks to those who chose to watch my presentation.

It was also great getting to meet many of you. For those that I didn’t, I look forward to connecting via linkedin or twitter!
I’m going to talk to you today about the new era of web 3.0. While you’re going to hear a lot today about the many benefits this new technology can provide, I’d going to speak to you about the potential issues that can arise from it because I think they are critical issues that we must address as we move forward and I don’t believe we are. Web 3.0 is essentially about Identity. The concept, idealistically, is about each of us having a personal data locker; a data profile that contains information about who we are, along with all of our needs and desires. The benefit of this is that now I simply update my data locker with my health interests – which of course, are protected via security and privacy measures I can control – and then healthcare providers can come to me with the services they can provide for me. The benefit, then, is that companies will come to me. I won’t have to go to all of them.The issue I see behind this, however, is this – who am I? That question, the question of identity, is one that we haven’t done a very adequate job of answering. How many of you can truly answer that question? When you think about it, isn’t that question the central one of our lives? Isn’t that what our life journey is ultimately about? Some of the greatest minds in history have tried to answer this question over hundreds, if not thousands of year, and none have really addressed it in a way satisfactory to everyone.Unfortunately, some of the lead thinkers, drivers, and proponents behind the web 3.0 movement have answered this question for you. You are this. You are data. You are bits and bytes. This is your identity. This is who you are. What is terrifying to me is that some of the gurus, the extremists, behind this new movement believe that this is what you are. Some of them, such as Ray Kurtzweil, believe that this is the end-goal of humanity, and admirable end-goal. A merger of man and machine in something they call the “singularity”. They have made it their life’s ambition to make this reality come true. Perspectives like this originate in a worldview. A worldview is a framework of ideas and beliefs that we use to interpret our world and interact with it. A worldview effects how we interpret our senses and then how we interact with each other. If you are a liberal or conservative or a centrist, you have a worldview, and, when you think about it, that designation definitely impacts the way you interpret what is said to you, the news you read, and it also certainly effects the position you take with others. Worldviews, however, are often unconscious. We are often not aware that we following these scripts because they are given to us in an implicit way via culture and our personality dispositions.The worldview that I believe the people behind web 3.0 are following, whether implicitly or explicitly, is what I call the world as machine worldview. This worldview is not new. It really picked up steamed during the age of enlightenment. Once humanity could figure out the motion of our planets mathematically, it had a profound effect on us and how we thought about the world. We started to believe that man could do anything, and that led to these values being adopted.  Humanity began to believe that they could use reason and rationality to understand the world by breaking it into its subcomponents and parts, by reducing the system to parts we could felt we could understand, and then extrapolating those findings to the bigger system. Through this understanding, we began to believe we could predict many future events regarding our lives. If we could predict the movement of the planets, what couldn’t we predict? This led to the belief that we could control the world. We could control our environment, and, ultimately, our destiny. As I mentioned earlier, worldviews permeate every facet of our lives. When you think of the world as a machine, you apply that same worldview to people. Hobbes, a famous philosopher, applied this world as machine worldview to ethics. He stated that man was driven by cold, calculating, and rational self-interest. It was a “war of all against all”. He also felt that, ultimately, man had to be controlled because of this self-interest. Hobbes’ contract ethics have had an enormous impact our society. What about the fields of healthcare and experience design? Do they follow the world as machine worldview? I believe they do. Healthcare uses reason to understand design and rationally devise treatment options that can be standardized to entire populations and can predictably have certain outcomes. The ability to predict outcomes, in fact, is huge priority within healthcare. And UX? It, too, tries to use reason to understand, predict, and standardize “user” behavior. A good question to ask about now is so what? The world as machine worldview has had amazing accomplishments, and healthcare has had magnificent, and admirable, accomplishments over the past several centuries. Is this worldview enough to promote health? Can we truly embrace the concept of health through following it?My answer, no surprise, is I don’t think it is enough. When we talk to our patients about what they value from healthcare, what their expectations are, and what health means to them, they often bring up values that are not the machine worldview values. They bring up values like emotion, and empathy. I’m going to illustrate this using two extreme events in life – birth, the beginning of life, and death, it’s end. What does reason have to do with this? For those who have experienced this moment, you know that it is a mix of emotions, panic, fear, love, and joy. While information in this moment certainly helps, it isn’t enough. It doesn’t prepare you for this moment.And what about this? My father-in-law recently passed away and I can tell you that there is nothing, absolutely nothing, predictable, rational, or reasonable about this moment. These two extremes, new life and