jamin.org

I’d like to continue a comment about bringing emotion into the design process because I think it deserves its own post. Kip said:

Design has some valuable roots in its ties with emotion, but in many ways we’ve lost touch. Can we bring a sophisticated discussion of “emotion” back on the table and include it in our design process?

I don’t know if we’ve lost touch or if emotion has been neglected in the bustle of quickly changing technology and products. But I think we can do more to bring emotion into the process. There might be an expectation that design is by default about emotion, and it does not need much attention.

Looking at my Basic Interaction design syllabus, emphasis is placed on the design process and methods. Although some of the methods, like personas and narrative scenarios are supposed to help get at the motivations and the experience, and by extension, the emotions. Video sketching is another method that I think helps to understand what the emotional aspects of the product might be like. Though we typically talk about video sketching as being about the experience, which leads me to ponder the relationship of emotion and experience in design (thesis paper topic for some grad student?).

I remember a recent comment about “shit in, shit out” in regards to the design process, which I took to mean you get what you bring into it. If you aren’t excited about the design process or problem, for example, your solution will not be very exciting. Perhaps if you are not emotional or consider emotion throughout the process, emotion will not be a strong component of your solution.

Last semester, when Kip and I were working on our TSA service design project, we spent a lot of time considering the emotional aspect of going through airport security. Taking lots of photos of people in context and having those photos surround us during design meetings really helped keep emotion at the forefront of our discussions. Though it also helped that we are both very aware of and keen to recognize the role of emotion in design.

Another suggestion I heard last summer at Adaptive Path came from Dan Saffer, who suggested considering the aesthetics sooner using an image, music, or word. This is similar to my experience with the TSA project, where we referred to certain photos to constantly remind us of the emotions involved currently and those we wanted the end result to embody.

For this service design project, our team worked with the University of Pittsburgh Medical Center (UPMC) Center for Quality Improvement and Innovation to identify design opportunities for Dr. Amin Kassam’s Neurosurgery Clinic. Due to being able to perform a rare brain surgery by going through the patient’s nose rather than cutting open the skull, Dr. Kassam’s once-a-week clinic is overwhelmed with patients.

Our team spent a fair amount of time at the clinic observing and interacting with patients. We worked closely with the staff and shared our process and insights with them every step of the way, which built trust and gained their support. This enabled us to gain access to patients in the exam room and interactions between Dr. Kassam, his staff, and patients. We also shared our concepts with the patients, iterating as much as we could to refine our ideas and final solution.

Team

• Melissa Cliver
  Interaction Design
• Jamin Hegeman
  Interaction Design
• Kipum Lee
  Interaction Design
• Leanne Libert
  Communication Planning and Information Design
• Kara Tennant
  Communication Planning and Information Design

Deliverables

• Dr. Kassam welcome booklet
• Concept and process documentation
• Clinic Chat concept video

Process

After many visits to the clinic, we had to sort hundreds of photos and observations.

Me, during a group meeting to synthesize the data.

Service blueprint of the patient experience highlighting opportunities for engagement.

We engaged with patients to get input and feedback as our concepts developed.

We generated and visualized numerous concepts through words and sketches.

Concept storyboards generating to solicit patient feedback.

In trying to understand the emotions and needs of the patients during their journey, we created this visualization, which we included in our final book for UPMC.

Concept rendering.

Page layout from the welcome booklet we created as an artifact UPMC could implement right now.

Visualization of the ideal interaction between patients, Dr. Kassam, and his staff.

Page from the book delivered to UPMC.

A system overview of Clinic Chat.

A part of our research, we went to the OR to see Dr. Kassam perform brain surgery.

More process and solution photos

This morning I read a NY Times article called “Put Buyers First? What a Concept” about an experience the writer had with Amazon.com days before Christmas. The PlayStation 3 he bought for his son had not arrived, so he looked up the tracking details only to find it had been delivered and signed for by his neighbor, who then put it in a common area. There is was likely stolen.

He realized it was not Amazon’s fault, but called anyway. They sent him a new one for free, which he got on Christmas Eve.

The rest of the article talks about how this is great customer service and how Jeff Bezos has made a lot of sacrifices in the name of customer experience.

Wall Street, however, has never placed much value in Mr. Bezos’ emphasis on customers. What he has viewed as money well spent — building customer loyalty — many investors saw as giving away money that should have gone to the bottom line. “What makes their core business so compelling is that they are focused on everything the customer wants,” said Scott W. Devitt, who follows Amazon for Stifel Nicolaus & Company. “When you act in that manner many times Wall Street doesn’t appreciate it.” What Wall Street wanted from Amazon is what it always wants: short-term results. That is precisely what Dell tried to give investors when it scrimped on customer service and what eBay did when it heaped new costs on its most dedicated sellers. Eventually, these short-sighted decisions caught up with both companies.

