Designing for the vulnerable - Chapter Three - Shared Learnings

What does it take to design healthcare for vulnerable people? This Saturday, at the Service Design Fringe Festival, we’re hosting a joint event between Livework and Coloplast, where Jennifer Bagehorn and Lilith Hasbeck will each be bringing a different perspective to the table. In advance of the talk, the two of them have contributed to a three-part long read. This is the final part of three blog posts. Start with Chapter One.

Our shared thoughts and guidance for a designer looking to work on often-stigmatised health issues

Empathy is a core skill of a service designer (or user researcher for that matter). Yet when it comes to vulnerable topics it’s even more important to be just that little more sensitive when talking with people about their challenges and fears. People might want to protect themselves and will not tell you straight away what they struggle with. The ability to be patient, genuinely listen to people and hear what they really say is even more acutely important within healthcare. It’s about establishing a professional yet personal connection. It’s about allowing people their personal space. Learning to be comfortable with silence and highly emotional situations might also help.

The healthcare space is a large, complex beast. Whether you’re coming at it from the inside or the outside, we often encounter great complexity due to its large scale and sometimes a wide patient/user population and many systems interacting and overlapping. And its closed silos make the whole system very slow to change. Therefore, to manage change, service designers need to be able to understand how to navigate in the political landscape of healthcare, public as well as private. They need to be comfortable operating within these different entities - and a little bit of patience doesn’t hurt either. Finding high-quality and stable leadership that knows how to engage stakeholders and drive change forward is key to implementing new service systems. 

Key challenges and opportunities for healthcare at the moment and what the role of service design might be

Many organisations still restrict themselves by adopting a very traditional approach to designing healthcare services, or services in general. There is a barrier and fear of trying novel things and following the usual way is safe and easy, especially for public service organisations who are on a tight budget. But solutions that are assumed and created internally in an organisation are rarely what users really need. In the end these solutions often create more costs in the long term, because solutions might not work the way they were intended to, are not accepted by the people using it and therefore might need a lot of changes before they can be implemented, if at all.

By introducing the user in the problem solving process, businesses can start to understand the real underlying need. They then can design solutions that reach people where they need to be reached.

In the particular case of mental wellbeing services, it is essential to take into consideration that there is a high stigma and low awareness of the problem itself. Organisations can’t assume that people with mental health difficulties will take action themselves. Especially because many people don’t even know that what they are experiencing is something that could be helped. Practically speaking, instead of designing another website, platform or service, and hoping that people will come and use the service, organisations should start to think of how they can meet their users in the environments they already inhabit and where they feel comfortable and safe in.

Generally, we see two major trends that are influencing the adoption of service design when designing for healthcare:

Digital health interventions: Digital transformation has entered the healthcare sector and it’s creating great opportunities for organisations as well as users. Tech should never be intended to replace human interaction where inappropriate, but can provide quicker access to information and services, personal data, quality advice, and connect people to relevant peers. The service will look inherently different depending on the patient/user population and the needs you are trying to solve, but the great news is that by leveraging digital and by creating accessible and safe online spaces we can help people who are in need much faster and/or more effectively.

With all of this also comes complexity – which is where service design plays an important role. Adopting service design can help organisations understand the bigger picture, reduce complexity in the digital landscape, and design better access to information and services for the population.

Digital health has grown immensely in the last few years, but only recently and increasingly has “examining the human element” in digital health design become a hot topic in the tech space. We are super excited to see this happening, because essentially it’s all about coupling great human understanding with new tech that might enable new ways of interaction or open up for new (product-)service-systems.

Empowered users: Also in healthcare have we witnessed a shift from passive to empowered users. People are now in the driver’s seat and take responsibility for their own health (or at least some do), and feel empowered to provide help for others. Health is no longer a one-way system with provider and receiver - it’s also growing in complexity.

Organisations will need to connect with users on the platforms of their choice, whilst creating a safe and trusted environment. It’s all about supporting people and meeting them where they’re at. Some might then be willing to reach out for help and share their experiences and challenges, while others might need just that little bit more support.

Service design can help to design these environments with the human element at its core. By uncovering what empowered users need, organisations will get a much better understanding on how to design for them.

Designing for the vulnerable - Chapter Two - Livework

What does it take to design healthcare for vulnerable people? This Saturday, at the Service Design Fringe Festival, we’re hosting a joint event between Livework and Coloplast, where Jennifer Bagehorn and Lilith Hasbeck will each be bringing a different perspective to the table. In advance of the talk, the two of them have contributed to a three-part long read. This is the second of three blog posts. Start with Chapter One.

LIVEWORK’S PERSPECTIVE: A case study on understanding Londoner’s needs to design a 24h mental wellbeing service

In 2015, we received a brief from Public Health England which explained that here in London, a third of those surveyed report low happiness, with half describing themselves as anxious. We also learned that most Londoners haven’t received clinical help for their difficult experiences. Some are stuck on long waiting lists, others are discouraged from seeking help due to social stigma and others are unaware that their experiences can be helped, or that help is out there.

