Nico Macdonald
OK everybody, we’re going to kick off. Welcome to Can Good Design Be Co-Created? I’m Nico Macdonald, I’ve been told not to bore you with any introduction this time because I was so boring yesterday, so we’re going to press on, which means more time for your wonderful contributions and I don’t take it personally, but I know who you are!
So the structure of the event today is going to be five to seven minute introductions reflecting on the broad themes of the discussions from our panellists in order – Jo, Lynne and Austin who I’ll introduce briefly in a minute. Then we’ll have a panel discussion around some questions which I’ll try and structure the discussion in a logical manner and then after about half an hour to 35 minutes or so, we’ll open up to audience discussion. I’ll ask to take a couple of questions from people; say who you are and ask the panellists to respond as they feel appropriate to the questions.
So on my immediate left is Joe Heapy, co-founder and director of the service design consultancy Engine, based in London although no doubt with expansion plans if they haven’t been effected already, and co-author with Sophia Parker, who was at Demos, of The Journey to the Interface, which is available both on line and in good... Demos designs print. And among many projects Engine’s worked on is working with county councils both in Kent and Buckinghamshire on looking at co-design and policy development which is some of the leading edge activity in this area.
Dr Lynne Maher in the middle is Head of Innovation Practice at the NHS Institute for Innovation and Improvement which is now based in Warwick on the Warwick University campus. Lynne lives in Surrey so it’s an interesting commute, which is a design challenge in itself, but like the BBC going... we need to move our bits of government around, so the country’s not too London-centric.
Lynne works on service innovation and advocates experience based design, which is an interesting spin on experience design, which has been a vogue phenomenon for 10 years or more. This is based upon the actual experience of the service provider. She also has academic affiliations as a senior fellow at Birmingham University and describes herself as an “interloper in the world of design with a message for designers,” and I believe also an interloper in the worlds in some respects of government and service delivery, advocating the value of design, which to some extent she argues designers need help in reiterating when they’re talking to other people.
Austin Williams is Director of the Future Cities project, and is a thoughtful and well researched and opinionated writer for publications, including the TLS, (Times Literary Supplement), the TAGS, Top Gear, Reason which is a US libertarian magazine associated with Virginia Postrel, who some designers might name check here, The New Humanist, Blueprint by Vicky Richardson who’s chairing another session, Building Design, Spiked Online.
So without further ado I’m going to ask Joe to make an initial introduction, and then Lynne, and then Austin.
Joe Heapy
OK, so Nico asked how Engine ended up in this kind of discussion about co-design and I think for us the answer is simple, we have had to. Engine supports designers and support service. Engine supports organisations in designing and innovating services and because services are complex, and they involve relationships between people, you can’t design services without co-designing with people, so we ended up having to co-design. So I guess fairly obviously in answer to the big question, “Can good design be co-created?”, well obviously the answer is yes, because if no, then good design can only ever be the result of some lone creative beavering away in a studio somewhere, and that’s alright if you want a chair, or a lamp, but if as a designer you want to engage with some kind of big thorny issues, then the only way to do it is through collaboration, through co-creation, co-design.
I think designers and design are more valuable, not less valuable, than ever before – we, if we choose to – have opportunities to transform organisations and meet communities, and even individual lifestyles if we want to through that design thinking that we’ve all been talking about. Design is still design however, and there is still huge call for traditional design and actually our agency, our consultancy, is a room full of traditional designers. We’re not going to stop doing that, but I think where our focus is is the need to figure out how to enable other people to design stuff, and I think the designer of tools and platforms which we’ll come on to talk about are probably where the new and really interesting design briefs are where they are going to come from.
I’m not a naïve evangelist about co-design or co-creation, I have this kind of essay in my head that I must write about the myths and misunderstandings of co-design. It’s not easy and it’s easily misunderstood and actually it’s one of those things where you don’t really want to get into a conversation about definition. There is a point made in some earlier discussions about also needing to avoid this trap of design by committee, which is used by people to scare other people into not collaborating, through fear that the outcome is going to be crap if you try and involve too many people. Our approach is to try and find tools to navigate the complexities of working with lots of people.
These terms do mean different things to different sectors. I think it’s interesting that the design industry has a problem with – well some people in the design industry have a problem with, co-design and co-creating – because one could argue that we do it all the time anyway, so what’s the big deal? Where it becomes interesting for us, is in new sectors like the public government sector, where ideas of collaboration, particularly with people who use services, and front line workers, is suddenly - and this is problematic - a new thing and has all sorts of difficult politics wrapped around it. But that’s where we find this all quite interesting.
Obviously an additional problem is that implicit in this argument that designers don’t have a monopoly on a good idea, so yes, we’re all designers now, my view is we should all be designers now, we’re not all designers now and for me design is about agency, which means it’s about shaping change through values, and I believe that the more people that can do that, the better, and if as designers we can help people to have agencies and to shape and change things, then we have a useful service to provide.
Nico Macdonald
OK, thank you. To clarify on the point about politics and the problem with the new thing of co-design, and what form does that take? – where are the barriers?
Joe Heapy
It seems that, and this is quite a big conversation about government and politics, I don’t find politics particularly helpful, but I have worked with, and am interested in, moving this forward, I have worked with some I guess fairly pioneering civil servants, some hidden pioneers, who are really trying to communicate to their colleagues that there might be a way of doing something in which the solutions are determined at the start, determined through a process, and that conceptual shift is quite challenging to a lot of people.