However, Amazon is doing well, the article states, largely due to its focus on the customer, which has produced great customer loyalty.

All of this, however, comes at a price. Indeed, as I’ve written before, customer service isn’t cheap. Certainly, a fair amount of the hundreds of millions of dollars Amazon has spent on R&D has gone toward developing, say, the Kindle, but a good deal of it has also gone toward improving the customer experience. Amazon is willing to lose money on some of its most popular items, like the latest Harry Potter novel. And even with Amazon Prime, it must surely swallow millions of dollars in shipping costs. Indeed, in a presentation to analysts in late November, the company’s chief financial officer, Thomas J. Szkutak, showed one slide that read, “Over $600 Million in Forgone Shipping Revenue.” And that was just for one year.

As I have said before, although I’ve been designing in a bubble at grad school, I do realize that companies and organizations also have to pay attention to the bottom line when making investments in good design and good experience. Though I wonder if there will ever be a major shift in the way businesses view the investment in the design of service and customer experience so that it’s not so short sighted. It seems Amazon is willing to suck it for a bit to improve the customer experience. And it pays off. (Although, is the focus on customer experience a design perspective—I don’t know.)

Some further questions I have: What is the general willingness of companies to invest in service or experience design? Is there an opportunity for design to help shift the perceived value of investing in the customer experience—and by association, customer service? Or will this remain a hurdle?

Adam Greenfield seemed really excited about Matt Webb’s year-end wrap-up, so I checked it out. It’s a bit of an abstract ramble of ideas, which didn’t excite me as much. But one idea sparked a thought:

“In order to keep going, the path of a user through a website must be designed to never end. In order for the website to grow, the path of the user must be designed to bring in more users, as in a nuclear chain reaction.”

While he’s talking about a website, I don’t see why this wouldn’t apply to all products and services. The the point that is interesting is “designed to never end.” Often in design, we create flow charts or service blueprints—documents that show the beginning of the experience and where it ends. While these have their value, should we also create models of the experience that don’t end?

This reminds me of my thoughts on changing the way businesses think about cost, which was stimulated by feedback from UPMC regarding our design solutions. They asked how we could create buy-in or show that our designs reduce cost. If there were ways to show the experience as endless, continually growing, could this help the argument that producing great experiences that keep people engaged and coming back for more is a more fulfilling (both for the consumer and producer) than reducing costs (not that reducing costs isn’t important, just not the most important aspect)?

I believe I read something recently—perhaps in BusinessWeek—that mentioned companies are starting to focus more on the experience than the cost. So perhaps this change is beginning.

The business case aside, the idea of products and services designed to never end seems worthy of keeping in mind.

Designers often argue about whether we’re designing an experience or designing for an experience, and ponder the more philosophical aspects of having an experience. Is an experience something designers shape? Is it something participants make?

Arguably, every experience is unique. But if this is true, what do we mean when we talk about the experience?

This makes for some great debate for designers. But what do the people who use the products and services we make think when they talk about experience?

I’ve been thinking about this question a lot recently, instigated by my…um…experience…designing for patients of a neurosurgery clinic. The patients referred to the experience as what they expected to happen: what they thought the experience would be like in a general sense. They would check-in, wait, it would be crowded, they’d get called to an exam room, wait some more, see the doctor, then check out.

But there was also the experience of what actually happened. They complained about waiting. The doctor joked with them, saying it was his goal to make them wait. They laughed and felt better.

Which is the experience? The perceived or the actual? Which is more important in the eyes of the patient? Which is more important in terms of the service? What can designers design?

I will continue to ponder.

Last week during finals, the four teams from the Designing for Service class presented their process and solutions to the class and invited guests, which included folks from University of Pittsburgh Medical Center (UPMC), for whom we were designing. During the presentation I took notes on what I thought were interesting ideas that were either brought up by the teams, the audience, or sparked in my head by one of the two.

Embrace the Situation

One of the initial problems my team heard from our client was that wait time is a problem. After our research, we acknowledged this and looked at it as an opportunity, defining our goal as to embrace wait time. Extending from that, in design situation that are perceived as problems, is it possible to embrace the situation or behavior and use that as an advantage?

Create Buy-in

The teams did not focus on how to create buy-in for our solutions, but it was of utmost importance to the people of UPMC. We were not prepared to answer how we or they could do this, which highlights a potential problem for the success of our ideas (or anyones). This is not new news, just good to remember. Involving people in the process was one possibility mentioned for achieving buy-in. But we should probably talk about this more in school.

What’s the Savings?

I hate to see design for a better experience reduced to a question of how much the proposed solution would save the organization, but it’s reality. We didn’t build a business case as part of this project, so we weren’t prepared to talk about cost savings when the question arose. Cost saving was also brought up by UPMC as a way to get buy-in.

