Reducing violence and aggression in A&E webinar: The Design Process from Design Council on Vimeo.
CHRIS HOWROYD
Hello, and welcome. My name is Chris Howroyd, Programme Manager for Health here at the Design Council. This is the first of three webinars hosted by the Design Council today, entitled The Design Process. All three webinars are centred around the design-led approach adopted to deliver a reduction in violence and aggression in A&E programme of work, the outouts of which are showcased this week. The aim of this mini-series of webinars is to share learning from this programme, engage, provoke and hopefully inspire.
We plan to be online for around an hour. A slideshow of presentations will last up to 40 minutes, leaving us 20 minutes for Q&A. We’ll be taking questions at specific intervals during the session, so if you would like to ask, clarify or query something, simply type a note into the textbox on your webinar app screen. So, without further ado, it’s my pleasure to introduce you to your presenters this morning, Colum Lowe and Neal Stone.
COLUM LOWE
Good morning.
NEAL STONE
Morning.
COLUM LOWE
We’ve been asked to come in and talk to you a little about design, but first to introduce ourselves. My name is Colum Lowe and I’ve spent 20 or 25 years in the design industry, first as a designer, but then, following the painful MBA that I did, I spent the rest of my career as a design manager, and I’ve spent nearly four years in the NHS as Head of Design and Human Factors at the National Patient Safety Agency.
So I have worked in healthcare in the past, but the last three or so years I’ve got my own design advisory practice where I help clients use design for whatever benefit they want to get from it. In the private sector, that’s usually money. In healthcare, that’s usually not it; it’s usually about patient outcomes, staff satisfaction.
So today we’re going to talk to you really about design, the design process, how to manage it and some of the bear traps that you might come across. I like this quote. I like quotes in general, and this is merely trying to say that, you know, we all like to learn. I’m sorry if it feels painful. If anything I’m saying sounds as if I’m teaching you to suck eggs, I apologise, but it’s… hopefully you will find it useful.
The first thing is to try and define what design is. It’s not making things pretty. It’s not about aesthetics. It is… in my view, everything made by man has been designed by man and everything else possibly by Mother Nature, or God, or whatever you believe in. But everything that we have made, somebody, somewhere has sat down and thought about it and brought it into being, and at a very basic level that is the design process.
The problem with a lot of things that we see around us is that they have been designed; they’ve just been designed badly. A few quick examples just to illustrate the point: this is a soup that is very popular in the West Indies, this being a male chicken. When they tried to export it to North America and the UK, it failed to get much traction. Not many of us want cock-flavoured soup and it’s purely… it is bad design. It is a company that didn’t understand their audience.
There are less trivial ones, clearly. This was how we used to buy tickets on the underground. It was designed by and for the engineers, I believe. Very easy to fix, open up and get to the back of; unfortunately, for a user, very hard to understand. Trying to find Victoria tube station on that is a nightmare, particularly if you don’t know it’s called London Victoria and not Victoria, so incredibly bad for the user interface and actually very expensive.
The Sinclair C5 for those of us who are old enough: this is actually a wonderful bit of technology, very well designed in that sense, very clever, cutting edge, but actually nobody wanted it. So it didn’t understand its market. It wasn’t useful to anyone who was going to possibly buy it. You’d like to think we learn from this, but the Segway is exactly the same thing. Wonderful technology, all very exciting, but nobody actually wants it and therefore it failed and it’s failing to hit the sort of market levels that they’d like. None of us really are prepared to part with £3,500 for one of these.
It can be… bad design can be quite simple as well. There are now two types of keyboards out there. There are… the one in the white is what you would call a numeric entry keyboard with the one on the top left, and the one on the left is a data entry keyboard with the seven on the top left. Numbers are very easily confused visually are not in the same position, depending on what sort of keyboard you’ve got.
Not such a big deal you’d have thought, putting the wrong number or adding up things incorrectly, not the biggest deal. In a medical device, however, this can result in drug overdoses and unfortunately on a lot of our wards lots of devices can co-exist on the same ward in a hospital. Some have numeric entry, some have data entry, some have the one on the top left, some the seven on the top left. This is, for me, a design that doesn’t understand the system of use and the inherent risks of using [unclear].
There are other examples from our time at the NPSA we could talk about, like lookalike medication packaging. The two photographs on the right, I think one is water, the other is Lignocaine [?]. One is basically water, the other is quite dangerous, and we know the problems of lookalike and mispicked drugs in healthcare. And again I would say this is bad design and I would say this is design that didn’t understand the system of use and the basics of human factors in healthcare. These problems can quite easily be designed out if considered at the right time of the design process.
But the hidden and one of the worst parts of bad design in healthcare and in most organisations actually are processes. So these are process charts that are… through LEAN programmes which I’m sure most of you are probably a little bit familiar with. The top left is a process for doing a fairly simple procedure in an NHS hospital and all… every single little post-it is a step in that journey. The middle circle is a hand-off chart showing the amount of times that people pass information to and from each other, whether it’s a conversation, a fax, a memo, a prescription, whatever it might be, and the one on the right is the journey time, the journey distances for staff to go and find things.
The top photographs all relate to one process and it’s for a patient to get their take-home medication. That’s it: how do you get a patient on the first floor of a hospital to their drugs on the ground floor at the pharmacy? We go through that process in most NHS hospitals. Not only does it cost us a fortune, but every step in that journey there’s a chance of risk, of failure and therefore it’s… I would say it’s a very badly designed process. It’s expensive and it’s dangerous. It could be… and it could be better designed if thought about at the right time.
