User-centred design is at the heart of a lot of digital philosophy. But users don't exist in isolation, they're embedded in communities and systems. We explore what this means for good design.

Over the years, we’ve talked a lot about user-centred design. But should the user really be at the centre? In the real world, there isn’t a single end user.  Human beings are complex and live in an interconnected system. What happens when we become aware that services should not solely be designed to meet the needs of a single kind of individual? They must meet the needs of society and the environment, too.

This changes our approach to design. Traditional design looks at solving a problem in isolation for an individual. But if you want to design well, you need to look at the problem as part of a system, and the user as part of a society. You need to design systems that work well for people, and for the social structures they live in.

How does this make a practical difference? During the summer of 2020, COMUZI worked with Understand Patient Data to: ‘discover new ways to develop people’s understanding of how health data is used’ 

Traditionally one might choose to focus on the patient as the sole ‘end user’, however when approaching this project from a holistic lens, you are better able to recognise that the health service is a system involving several other stakeholders such as doctors, nurses and care assistants.

We came across a lot of things which helped us tackle this brief, however we found that one particularly tricky part of this process was engaging the doctor. They collect a lot of the information, and they’re often listened to by the patient. 

The problem is that doctors aren’t necessarily given the time to explain the importance of health data to patients during appointments. We also found that generally, healthcare professionals aren’t able to see the wider impacts of collecting data because the system doesn’t show them how the patients actually benefit from it. This means that it doesn’t feel like an urgent priority, especially when there’s a lot of time pressure.

In this instance, user-centred design is difficult to define. Who is the end user we want to help? Is it the doctor? Is it the health service? Is it the patients? 

The end goal is not to prioritise benefiting any individual type of ‘user’. Our actual goal is a healthier, more productive society. To reach that end, we need to consider the needs of every stakeholder.

How do we create a system which makes space for the doctor - who wants to focus on treating their patient, as well as for the health service and the patient?

How do we develop a framework which also helps the patient understand more about their health data without simply asking the doctor to do more work?

Our research insights stated: “Many healthcare professionals feel like they work a ‘thankless’ job, how might we make working with patient data valuable to them?”

We asked the question: how we could avoid adding a greater workload to their job roles?

To solve this problem we need to think about a lot of things:

  • The environment they worked in,
  • The impact COVID has had on them and their work 
  • Use of new digital tools within health and care 
  • Impact of hierarchy on final say and decision making
  • Career progression within their field 

Doing this, we found a lever that worked: demonstrating that you are able to work with health data is becoming a preferred skill within the health industry. Marry this with doctors’ natural desire to provide excellent care, and you have a winning formula.

We prototyped a flyer for accredited online workshops where experienced health professionals could share examples of how they used data to improve the patient experience in their area for others to learn from. The idea was to help doctors see the value in becoming data collection champions.

Holistic design principles recognise the people we are designing for beyond their physical interaction with whatever we are creating. This means substituting the term ‘user’ with ‘human’ and respecting the intellectual, emotional, spiritual and physical needs of an individual, within a cultural context. 


A closer look: Holistic Design principles


Understanding the why

When we create something that has a functional purpose, it is incredibly important to understand the responsibility that comes with that. Mike Monterio states:

‘...you are choosing to impact the people who come in contact with your work. You can either help or hurt them with your actions. The effect of what you put into the fabric of society should always be a key consideration in your work.’

Holistic design is rooted in empathy and a conscious decision to work towards impact rather than profit, so that the complexity of designing for the real world can be taken into consideration.

It must be approached with a desire to be intentional at every stage of the design process. Every interaction counts, even the small ones. 

In turn our work becomes more nuanced, and more effective in the long run.

Take the example of Yona Care, a healthcare organisation for women. Yona redesigned not just the speculum, but every single touchpoint along the pelvic exam experience, in order to encourage more women to actively engage with their reproductive health.

De-centering the human 

It is possible to de-centre the human in the design process, while still understanding the importance of meeting the needs of people. Dori Tunstall talks about how ‘de-centering the human allows us to “decolonise” design In everyday life, we do not exist in silos. We are in constant relationship with the environment, our local communities, and wider society.

Being held accountable

When we design with communities instead of for them, we establish relationships with the people that could potentially be affected by whatever we are creating. This questions the traditional ‘designer-client’ relationship and diminishes the power imbalance. When done properly, community members have the opportunity to make decisions and share their perspectives along the whole design process.

Approaching design in an interdisciplinary way

The whole ethos of holistic design involves seeing the world through a lens that acknowledges the interconnectedness of everything. Adopting this mindset also helps you expand your creativity. Don’t hold back from drawing inspiration from other disciplines. 

Take the example of MIT Mixed Media lab, where Neri Oxman takes principles from nature and applies it to the manufacture of ergonomically designed products.


How can you practically apply holistic design?


Think about the job to be done, not the process for doing it

This approach helps us solve problems from a lateral perspective. It lets us think imaginatively about a challenge. 

When describing challenges in a job-to-be-done method it is important to ask yourself what is the most critical thing we are trying to achieve?  


Example 1

Q: What are the most critical things we are trying to achieve after we wash our hands?
A: To dry them.