In addition to the personal consequences, poor mental wellbeing is costly. In London, £7.5 billion is spent each year by health and social care on treatment, benefits, education and criminal justice. A further £10.4 billion is lost each year by London businesses and society.

We were given the challenge to design a service to address this unmet need, at scale. We began at the human scale, by designing for individuals. This service could then be scaled to reach the whole of London. The future vision is to scale the service to reach the entire UK.

Years of research and effort were already invested in addressing this challenge. This resulted in a business case, which argued that Londoners’ needs could be met by a combination of access to information and services, safe online spaces and peer to peer connection. There was a strong sense that these could all be delivered through a single centralised website. The stakeholders assumed that if they built this website, people would come and use it.

It was our job to question this assumption. Is that what Londoners need? In order to explore this, we went out and spoke with Londoners in their own homes.

We met with Christina, who has suffered from insomnia and anxiety since a burglary at her home. She said, “I think lack of sleep will make you anxious, and that does make you depressed, and obviously because of the trauma of what happened, but I just tried to sail through it and I don’t think it has gone away.”

Christina was already seeking information and support in peer to peer forums like Netmums. She finds it useful to hear other people’s stories and to share her own. Christina is aware she has a problem and is willing to seek help. She’s the kind of person who’d be open to a centralised website about mental wellbeing. Christina is who the stakeholders thought they were designing for.

And then there was Martin. When we asked him about his experiences, he said: “I don’t really know what causes it, but I know I sweat profusely when I sleep at night. I don’t know why, but it wakes me up.” And then he said, “Other than that, I don’t know what else to say to you.” Later in the conversation, we eventually asked something like, “so how long have you been living here?” He explained, “I got my own house, that I own.…but I’m not living in it since I split with my wife. I get to see my child every weekend…I used to love going home, helping her with her homework….I’m back living in the room that I grew up in….It’s not ideal, is it? That could be a contributing factor, I don’t know.”

Then we asked him what he did for a living. Martin works on a team that digs ditches for the sewer system. They crawl forward on their hands and knees, and with each inch they progress, Martin needs to extend the support structures. Otherwise, the tunnel can collapse. Martin remembers the panic of past collapses and finds it stressful to be responsible for everyone’s safety. Maybe this was a reason he couldn’t sleep. We asked Martin if he ever spoke with anyone about his stress or sleeplessness. He hasn’t. A bad childhood experience put him off doctors of any kind. Martin would never knowingly go to a government healthcare website about mental wellbeing. Speaking with people like him, we learned that the real challenge is in reaching those who are unaware and disengaged.

We realised it is not enough to make a centralised website. We need to take a different approach to imagining service experiences. We need to meet Londoners where they are. In Martin’s case, this means meeting him where he is in his journey, in his ability to identify and express his experiences. Secondly, it means bringing relevant information and services into the digital spaces he visits, so he’ll find help whether he goes looking for it deliberately or not.

These insights led us to develop a vision for the future, a world in which mental wellbeing services are distributed into the environments where people already are. By meeting Londoners where they are and integrating delivery, we can reduce the cost on the system, whilst still reaching those that might not seek out help on their own.

It’s not easy to know what will help us. Some people benefit from meditation. Others exercise, try sleep apps or share their experiences in cafes or online forums. And of course, some people visit their GP and get referred for therapy. The key is connecting with information and services that work for you. The aim of this service is to facilitate that connection.

Read Chapter Three

Designing for the vulnerable - Chapter One - Coloplast

What does it take to design healthcare for vulnerable people? This Saturday, at the Service Design Fringe Festival, we’re hosting a joint event between Livework and Coloplast, where Jennifer Bagehorn and Lilith Hasbeck will each be bringing a different perspective to the table. In advance of the talk, the two of them have contributed to a three-part long read. This is the first of three blog posts.

COLOPLAST’S PERSPECTIVE: Working closely with users from within a large healthcare organisation

Let’s turn the clock back 60 years. We’re in Denmark. It all started with a lady called Elise Sørensen. Elise was a nurse, and she saw her sister suffer with her new stoma: She’d become isolated, not leaving the house as her collecting device - a big rubber ‘jar’ strapped on a leather belt - was just too embarrassing and impractical. Determined to get her sister enjoy life again, Elise invented the first disposable, self-adhesive ostomy pouch. And that’s what led to Coloplast’s existence.

Now let’s fast-forward to today again. ‘Listening and responding’ has been in Coloplast’s DNA for a little over 60 years. That’s how it all started. Elise had a close understanding of the emotional and practical challenges her sister was facing and because she was so close to her sister, she’d developed a lot of empathy for her situation. She listened and found a solution that fitted into her life rather than the other way around. While it has always been in the company’s DNA to listen and respond to users, in the last nine years Coloplast has made a step change in innovating through user research and design.