But we’re surrounded by bad design. It’s not just healthcare, it’s absolutely everywhere. Some common devices, the phone on the right is one I personally owned and recommended to me by the then director of Orange. He said it was a great phone. He then later admitted that 90% of the features couldn’t be used by 90% of the owners just because they were too complex, and there is a lot of research that links badly designed products to returns in the inability to use.
Even in bad design, you know, some things have been with us for a long time. The common door is one of man’s boldest inventions. Shortly after we invented tools, we invented the door, about 80,000 years ago. The wheel by comparison is a very modern invention, only 8,000 years old. So the door is ten times older than the wheel and it’s actually a more complex piece of equipment, but we’re still not very good at designing it.
Quick exercise just to sort of bring this to the front and I’ve never tried this in a webinar in front of a live audience, so we’ll see how this goes. But when you ask yourself, door A on the left, how do you know where to open it? Is it, you know, is it push or pull? Is it left or right? The first inclination would be whether to pull handles, so you pull it on the left, but there are no hinges visible, so actually this is a push door and many push doors have pull handles on them, already confusing the user.
Door B, again, push, pull, left, right? Well, there is no way to pull it so it must be push on the left. But the more observant will notice there are hinges on the right and therefore it’s actually a double-swing door, the type you would find in a restaurant, so it can open both ways. If you don’t know this, there’s a big chance it’ll open in your face when you’re not paying attention.
Door C is… when you look carefully, there are no affordances. There is nothing there to give you any indication whether to push or pull, left or right. It is what’s become lovingly known as a designer door. Back? Oh, it’s back up. I believe we lost you there for a minute. I was told we lost you at door C. I’m not sure where we got to, so I’ll just start on as if that’s where we left off. Apologies if I’m repeating myself.
Door C is called the designer door. All the affordances have been removed for aesthetic considerations and therefore you’ve no idea whether it opens left or right, forward or back. It’s probably automatic. You will probably arrive and it will open for you, although it’s hard to know.
And that’s just another theoretical exercise; I’m collecting my own Norman doors at this stage and here is one I found recently in a hospital. The door to the left, push to the left, right? Well, the answer is neither actually. You follow the green sign to another green sign, which you then follow to a green button, which you press, being careful not to press the [unclear] fire alarm, go back to the door and then you push it before the timer runs out and you have to go through the process all over again. The door is 80,000 years old and we’re still not very good at designing them.
Of course there are some good designs as well. Dyson products, I would say is a lot of good design, reinvented a whole category, and mainly me for my [inaudible] the first time in a long time because they’ve got a piece of equipment they can feel very comfortable with, but nonetheless it’s still a very good piece of design.
Design can create new services if you know how to use it. This is a Streetcar. For those who haven’t used it, they discovered the small problem if that, you need a car because you haven’t got one and you’re told, well, come into Avis and we’ll lend you one. Well, how do I get to Avis? I haven’t got a car. What streetcar do is they park cars randomly throughout London in certain spaces, you join their club, and then you just go and pick it up. I live in Sydenham which is not a very popular part of Southeast London, Southeast London not being a very popular part of London, and [unclear] my house. So if I want to, I can just walk out, get in and take one away.
It can also help, well, enhance customer experiences, good design. Airlines learnt very quickly that people used to get bored on planes for long flights. They used to get agitated, complain a lot and get into trouble, possibly drink too much. And there were things like putting a TV in the back of the headrest stopped all that, gave them something to do, and created a better experience and customer satisfaction levels rocketed.
It can also change perceptions of an existing product. When I was a kid and I was skiving a day off school, pretending to be sick, this is what my mother gave me. This was a drink for ill people when I was a child. It’s not a nice sports drink. It’s an energy drink that had issues and that… and design changed that through marketing communications and packaging.
So, good design helps create relationships. We’re not very complex beings, humans. We find it difficult to deal with the complexity of the world and therefore we assign human characteristics to inanimate objects around us. We shout at our computers as if they hear us or they care. We call our Italian sports cars temperamental and blame them when they break down. So design has that power; it’s got the power to create things that we talk about as being human and relate to that strongly.
And fundamentally design has the power to shape the future. We can all have visions of how [unclear] to be, but design is a tool that can make them real, not just in terms of solving the problems, but just physically bringing them into being so we can look at them, challenge them and understand them, and take them to the next step in their journey.
For me, though, and I have been to [inaudible] designer from the design industry, but a lot of times design is the difference between success and failure. These are two retail outlets with an incredibly similar philosophy and policy in terms of flat pack furniture, you do all the work, we keep the prices down, everything is shipped around, we don’t move air around the country and packaging, all of it very good.
IKEA embraced design from the very beginning and is in every part of its business and they have succeeded wonderfully. MFI saw design as an expensive bolt-on and ultimately they went bust because they just weren’t designing and building pieces of furniture that people wanted to buy.
There is one problem with design. British manufacturing predominantly in the 70s, 80s and early 90s went through efficiency drives and effectiveness drives trying to reengineer the process, which is about taking cost out of a process to improve profit and productivity, which is all good and not be ignored. [Inaudible] design is absolutely about an investment decision to improve profits or effects. You have to invest to get that return.
Although there is a more stronger [unclear], but there is now a growing evidence base that says that those who understand design and invest in it wisely ensure a very, very healthy return on it. Not the 2% or 5%, but significant returns for using design well.
I’d like to talk to you a little bit now about the design processes. There are a lot of design processes out there. This is the Design Council’s Double Diamond that we use, which tries to explain the four major stages of the design process and the way that people think during those stages, so divergent and convergent thinking. The idea about, you know, exploring and coming up with lots of ideas and then focusing down to a single point in time and how that will repeat and go down in cycles.