Thinking about the critical thing you are trying to achieve allows you to creatively fulfil the job outlined: to dry hands. This will allow your thought pattern to break away from the paper towel and dream of an electric hand-dryer.

Example 2

Thinking back to the COMUZI example in the beginning, working with Understanding Patient Data, to co-create alternatives to a ‘national conversation’ to raise people’s awareness of how health data is used. Here there are several layers of jobs to be done, and critical questions:


Q: What is the most critical thing we can use to engage healthcare professionals in a conversation about health data?
A: Their desire to provide excellent care to their patients.

Job outline: How might we pair providing excellent care to a conversation about health data?

When creatively thinking about ways to fulfil our ‘job-outline’ we also ask ourselves:

  • How might our solution empower someone in every action?
  • How might we deliver this at scale? 
  • How might we keep the conversation about health data focused on what mattered to health and care professionals?

COMUZI proposed a series of online seminars based on a variety of healthcare settings, which could appeal to a wide audience, be replayed on demand, and come with industry recognized CPD accreditation. 


Consequence Scanning: a framework to understand the implications of your decisions

When we design holistically, we tend to ask more questions about how a product, service or digital campaign can affect different people in different ways. 

Consequence Scanning is a framework that purposefully inserts friction into the product development process, with the goal of identifying and then mitigating negative or unintended consequences and identifying opportunities for impact.

Below is a guide on how to do consequence scanning for yourself:

  1. Collect a diverse team, if possible look to include people who represent the community you look to impact.
  2. Articulate a project, outline its purpose and who it looks to impact. Ensure you explain how.
  3. Assess negative or unintended consequences by asking some of these questions and map them out where everyone can see them.

Consequence scanning questions:

  • How could this help someone?
  • How could this hurt someone?
  • How does this impact the wider community?
  • How could this assist the most vulnerable?
  • How will this impact the environment?

4. Reflect with the team to see how some unintended consequences could be mitigated or turned into opportunities.

Consequence Scanning is a very practical tool;, it can be executed in any time frame. Assessing a low risk situation, you can even do it yourself in 15 minutes. When addressing more high risk ethical challenges, you also have the opportunity to engage a team over a longer period of time.

Consequence scanning is most impactful when the community who is going to be impacted is included in the process.

‘Are you aware of your assumptions?’

We all have assumptions about how the world works, and how it ought to work. We take those assumptions to work. 

Being self aware of the impact we have as designers on communities we design for also allows us to think holistically about how we go about designing a service.

“Why are we seeing the world the way we are seeing it?” is a powerful question you can do to assess your point of view and what you are using as a fixed point to shape your thinking.

When designing for communities non-native to you, this question becomes amplified. Another community may interpret something completely differently. 

This is particularly true when discussing culturally sensitive topics where there may be an assumed view on a community which could be completely inaccurate such as health and wellbeing, religion, politics, discrimination and disability. Things like clothing and headgear, colour choices and language choices all have profound impact. 

But it can be true in all sorts of circumstances. For example, a remote blood testing kit that contains instructions directing the user to squeeze their forefinger ‘until it becomes pink’. This clearly communicates that the instructions were written under the assumption that the end user would be white.

While such ignorance may be acknowledged as a careless mistake, it further marginalises black and brown communities within a society that is already systemically unjust. 

Furthermore, it communicates; ‘this was not made for you’. As designers, if we are to help our society to move towards a future that is rooted in equity and fairness, we must interrogate our biases.

Co-creation 

Co-design is an approach that centres around the idea that people who are affected by a decision, event or product should have an opportunity to influence it. Co-design can be described as the WHAT. (Figuring out what we can do to solve the problem with the community you are designing for.)

‘Co-production’ describes the process of implementing the idea/making it happen. This involves bringing an idea to life by recognising the superpowers of each individual involved on the project. Co-production is the HOW. (Figuring out how we can practically solve the problem, with input from the community we are producing for.)

Co-creation is a combination of co-design and co-production

It has been proven time and time again, that involving the community through co-creation:

  • Is more economically sustainable
  • Is more accurate at meeting the needs of the people we are serving
  • Is more likely to generate long-term solutions
  • Helps the team to develop a more holistic understanding of the issue we are tackling
  • Stimulates a sense of ‘ownership’ among users because it is made for the community, by the community
  • Fosters long lasting relationships across network
  • The service is more likely to be recommended and engaged with

Sources

https://www.interaction-design.org/literature/article/holistic-design-design-that-goes-beyond-the-problem

https://uxplanet.org/a-guide-to-holistic-design-514de5725310 

https://medium.com/joint-futures/towards-a-holistic-design-approach-122dcf4d02c0 

https://www.dezeen.com/2015/02/25/hella-jongerius-design-indaba-industry-new-holistic-approach/ 


When we acknowledge that the things we create ‘do not exist within a vacuum’, but instead within the larger framework of society and nature, we are better able to design products and services that have a long lasting impact in the world. 

The tools listed above have the potential to refocus the way we approach projects, and how we define their success. They can be applied at every level of an organization in order to solve problems in a truly innovative way, and recognise people’s needs from a physical, emotional and spiritual perspective.


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