This mindset that cost saving is such a dictating force irks me. Who’s to say that spending more money on a better solution won’t lead to greater profits? I wonder if we can reframe it so that cost is not necessarily monetary. For example, funding for a solution will reduce the cost of a crap experience.

Blue Sky vs. the Little Guy

One group decided that rather than design a solution for their particular client, they would propose a system-wide solution for UPMC, of which their client might benefit. The idea—to create a design practice and idea hub—was good, but I thought it did a disservice to their client, who got no implementable solution. When looking at the whole, it is likely that you’ll find problems throughout the system, and with the system itself. However, what may seem like small, local changes can actually have a great impact, first locally, then systematically. So don’t disregard what I’m calling the little guy and instead go straight to blue sky, unless, of course, you’re asked for blue sky ideas. Better yet, propose implementable solutions now, and a blue sky solution as a bonus.

Give People Time for Design

The clinic staff my group worked with were inspired by our presence and the design eye we brought to their space. One of our proposed solutions encouraged them to meet and continue to think about how to improve the experience. UPMC acknowledged a shift in health care toward our kind of thinking—design thinking, if you will. A problem with asking staff to think about the experience on top of their already busy schedule is…well…their busy schedule. Solution: give people time for design. Make design a part of their job description and give them time to do it.

What Is Experience?

This is a question I asked myself amid the discussion. But I’ll talk about this in a separate post.

After 13 weeks of working with the UPMC Neurosurgery Clinic, direct by Dr. Amin Kassam, we have decided to produce a small communication design piece. Compared with other projects, which have mostly focused on technological solutions, producing a booklet feels a little uncomfortable. I catch myself thinking, “This is it?”

Well, actually it’s not. In addition, we are also providing the clinic with a design guide that outlines our research, observations, insights, and possible concepts that they can reference as they continue to shape the clinic into a more ideal vision.

Service design is a holistic approach that focuses on understanding the service first before introducing products into the service. I see it as applying design thinking to a system to understand what products or behaviors might impact the system in a positive way, with a perspective that all elements within the system, from product to human behavior, are interrelated and form the service.

What this means is that there are intangibles that make up a service that you can design for but not actually see manifested in the form of a product. This is what has been making me feel uncomfortable, as the potential impact of our efforts and deliverables are not easily viewable.

Despite this discomfort, I know the small communication design piece will have an immediate impact on the patient experience and quite likely the way the clinic sees itself, which may lead to further positive changes in their behavior. And that’s not something I would have felt comfortable about without having done all the research in order to understand how all the parts of the service affect each other.

The design guide—also a print piece—will serve to embody the presence of our design team and of design thinking in the clinic. Embody design thinking? Yes. We found that by having us around and sharing our process and perspective helped the clinic staff make immediate changes in the way they viewed their work and the patient experience, which led to behavioral change that we had not expected. The great thing was that the staff would openly confess to being inspired by our presence and perspective to make changes themselves. This is definitely an intangible that we’ve essentially already delivered. But it’s difficult to see without a bit of reflection.

The aforementioned might not have been successful without having formed a good relationship with the clinic staff. This is a key point to service design. The people who deliver the service need to be on board with what you are doing. To this end, involving them in the process early and often is highly important. We accomplished this by presenting our initial research findings with lots of photos of them and quotes from them to show that we understood their experience. There was an immediate change in their behavior toward us after that because they then saw us as their colleagues.

So while the only design artifact we are introducing that patients will see is a small print piece, how it relates to the whole, and the behind-the-scenes design guide, and the other intangibles I mentioned, means that we delivering a lot more than is apparent by looking at the individual artifacts. Understanding that relationship is the point of service design.

For the Designing for Service class this semester, we are exploring design solutions for the University of Pittsburgh Medical Center Neurosurgery Clinic, specifically for Dr. Amin Kassam, who is acclaimed for his minimally invasive endoscopic surgery—a procedure that allows him to remove brain tumors by going in through the patient’s nose.

While our efforts are focused on improving the patience experience at the clinic, last week Dr. Kassam invited us to the OR to watch one of his procedures, “if it will help,” he said. We jumped at the chance.

Yesterday was the day. We arrived around 11:30. They set us up in the observation room, which was adjacent to the OR with windows dividing the two and had LCD screens projecting the view of the camera that was inserted into the patient’s nose that allowed the doctors to see what they were doing.

The surgery we were watching began around 8 am. When we arrived, they were in the process of creating a hole in the skull behind the nose to get to the tumor in a 26-year-old patient. They took a break to wait for Dr. Kassam, who was in another surgery. And the attending physician came out and showed us the MRI of the tumor, which was a few inches in diameter and putting pressure on the optic nerves, causing the patient to go blind.