We also take that and think about it as a crisis. A lot of design problems, design projects, a lot of intervention and change projects hit problems and it’s about how you manage that during the journey. You know, the first crisis, is it a need, whether it’s not hitting your targets in a hospital, or whether it’s hitting sales in the private sector. You then explore the need, you distil that into a brief to tell somebody what to do, and that is usually the first crisis when the need gets so big you don’t know what to do about it.
You give the brief to the design company, they explore the design challenge and come back with millions of ideas, none of which you like. You’ve then got to stop it all and you distil it down into a specification that you’re actually going to build. [Unclear] crisis are the biggest crises. The design process generally speaking doesn’t cost very much compared to actually manufacturing. You might spend 15 to £20,000 having part of your hospital redesigned. It’s going to cost you maybe 100 to £200,000 to build it. So the third crisis point is usually pushing that button.
[Unclear] design company and say, we would like you to design something for us. This is the process they will normally follow. Follow and it will become obvious. You give them a brief. You’ll dance around that brief proposal until you’ve all agreed what you’re going to do. They will do some research and some vision work for you and they will come up with some initial concepts, lots of concepts are very rough, and then bundle that down into a single final design that they will draw up and specify so you can build something.
It’s not that any of these are the one. It’s just that all of them are very similar and it’s understanding how the process works. At the beginning of it there’s lots of loose ideas going down into one final one.
The problem with design, one of the many problems with design and one of the reasons it gets not much traction is all design involves change; all change is risk. And anybody who’s read Machiavelli and the Prince will recognise this, one of his most famous quotes, about how things are likely to fail and this is for me still as true today as it was when he wrote it, that change is difficult.
People like to do what they’ve always done. They understand the process, they understand the risks and they know how to manage them. With change, the new, people don’t understand what the risks are and therefore don’t know how to manage them, and it can be personally quite uncomfortable.
And there’s a good bit of work by Diana Parker at the University of Manchester looking at culture change or behaviour change programmes in all organisations, whether it be through design-led programmes or not, and as I’ve said before, I think every change programme, anything that we create is design.
They tend not to work… if you just tell people to pave them in a different way, they tend not to do it, or they’ll do it for a short while and then they’ll quickly go back to their old ways of working. So when we do change programmes they tend not to deliver the massive result that we want and that’s because if you don’t know how to change the system within which people work, they will go back to complying with the old system. They have no choice but to do that, in fact.
And a little bit of work previous to that looking at the healthcare system, trying to understand what the different elements are, and there may be six distinct elements in healthcare that make up a system. There are the healthcare providers, you know, the clinicians and the staff. There are the patients and perhaps the visitors themselves. There is the clinical or administrative procedure being undertaken. There are products that are used in the procedures. There are peripherals in terms of environments; light, heat, noise, other devices, wheelchairs, things going about. And then there is policy, either central or national policy that affects the way people behave.
Just… and this is what we learnt in all the healthcare programmes we’re working on in the Design Council on healthcare, but just telling patients in the accident and emergency room to behave better is unlikely to have any significant impact, unless you start using other elements in the system, some of which do involve heavy design, some of which will involve training or other programmes of intervention.
And also we try to understand… this is a model from intervention programmes as well, looking at the risks of failure in terms of change programmes. I’m just making sure that we have each of these ticked off. If there was no need for change [inaudible] individual staff level or at an organisational level, it will not happen. If there is no need, people will never quite get around to it and there’s always something more urgent.
If you don’t have a vision of the future, then the activity is disjointed. People do not all drive in the same direction; they want to do different things and again, you will be unsuccessful. Particularly in the NHS and particularly in emergency departments actually we learnt that if you do not get staff engagement early on and throughout the process, then actually this doesn’t happen. If you want somebody to do something, you’ve got to engage with them.
You’ve got to build the internal capability. If there’s no internal capability, things don’t get delivered. You’ve got to have an effective process or the outcomes get disjointed and fall to pieces and don’t get to the end. And you’ve got to continue to support people and tell them they’re doing the right thing. Continue to review.
And if you do all that, apparently, you know, your culture change, behaviour change processes work. You do produce, sorry, prove the way you want people to behave, but the cultural change programme itself is the last thing you do. You can only do it after everything else is lined up.
As part of this programme with [unclear] we looked at classics with behaviour change models, either from academia or from consultants working in the business, and all of them did have an element that you could call design. They used probably words for it like symbols, aligning symbols, but all these things can be designed to help people change.
And we created our own model for behaviour change. Trying to get senior management buy-in being the most important, Then, you know, reviewing the current situation and developing the plan, engaging the workforce, and only then do we take it [inaudible] for design interventions and then this continual sort of review adjustment.
To give you an indication how this works I’ll very quickly and finally take you through a healthcare programme that did this very successfully we believe, which was the Clean Your Hands campaign, which I was lucky enough to be involved in when I was with the National Patient Safety Agency. Although it was [unclear] who ran this programme, I was involved in it and later on [unclear].
So very quickly, we did take senior management buy-in incredibly seriously. There was a lot of pre-campaign preparation, a lot of engagement with senior staff, either carrot stick, the patient safety [unclear], but there was a lot of information to get people on board for that.
We reviewed the current situation. We understood exactly what was going on across [inaudible] and financial and so we knew what we were trying to achieve. We developed a master plan, a social marketing campaign that was multi noodle [?], not just a poster campaign. So we knew what we were doing in year one, year two, year three and year four, and how the programme was going to develop from a national driven scheme to a locally driven scheme.
