Lift 09: responsability and appropriation

Fantastic day yesterday at the Lift conference, lots of stimulating speakers, and lots of resonance between diverse speakers and points of view.

One such resonance for me was between Ramesh Srinivasan, who talked about appropriation of technology by users and into contexts that it wasn’t designed for, and Anne Galloway, who described design as an act of gift-giving, where one must accept that the recipient of the gift may react and use your gift in ways you consider ‘inappropriate’.

See their talks here

What both of these point to, for me, is a debunking of a number of user-centered design myths; the ‘intended user’, the ‘intended use’, the ‘ideal path’, etc.  Once we put something out into the world, it will be appropriated by people and used as they see fit, and it’s consequences are often unknowable.  Somehow, we have to push ourselves to imagine those unexpected consequences (be they positive or negative) and consider them our responsability, as the real final work product of the design process.

Social Contracts

The principle of the social contract is that I agree to live according to the law and pay a contribution towards the common good, in return for certain benefits that I receive, directly or indirectly, from the state.

While the majority of the world agrees with this general principle, there are widely different ideas, across the politcal spectrum and across different geographies, about what primary benefits the state should provide.  Furthermore, when one finds ones own views or assumptions challenged, it is often very difficult to find rational arguments one way or another.

For me, having grown up in one of the worlds first and best welfare states (New Zealand), it is ‘obvious’ that the state should provide:

• Universal free primary and secondary schooling
• Universal and ‘almost-free’ healthcare
• Free dental care for children
• High-quality, meritocratic, and affordable university education
• A guaranteed minimum income for the unemployed, single parents, the physically and mentally ill, and the elderly (i.e. everyone who can’t provide for themselves)
• Affordable housing for all the above categories
• An efficient network of roads, railways, data and energy services
• …and so on.  You get the picture.

I get indignant, whenever I see countries that don’t provide these things.  But, digging deeper, one discovers that all kinds of things that could equally well merit being in the list, which even in idyllic NZ are provided by profit-motive or non-profit organisations, for example:

• Dental care for adults (why our teeth are somehow less deserving than the rest of our bodies, I never did understand…)
• Preschool education
• Ambulances

Mainly for historical reasons – all these complex social solutions have evolved over time, and each choice has had its specific motives and internal / external causes.  And each country around the world has its own idiosynchratic list of ‘whats included’ in the package deal of the social contract.  The question I ask myself is: is there some sort of general principle that defines whether it would be better to provide a state solution or leave it to the market?

Maybe.

Here are some factors that seem relevant to me – the formula, if it exists, should somehow combine these (and probably many others):

1. Is it a regulatory mechanism of the democratic system itself? (police, justice system,…)
2. Is it a natural monopoly? (Physical networks – road, rail, power, fiber optic,…)
3. Is it primarily a common good? (Air, water, …)
4. Are the consequences of individual deprivation unacceptable to society? (education, housing, healthcare, minimum income,…)
5. Is it a mechanism of social mobility and integration (healthcare and education, again)
6. Are its objectives unsuited for profit-motive organisations (healthcare and education, again)

Well, you can easily guess my stance on this from the questions I’m asking.  But the most pertinent, and the one I use more and more often in my thinking, is point 4.  Focus on the consequences, not the ideological principles.

Thats one of the things I loved about Obama’s inauguration speech – his pragmatic ‘if it works, we’ll fund it, and if it doesn’t, we won’t’ line.  Unfortunately, I have my doubts that even he is going to be able to put ’the whole goddamn multi-payer profit-motive healthcare system’ in the bucket of the things that don’t work…even though we all know that’s where it belongs.

Stating the obvious.

Um…Americans…

You’re the only country in the developed world that doesn’t even try to provide universal single-payer healthcare.  Oh, and you spend twice as much as the rest of us, to get worse quality of care. 

You will NEVER be able to achieve better health at a population level unless you address this.

Is our society too complex for individual responsability?

I believe we are responsable for the consequences of our actions, and in my own little way have tried to live accordingly. But, are we really able to predict the consequences?

For example: I buy an electronic gadget. The consequences I am immediately aware of are:

• I enjoy the benefits the gadget provides me
• I aquire some form of social status
• I stimulate the economy (consumerism as altruism; it would seem like a joke if the worlds politicians weren’t espousing it daily)

But, there are plenty of other consequences, upstream and downstream from my purchase.