Unless you want to believe in a conspiracy of control around government or that government is trying to create an illusion of self determination, I actually believe that in a way all of this stuff is happening to government because all sorts of social and economic trends that are bigger than government are driving government in that direction.
Nico Macdonald
Right, OK, we’ll come back to that theme. Lynne?
Lynne Maher
Thank you. I’m really pleased to be here, this is only my second design conference, so I am truly an interloper. Where it started was, I’ve been in the NHS all of my life, and with the latest reforms that have been going on for the last 8 – 10 years of the NHS to say how do we move it forward, how do we transform it to make it better, one of the things we’ve coined is the term “improvement redesign” – we use redesign as a common terminology and we have tools and techniques for that. What we know is, despite what the Daily Mail says, actually health care has improved in terms of waiting times. Clearly it’s got a long way to go still and will, and clearly the tools and techniques we’re using now, we don’t think are going to get us to where we need to be in a quick enough time. Add to that we have the complexities of the NHS as an organisation, it’s the third largest organisation in the world, only the Chinese army and the Indian railways are bigger than us, we have professional hierarchies of tribes, so it’s a massive organisation, it’s a massive thing to move. And we are insular, we’re professional silo based and we’re quite insular. So we’ve got lots of things that we need to get over, and one of the things we’ve been trying to do is say, ok, we’ve got some problems, if we’re designing, if we’re redesigning services, who can we learn from? Who else is doing these things?
In that quest to say where else can we learn from, we got to the notion of designers, or I started saying, well, how do designers design services? Do they do it differently to us? And what I discovered with talking to a number of designers and watching a number of designers is I think you do, and one of the big things that is a difference is what I perceive as co-design and working with people, to understand what their experience is of a service or of a thing even, and then making it better to suit them. When we redesign, what we do is get patients into a forum like this, we sit them in front of the very professionals they might be seeing, you know, the doctor, the nurse, the people like that, and we ask them to say what’s wrong with their service, and really that doesn’t give us a very good insight into how it is for them. They’ll give us some information, we’ll take that as professionals, we’ll interpret that in our professional way, and then we’ll redesign the service based on our professional interpretation.
I think what that’s given us in some respects is technically good services, that meet targets, that are safe to a degree, that follow the clinical pathways, but not good experience, and actually we need to move towards both, if we’re to retain any thought of the NHS being a national treasure. What we know is that even if the patients enter into a technically good service, it can actually be a very poor experience, and just from working with designers to say, “show us how you would redesign this service”, we’ve learnt a lot about the fact that patients are humans, and not a condition, which is the way we tend to relate to patients in the service, and that patients have fantastic expertise that we can draw on and we can work with them on to make whatever better, and a good example of this is information – the way that we write information is appalling, and through one of the projects based on patients’ experiences, they said that, even though that information is technically correct, actually humanely it’s quite wrong for us, either in its interpretation or the timing that its giving information.
Now typically we would go and rewrite that, but actually the patients said, “no,” this is for us, let us write it and actually one of the patients turned out to be a writer, so far more experienced than any of us to do that, and came back with a remarkable information leaflet that actually everybody subsequently said is the most marvellous thing they’ve seen. We gave it back to the professionals, and said, put your professional bits in, that this is information for the patient, so it needs to be written in that language and with the sense of somebody who’s actually been a patient, because many of us in healthcare have not been a patient in our specialism. So from that, I think we’ve learnt a big lesson about working with patients, carers, users of the service, but also with our own staff – we tend not to listen to them very much either, and involve them in redesigning or designing services.
For me it’s been a revelation, and I think for me it’s identified things that we thought were good, that actually were appalling, now we’ve had our eyes opened to them. So I think the focus on working with people who are experiencing services, understanding what that experience is like through other tools and techniques that we’ve been poor at – film, storyboards, all that sort of narrative, displaying that, sharing it, and acting on it together, has certainly revolutionised a service in a hospital that was technically the best service in that hospital. We made 43 changes to that service, based on patients’ experience, and now we can say, not only is it a technically good service, but actually it’s a good experience for the patients. We would not have got there without working closely with patients and carers.
Nico Macdonald
OK, thank you very much. Austin?
Austin Williams
Thanks. Well I don’t have much time I don’t think so I’m going to make quite a few assertions. On the title of the debate, “Can Good Design by Co-Created” we were talking earlier about what that ‘good’ in good design might mean… generally I’d make three points:
One is that designers, and I’m talking about design in a broad sense, in terms of architects, engineers, and product designers or whatever, have prostituted themselves in the current climate. Secondly, I want to say that even though there’s a supposedly egalitarian ethos to good design, designers have an inflated sense of their own purpose and worth in this discussion. Thirdly, that many design solutions I think have suffered because of the first two points.
So I’m a bit of a… on this panel I’m afraid. From the 25th anniversary of… completed just up the road, I just want to start by saying that co-design, consultative design, whatever you want to call it, is not the same thing as tenant participation, as it was called… who designed after the War… for him that would like simple clarification of the briefs, it was about sitting down with the tenants to convene… partly because of that, but generally if you look back historically specifically in those days, we’re talking about the 70s… kicking against the traces of state intervention at a time when self build was… trajectory in housing. He was kicking against intervention, what we find now is that actually designers are wilfully defying the state intervention and representing the… things were the objectives of Dott. I don’t want to bite the hand that feeds me here, but some of the objectives include the need to reduce consumption, need to reduce energy, transport needs, and I think with some acceptances of constraints, and restraints as it happens. It’s ironic that designers propose themselves as being radical in these terms. Here in… for example, I’ve said that design interventions depend on new ways in which people live their everyday lives, how they eat, exercise and consume energy.