We understood how the logistics would work, how we’d get everything to everybody, and then we engaged the workforce. We engaged with people in every single trust in the country to make sure that it was going to be driven internally as well as externally. And a lot of them will take credit for what we were doing; we gave people titles and responsibilities and on the whole these were very well-adopted.
We also then went about creating the tools and symbols for change. There was a brand created. There was the poster campaign, the leaflets that went throughout telling people why they should, they need to take this seriously, what they should do about it, why, you know, what the issues were, set point of care prompts, all things set up in a non-intimidating way that [unclear] to bring about change, including microsites.
But the most important thing was clearly giving the staff the tools to do the job we wanted them to do. If they haven’t got the ability to clean their hands at the point of care, it’s very difficult to do, so the alcohol gel was clearly a massive part of this campaign.
We then reviewed it, and of course some of these figures are a little bit old, but it was amazingly successful and I think probably the biggest figure is that product usage increased by 250%. So at a very basic level people are using alcohol gel two and a half times more frequently than they have done in the past, and that’s one of the things when I go into a hospital these days I look at.
I sort of believe that you can tell a positive culture in a hospital by how well it got to the hand cleaning techniques, and if they adopt it well, then they have got a good strong culture for change and if it’s invisible, then it, for my money, there’s a problem.
But it wasn’t just me that thinks this was a great bit of holistic design; it actually won the Grand Prix DBA Design Effectiveness Award in 2005 which, for anybody who does know it, the Design Business Association is the industry body and this is probably the highest profile of design award you can get in this country, and this campaign won the Grand Prix, the top award.
I look forward to receive any text that you might have sent in, or letters, and I will now pass over to Neal who’s going to handle the second part of this.
CHRIS HOWROYD
Before we hand over to Neal, I have a question for you, from our audience which is, how does the design process differ for different sorts of design projects? For example, architecture versus graphic design.
COLUM LOWE
Not at all. The process of invention is universal. The issue is that architecture, design have not been very well-related I guess in the past, even though the design disciplines, graphic products, industrial, interior, website are not very well-related so we’re all learning our trade. It’s not a gold industry. My father was a designer. When I was young, he was the only retail designer in the north of Ireland. Our heroes of design that we talk about, the Robbie Fitch's and the [unclear] are all still alive, the people who started our industry. So we’re all [unclear] and what we are seeing is a convergence about the way architecture, interior design, product design, design works and even process design. We’re all following each other’s tools and each other’s processes, so it’s all coming together. But I would argue there is no difference; it is all just a process of inventing and creating that is based on a customer and user needs.
CHRIS HOWROYD
Okay. Just a second question with reference to the A&E project; is there anything which you have learnt fresh, new from being involved in this particular project?
COLUM LOWE
Yes. I believe we’re coming up later on the day, but the ethnographic research done by ESEO and Martin Bontoft literally blew me away. I have not come across better research than that I don’t think in my time in design. And it surprised me that if you follow a good process, go with the right experts, give them time and follow their lead, the insights that they will create for you are phenomenal. Their perpetrator profiles I think were truly enlightening. Their trigger to a bad behaviour were again truly insightful and I think were the foundation for everything we did in this project.
CHRIS HOWROYD
Fantastic. And just to remind you, we’ll be hearing from Becky and Martin at 12 noon today. So over to Neal.
NEAL STONE
Brilliant. Thanks, Chris, and thanks, Colum. My name is Neal Stone and I’m here to talk about three things this morning: firstly, about user-centred design; secondly, about gathering key staff insights; and thirdly, from learning from analogous sectors.
A brief intro to me, and I’m a product designer by training and I went on to join the design management team at BA where I led a couple of big projects for them amongst others, notably flatbed projects. Headed up a design team for GNER, the railway, where we redesigned a train, and returned to BA to become of head of design.
And about three years ago set up my own business which is called leapSTONE which is all about helping client organisations who have particular challenges meet with designers who have create solutions to offer. And part of the process there is about exploring how design and creativity could help, and reframing problems in a creative context as briefs and helping to steward that process.
But enough about that, let’s talk about those three areas which are summarised as user-centred design, analogous sectors and barriers to entry. About user-centred design, actually I’m a big believer that actually all design is ultimately about the user and whether they’re paying customers, whether they are nursing staff, they’re patients or engineers. And, in fact, in any user-centred design situation there are likely to be several user stakeholders, all of whom at some stage will have needs which will require attention.
And the brilliant thing about the user-centred design approach is that it puts those users and their needs at the very heart of the design process. It centres the creative activity on meeting their needs and really hones in on that and, as a result, in a well-run user-centred design process those users should be engaged in the process. So you would actually engage real world users of a product or a service throughout the design process and one might consider forming an expert user group. It’s something that the Design Council have got off hat and users were involved in this process like never before.
So how can user-centred design help? Well, Colum mentioned the ethnography that was used in this process and I would agree it was a tremendously powerful piece of research that Esro and Martin Boktov [?] ran. What ethnography does is that it unlocks incredibly rich and deep micro insights into a particular problem or an area that is requiring a design solution and that informs the design process, it informs the designs about the real gnarly problems that might exist and may not actually be known to the users.
The user-centred design process also recognises that some of the answers may already be known to your team, so I’m a big believer in looking for heuristics, which is our, so nature’s way of creating shortcuts. They exist all around us, whether that’s bike locks that have been left on railings so that people don’t have to ferry their bike lock back and forth – that’s some type of heuristic.
And ethnography and design research can actually tease all that stuff out and the design research and the ensuing creative process is a way to both elicit those observations and bake some of those shortcuts into the real design solution because people may already be shortcutting stuff and making a system of product work for them better.