death, show some of our rawest and truest moments of what it means to be human. This is our identity. At times, we are an ineffable mystery. And where is healthcare in these moments of need, arguable the moments when we need it the most? Not to be seen; it stands back confused and incapable. The world as machine worldview does not capture the rich and dense complexity behind what it means to be human. It has a limited understanding, and as a result, it provides limited solutions. It limits us. It de-humanizes us by not being a complete view of what it means to be human. Unfortunately, I think we have a tendency to be overly optimistic about this limiting worldview, which comes itself from the belief we have in control that the same worldview promotes. Because we believe we are in control of our world, we have a tendency to defer these issues. We tell ourselves “Sure, these issues exist, but we’ll solve them… some day”. “We’ll figure it out”. There are many examples, recent ones, however, that show this optimism is misguided. The line on this slide is actually real estate values and we all know what happened after that peak. As long as we limit ourselves to a machine worldview, we are kidding ourselves. We are not in control. We can not figure every issue out. Not now. Not someday. Luckily there is a new worldview that I think could be a worthy alternative. This worldview is being developed within mainstream science within fields such as ecology, moral psychology, positive psychology, neuroscience, and behavioral economics. It is a worldview that not only embraces the old machine worldview values, but includes these other values as well. It acknowledges that people have an intuitive capacity that provides value, that, in fact, our decision-making is often driven by intuition as a snap judgement that we then rationalize via reasoning. It acknowledges that emotion is an enormously influential foundation for those decisions and our other cognitions.The world is not simple and can not be understood though reduction of its parts. There are emergent behaviors that happen at a systems level. It states that humans are not purely driven by self-interest, but are actually driven by empathy and altruism as well. That empathy is actually hardwired into our very behavior. It knows that not everything can be predicted.  This worldview celebrates diversity. Some of the healthiest ecosystems are incredible diverse; they are not standardized simplicity. Knowing that not everything is rational, and not everything can be predicted, this worldview shifts from one centered on control to one centered on enablement.  I call this worldview a world as life worldview, and, as you can see, it greatly expands what it means to be human and what our reality entails. It places a primacy on these new values without abandoning the rest. I believe that it would give us a much better, and richer, foundation on which to build healthcare and UX. A healthcare system that embraced the world as life worldview would be truly life-centered. It would more fully understand our needs in those times of utmost urgency that we discussed earlier and would be able to provide us with the help we so badly desire. I believe it would lead to healthier outcomes for us as individuals and a healthier society. What would a healthcare institution that supported this expanded worldview be like? Here’s one possibility. I think that we would first of all redefine health. Health would be about flourishing. It would go beyond mere physical needs and truly focus on providing people with a holistic focus on ALL of their needs, emotional, physical, cognitive and social. It would do this through nurturance. Our providers would reach out to us to address our emotional needs first. They’d understand those our emotional health and would start their diagnosis there by asking questions about them. Not only would they ask about our emotions, they’d connect with us emotionally and with sincere empathy. That emotional connection would extend itself into a natural friendship. Our providers would ask us about all areas of our lives – our work, our families, our ambitions and goals. They would have an actual conversation with us. They would take the time to engage us and listen to us. That friendship would extend to the community as well. Providers would acknowledge that no matter how much willpower I have, my community, and my environment, are critical components to my health, to my flourishing. They would be civic participants and activists in my community helping promote a flourishing environment for us all. Finally, they’d be focused on each of our actualizations by helping us become better human beings. They’d not only focus on our weaknesses but our strengths; utilizing our strengths to overcome our weaknesses.  I think a great summary of this vision is really a relationship. Our patients want a relationship with us. One that is deeply intimate, compassionate, and caring. The world as machine worldview does not fully address the type of relationship that our patients want, but a world as life worldview does. At the beginning of this presentation I asked you to ask yourselves who you are? I also told you that the web 3.0 era would like to provide you the answer that you are data. You are a machine. But we are not machines. We are complex, interdependent and whole. We are part of an ecosystem; part of something greater than ourselves. We are compassionate and empathic; even in the most horrific of circumstances.We are raw emotion. We are life. As Amy mentioned to you earlier today, we are in a moment of crisis in healthcare, but I am optimistic that we can do something about it. It is never too late. Even if you begin making minimal changes that adopt this wider world as life perspective, I believe great changes can happen. Ask yourselves, how are our products empathetic? How are we enabling relationships? Who are meeting our emotional needs? Ask these questions, and I believe we can begin, together, to bring about healthier individual, healthier communities, and a healthier planet.