Apart from the fact that sounds like a cross between Jamie Oliver and Gillian McKeith in terms of this intervention into people’s daily lives, even the most boring in the person in the world, the government’s chief medical officer, Sir Liam Donaldson, by having a 10 point plan on intervention and including the three about eating, exercise and consume energy and another about eating five pieces of fruit. So the thing is that I think that actually… I think designers are stooges of government policy and I think it’s a problem. Just to be clear, Matthew Taylor, who was Tony Blair’s policy advisor at Number 10 for about seven years… in design… said that “co-production blurs the boundaries between state and civic action”. For him it’s a way of… government to get this message across. I just think designers have simply been used as ciphers and need to have a bit more of a critical take on some of these things.
The second point is that designers going to need purpose, that’s fair enough but unfortunate for design. If you look at the Design Council cutting crime through design, Dott’s eco-challenge, saving the planet, design for action as I’ve just mentioned, strategies to tackle obesity, and smoking cessation – these are social policy issues masquerading as design, but these are social policy issues, this is politics as it used to be called in my day.
Design is never really talked about in its own terms any more, it’s always co-design, disabled design, medical design, responsible design, you name it, eco design is there, but you know, it’s like design’s now justified in terms of its prefix, never in terms of the design element, and it’s a way the designers can justify themselves in terms of a quantitive relationship rather than qualitative statement. So you’d have the rise of justified design, of proving design is worthy, of tick boxes and productivity indicators and what have you. This is a kind of spurious evidence based approach to design, once you get on that trajectory, I think the targets become king and somehow design suffers or becomes secondary at the very least.
So generally, the question “what is good design” is a short-ended question for me, basically sustainable design is good design, good design is sustainable design, it’s a very cyclical, non-meaningful process today. Is design good that achieves its results? Who decides what those results and targets might be? Can you have good design made better by applying more energy, using more carbon, or is that a contradiction in terms – is reducing carbon the be all and end all objective of what good design might be? I just think that of all these issues, design, graphic design in its own terms – again an old fashioned concept – to be traded up against the very mainstream moral and instrumental view of what design should be.
A final point, designers are ignorant of these dilemmas as I’ve just outlined, that will partly be because they’ve had their day in the sun, there are designers in the audience here and I’m sure it’s nice to be fashionable again. I’m an architect, it’s taken an awful long time for architects to get over the 60s and they are sort of basking in their new-found glory as grand designers, but I just think once you are going to buy into somebody’s constraints, which are whatever it might be… or consumerism, or reducing consumerism, or carbon capture, whatever it might be, designers cease to have… possible solution there can be to a problem, you have by definition a tunnel vision idea of idea of what the problems and the solutions are. I think that focuses on the fact that designers to a certain extent have lost their critical edge and lost the great intentions which I think is part and parcel of what I think the design process is. So my intentions really, if you have a really experimental culture in which genuinely radical views can flourish, then we have break from a bureaucratic self-flattering authority which a lot of designers are doing and in response to that, I think, hiding behind the public to do.
Demos, I was on a panel with Demos fairly recently, and they’ve… for winning the Olympic Games to make it more relevant, to people outside of London, they would organise Olympic street parties in the North, Manchester – but what if I don’t want to join in? What if I don’t feel included? What if I’m happy to be excluded? I automatically… become a grown up… a person who’s detrimental to that community in recent work that’s been carried out… I think it’s really worrying… We live in a day of increased monitoring and intervention in people’s private lives. I think that’s something we really have to be critical of. Just to talk about Joe’s report… Joe says people need to be mobilised, coached and encouraged to participate, that’s one thing, that’s bad enough, but participate in a common enterprise of generating positive outcomes. Whose outcomes? What if I’m… Leave me alone, is my general response to something like this.
What if I believe in the leading examples in the hype around binge drinking? Or passive smoking? Which I don’t as it happens. What if I want to go out and get rat arsed on a Friday night and smoke funny fags? That’s my business. The problem is that an awful lot of these… if you read the… and the publicity it’s all… and personal moralistic behavioural interventions. I think that’s incredibly worrying. So activity… expertise on some of these things we possibly we can all agree on that level. But for the less interactive… great deal more perspective on some of these things and have the courage of our convictions to argue for design on its own terms. Without that I think we might as well get No 10 to write our brief and the design might as well become part of the social services.
Nico Macdonald
Thank you Austin. Can I ask, are there any scenarios where you see co-design could work without being instrumentalist or a tool of social policy? – perhaps, although Lynne did elaborate on, what service you were describing? It sounded like something which had been improved by co-design – is the problem in co-design itself or is it just the way it’s been inducted and where it’s been inducted into practice?