Thirdly, design projects can actually give teams the space and the time and the permission to enact their ideas. So if a team has been shortcutting stuff, or they know workarounds that are working, then the design project and the design intervention can actually bring all that stuff to the fore [?] and allow those things to bubble up and it can enable people to make their suggestions known and it can bring them into reality.
And last, but certainly not least, there may be entirely unknown user needs that a user-centred design process will unlock and some of the most powerful design responses will generate winning responses to needs that people didn’t know they needed answers to.
So thinking about user-centred design and the A&E project, we’ve already touched on this a bit, but the project ethnographers spent a lot of time in emergency departments creating very, very high quality observational insights into the day-to-day operations and they had no-holds-barred access, which is really important for the design researchers to kind of see a system, warts and all, because it’s those insights that really develop the launch pads to really great creativity and response.
Those insights then went into a process of being synthesised into I think six territories in the design briefs which, if you like, were vectors for change. So the design brief was very careful to point out the opportunities and some of the problem areas, and that ensured that the creativity that was then bought to bear by the design team was focused on real world insights and challenges that staff were facing day-to-day.
And last, but by no means least, you know, really well-run user-centred design process, it, there is normally a very clear trace of frontline thinking that remains evident throughout the entire process and, even better than that, in the output that comes out of the end of it. So that’s user-centred design.
The second area that I wanted to talk about is around analogous sectors and multipurpose design teams. The first point here really is to say that real inspiration will rarely come from within a sector itself. I think that this is because our horizon of influence is such that we tend to get locked into our world of work and that kind of provides a limiting factor on our knowledge, so it’s really important to look outside of our world and design is a really powerful means of doing that.
Henry Ford was asked, if I’d have asked my customers what they wanted, they would’ve responded a faster horse. That’s because that was their knowledge, that was their horizon of knowledge at the time, and Ford obviously broke that code and the rest is history.
I think it’s really important that we look beyond our horizons in order to tease new ideas and that will mean having conversations with people from dissimilar backgrounds and dissimilar expertise. I think that’s a really important thing. In his book, which is Where Do Good Ideas Come From, Steven Johnson talks about innovation effectively being the product of conversation and the best conversations tend to be between people of dissimilar expertise and background because we’re learning something about the other party.
Design actually colliding with an area which it’s not expert in is a really, really powerful tool and it’s a brilliant way to steward those unlikely conversations and those unlikely relationships will yield, in my opinion, the most powerful results. It seems to me that the new thinking emerges at the boundaries of those conversations, so it’s when you collide these different expertise that the exciting stuff happens, and designers are really adept at achieving this. So whilst on the face of it a design team may say, we know nothing about this area, that’s possibly one of the most powerful relationships in prospect to generate new ideas.
And I think it’s important to also think broadly about framing problems, so I think that as potential clients it’s important to think broadly about the problem that you’re experiencing and take the time to frame it correctly to the designers. That’s really key because it will help ensure that the design team are answering the right question and that in turn will help de-risk. You won’t eliminate the risk of poor results, but it will help de-risk poor results.
I think we should also think about in terms of the question that we’re asking, are we asking for a product, a service or a system problem and answer? So we might be experiencing a problem with a product, but it may be a service design solution that can play into that and create the right results.
And a little bit like the slide before, it’s important to take a really wide feed of inspiration, as well as convening the most diverse team as possible. All the work that the Design Council do is focused on convening people from across organisations and at different levels so that you can have buy-in from senior management at levels from organisations, but one can also get the really important insights from people who are dealing with the problems, or opportunities, or challenges day-to-day.
And the last point on this slide is quite important to try not to preconceive or force ideas or creative responses to the brief. We may have an idea when we write a design brief about the problem that we’re trying to solve and I have a view that there’s a designer within all of us and perhaps sometimes we try to preconceive what the answer is. It’s important to try and be as open as possible. So that’s analogous sectors and thinking in a multidiscipline way.
The third piece I want to talk about is about barriers for entry for design. This is all very good stuff and the Design Council has got a tremendous track record in this area, so why isn’t design used more? Well, I think unfortunately for many design is still seen as decoration. I think there’s a tremendous misunderstanding about the scope and the role that design can play in solving quite gnarly problems and in that regard traditional consulting methods may be seen as more tried and tested, and I think that in turn means that it’s quite tricky for designers to connect with potential clients in this area.
One of the great things that the Design Council has done through their demonstration projects and the challenge projects is to actually raise the profile of design in solving problems that perhaps on the face of it people wouldn’t consider there being design solutions to. And I think that if design itself is seen as decoration and it’s misunderstood, well, the very design disciplines that sit within that are definitely relatively unknown.
So there are different types of design discipline and for those who don’t know, there are… some of them include product, interior, graphic, interaction design. The list goes on and each of those different disciplines will resolve a challenge or a brief in myriad different ways, so actually taking a brief into a graphic design team will yield a very different response to taking that same brief into a product design team.
Design management is a way of stewarding that conversation and making sure that, number one, we’re framing the problem correctly, we’re getting designers to answer the right question, and that we’re fielding that question and that design brief into people who are practiced in the right discipline.
And so I think there’s a real opportunity for design leadership within organisations moving forward. The world is moving and changing at a tremendous pace, faster than ever before. If you sort of cast your eye back over the headlines of this year alone, it’s changing at a tremendous pace. So organisations, especially big organisations, need to get much better at dealing with uncertainty.
Actually, it’s really, it’s almost an aftermath to be thinking about a kind of five, ten, 15-year fixed plan, so it’s going to be important to be able to deal with change and to be very important to, yes, to navigate and manage change. And I think that design as a discipline is all about navigating and managing change, so there’s an opportunity for design leadership within organisations.
