Playful and Messy

Christine Richter and Chris McCarthy being playful and messy. 😉
Christine Richter and I just finished presenting a very special WebEx on KP’s innovative nurse shift change called Nurse Knowledge Exchange Plus (NKEplus). The format of the WebEx was a new feature of the Innovation Learning Network to help diffuse innovation across systems. This blog post is not about that, but about one question that really caught my attention:

“what special skills does your group bring to implementation? Meaning what would we be missing if we tried to implement without you?”

The answer is “being playful and messy”. Too often when implementing new stuff, the “serious factor” rises exponentially. There is pervading sense that all must go right and tolerance for the imperfection plummets. And this is exactly what we combat when we implement new ideas. We try to help the end user and management take on a playful and messy attitude. Get them to smile, laugh and stumble….laugh again, and get it a little more right. Official permission for playfulness goes a long way: stress is reduced, and users become more perfect, faster.
So give it at try. You will be amazed at the serious results from being truly playful.

(and smile).

For those of you interested in implementing NKEplus you can signup and get more info here:

Don’t Forget the Humans

Last fall, my partner in crime, Christi Zuber and I had the opportunity to present on why we think human-centered design is so important…and so huge for healthcare. In an amazing event designed by Adaptive Path, UX Week took many of us on a journey of exploration, from comics to starships and behavior to dancing. I loved that the organizers made the week theme-less; instead they focused on bringing together cool, inspiring stuff.

Since the conference I’ve received several emails sharing that the video was an excellent “intro to HCD” for their organization. Although it was certainly not designed for that purpose I am thrilled it is finding a second life.

In any case, here is the video in its entirety…thanks to the folks at Adaptive Path (and you can get the Transcripts here).

Innovator’s Insights

For this week’s blog I want to simply share the Innovation Learning Network’s Annual Insights. Each year the ILN packages up the coolest techniques, workshops, explorations and ponderings to share with the public. It’s the culmination of a year’s worth of mixing 20 healthcare organizations, foundations and design firms.

This year you will find:

• Storytelling with Gravitytank
• Deep Listening for Ethnography with PointForward
• Dozens of promising innovations and prototypes from California HealthCare Foundation, Kaiser Permanente, the US Department of Veterans Affairs, Via Christi Health, and many more

I invite you to grab a glass of wine….and get inspired!

Download your free copy here:

Order your not-free hardcopy here:

I Heart Guardrails


What am I working on? Or what is the design challenge? For the uninitiated these may seem like silly questions. But rarely is a design challenge crystal clear. More often than not, it’s murky at best. It is the role of the designer to clarify, and point the way to opportunities where there didn’t seem any before. And the final phrasing of the design challenge is perhaps one of the most important elements especially if you are co-designing (more on that in another posting). Take for example a recent challenge that I was asked to pose for the Service Design Network Drinks night. My friend Jamin Hegeman hosts this informal monthly gathering. He asked if I could bring a healthcare challenge to the group.

The challenge I brought was one recently posed by the Innovation Learning Network, “non-healthcare provided healthcare”. We gave a few personas to help focus the drinkers, but did not provide much more guidance. From my sequestered healthcare life the challenge seemed obvious. However the group used the challenge to launch into all sorts of crazy and exciting areas from senior adventure tours and dementia television to church-based care and tech-enabled homes. All incredible stuff, however I was looking for their exploration of “off loading” the healthcare basic from the current healthcare system to non-healthcare systems. And THAT was the guardrail I did not provide.

The guard rail is the design constraint. Although called a constraint, I tend to see them as liberating. They reduce the universe to a galaxy to a star system of ideas. Most business leaders don’t want a universe of solutions, but something closer to the realm of the problem. It’s a delicate balance though. Too many guardrails and you will end up with known mediocrity. Too few and you won’t solve the problem. Guard rails need to be as carefully vetted as the design challenge itself.

So if I could do it again?

“How might we offload some of the basics of healthcare such as the basic office visit to non-healthcare industries?”

Of course the senior adventure travels might have not been born.

An Innovation Team Looks Like….

“I’m starting to build my innovation team, and I’m trying to figure out what type of roles that should be on it?”

“What characteristics do you look for when building a design team?”

“What type of degrees do I hire to ensure innovation success?”