Upstream, my purchase accumulates with those of others, and through ‘demand flow technology’ (DFT) the factory in china is informed they should make another one.  I, consumer, regulate the production cycle. By now you should all know the story of stuff; it’s a production cycle based on exploitation of unprotected workers, burning vast quantities of coal and oil, stripping raw materials from the earth, and generating velenous byproducts which enter the biosphere.

Downstream, you’ll be pleased to know that most electronic waste doesn’t end up in western landfills. Instead, it gets illegally shipped to asian ‘recycling’ centers, in China, Souteast Asia, and South Asia. The entrepreneurial locals then burn the pcbs in open fires to melt out the precious metals, and melt PVC cable covers with a naked flame to get to the copper. All without any form of individual protection or environmental safeguard.  They die directly from the accumulated toxins, but luckily it gets sufficiently diluted by the time it blows our way that it just ups our cancer risk another few percent.

So if I believe all that, why don’t I baulk at the purchase? 

Maybe because my morality isn’t sophisticated enough.  I would never knowingly buy something stolen , or produced with slave labour.  But when the production-consumption cycle is so complex, I never get such a clearcut moral choice – there is more a kind of vague, unlocalised sense of guilt, insufficient to have much influence on my actions much.

I believe that this is a typical example of a system that is too complex for our simple, biological, individual sense of responsability to deal with – and thus the idea that the informed choices of consumers can lead to social change is a fallacy.   Government has to take the lead and try to make decisions for the common good.  Because just letting us citizens spend our money however we want, is dangerous for all of us.

Ezio Manzini’s Next Design

Ezio Manzini gave a great talk at the design library yesterday – Design for social innovation and sustainability.

Extremely dense with insight into the nature and future of design.  Some of the aspects that particularly struck me:

• the overlay of 3 elements: new kinds of solutions (sustainable); new areas of focus (social cohesion); new methods of collaboration (open networks)
• the ‘solution’ (formally known as a product-service system) composed of Assets (buildings, products, infrastructure) and Interactions (people, data, material, energy, in dynamic interplay with the assetts).  I particularly like this assett/interaction dichotomy because it gets away from the sterile HW/SW dichotomy which has bugged us since the first days of UI design.
• solutions inevitably built by the combined efforts of business and non-business players (especially in any complex social system such as healthcare or education)
• the fluid or even non-existant boundaries of system design: in time (the project is never finished); and in space (since everything is networked, we just have to trace a boundary around our area of intervention).

4 keywords for the next design: small, local, open, connected.

My question was (and is) how can this new design be represented?   As designers, our work can be separated from production because there are codified ways of representing design solutions (for example, drawings and 3D files).  When the solution is a web of assetts and interactions, some custom and some pre-existing, it is not easy to find a descriptive medium to communicate and verify the solution prior to building it.  And perhaps this is even not desirable -  the sequential ‘design/build/use’ model of production may be inevitably shifting to more of a ‘gardening’ approach where design, constructuion, and use are concurrent.

Healthcare: fragmented views of a fragmented picture

I look at healthcare as a designer – my profession provides the lens through which I look at the world.  Through that lens, I try to look at all aspects of the system – clinical, social, personal, technological, political – and compose some kind of general view for myself.  This view is shaped by:

1. What information is available to me (which depends on my ‘position’, i.e. my location within the system)
2. What I take notice of (based on my value scales of significance and relevance)
3. The way I elaborate and understand it (using mental tools largely from my professional life)

Let’s call that the ‘designers view’.  Other observers compose totally different views, based on their own positions, value scales, and professional toolkits.  One of the biggest challenges facing healthcare is that changing only one of these variables is often sufficient to modify one’s view beyond recognition – let alone changing all three!  The different roles in the healthcare system – administrators, practitioners, patients, insurers, IT integrators, device design engineers, pharmacologists, politicians – have access to different information, which they filter by different criteria and process with different tools.  Combine this with different motivations and economic interests, and all too easily this leads to divisions along disciplinary lines; ‘Doctors vs. technologists’ , ‘Provider vs Insurer’, and so on.

Somehow, if we are going to address the macro-problem of providing the best possible care to the widest group of people with limited resources, we need to establish a set of common landmarks that allow these myriad viewpoints to be composed into a somewhat coherent picture.