And the value of design, thinking about the value of design, Colum mentioned the design effectiveness awards which are run by the DBA. I think they’re possibly the exemplar, the kind of the gold standard for actually codifying the value of this quite ethereal process that we call design.
I think it’s important that we all learn from design interventions that we go through and that we measure and document the successes that we take out of a project, and we measure and document the key learning’s from it.
Why is that important? Because actually we’ve got to gather evidence of design’s effectiveness so that when the next big project comes along we can actually say, we can explain quite how powerful a tool design is. So we should be asking for evidence of design’s effectiveness, we should build it and we should share it amongst [unclear] where possible, and as a management team we should be reviewing design effectiveness evidence.
For designers who may be listening, I think it’s really important for designers to go back and reflect on what’s been learnt from a process and try wherever possible, however difficult, to go back to clients after the event and try and help gather some of that evidence. I think as a former client and now a kind of consulting client, this is one of the most powerful tools in the designers weaponry, as it were, is to be able to say, here’s a project that we did, this is what, this is the output that we created, and this is what happened as a result of it.
I think it’s entirely possible for organisations to think more in beta. What that means is that in practice the first sketch, the first design that gets created needn’t be the final finished product. Design as a means of discovering what the right answer may be allows us to learn from early mock-ups and to collaborate with users and, going back to the piece about user-centred design, bringing them right into the fold and right into the heart of the process.
And we can think beta and when it’s safe and ready to do so, it’s important to get those prototypes out in front of people and start to test them and learn from them. In that regard it’s a tremendously cost effective way of managing change and that kind of thinking in beta is a way of managing risk in projects as well. So I think there’s lots of good stuff to be learnt from that and indeed the A&E stuff hopefully now will go into the prototype and will be learnt from before it gets finalised and rolled out.
So last couple of points from me, I think management within organisations would do very well to consider how to embrace creativity in design per se rather than just during design projects. What I mean by that is, design thinking and creativity has a very important role to play within management systems and within teams and their interplay, and rather than just thinking, we’ve got a design project now, let’s be creative, perhaps there’s a role to think more creatively on an on-going basis.
And lastly, for any designers that are listening, I think it’s important that we as a community, and I talk as a train designer, that we make it easy, easier for non-designers to interact with designers. So about talking the language of the business in commerce and understanding our customers’ needs implicitly. So they’re the three things that I wanted to talk about, and thank you very much for listening.
CHRIS HOWROYD
Thank you, Neal. I’m pleased to say we have a number of questions. I think the first one is principally directed at Colum, but I’d like to invite both Neal and Colum to answer these questions. The first question is, how would you address design in psychiatric wards where the familiar that appears to be of paramount importance to the service user rather than the clinical which is not paramount in this environment?
COLUM LOWE
Well, it goes back to what Neal was talking about, about user-centred design and understanding who the users are. You know, in healthcare the staff are also users and families are users, but then also the patient is a user. You know, we really must start designing our healthcare environments based on the needs of our user groups, so if that sort of environment is the wrong environment and leads to issues, then it must be changed.
My work is two-part, one in dementia and one in autism, and it’s exactly that sort of problem, trying to create environments that are appropriate for the people living there and if, particularly autism where, you know, any sort of change is pain to some of our residents, that we have to create environments from, when they move from their family home or boarding school into the adult residential areas that are almost identical to the ones they left. You know, the same colour, same [unclear], same blinds if we can manage it.
And it’s nothing more than just sitting there and understanding what the customer or the user wants from the experience and creating the environment and the system around their needs. It sounds difficult, but it actually is not.
CHRIS HOWROYD
I think the second question is related to that point with reference to. How do you feasibly prototype in an operational live area such as A&E?
COLUM LOWE
Slowly and carefully. There is no excuse not to do it, but it’s doing it in a way that is controlled and would be not different from any other healthcare. You would test and [unclear] in a managed way to understand what’s happening so you do not put patients and more staff at risk. You can test in a workshop or lab style that you move in to liver, more live environments with more and more real interventions. It sounds difficult, but again, it doesn’t have to be expensive and it doesn’t have to be timely. It can be done.
NEAL STONE
I would add to that. I mean, I think that it’s perfectly possibly to build entire systems of quote-unquote live environments, but in an offline manner. So, you know, I’ve built mock-ups of really quite complex things in the past at full scale and run them as though they were live environments and that’s a really good way of teasing out and debugging before you start to then very slowly, piece by piece, build up and test in the real world.
COLUM LOWE
It seems strange and I’ve spent time in my career as head of design at Sainsbury’s Homebase and we had about 270 stores nationally at that time and there was one fake store in Croydon, an entire store in a hangar, fully merchandised, made up, and the merchandise would come in and take things out, put something in, take things out and put them in and test them with [unclear], with the [unclear] team, with the customers to see how things worked before you went live to try to understand what was going on.
But an organisation, you know, in terms of budget size it’s miniscule compared to the NHS. The risks they faced were not setting quite as many [unclear]. I do find that maybe, perhaps maybe in the NHS there isn’t a mock hospital somewhere where we try these things out, just one in the country somewhere where we try these things out to see if they will work.
CHRIS HOWROYD
And there are of course [unclear] in the US with Guys Permanente [?]. Just talking about how we’ll be engaged with different [unclear], Neal and Colum, is there any tips that you can offer with regard to bringing those guys who are on-board to better appreciate and understand what design can achieve and why they should be involved?