Austin Williams
Well the health service could be improved by a team of blind monkeys. The point is that ultimately I’m an architect who has worked for housing associations; generally for me we had a discussion before on the reasons about these terms and co-design means what? Obviously there’s a bid for meaning behind it really, but in terms of me developing a brief, I’m an architect who asks the client. I’ve designed schools where I’ve asked the teachers. There’s nothing magical about this. I’m not in an ivory tower saying this is my school design, like it or lump it. Generally there’s a sense of professional engagement and that’s what professionals do. Once it becomes this general idea that, ‘who am I to possibly know what might be a good design, I have now to ask the children of the world to guide me through this kind of turbulent jungle of my lack of knowledge,’ that’s when it suddenly becomes worrying – it becomes worrying for my inability to grasp my professional capabilities and my knowledge on certain fields, and my elite perspective on certain issues where I know best. However, there are certain things that I’m happy to agree with, but there are issues where I would want to be brought in. I get leaflets written for my company, I can write them myself, I get somebody who’s got a good journalistic skill, that’s common sense.
Nico Macdonald
I just want to start off, this terminology – although we don’t want to get into semantics which we talked about earlier on in the panel, after talking to people at this conference I find that everyone I ask has a different definition of co-design from the one I am familiar with and I wrote about this in my book on design for the web, so I’m interested in talking about what people think co-design is and also what scenarios it’s useful in, and this might be in redesigning something with employees of an organisation, or with users of a service or consumers or other stakeholders in the organisation, and at what stage do you think co-design is important – is it about a research tool, is it about what I call ideation and concept development based on research and design thinking, or is it about the development of the actual product of service based on that ideation? So Austin, I guess you’ve clarified what you think this is, so I think it’s more a question for Lynne and Joe. So just to get some clarity on that from your point of view.
Lynne Maher
I just want to pick something up from Austin, I think in this debate we’re polarising, we’re saying either or, it’s either co-design or I’m using my professional design expertise, or whatever, and I don’t think that’s where it sits. I think it sits where it best sits depending on the circumstances, and I absolutely agree that a professional designer, a professional whoever, they’re trained, they’ve got skills, they understand an area much more deeply than somebody who’s not a professional in that, and I always draw on the Henry Ford quote, where he says “I’ve I’d have asked people what they wanted (when designing the car), they’d have asked for a faster horse” – because they couldn’t see the possibilities of what design could bring. So I don’t subscribe to the polarisation, I think use it when it’s appropriate, and certainly some things in health – it’s not up to the user. They can have a choice: do you want this radical surgery or not? – but the way the radical surgery is performed, it’s up to the professionals and that’s how it has to be.
Nico Macdonald
Yes, although the example would be designing the surgical process, rather than which process one has.
Lynne Maher
Yes, absolutely, but I would say don’t polarise them. I think for me it’s about understanding, we have used it as a cancer service, primary care cancer service, and we use what I would describe as the element of co-design throughout that service, so to understand what the experiences were, to work with the people to make sure we really interpreted what they were saying, to identify what the key things were to work on, so that the professionals didn’t just take the things that they wanted, to work together on those and then to say “have the changes been implemented in a way that’s going to make that experience different?” – make it safer, make it quicker, and some of those things absolutely hit on targets, and just about the politics of it – I think designers have got a great opportunity, certainly in health and I think in other politics – what happens is, politicians design or define what they think are the solutions. The second big thing I’ve learnt from designers is what you all think is a plinky plonky tool of observation; I’m a trained clinical observer but I couldn’t see what designers have taught me to see in the way that you observe, and we have been able to, we’ve had policy iteratives to say, do this solution, and through the help of designers, I’ve been able to go back to the Department of Health and say, that’s the wrong thing, this is why, that’s the wrong thing and what we should be doing is this, and I think the designers have got such a fantastic opportunity to learn the language of the politicians and then be able to articulate that that’s not necessarily the right solution.
Nico Macdonald
Right, OK, well I’ll come back to that in a minute, but Joe, your thoughts on tools, methods, what it’s appropriate for audiences.
Joe Heapy
I would like to come back on that, maybe could we could skip that just so I can understand this prostitution thing.
Nico Macdonald
Yes, we’ll come back to the bigger issues after, just want to establish the territory.
Joe Heapy
I think again it is the right tool for the job or horses for courses or whichever metaphor you’d like. It isn’t a fix, or you must do things in this way. I think it’s worth noting that people like ourselves and Austin are fairly in control of their lives and have agency – I mean we’re working at the moment with Families At Risk in Kent, who actually survive perfectly well without the kind of, to a degree, formal institutions of the state and will find ways around doing things and do things anyway, but have benefited, as have patients that you’ve worked with. From being able to come into a neutral state as an expert team, and they are experts in their own lives, we have some expertise in design, and doctors have expertise in being doctors, as part of an expert team to create a situation in which their experiences can be revealed, and they’re genuinely useful ideas and insights can be revealing to that situation to make a better service for everybody, not just the patients, but also for the front line staff. So in revealing stories, expressing experiences, getting professionals and managers to understand the people that they’re working with more fully, to make sure that the ideas that are there, as designs are very good at, but take an idea and nurture it and organise it and make it into something that is quite compelling and exciting, before somebody else comes and slams it into the ground for being ridiculous. We can actually take some ideas and build scenarios round them and make people who don’t normally think about things in that way go “actually, that’s a pretty good idea and I can see how it works,” because designers are also pretty good at dealing with constraints, technical constraints, whatever that might be. So we can take ideas to the point when they become compelling, which many people would love to be able to do that but are never going to get an audience with the people who really need to hear that story, so designers act the design process I think, and hear out designers – it’s about the design process, can sort of help to push that gap.
