By Stephanie Morgan
Surprise has long been an integral part of the human-centered design process. Historically, the role of design research in the human-centered design process has been to understand and observe people in service of uncovering notions characterized as “surprisingly obvious”—the clever workarounds, the visceral pain points, the hidden usability challenges—as they identify specific unmet needs that translate into clear opportunities to increase end-user satisfaction, and thereby profits. In fact, these delightful discoveries in the design process are so highly revered that designers even have a name for them: insights.
However, not all insights are welcomed with open arms. Rather, there are numerous insights we as designers have come to discredit, negate, and at times even fear. In my personal practice as a design researcher working on complex systemic health challenges, I have found myself increasingly uncovering these aforementioned insights that, simply put, make me uncomfortable. They are insights that make me reconsider if design can actually do something meaningful about the problem at hand, and if so, how I would be able to prove it; they are insights that push the boundaries of the design discipline and question the roles design can, and perhaps needs, to play.
However, to truly advance the practice and impact of design in complex systems problems such as health, it is necessary to examine insights we have traditionally discredited, negated, and feared, and reframe them as opportunities to evolve legacy practices of design research, collaboration amongst multidisciplinary teams, and communication in the human-centered design process.
We discredit insights that are not novel.
In the past year, I’ve completed or contributed to three distinct, primarily exploratory design research engagements in health contexts that all yielded strikingly similar insights despite subtleties in region, population, and health needs. Our insights included existing knowledge about human behavior change, such as the fear from experiencing a significant health scare is a strong catalyst for positive health behavior change. Another related to established relationships between social determinants of health and health outcomes—for example, when people lack consistent access to reliable transportation and have to choose between using their monthly income for groceries or rent, they tend to miss doctor’s appointments as they cannot afford the bus fare, and their health suffers as a result.
Our insights made me feel as though I had failed as a design researcher because our insights were not novel. I did not want to believe that our design research solely outputted insights already known, so I kept looking at the data in different ways, hoping I would find at least something that was new and would surprise my team and me, but we ultimately came up short. However, after some time to reflect and discuss with my colleagues, we realized the following opportunity:
Rather than discredit recurring exploratory insights, embrace it as validation of your problem area and then focus on generative and evaluative design research.
- Strive to uncover generative design research insights that reveal what aspects of the problem you are investigating should be tailored to a specific region, type of person, funding, cultural norm, etc., in order to be successful. For example, if you are seeking to mitigate the aforementioned transportation challenge, engage your intended audience in generative research to understand the nuanced factors and attributes of a practical solution that would work for them, which in this case might be seasonal effects on transportation frequency and intent, such as when school is out for the summer.
- Strive to uncover evaluative design research insights that embrace the principles of systems design work where solutions entail multiple facets—inputs and outputs, variables and constraints—and thereby success is currently challenging to define, let alone evaluate. For example, if the solution you create ends up improving one challenge but creates a whole new set of challenges as a result, is this considered a success?
We negate insights that identify the need for solutions that require extensive coordination and time to be realized.
There is a growing understanding in the health design world that bringing about positive change in health requires multi-faceted solutions that cross diverse disciplines and various sectors. For example, our team is currently working on multiple projects that involve building community health and wellness centers that will house integrated primary care and social services to meet the needs of underserved communities in Central Texas. Ultimately, these projects seek to realize design solutions that entail physical buildings and the demolitions, restoration, or new construction that come with them; creating new models of care—where and how care is provided, by whom, why, and funded through what means; and even potentially new workforces to bring these care models to life.
Realizing design solutions like this takes time as well as a lot of hard work, and has required we work with diverse teams that have included: architects, engineers, safety-net clinics, local government officials, city housing authorities, developers, property managers, food systems experts, faith leaders, and of course, the people for whom these spaces and offerings will serve. These sectors do not yet know how to collaborate, and many of them were not designed to work together. There is no single client nor decision-making body when it comes to trying to solve big, societal problems, and there is often no collective, aligned understanding of who should even have a seat at the table in the first place.