NEAL STONE
My golden tip in this area is to involve people as soon as possible. Colum touched on it. When I was doing the train project, I gathered together a working group of people who were actually working on the trains and on the stations and in the engineering department and they were part of the group that designed the train.
And a little bit, like I was saying earlier, there’s a role that the designer plays in this process which is the kind of, the naïve expert, if you like. They’re naïve in the subject matter sense, but they’re the expert in convening and honing opinion from people who are experts and then focusing that into the right solutions. So have people who are on the ground doing the job day-to-day at the heart of the design process, and it’s a very powerful thing to make sure that design is aligned to real needs.
It has another really important effect, which is that at the end of the design process you’re then left with a group of ten or so ambassadors for that design because they’ve been part of the team, they saw it grow up, they fed into it and helped shape it, so that when it goes live or when it goes into prototype, they are the natural ambassadors for the process and for what is wrong here [?].
COLUM LOWE
I would add to that a little bit [unclear]. If you do not engage staff, you will likely fail in your ambitions, because if they’re not engaged, they won’t do it. And that’s not healthcare, that’s just everyone. If they’re not engaged, they’re not that interested. So you have to [unclear] and also because they actually have all the ideas. They are on the ground and see what’s going right and what’s going wrong and they can help sort the problem.
In process design [unclear] nurses, 30 nurses were redesigning part of the process and would come up with a solution and they have designed it entirely themselves with facilitation, expert facilitation, but they have designed it and it was absolutely [unclear]. I did remind them that in that room there were 30 nurses with 750 years NHS history. That’s a lot of experience [unclear], but I think the principle is true.
CHRIS HOWROYD
Right, the question is for Neal. How can designers get into board room, I guess following the steps of Johnny Ives [?] and co?
NEAL STONE
Wow, that’s a big one. I wish there were more and it’s a real shame that one of the guys who really got it, Steve Jobs, just passed away. He was a tremendous advocate of design and all the rest is history. I think that designers need to get better at talking the language of commerce and business and organisation, and I find that a lot of my day-to-day consulting work is acting as a translator in the sense that I’m translating from the design and creative work that our excellent creative industries can turn out in the UK and I’m translating that into business speak for our clients and helping them understand how to integrate that into their world. So I think that would be my summary.
I think there’s some tremendous stuff that’s unfolding in this area. So Design London, for example, are pulling together Imperial RCA and Imperial Engineering and Imperial Business School and RCA, and I think we’re starting to see the shoots of some new types of training which are teaching MBAs and quote-unquote business people the language of design and we’re seeing that in reverse [?]. So design that’s starting to learn about the language of commerce and so forth, so they’re getting up to speed and I think that is, that would be necessarily the key to unlocking that.
COLUM LOWE
I’ll try and add a couple of things to that, but it’s important for designers to start learning the language of business and the language of their clients, and talk to them in a way that they understand and talk with designers to achieving [unclear], whether it be patient safety, satisfaction, whatever it is. You’ve got to talk about that as the focus. Design is only a tool to get there.
And the second thing I’d say is it’s not important to get designers into the board; it’s important to get design into the board. That doesn’t mean a designer sitting on your board, but somebody on the board who understands design. I mean, with the NHS there was a design chap in for a while but, in my experience, it didn’t work very well. The design chap had limited understanding about design, the way that we work today, so it is about getting design understood. We’ve got to talk their language and [unclear] design language.
NEAL STONE
And I would add one other point there. Sorry to come back there, but evidence is key. So there are so many other bits of an organisation that can evidence the power of what they’re doing, or the value of what they’re doing and designers more often than not will be unable to argue in factual terms that the value, or the power of what they’ve just done, or what they’re about to embark on, so gathering that evidence is really important. There are some fantastic resources out there like the designfactfinder.co.uk which the Design Council put up and it evidences hard facts about the value of design, so let’s get talking more about that.
CHRIS HOWROYD
And building on this, there’s a question which relates to the importance of the corporate suite being aware of design rather than designers being in the corporate suite. Would you agree with that?
COLUM LOWE
Repeat that?
CHRIS HOWROYD
Is it not more important that the corporate suite be aware of design rather than designers actually being within the suite itself?
COLUM LOWE
Yes, I think that’s the point I was probably trying to make. It’s, you know, the board of the trust or any organisation has to understand that design is a tool that they can use to achieve their results. And again, it’s not about having great designers kicking about; it’s about having great designs. In the same way that it’s not about having a great individual manager, but having great management systems. There are more [unclear] and they can be benchmarked and adapted.
So, yes, I’d agree. I think the board has to know how to use design, but we haven’t found that intervention healthcare yet with our council. But we did, well, we felt that everybody knew exactly [unclear] on the board, and it’s the same for any big corporate organisation. They learn how to use design, what to expect, how to measure it.
NEAL STONE
Speaking personally, I’d be happy with either and I think the former is a step to the latter. So I think that boards and trusts and management and government being more aware of the power of design is a step to design having a place on those. I mean, wouldn’t it be great if we had a minister for design?
CHRIS HOWROYD
I think this next one is more of a statement or a discussion point, but to Neal’s last point in your presentation, design needs to show value and to speak the language of business.
NEAL STONE
Yes. I think sort of see the above conversation really. I think it’s about understanding the language of business, what ticks senior management boxes, and then figuring out how design and design processes and design activity play into that [inaudible] and all that.
COLUM LOWE
The statement is absolutely true. I’d like to think there are very few designers and design companies out there that go to their clients and say, I’m just going to make it pretty for you because that’s what you’ve asked for. I’d like to think that designers are more focused on return on investment, and that doesn’t mean necessarily money to invest. It could be safer hospitals, it could be reduced [unclear], it could be better environments, it could be staff satisfaction.
