How can we overcome the gravitational pull of the status quo in health care? When working as a service and systems designer in healthcare in Canada and the United States, my teams and I were constantly came up against the “that’s just the way we do things around here” mentality.
While we had an abundance of promising concepts to improve the healthcare system, it was hard to implement these changes and even harder to have them stick over the long term. Plus, I became frustrated with incrementally tweaking existing services and wanted to better understand how we could get to changing some of the fundamentals. So I decided to take a step back and move to Sweden to do a PhD focusing on designing for transformation in healthcare to learn from the great work that is happening in Europe and help move the practice forward.
In my research, I have started to focus on “designing the invisible” – more specifically how we can reshape the norms, rules, roles and beliefs that guide our actions related to health and health care. All too often when designing, we focus on the things we can see in systems, without full regard for the invisible social forces that influence our thoughts and actions.
In design, we are good at thinking about how things “out there” need to change. But increasingly, I am discovering that systems change and reshaping social forces requires changes from the inside-out. That means critically evaluating our own beliefs and what is influencing our actions. We are all embedded and entangled in the systems that we wish to change and uphold the existing system though our actions.
But we also have the ability to intentionally make, break and maintain these social forces through our actions. Based on my ethnographic research, I have a hunch that participatory design processes can help with that. By making the invisible visible, immersing people in surprising experiences, engaging diverse perspectives in dialogue, coaching people to look at things in new ways, and prototyping alternatives, participatory design processes can help people reflect on the invisible social forces and actively reshape them.
On March 29th, 2017, I was invited to lead a workshop on “Designing the Invisible” at the REshape Center of the Radboud University Medical Center. During this session, we unpacked the doctor-patient relationship. First everyone drew their own mental models of the doctor-patient relationship as it is today. Then two brave participants improvised their version of what a doctor’s visit looks like based on their mental models.
Together we unpacked the invisible social forces or “unwritten rules of the game” that were at play during this doctor visit. Workshop participants called out unwritten rules like “the patient is the disease” and “patients go to the doctor”. Next, everyone wrote down a headline about an innovation in the doctor-patient relationship that might be seen in a newspaper in the year 2020. Based on that, together we identified which of the rules of the game we would need to break make or maintain to realize this desired future. Based on these changes to the invisible, the participants improvised the new scenario.
Next, all the participants were asked to reflect on what social forces are influencing themselves and their vision for the future. Then examples of design processes from Experio Lab (Sweden), Mayo Clinic Center for Innovation (US) & CAMH (Canada) were shared as promising approaches to designing the invisible. To cap things off, all the participants were asked to create a tiny test for themselves in the next week – finding one small thing they could do to experiment with designing the invisible.
A big thanks to all those who came out and to REshape for hosting the session. The slides for the presentation are available on here.
Josina Vink is a PhD Student at Experio Lab, a national center that uses a participatory design approach to transform Swedish healthcare systems. She is also affiliated with the Service Research Center at Karlstad University. Josina’s research is part of the Service Design for Innovation Network (SDIN), a European Union Marie Curie Innovation Training Programme. You can get updates of Josina’s research on twitter by following @josinavink