The value of design often butts heads with the rigor of quantitative proof. But as the design advances into more complex territory, proof becomes even more challenging.

While at the Institute for the Future HealthCare 2020 open space meeting on Science and Technology in Health, Chris McCarthy, Director, Innovation Learning Network at Kaiser Permanente, talked about how his team addresses the issue with a mixture of design intuition and analysis. Their objective, he said, was not to absolutely prove that a solution would work, but that it was “directionally correct.”

I assume this is a bit of business jargon (Googling says yes), but I had not heard it before in a design context. I thought it was an interesting way to acknowledge there isn’t a way to prove the direction of a design solution, while also recognizing that a solution seems rights given the fuzzy evidence (user research, competitive analysis, technology development, business value, etc.).

One huge problem for US healthcare is that technology moves at a much faster rate than the system of change and adoption in the current system. For obvious reasons, there are a lot of regulations, studies, and tests to help ensure effectiveness of processes and products that are introduced into healthcare services. Unfortunately, this system means the technology and ideas that could benefit patients and healthcare workers are years behind.

On Monday, at the Institute for the Future HealthCare 2020 open space meeting on Science and Technology in Health, which took place at the Kaiser Permanente Garfield Center, participants expressed frustration that rapid prototyping and iterative learning were not syncing up with the demands of scientific rigor. It seemed the rigors of science were being perceived as putting a bind on using new technologies and modes of interaction to quickly improve information and conditions for patients.

An idea that came up several times was to use crowdsourcing to get a greater amount of information and data more quickly and easily than clinic trials. While potentially very effective rife with opportunity, participants said such services are not seen as scientifically valid.

Like most complex challenges, this presents several opportunities for designers. One role designers can play is to ignore the current system, focus on the people and enablers, and design services that through their success and uptake transform the current system. For example, we could use crowdsourcing to enable people to share their information and stories to better understand their condition and help others. That is, I believe, what PatientsLikeMe aims to do.

But another role designers could play is facilitator between the needs of science and scientific rigor and the real, messy world of people and the technology enablers that provide new opportunities for healthcare services. In this role, we could find ways to engage all stakeholders, learn through doing, and through engaging and doing create advocates that will help propel transformation to a system that takes advantage of emerging technology, embraces rapid prototyping where appropriate, and improves the situation for everyone.

“Like the soil, mind is fertilized while it lies fallow, until a new burst of bloom ensues.”
–John Dewey

Presently, it will be a year since I started working at Nokia. Since starting, I have been involved in several back-to-back projects with the usual short time frames and high demands. If ever ideas began to flourish in the midst of these projects that were outside of the scope, I did not have the time to give them attention to grow. They withered and faded in the bustle of productivity.

One of the great things about my graduate school experience was being in an environment and culture that encouraged exploration, cultivation of new connections between disparate ideas, and tolerance for failure. Even though I had less time and more stress in school than I currently have at work, the conditions made it possible for me to wander, to go off on ideas just to see where they led. Built within the framework of my graduate work there existed space to explore. Pursuit of tangential ideas was expected and it often led to the learning and production of designs that were beyond what could have possibly been asked for.

Reflecting on the past year, and while setting objectives for my next six months with Nokia, I realize I miss the wanderings of my grad school experience, and desire to have those wandering be a part of my current experience. While it may be something my team would support and understand as valuable, the greater organizational culture may not tolerate the sacrifice to production. Wandering needs to be part of the culture and holistic, Just as Google’s 20 percent personal project time is part of their culture, wandering needs to be understood within the culture as contributing to productivity. For that to happen, it needs to be supported as a productive activity, where the ideas that surface are encouraged to become realized.

During casual conversations, others have commiserated their need to wander as well, to have time to pursue an idea when it comes up, to not have it slip away. I wonder how much creativity and innovation is lost when people don’t have time to nurture their ideas. In the innovation gold rush, can wandering be an untapped mine of creativity? How can we use design as an approach to understand the needs of people and business, and help shape organizational culture to support both?

In his Ask the Innovation Guru video series (yes, there is such a thing, and yes, I watched some of it), Bruce Nussbaum tackles the question Why Is Design Thinking Relevant. He parses views on design thinking into two camps: those that think it’s too abstract and has little to do with doing; and those who see it as dealing with large-scale systems or things that aren’t tangible. Nussbaum supports the latter viewpoint.

Nussbaum defines design thinking as “designing a new experience” and “redesigning a service” and “taking the principles of design and recreating a new experience.” The examples he gives to clarify what he means by design thinking are Bank of America’s Keep the Change service, Kaiser Permanente and Mayo Clinic’s efforts to improve the health care experience, and New York City’s Quest to Learn Digital School.

Any designer will recognize that both his definitions and examples are not design thinking, but design itself! The thinking that goes into design cannot be separated from design, nor is it only appropriate for certain types of problems. So what I believe Nussbaum is really saying is that design thinking is the new design.

But why? Why can’t design just be design? Can design alone not pique the interest of business? Is it not cool enough to be the force of creativity and innovation for everything in the world that is not natural? Or is it an attempt to redesign design so that it may forge into places where it was previously not recognized?

Regardless of the answer, I am highly skeptical of language and ideas that divorce design thinking from design, and definitions that suggest design thinking only applies to certain types of design. Just because the world is starting to think about design in a new way does not mean design thinking is a new way of thinking or doing separate from design itself. Calling design “design thinking” is a disservice to design.

Recently, Jonathan Ive, of Apple, had some thoughts on the key to Apple’s success. He bemoaned designers who always have excuses for their work not turning out as intended. His advice:

“If you really do care about the quality of what ends up getting made, wouldn’t you find an answer, some sort of alternative, and somehow figure out a way to take your idea and do something with it?”

I could very easily be pissed off at the naivete of this statement. But it’s not his fault. After all, he works for Apple. Current Apple culture (I’m assuming I know what this is) is built around the quality of the design. This makes it easy for designers to produce quality work and see it executed as designed. The issue is not that in other organizations designers do not care about quality, it’s that most organizations are not designed to produce designs of the highest quality.

Designers the world around complain that their ideas are not implemented due to myriad outside factors. And they complain because it’s true. Whether it’s power or politics, time or resources, designers are not in control of the forces that affect the outcome of the quality work that goes into the products and services they make.

Unfortunately, in their current positions, designers do not have the power to do what Ive suggests: figure out a way to take an idea and do something with it. There is too much working against that, despite passion for quality or a willingness to do something.

Organizations that prohibit great designs from being realized need to be redesigned. That’s right, organizations are design products, and can be designed. Who better than designers to participate in, or perchance lead, this effort?

Perhaps Ive was onto something after all. If the forces at be prevent good design from being realized, and the structure, environment, and culture of organizations are to blame, we need to figure out a way to change the situation. We need to shift our focus from the ends, and refocus on the means that enable design in the first place. We need to redesign organizations.