But you’ve got to be able to start talking about the measurement. If you want to… if my target is to increase staff satisfaction, well, what does that mean? From what to what? How can we measure it? How do we know we’ve succeeded? And yes, I agree that both designers have to [unclear] and clients have to be asking designers those sorts of questions.
CHRIS HOWROYD
And a question for both of our presenters: where with regards to service areas or locations has design thinking been used within the NHS commissioning body?
COLUM LOWE
Well, [unclear] partly because of… I mean, I think it was quite a, from a design perspective quite a revolutionary project and the people who instigated it guaranteed they do sort of a phenomenal job in it [inaudible] marketing campaign. So it was a great to dabble [?] and the trust who embraced it could say that. So there is that, but also there are some hospitals now, Pengrave and there’s one or two others being built, that changed the game and you’ll see the patient movement because we really followed what people wanted. This is what people want. It’s safer, it’s easier and so these things are happening.
But to be honest, in the NHS, partly because of the urgency of the right clinical care, partly because of budgets, partly because of workers [inaudible], partly because of designers [unclear] in terms of really exemplary design that you can pick up from the NHS and say, this is the apple or that’s it.
CHRIS HOWROYD
Another question for Neal. Neal, you introduced ethnographic work, with observation in brackets after it. Surely ethnographic work is more about active engagement than users?
NEAL STONE
I would defer that to Becky and Martin for their presentation to answer in detail. I think that ethnography can work in both senses and it’s about really getting under the skin of what’s going on in a particular environment and learning about the, kind of the first principle problems or opportunities that people are facing day-to-day. And I’d put observation in brackets as in the sense of that’s really the outcome of an ethnographic research process necessarily as opposed to that’s the way it works. I think brilliant ethnographers are able to be chameleon-like and blend into their environment so that they almost go unnoticed, but for sure conversation is a skill that the ethnographer brings and it’s that conversation that teases out the observations.
COLUM LOWE
I’d say I agree and I wouldn’t get too caught up in words, whether it’s anthropology or ethnography, but it is about observing people and interacting with people. If you’re observing and you’re changing your behaviour [unclear], so part of it is about interaction and then part of it is this bit of [unclear]. The more people you ask what they think, they’ll tell you partly what you want to hear and partly what they think they think. But actually watching people do things unprompted will tell you what or how they actually get in their environment. And whether it talks about it’s an interaction or not, you know, Becky will talk about that more this afternoon, I guess.
CHRIS HOWROYD
Okay. And the penultimate question: do the panel agree that engagement of user groups with the design team could be better achieved through a process which utilises a virtual building model rather than systems which engage around 2D processes?
COLUM LOWE
In that it works? I mean, I thought [unclear] hospitals, but of course we have not got unlimited budgets and unlimited time, and certainly what we were doing at the Design Council with AMY was, you know, linked to time and budgets. We had expectations, so you do the best you can with the resources you have available as long as they’re adequate for you to do a good job.
But, yes, you could create virtual scenarios, 3D modelling and this and that, but, you know, if you’re talking purely engagement, you know, face-to-face, talking to people, get them [unclear] trying to find out what [unclear].
NEAL STONE
And talk to your design team. So, you know, as a part of the briefing process Colum mentioned the dance that goes on between briefing and proposals, and part of that should be about discovering what’s the scope and the premises of a particular project and therefore what can we, what are we able to do within those parameters to make this process work as hard as we can. So for a really huge project you may go all out and build a full scale model, for others it may be flip charts and posters, but the design team will help manage that and [unclear].
COLUM LOWE
Absolutely. [Unclear] it’s very difficult as a designer to be given, here is a brief, all of these sets have been done already, but [unclear] just go off and solve the problem. If the design company is involved they don’t mind doing it, but part of the process and they are engaged in the outcomes of it and as [unclear] staff and everybody else. So as much involvement and engagement [unclear]. I can say that engagement is one of the keys to all of this.
CHRIS HOWROYD
We’ve talked about the premise at the heart of this next question previously, but we have a question which states: my biggest challenge as a designer is working with clients who have little or no background in design thinking or the design process. How do you convince the public/society to engage and buy into the design process? So I think that maybe goes beyond the frontline staff which we were discussing before.
COLUM LOWE
Well, make your cheques payable to the Design Council [unclear], but it is about education. I know at the beginning of my career 20-odd years ago, before I could sell anybody my services I had to first explain to them what design was. And it isn’t part of the job of the Design Council and the design industry to educate potential clients to the power of design, what it can do and how to manage it, and it is a problem [unclear]. It’s still a problem in the sense that I think a lot of people understand design as a predominantly aesthetic [inaudible] and television doesn’t help and a lot of designers on television don’t help. But there are two different types of designers in that sense; there are the real grownups [?] who do design, and decorators of fine arts.
NEAL STONE
I agree it’s an education challenge to get clients who aren’t design literate to understand what it is. My suggestion to the person who asked the question is, for me it would be all about small steps, taking that client on a journey and explaining the broad gamut of what design can do, use examples, refer to perhaps some of the more well-known examples that everyone would be familiar with and where, if possible, point to evidence. So, you know, point to the evidence of where great design has led to profitability or saving cost or whatever, that, you know, increases in figures or what have you.
CHRIS HOWROYD
Thank you, Neal, Colum. Just a reminder that this webinar will be available to view again by the Design Council website. Please do join us for the remaining two webinar sessions today, design research at 12 noon and design solutions at 2PM. Thanks again for your time. I trust you found this session both interesting and thought-provoking.