Nico Macdonald
Right OK, and in terms of areas you are clearly focusing more on policy related service provision of the government level of this or whatever government level. Is it not about designing chairs, as we’ve talked about earlier on? You can design a chair.
Joe Heapy
You can design a chair, I’m just not that interested in it. I think we operate in this space between policy and practice, and the experiences of people who use services will provide services. There is an argument for saying we are just poodles or puppets and we’re just there to play out policy in a nice fluffy way with pictures. But actually what we’re more interested in is designing the upflows which lead to policy and that sounds crazy but we’re actually not interested in certainly talking to central government. But actually just a small feedback group into a primary care trust or social services and I think designers should be a social service but those things in themselves are actually quite powerful, especially the big policy level was a different one where I think all of this is as I’ve said feels like it’s almost happening to government, it’s not some kind of wish to control us. And also I think it’s worth being a bit more critical of the dock projects because I actually agree, and this came up yesterday, there’s a lot of stuff over sustainability around manipulating behaviour but the project that we did and also the sexual health project and dementia project – very different from the ones about food miles and drive less and all that stuff. We worked with a school in Walker, who are coming up to their “Building Schools for the Future” process, and our brief was to help them prepare themselves for being consumers of a massive government building programme. It was all about getting them to give me the skills and techniques that they can’t do themselves and they can’t readily buy to properly articulate in a compelling way what they wanted their school to be. And I think that’s very different from the kind of design that’s contributing to everybody having to eat the five portions of fruit and veg a day, I’m not particularly interested in that either.
Nico Macdonald
It reminds me of the Sorrel Foundation Project, Joined Up Design for Schools – an earlier brief, I’ve just mentioned it so that we know what the territory is, I won’t ask you to comment on it particularly but you felt it was a little bit unambitious, given the scale of school building which is going on which was referred to in Peter’s presentation earlier on as well.
Joe Heapy
Although they had being doing Joined Up Design for Schools for many years, actually when they started doing it, it was radical. I don’t think designers have to be radical, but you’re right to put in a context of this, aren’t you? It was quite radical to have people like us go in and work with a school in Walker, had never experienced that. That’s radical, it’s radical in health, it’s radical in a school in Walker – but it’s not particularly radical.
Nico Macdonald
OK. What I’m a bit confused about is this…when I wrote about service design – by the way, open source, which was mentioned in the introduction to this, is yet another concept of design and innovation which I’m happy to talk about but I would definitely separate out from this discussion. So co-design for me, the example I wrote about was of a company in… Ohio, called Sonic… who worked with the Iomega Corporation, if anybody is in IT, they’ll remember them, the zip drive and so on, and they gave a consumer facing product, bit of a business product, gave consumers a set of prototyping tools made out of felt or very basic things which they could assemble into their idea of a zip drive, and one of the things that Liz Sanders, who ran this project, observed from the things that these people co-created, co-designed, participatively designed, and she noted that people wanted to see what was the label on the zip disk that was in the drive, because obviously you have lots of zip disks and you don’t know what’s on each one. Now that was an observation made through co-design. Now for me what we’ve been talking about a lot and when I’ve talked to people about this, it seems that what is being talked about is really an extension of research methods which we are familiar with from interaction and product design and so on which is in everything from ethnography and observation, through to cultural probes and interview methods which are a bit more imaginative than a user forum, focus group kind of thing. So I’m interested whether it is just a nebulous concept we’ve got here or whether… Lynne, the example you gave of rewriting the patient literature, as a writer, that’s my domain, not saying that I should be writing it, but writing is not design, I think, but you know, maybe it is, but it’s the idea of working with someone to design something – that is for me what co-design idea is and everything else seems a little bit like it’s an extension of research methods – am I wrong there?
Lynne Maher
Well I think, if you put yourself in the shoes of those patients, they perceive they were designing that leaflet, so that they changed its form as well, it was one sheet of A4 and now it’s something else, so they completely changed it. Another tiny example that made a difference to them was they completely changed the way the chairs were set out in the waiting room because there were two rows back to back and they hated it when they came in, so they completely changed that. They completely changed the way that they would taught to look after their tracheotomy tubes, because they found it cumbersome in the way the nurses taught it and in the timescales that the nurses taught it, so they had that done completely differently. So in terms of services, from my perspective of not having the skills that designers have, or your background, I would say that that has redesigned or changed the design of the way services and elements of that service are delivered to patients.
Nico Macdonald
OK, that’s very much clearer. With the methods you used with that sitting everyone in a room with a workshop and lots of post it notes, sitting them in a real situation and say, ok, imagine that this was your space, what would you do with it? What were the techniques?
Lynne Maher
All of those, so narratives, single narratives, narratives together, drawing it, creating storyboards, doing it.
Nico Macdonald
Joe, anything on methods here, is this just extended research?
Joe Heapy
I think what this design process and designing is a mixture of threads, having a think about it and having to producing stuff, trying it out – we saw that funnel thing yesterday, and you could argue that having some service users in your team does support the input side, but it can equally support the output side. We’ve had a situation where the work we do with schools, students are very much part of designing the new concepts for the website. Again they began to block it out themselves as they wanted, so I think it’s important to remember that we are as designers part of a team of experts in that situation, students being the experts on what they want. Which isn’t to say that if somebody draws something, it’s got to be built, that’s not how design works anyway. Design is this amazing process of evaluation, analysis, creativity, the process of compromise towards a better than expected solution, but it’s not just about somebody saying, ‘I want it this way,’ with no evaluation at all. I think within a group we often just provide extra capacity for lateral thinking, we’re not the only people who can do lateral thinking, we provide extra capacity for creativity into a group but we’re not the only people who are creative. We do bring aesthetics, which was discussed yesterday, which is actually in itself extremely powerful in terms of creating projects that are accessible to groups of people who perhaps don’t normally work in this way. We have that whole system view that we can bring, we have a very detailed group view that we can bring, and we can manage those simultaneously. We bring some empathy which is a big concept in itself, and a keen sense of direction on behalf of the group, which is based on the fact that we have as a core skill we have design method.