When Dr. Kassam arrived to the OR to take over for his attending, he invited us into the OR itself. So we suited up and went in.

It took another hour and a half for Dr. Kassam to access the tumor. He used tools that he had created himself and named after his kids. During the surgery he asked if we could do anything to improve his tools, and made adjustments to the tools himself when they weren’t bent at the correct angle.

Six hours from the beginning of the surgery, he reached the tumor, which was rather quickly sucked up by a tiny vacuum. The tumor was the result of the formation of the embryo, all the way back before the patient was born. Some fat and skin cells got caught in the middle of his brain and over time did what they were programmed to do—create fat, skin, and hair. That’s what they sucked out.

Ironically, after drilling through the nasal passage, removing bone, and sucking up blood along the way, it was only after the doctors encountered the hair that they exclaimed, “Disgusting!”

This week Maggie Breslin, a former Carnegie Mellon design grad, visited our Designing for Service class to hear about our University of Pittsburgh Medical Center projects and give a presentation on her service design work for the Sparc Innovation Program at the Mayo Clinic in Rochester, Minnesota.

She described her role as both understanding and making. But what do you make if you’re a service designer? A composition of elements—space, technology, people and roles, processes, and tools—within a given context. Adding, subtracting, and manipulating those elements is the work of service design, she said.

Part of her job as a designer is also to steward the customer experience. In healthcare, service is often designed as a rational systems, but she points out there is also an emotional system, through which the most interesting, most powerful information, is revealed.

The idea of the emotional system, or feeling system, as she sometimes said, got me thinking about the complexity we face as designers when you truly consider the dimensions of human behavior. As evidence of this, Maggie said they start every project by talking to patients in order to reconnect to that moment. “You can never talk to too many patients,” she said. Further, their process is to prototype with actual patients and doctors because the emotional piece is too hard to predict.

Regarding design, Maggie stressed the importance of storytelling, making, and critique. She claimed that if you can’t tell a good story, you can’t affect change within an organization. By telling a story, you can immerse your audience in the experience, which works better than a presentation, she said.

This speaks to the value of video sketches over presentations. As designers, we seek to envision the future and share that vision with others. Stories are an excellent way to convey that vision, and visualizing the story works even better. And while video sketches can do this, Maggie acknowledged that there is a lot of opportunity to do something different. The key, she said, is to find a way to make an idea stick.

As for making, that is a skill that separates the designer from other practices. Designers translate understanding into making, she said. Making is key. This point is echoed by another School of Design alum, Dan Saffer, on A Brief Message. Maggie recognized the value of all the making she had to do as a grad student, even when the making seemed unrelated to her field of study.

Finally, she expressed critique as a skill the differentiates the designer. I had not considered critique to be a skill, but it makes sense. She put it in terms of being able to share work and ideas without being fearful of criticism, and in fact welcoming the criticism because you know it will make your work all the better. In addition to taking criticism, she also acknowledged that because of our experience with critique, we are skilled at giving criticism as well.

The last thing she mentioned that I really appreciated was an example of designing for interaction that involves no technology or interface. She showed a video where a doctor was having difficulty talking to a patient about quitting smoking. Designing for a conversation…that too is interaction design.

For the airport security service design project and for my current service design project, my team has defined design principles to shape the final solution and ensure a benchmark of success. For airport security example, saying goodbye was a design principle. In order for our solution to be considered a success, had to address providing a place for people to say goodbye.

But how do you come up with design principles?

First, you need to do research. The way I view design principles are a reflection of the needs and values that were witnessed during the research. My current service design team had a recent meeting where we began defining design principles and we talked about how the principles are similar to need and values, but not quite the same. Perhaps it can be articulated in terms of “our solution must address design principle X in order to fulfill need Y.” And it may be that a design principle addresses many needs.

Even with good research, coming up with the principles isn’t easy. It took us a couple weeks to come up with the design principles for the Charmr this summer at Adaptive Path. And starting out can be intimidating because your developing powerful statements that drive the product.

For the airport security project, my team found it helpful to phrase the principles in the voice of the primary stakeholders. We asked ourselves, if this person were to describe what the end thing should be, what would she say? We found ourselves beginning the phrase with “Help me…” For example, “Help me communicate to passengers,” and “Help me say goodbye.”

For my current service design project, we used this same technique, and it really helped get the ideas flowing. It seemed to be easier for team members to put themselves in the shoes of the stakeholders and say, “Help me…” than to ask people to shout out design principles. One is concrete, the other abstract, and hence more difficult to do. It also provides the sense that you already have something started, you just need to complete it, which can help overcome the blank slate.

So in your next attempt to begin synthesizing your research and develop design principles, consider using the “Help me…” statement. It may just help you.