Back in 2010, design was pretty new to Coloplast. The company didn’t have the experience nor the tools to deliver design. And by design we mean industrial design. Product design. Conversations were often about personal taste. Some of you might recognise one of those moments when someone senior in the room puts their foot down and says ‘but I like green!’

We’ve come a long way since then, and today the company is in an entirely different place. But we still have some way to go.

I’m part of a relatively small team of soon-to-be seven people. We all have various design backgrounds, working under the title of user researcher, and all share the same vision: We want to help Coloplast enable people to live easier lives with their condition. This all starts with listening and responding, professionally and holistically.

As a team, we’ve first had to professionalise how user research is conducted within the company. We’re constantly asking and challenging ourselves on how we listen and respond in a modern world. And on how to have intimate conversations with users who are suffering from taboo-ridden health conditions that they may have never spoken to anyone else about.

But it doesn’t stop there. Building on our rich history of listening and responding, we’re also looking and starting to grow discussions within the organisation about other types of design apart from industrial design. Design of more holistic experiences. Design of services. And the timing is just right.

Sadly we, as a company, can’t cure people. What we hope to achieve with these products is to enable our users to live their life as normally as possible. Products are and will always be core to our business, as one simply cannot solve our users’ healthcare issues without some form of product (at least for the time being). But we also live in an increasingly digital world, where people’s expectations for how health is delivered are rapidly changing. Companies like Coloplast have to respond and sometimes even adapt. Again, this all begins with listening to the user. Finding that Elise Sørensen moment, where empathy, understanding, and vision all come neatly together.

In some ways, one could say that we’re working on the inside of a healthcare organisation in its early stages of servitization. It’s exciting. It holds a lot of promise. But it’s also challenging. Sometimes very challenging. At the Service Design Fringe Festival, we will openly share some of the challenges we face every day in the hope of starting honest conversations about these things within our practice.

Read Chapter Two

Why you should come to the 2018 Service Design Fringe Festival

Long time festival supporter, and service designer at the Government Digital Service, Harry Vos, tells us why he thinks you should all come to this year’s Service Design Fringe Festival.

  1. It’s less samey. The festival spans from vulnerable users of financial services to the future of love. It’s not just talks, but a series of workshops, panels, and a speed recruitment event to help you extend your network. We’re asking how inclusive our industry is, and how inclusive are the services we’re designing? We’re exploring the fringes of the industry, because service design is no longer fringe, and these conversations need a bigger platform.

  2. You can come for free. We have some free tickets, as well as donation tickets. We want to reduce barriers to coming. The festival is volunteer-run and receives some financial help from our partners. The money we get from donations goes towards the hire of the venue, and to pay volunteers expenses.

  3. Everyone is welcome. All venues are fully accessible to wheelchair users. We are hoping to get sponsorship for some sign language interpreters and/or subtitling of the events we film (get in touch if you can help!).

  4. You’ll meet lots of passionate people who we want to inspire you. Our strength has always been the atmosphere in the community we’re lucky to have. This year, we are looking to broaden the community, reaching out to people we feel are under-represented in the service design industry, looking to bring greater diversity to conversations about inclusive services. We are trying to make everyone feel safe and included through our Code of Conduct.

  5. We welcome people from all sectors. We think we have something for everyone, covering business, startups, healthcare, government, 3rd sector, media, and academia. If we missed you out, please let us know!

  6. We’re gonna have a party! At an LGBT+ theatre. Yes, on a Thursday.

Industry Issues - the short version write up | A Festival Story by Sam Richards

Industry Issues - the short version write up | A Festival Story by Sam Richards

Industry Issues, 17 September, Katie Baggs and Chris French

This was the first session of the festival and the organisers, Katie and Chris, drew in a big and varied crowd of designers, creatives, and students.

The room mapped out all of the challenges facing the service design industry but the focus was largely around one burning issue: why is service design so misunderstood? How best can we describe it and, importantly, how can we get senior leaders to understand its value?

 Diversity and Inclusion in Service Design Write Up | A Festival Story by Sam Richards

 Diversity and Inclusion in Service Design Write Up | A Festival Story by Sam Richards

Julian led a thought provoking workshop on the first Sunday afternoon of the festival with a discussion about diversity and inclusion in the service design industry.

The group began the session by discussing what diversity means to them and exploring the difference between diversity and inclusion. We discussed culture, background and values. We also shared our thoughts and experiences of diversity (or a lack thereof) in the workplace and why we think diversity matters in service design.

There was a lot of food for thought in this session but, in brief, here’s what I learnt:

The Craft of Service Design Write Up | A Festival Story by Sam Richards

The Craft of Service Design Write Up | A Festival Story by Sam Richards

Sam Richards is a programme development officer and illustrator based in London. She attended and helped out at three workshops at this year’s Service Design Fringe Festival. Here, she shares her thoughts on the The Craft of Service Design, held on 21 September and run by LCC.