Nico Macdonald
Right, we’re straying into the area of what the role of designers is when everyone is a designer, so I’m going to open up the floor now, given the encouragement I’ve had from the front row, and you’ll be first! So things I’m interested in – I wanted to get to the critical side of this towards the end of the discussion which is what Austin’s outlined and we’ve responded to to some extent, so I’m still interested in what people think co-design is, what the role of the designer is in this situation, how you would sense co-design, what kind of things with which we assess the quality, quantity, depending on Austin’s terminology, have evaluations of. I’m taking two questions at a time, so here you are, you’re first and then the gentleman there.
Audience member 1
Simon… from… I’ve been listening to a debate… moving chairs, the customer being involved in the process, but I’m thinking why is it the realm of the designer to get involved in facilitating that, what is wrong with the creator operations value or customer services value… Being slightly controversial, is it not just a question of the NHS has really got to get its own act together as one example and looks outside for some designer to come in and then offer solutions. Bit like using a consultant to tell us the bleeding obvious! I’m using that as a sort of… view. There are some incredibly creative business people, business managers, in organisations like the person here, I’m a designer, I’m also a business person, joint background, leading to their expertise, they know what they’re doing. The fact designers are getting involved, coming in to do that, seems to me sometimes depends on the type of project failing the organisation not to be practical.
Nico Macdonald
Let’s take one other question. This is the big question of the conference, why designers, if we’ve just discovered things people do already, we just naively qualify this, so the gentleman here? – please say who you are.
Audience member 2
Phil Davies from MCR. I’m actually following on from that question. I also need to break my question is in two parts. The first one is… What tools and techniques do you use? Are there any in co-design, co-creation roots and background,
Nico Macdonald
Can you also… I’m a bit unclear about that.
Audience member 2
What tools and techniques do you use?
Nico Macdonald
OK, we’ve covered that a bit, you weren’t happy with what people…? OK
Audience member 2
And the second part was what’s the relationship between co-design and mutability… whichever label you want to choose.
Nico Macdonald
Interesting question. Alright, who would like to start? Lynne?
Lynne Maher
I think some NHS managers or operations managers are doing some good work on involving patients when redesigning services without the help of designers, absolutely, but I still believe that designers have given us some tools and techniques that were not naturally in our toolkit, so what we have is some sporadic areas of good practice and we know there is a big issue in terms of dissemination spread uptake in the NHS, and that’s being looked at. But I wouldn’t say that OK we’ve got those, so let’s never look at any other industry to see what we can learn from them, and just that simple tool around observation has been mind-blowing in that might be something that you’re used to dealing with every day, but in terms of clinical observation, we observe to put something into a symptom box, we observe in a completely different way and learning from designers how they observe, has taken us down a drastically different road and that actually that tool has spread like wildfire in the NHS and so I think, great, I’m glad we had to bring in a designer to learn that because the benefits are huge and in terms of working with designers, I think it’s about saying what else can we learn? We didn’t know we were going to learn about observation so it’s not saying, bring a designer and bring a management consultant in because we can’t do it ourselves. Clearly we’ve got problems but I think the criticism should be, if we’ve clearly got problems that we can’t sort out, the criciticism should be if we just stay internal in just trying to do that ourselves. I applaud people who are going out and saying what can we learn from other people that we can put into practice in the NHS to make things better?
Nico Macdonald
OK, so development skills rather than the professionals coming in.
Lynne Maher
If you’re a designer running the project, the hospital team were running the project, we were just learning different tools and techniques.
Audience member 2
…co-design, it’s making it sound like some kind of rocket science, which it’s not.
Lynne Maher
No, I don’t think it is, but it’s different for health, it’s not rocket science but we haven’t really got a lot of examples in our industry where we’ve been doing it as well as we think it’s happening now, so it is new for us.
Nico Macdonald
Joe, can I ask you to come back on Phil’s question about 1, more tools and 2, usability relationship to co-design?
Joe Heapy
I think what we probably do at the intersection between what we steal from management consultants, our traditional design practice as designers, and I’ve added “traditional” – whatever that means – design training as a product designer and worked as a product designer for five years, and then got drawn into designing for service organisations as opposed to manufacturing companies so it kind of happened to me. So management consulting, traditional design practice and social sciences, we sort of sit in the middle of all of that and we deal magpie-like with bits and pieces and bastardise them for our own projects. Interestingly, central government is becoming really interested in the idea of customer journey mapping at the moment and commissioning all sorts of work to try and understand what it is. They’re particularly interested in how it can be used to drive efficiency within a system and our clients are sort of pushing back and saying it’s actually also a way of analysing and representing people’s experiences which is actually really good, really useful as part of the design process. Again, not radical, but unnervingly radical perhaps within central government. We do a lot of mapping of relationships between people, how a service and the wider organisation is held together and we can work with those groups to understand when relationships between people are working and not working and help there and what we can create collectively is to help those relationships to work better, so that might be between a patient or a doctor or it might be between a local authority and a school. We help them to see whole systems. We use personas to help people understand people, storyboarding, analyse – big word – or map, model or visualise the movement of resources and money and incentives around the system so people can see why isn’t this working? Well it’s because so and so’s not incentivised to do anything or they’re incentivised in the wrong way. How can we reorganise that? We use a lot of communication as part of developing a project and we design or help to design the support for design of training and the measurement of services based on what, for example, patients want to measure, so you can have two sets of measurements. A lot of my matrix and organisational matrix, and really good service designs optimising that for service for both.