Has quality lost it’s meaning?

Most of us have a common-sense notion of Quality – high-quality things are well-designed, well-made, and fit for their use .  Unfortunately, Quality as defined by the QA profession, with it’s obsession for protocol, procedure,  and documentation, bears little resemblance to this common-sense definition.

The touchstone of medical device QA is the idea of formally defined design requirements, against which design outputs are then tested.  This does little to ensure quality, it merely ensures compliance – solutions can be designed that meet the requirements without necessarily being ‘good’ or ‘quality’ solutions.

This process deformation is at least partially responsable for the dismal state of Healthcare IT, denounced in a recent NRC report (The Healthcare Blog provides a great summary).  I’m sure all those IT systems were developed in strict adherence to quality standards and procedures, but with insufficient regard for fitness for use and true quality. 

There is a pressing need for medical technology and design professionals to restore quality its true meaning and promote development processes that lead to genuinely high-quality outcomes.  A good place to start would be to pay more attention to discovering and meeting real needs of end-users, and less on creating the perfect paper-trail.

Product planning: Garden or Jungle?

Good product planning is like gardening.  Mature plants need to be pruned and fertilised (product maintenaince) and occasionally removed (end-of-life).  New plants need to be grown from seed (internal R&D) or purchased already grown (aquisitions).  The evolution of the garden needs to follow some form of master plan (the road-map) yet be flexible enough to adapt to good and bad surprises.  Critically, weeds need to be removed, and hard choices need to be made about which plants will be given priviledged access to light, air, and water.

Unfortunately, the way many companies manage their product and R&D portfolios bears more resemblance to the law of the jungle.  Dozens of competing ‘innovation’ project battle for their share of funds and executive attention, growing gawkily like light-starved saplings on the forest floor.  The majority are killed off, by a tremendously complex process of attrition.

Is that a bad thing?  In theory, the law of the jungle should guarantee ‘survival of the fittest’.  However, I am increasingly convinced this is not the case.  We desperately need executives to be gardeners who bring vision, direction, and a criteria of ‘rightness’ to product planning.  The ubiquitous Steve Jobs is the perfect example in the consumer product world.   

In a future post, I will go in more detail into some of the negative outcomes that stem from the jungle-planning approach.

Problems, Opportunities, or “Situations”

In my training as a designer, a great emphasis was placed on problem-solving abilities.  I strongly believe in the kind of design which is typically described as “problem-solving” but I’ve started to have doubts about the name, and the mental model of design that it represents.

“Problems” are a mental abstraction.  To state a problem is to make a selection or distillation of a real-world situation, or “things-as-they-are”, which focuses on those elements of reality that we hope to change through our design.  That is, a “problem” is the reduction of the infinitely complex real-world situation, into a finite abstraction that can be solved. 

In my experience, the ability to state problems appropriately is much rarer than the ability to create “solutions” in the subsequent step, and is the true sign of a great designer. 

Why should that be?  The answer I’ve given myself involves turning traditional problem-solving theory on it’s head, by considering design as a process that is “pulled” by solutions, rather than “pushed” by problems.  In the earliest days of a project, when one is trying to create the problem statement, it takes tremendous sensibility and insight to feel the “gravitational pull” of solutions over the horizon.  As a project progresses, solutions get closer, are more discernible, and there is a convergence of qualitative indicators telling you it’s the right way to go.

This has implications for the entire construct of the design process, and especially for the dogmatically rational and controlled design process that is promoted in the medical device industry.  I will go into the implications for ‘requirements’ in a subsequent post.

Healthcare technology and the ethical balance sheet

When discussing the ethical value of technological progress, healthcare technology is often cited as a key ‘positive’ factor.  For those of us who have access to quality modern healthcare, it’s often a pretty convincing argument (outweighing things which are far from us, like warfare, or hard to grasp, like global warming or an environment full of manmade carcinogens)

And those of us who work in the medical device industry tend to feel like we contribute directly to that positive balance, “making the world a better place”.  But it’s worth stopping to think about how much advanced medical technology really contributes to quality of care.  My guess would be that factors such as the number of medical professionals per capita, universal availability of basic care, and pro-active free pediatric assistance are more important.

If anyone has statistical data enabling independant evaluation of these factors, I’d love to see it.