 

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Categories deep design, featured, flourishing, identity, web3.0, worldview

Towards a deeper design

December 28, 2010 //
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If designers are serious about helping people, they will need to radically transform their way of practicing design. Human-centered design is not nearly human-centered enough. For products to be human-centered, they must begin to address the deep, foundational, need for growth within people.

Reflection on growth as the ultimate purpose, or goal, of humanity can be traced back to Aristotle (eudaimonia), but it has had many modern day advocates focus extensively on it as well. Maslow and Jung, major psychologists of the 20th century, both recognized in their patients that they were happiest when satiating their drive, their need, for growth. Jung called the attainment of this drive self-individuation, and Maslow referred to it as self-actualization.

Self-actualization, in a nutshell, is about challenging ourselves every day to become the master of our weaknesses, further our mastery of our strengths, and, ultimately, master our lives. As people begin to experience increased development towards self-actualization, they often experience happiness and fulfillment. They realize that the journey they are experiencing IS the purpose of their lives. Self-actualization is a journey AND a destination.

Product design today is far too focused on meeting people’s superficial needs without focusing on their foundational need for growth. At best, today’s product design makes life a little more tolerable. At worst, it is making life far less fulfilling and is contributing to the unhappiness of millions of people.

For someone to grow, they need careful, quiet, and studied self-reflection that goes to the core of their being. It can be a painful process that requires focus and discipline and a steady hand.

How often do our products help this? Help people challenge themselves? Help them find their inner selves by providing them with focus? Encourage their discipline?

In my opinion, the answer is rarely, if ever. In fact, most products, unfortunately, do the opposite. They pull people into ever larger fantasy worlds, filled with distractions, delusions, and a need for speed. Our world no longer understands what the words slow, focus, steady, or deep are about.

The industrial designs of the 19th and 20th centuries have helped humanity discover the dizzying heights of the highest peaks. How can 21st century design help it rediscover its roots?

For design to be able to meet this challenge, it, too, must undergo transformation. Design must begin by focusing on its own foundational drives and system of beliefs to understand them and transform them into a new design. A new, deep design, comprised of beliefs, practices, and processes focused on helping people not only transform themselves, but the very world around them.

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Categories deep design, featured, flourishing

People ARE the product

November 16, 2010 //
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People are putting more and more of themselves on the web these days. Their thoughts and beliefs (like this blog of mine), along with their personal photos and experiences; it really is amazing how much you can learn about someone simple from scouring their google results.

An extreme example of this can be seen in Healthcare. One of the largest initiatives underway right now is the creation of personal health records (PHRs) and electronic medical records (EMRs).  Both of these platforms allow users to place their health data – both wellness and disease related – securely online.

Clearly, there’s a lot of privacy issues with having this data online, and there are a lot of efforts underway to secure that data as much as possible, but the reality is that our current world of exchanging data between multiple machines (and, thus, the people behind them) just doesn’t support privacy and security as much as we’d like.

This concerns me, but what concerns me more is the approach designers and developers have been taking with the treatment of people’s extremely personal data. We treat it like it is merely data, and this is a substantial mistake.

Time and time again, I’ve seen people in user research sessions take offense to their data being treated simply like data. That’s not how people view their data, as a piece of information out in the cloud of webdom. They think of it, instead, as an extension of themselves. The boundaries between products and people are blurring, particularly in the digital realm.

Due to this, people have a hard time viewing themselves as cleanly separated from the products they use. That product is them, and, from a design perspective, people are the product.