Nico Macdonald
Do you co-design what the visualisation is for the patients with the patients?
Joe Heapy
Yeah.
Nico Macdonald
And what tool do you use to do that?
Joe Heapy
Regular drawing.
Nico Macdonald
So you sit with them and they draw?
Joe Heapy
They draw, we draw, we draw together, we might go away and mentally look nice because you know, the design process as you know involves that kind of synthesis and organising and turning something …as designers we
Nico Macdonald
I’ll move onto the usability question - usability for me is post ideation, post creation of at least a prototype, how does that relate to what you do in co-creation?
Joe Heapy
I think we would draw on all previously understood traditional design practice, so it might be that the output is a website, in which case we design a website and usability is a part of that.
Nico Macdonald
So there’s nothing new.
Joe Heapy
Nothing new.
Austin Williams
Can I just come back on something? I think you need to be quiet here. Because I agree with you which in fact for me, one thing from a design world is flipcharts, spreadsheets, story boards, focus groups, changing around bloody chairs in a waiting room! It’s like deck chair Titanic springs to mind here. Obviously with the health service, part of that seems to be very health service, that would be the kind of bureaucratic response, the changing of a waiting room, the same way as you mentioned the education sector. For me the process and how you go and chat to people is one thing, but movement’s a disaster which is the British education system, which doesn’t gives kids an education, it gives them skills, teaches them how to get a job at the end of the day, rather than knowledge, is for me the biggest problem and the ideal that you go in there preparing them for their terrible journey to another school doesn’t sit very well with the fact that when I was 13 and moving to another school I thought it was exciting, nobody told me the horrors that might await, I just thought it was part of a general process of growing up. Why didn’t a designer come in to tell me how to make the effort to deal with it?
Nico Macdonald
Is this a critique of designers or a critique of government?
Austin Williams
The problem my rhetorical flourishes, obviously we’ve got two designers, who admit to being part of the social services, but is part of my rhetorical edge. Generally this is a broader phenomenon amongst all of you, who think we’re being radical, but we’re not.
Nico Macdonald
Fine, OK, good. So a question here and then one at the back, I think?
Audience member 3
…Northumbria University. A question for Joe. Joe said that these ideas are not shaping their use?
Joe Heapy
Shaping change through?
Audience member 3
…said “design is one of the most destructive professions on earth, that was before they introduced length of service. The physical aspects, my question is, also the gods that designers are, also knowledge, they shape and determine values of others and… things… also they confuse because that you said that designers observe the… and it was their observation… was the insight for you and then you said the observation was an expensive… So did you employ thousands pounds of design to observe?
Lynne Maher
No, we learnt and then we did it.
Audience member 3
But how do you copy? Does it mean then that design… design in one week? …design schools?
Lynne Maher
I didn’t say we learnt in one week.
Audience member 3
It’s just the question for me…if you say the designers view things differently, if the designers… universities for example, four weeks… journey of learning and observation, and they can see things differently. Then how is it possible that you use the tools within your organisation to pick up designs?
Nico Macdonald
This is also the question about what role the design is when everyone’s a designer. Joe’s talked about a bit the example of visualising patient information. The question at the back?
Audience member 4
Mark… from… investment fund. I’d been interested in this whole debate because the way I see this all going, actually designers moving away from design and moving into other disciplines and other areas, and the reason that they’re doing it is because their tools, techniques are novel applied into different markets, and the whole area, and Joe touched on it, of management consultancy and its connection with design, how designers are beginning to see that management consultancy connects to design really well and how management consultants can utilise design because they have novel ways of, as Joe would say, of providing extra capacity that generates ideas and insights and also the impact of those ideas and insights, and how these reveal. More importantly, how they are articulated is one of the great assets of being around designers. They have ability to articulate in a way that’s very easy for a broad population to understand, very compelling ways… I think what is really important is that it is at a low cost, because if you can compare the cost structure of Kinsey and you compare the cost structure of the Engine Group, there’s a real differentiation there, and that’s why this whole area of service design is beginning to build up, Kinsey actually starts to employ designers within their consultancy structure, that would be a very interesting position because then design would be allied to the management team. So that discrepancy between one and the other is I think what’s driving this whole kind of thing.
Nico Macdonald
That’s an interesting observation. I would be clear that we are talking about co-design which could be applied to certain services but not about service design per se which we addressed on another panel here.
Are there any other questions particularly just on a critique of this, what are the limits? Some of the responses you make, you may disagree, have another point to make about what the limits of co-design are, why it’s been adopted by government so enthusiastically, what relationship of this to the government’s general attitudes to democracy and citizenship is, I’d be very interested to know. So, gentleman at the back with the glasses and then there’s someone in the middle here.