As such, my team and I have found ourselves increasingly being called upon to orchestrate and lead these diverse teams as part of the design work in order to ensure they optimally work together and that our design intents are sustained and manifested as desired. These unforeseen organization design and management responsibilities require flexibility, additional skill, and different dimensions for the designers on the team. However, given that this “not-my-scope” mindset and siloed sectors are exactly what created these problems in the first place, I suggest the following:
Rather than fear insights that require substantial, complex collaborative design work to solve, reframe them as opportunities to glean further insight into how to conduct successful longitudinal collaboration across diverse disciplines.
In actual practice, collaboration is not easy. Teams that do not traditionally work together cannot learn how to do so overnight. However, working to achieve this necessary integration can be facilitated through means such as the following:
- Establish guiding principles for all involved. This includes aspects such as generating guidelines for who makes decisions, which decisions, and based on what evidence or parameters. It is impossible for any one individual in systems design work to be capable of always making the best decisions on all topics at all times, so work to sort out this strategy sooner than later and delegate decision-making to key leaders in their respective domains or practices.
- Develop an aligned vocabulary to facilitate communication across multidisciplinary teams, who likely each possess a wealth of jargon along with varying definitions of the same word. For example, the term “stakeholder” is commonly used to refer to very different groups of people, such as end users or internal decision-makers, depending on the team or organization, and is worth collectively clarifying and defining the moment it is used in team conversations.
We fear insights that conclude that at their core, our problems are people problems.
Health is a people system. People are complex. Complex people working in complex systems should come as no surprise as being ripe areas for challenges to arise. Frequently, these challenges cannot be traced back to tangible artifacts or instances, but rather intangibles such as personality, emotional intelligence, and internal politics. In most (if not all) of our work, we encounter the full gamut of these human challenges, including people opposed to design approaches, people reluctant to change, and simply the overall messiness of numerous people working together to create a system. Occasionally, however, through education and dialogue over time, these circumstances can change—and people might surprise you. So when faced with challenging individuals in all of their forms in your design process, consider the following:
Rather than fear insights that conclude people make things hard, reframe the insight as an opportunity to leverage the investigatory and iterative principles of the human-centered design process in service of driving organizational progress.
At the end of the day, at least in health design, we are all working toward very similar, if not the same, goals and visions. Legacy conflicts and interactions can taint working relationships for months or years when we should rather be working tirelessly to mend them. Potential avenues for fostering this change include:
- Reframe findings as systems failures so people who are a part of those systems do not feel personally attacked, and instead realize they can be a part of the solution. Conduct informal design research to accurately understand the root causes of the systemic and organizational challenges, and be mindful of how you communicate the findings. While it is impractical to accommodate everyone’s unique needs as a result of this process, it will likely identify easier ways to work through challenges with diverse groups of individuals.
- Frequently revisit challenges stemming from personalities, emotional intelligence, and internal politics to inform and iterate on your own perspectives and preconceptions toward the matter as appropriate; a lot can happen with time, and it would be fundamentally contrary to the human-centered design process’s purpose and integrity to assume otherwise.
As designers in health, we’re not doing what we thought we’d be doing. The challenges human-centered design faces today no longer exist within strict boundaries of products, disciplines, siloes, or organizations. They are increasing in complexity and highly systemic in nature. No longer are we seeking to make incremental improvements to surgical devices, for example, but rather we are striving to prevent an individual from even reaching the point of needing surgery in the first place through education, preventative care, and evolving the health of the communities in which people reside.
Accordingly, we need to be increasingly questioning, exploring, and evolving how we practice human-centered design in systems problems. We equate novelty with brilliance, but not every problem will be solved by unearthing surprising insights or creating new artifacts. Rather, the novelty we so crave also resides in reframing the same old existing challenges as ones we have to embrace and collectively dig in to in order to solve through collaborations requiring new ways of learning, new ways of working, and new ways of listening.
Stephanie Morgan is a Design Researcher at the Design Institute for Health within the Dell Medical School.