This revelation requires a significant shift in our approach to design. We should be treating a person’s data like we’d treat the person themselves. Would a person want their personal health condition shared amongst multiple strangers? No. Should their health data be treated like that? No.

I’ll give you a more concrete example.  Many PHRs allow users to input profile data for relatives, such as aging parents and children, as well as their own.  How should we handle that profile of data if that child, or aging parent dies? Do we simply throw it in the trash?  What about someone who is so sick they may die? Do we show their weekly health stats trending downward in an attractively designed line graph? Clearly, either of those solutions lacks basic humanity. Yet, that is how some products will deal with those problems.

As the use of these platforms continues to grow and data driven devices and environments permeate ALL aspects of our lives, designers, developers, and the businesses, will have to treat the personal data of individuals more humanely than ever before.  We are NOT manipulating some mere combination of bits and bytes. We are manipulating people.

From what I’ve seen so far, we’re not prepared for this level of responsibility or accountability.

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Categories featured

Convergence Confusion

September 15, 2010 //
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There’s been a lot of discussion lately around device convergence vs. device divergence. With the success of the iPhone, I’ve noticed some people claim victory for device convergence. I’m not so convinced.

Now that I have a household complete with laptop, smartphone, tablet, and mp3 player (all Apple products), I’ve found myself becoming increasingly confused. At first, there was relative harmony at my house. The iPhone and laptop lived in a perfect, symbiotic, relationship. But then the iPad showed up, and all hell broke loose.

With an iPad, I find that I don’t have as much need for my iPhone. In fact, I hardly use it. I still find it comes in handy for times when I’m truly on the go, but otherwise, it almost seems like I have too much power in my pocket for what I need. Now I find that a lot of the time all I really need is a phone with very basic functionality, nothing more.

Instead of accessing my iPhone to read content or check e-mail, I now open my iPad. And the iPad, as Job’s exclaimed, truly IS a great consumption device. It is so successful that I find myself wanting safari to just go away, with everything being replaced by an app, and I also find that I rarely use my laptop for content consumption anymore.

With that said, where DOES my laptop come into play?  For content creation? Perhaps, but if the iPad had a keyboard, I’m not sure how often I’d need my laptop. For heavy hitting assignments, sure, but the vast majority of my work could be completely finished on an iPad.

So where does this leave us on the device convergence spectrum?? Somewhere in the middle, and, unfortunately, it seems situationally based. For my day to day life, a DUMBphone and an iPad seems like more than enough. On big travel days, however, I need my multi-function iPhone and nothing else. Hardcore work days – Laptop, with skype… screw the rest.

This has become a dream situation for corporations – we’ll all have, and need, multiple devices that provide far more features than we need at a price we can’t afford – but it is an absolute nightmare for people. To top things off, this nightmare is only going to get worse. Seen the new iPod Nano, it now brings music and fitness in a watch-like format that you can wear on your list. Now if only it had e-mail…

Bottom line – it seems ridiculous to have this much technology per person, particularly when it is redundant.

Are there solutions that can address this? A module that can make a dumbphone smart when needed, that powers my iPad the rest of the time? A workstation I dock my iPad to that juices it up to super laptop power?

These are the things we should be asking ourselves…before the episodes of “Hoarders – the Device Edition” break out.

**Update – literally the day after I wrote this, I discovered this modular system on Gizmodo. Not the best design, but it gets the idea across**

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Categories web3.0

The iPad is converging visual design

August 29, 2010 //
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In a previous post, I discussed how the iPad has started converging multiple interaction models (at least 7) into one device.  I believe that the iPad is also converging multiple styles of visual design into one device.

Many of the information apps, for example, are taking their visual design techniques from the print world. No longer constrained by the browser, people have begun creating some beautifully typographic, and graphically rich, information-based apps. These apps, however, also have interactions within them, such as trackers, location services, and social media interactions. In these instances, the apps have relied more on traditional web visual design techniques.

Combining these different approaches into one application creates some very interesting, beautiful, and strangely schizophrenic compositions. As with the convergence of interaction models, the convergence of visual design techniques also creates a plethora of accessibility, and usability, issues. I’m curious to see how the design/ux world will respond to those concerns. I’m also curious to see if this convergence will create new form factors that blend these different techniques more substantially.

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Categories web3.0
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