Audience member 5
Hi my name’s… from the University of Leeds. I’ve just got a little bit confused here including what co-creating, co-designing – it’s basically different things for me. Design is a formalised process, something quite open. Co-creation sounds very exciting. Co-designing sounds like its been done for quite a long time in lots of other ways to design all sorts of other problems in doing this… co-creating sounds really exciting and the concept’s got confused somewhere, co-designing… process… groups of people you want to bring together who are interesting… creating new things, creating new opportunities, not necessarily solve problems, is that co-creating, that’s where I got lost in the process here.
Nico Macdonald
I think everyone’s vague about it, that’s the truth. And there’s a continuum between open source, research methods, co-creation as you talk about it, which says something about this discussion I think.
There’s a gentleman in the middle here?
Audience member 6
It was suggested that… going on for a very long time in architecture… revisit the services… processes within…
Nico Macdonald
OK, do you have any final questions? We still are running on a few minutes if people don’t mind eating into their lunch. Any final questions? Gentlemen here, anyone else? Critical views. Yes, gentleman at the back? Can you say who you are?
Audience member 7
Alan… from… I recently have been exploring... opposition and breaking it down actually… somehow… on this discussion… position between the experts and the public… members of the public… turned out to be an expert… Crystal Palace fire in London where people who also turned out to be experts on birdlife in the park and then were commissioned to do… so could you say a bit more about experts which have a relationship to this process or…
Nico Macdonald
OK, thank you..and there was a question at the back?
Audience member 8
I wanted to ask…
Nico Macdonald
Austin’s critique, you’re saying, yes?
Audience member 8
Yes… co-design, co-creation can help people engage with… society.
Nico Macdonald
And what kind of things might you be thinking of?
Audience member 8
…the government in particular can copy these techniques and… society… top down fashion… co-design arguably… other examples of co-creation certainly creating circumventing that top down model… take some sort of control out… large organisations…
Nico Macdonald
Right, OK, good, I’m going to leave it there for the questions. Respond to any that you were directed to you, or you’ve got a strong feeling about. I’ve Austin to try and identify the positive aspects of co-creation, co-design, can I also you to identify one limit or problem with it you see or a way in which it might be abused, that’s after you’ve responded to the direct questions. Joe, do you want to start, sorry?
Joe Heapy
I think the point about designers and their values is a really important one. I think you have to be very careful as a designer not to, er, to be watchful of your own values. It’s the same I guess in the research and other things where you do shape the group that you’re in. But I suggest if you want to purge yourself of that problem, working with some of Lynne’s patients, rather than sitting in a studio, is probably a better way of avoiding driving your own design work through your own values because part of the process is to listen and understand and design on behalf of people who are often nothing like you, so I think it’s probably the best place not to subject your work too much to your own ego.
I think very briefly the co-creation, co-design thing is an interesting one. Co-creation is a much bigger, more exciting phenomenon which we could do now, we could co-create something now. Decent co-design is a methodology which is appropriate in some situations where you have a more complex problem or a more complex context, it’s simply gives you some structure to co-create with. I think the point about architecture relating to architecture, I mean all of this has been happening forever, but the old sort of production model says the design stopped at a certain point. We’re coming at this from a services point of view, and one of our frustrations at the moment in terms of our work with the school in Walker is that money’s run out, but I think one of the particular things around this approach is the transfer hopefully of skills and a little bit of culture change, and we would want to design in the means for a school, for example, to continue questioning and challenging itself, so it’s not the same as the Lord Mayor coming in and cutting the ribbon on the building and everybody walking away. Unfortunately often it is like that, but yes, these kind of social systems will continue to change so maybe all that we can do is maybe left a few tools or a few ideas that might support them in continuous redesign.
Nico Macdonald
OK, and possible abuses, misuses of co-design?
Joe Heapy
It risks being misused at the moment by central government to provide a shiny new label for traditional public sector consultation. It also requires an awful lot of those involved and it has its limits, so it needs an appropriate approach, you’d have to be very sensitive. It would just be better to get PWC in and do a massive restructuring of the organisation. PWC are becoming very interested in working out designs.
Nico Macdonald
There you are, to the person at the back…Lynne?
Lynne Maher
A couple of things, the question about what do we do when we redesign the service or co-design it – we carry on, and in fact in the same hospital that we did the work with cancer, they’re doing it with lots of other specialities but also they’ve just been asked to do a major reconfiguration of emergency services for their community. Rather than doing it in a way that they would have before, with what I would say is a fairly useless consultation process, they are doing it based on co-design, which is a difference. Lots of experts have come through with expertise that we didn’t know. I think for us there might be a risk of it becoming a catchphrase, absolutely – you get that with everything but that’s up to people to make it not a catchphrase.
Nico Macdonald
Austin?
Austin Williams
…two sentences?
Audience member 9
It’s twenty past now…
Nico Macdonald
Austin’s going to be very brief.
Austin Williams
The message is that co-design, we can pontificate about what it means, somewhat of a semantic exercise… This is about… people’s income, social factor, all the other things of government which the gentleman can rightly appreciate from what I said earlier, but you know ideally I’d like to lead from a positive example for this… in India is an interesting example of co-design architecturally but it is one of those hippie communes. Generally… this environment I’m afraid, there’s an awful lot of ways in which this has been used to court people into… should be more critical of.
Nico Macdonald
Thank you very much!