I hear these questions monthly; both from business leaders from around the world and from myself. Clearly there is no right answer, except for one “It depends.” There are all kinds of innovation and design teams tackling all kinds of problems. If you are creating a team that embodies human-centered design, there are a few fundamentals that I’ve stumbled on.

My good friend, Michael Winnick of Gravitytank, looks for versatility and attitude. Versatility in my world translates to the “Jack of trades”; that guy or gal who can do it all, and wants to. The “and wants to” of course is attitude; that person who is deeply curious…so curious that they follow odd strings, pick up strange assignments, but equally execute more mundane tasks. Innovation teams need people who ride the rollercoaster from the 1 foot view all the way up to the 50,000 foot view and back down again. Versatility and attitude are must haves.

We also look for folks who are:

• Energetic
• Smart
• Creative
• Quick
• Humorous
• Diverse

This seems to an optimal combination. Innovation teams work a LOT of hours together. There is not much alone time and having folks that are energetic and smart but are quick to laugh, and don’t mind looking occasionally silly creates that special team “chi”.

Over and over again, we have come to the conclusion that design teams are not only about skills, but also deeply about people. Success is equally attributed to the people and their personalities as well as their ability to deliver.

Hello Soup!

“Hello!” we called out in Vietnamese biking through the countryside. Over and over again….shop owners would wave, children would giggle and shout back. And many would have a good belly laugh at the foreigners peddling through their town. As least that is what we thought. Turns out that we weren’t cheerfully greeting folks with “hello!”, we were screaming out “soup!”. Typed out in English the difference is so clear; now take a look in Vietnamese:

Chào = hello
Cháo = soup

A simple nuance in the stress of the word completely changes its meaning. And nuance is what makes ethnography so compelling and rich. Ethnography is where good designers and design thinkers kick off innovation projects. It is intensive and often takes several weeks to complete a cycle. As the ethnographer begins his/her work, often the observations and interviews seem more similar than different; however over time nuance become more and more pronounced. And a more complete understanding of the system emerges….as do innovation opportunities.

Putting together an innovation project plan, sponsor and project managers will often consider streamlining the ethnography/observation phase. “It seem so long! Do we really need 6 weeks for that? Can’t we do it 2 weeks?” It is certainly tempting, but my experience is that thoughtful ethnography yields the clearest design paths, and thoughtful ethnography takes time. So plan your time well…thoughtfully…and enjoy teasing out the nuance puzzles. It’s the difference between hello and soup.

The Rise of Service Design

This title is a rip off of a panel I was on a month ago hosted by AIGA-SF; and seriously I could not think of a better title. All indicators are indeed pointing to its rise. It seems every design firm is retooling to offer it, entire consultancies are built around it, and everyone is talking about it. And this is a very good thing. “It” has been around for a long time, but most of us never knew what to call it. Its rise is giving it a name, language, tools and methods. It is even giving us jobs…and dare I say a culture?!

Friday I got to swirl in this world with some of the best and brightest in the field at the Service Design Network conference in Cambridge. It was amazing day that started out with Oliver King (Engine Service Design) who led us through some of the fundamentals. It was one of the talks where you have several mind bending “aha! Yeah that’s what I’ve been thinking!!” and concluded with Mark Jones from IDEO who gave us a compelling understanding of what attracts us to this “hairy” line of work.

Here are a few sources of service design knowledge:
Service Design Network
Hugh Dubberly
Service Design Tools
Shelly Evenson

Where do you think service design is taking us? What are your sources, tools or techniques?

I Kept My Pregnant Teenager Home

A (Very) Low Fidelity Pharmacy
I had the incredible opportunity last week to participate in a poverty immersion. With so many uninsured and underinsured getting ready to enter the healthcare world in just a few years, the simulation was a chance for those providing healthcare to gain a better sense of their lives. It by no means could ever replicate it, but I was surprised at the choices I made and the feelings that emerged. The immersion started with me as a dad in a family of four. I was laid off for months without health insurance, with a full-time working wife, a seventeen year old pregnant daughter, and an eight year old son. The object was to get through four 15-minute periods each representing a week with as much of my family needs met as possible. Suffice to say, I chose to keep my 17 year old daughter home for one week to watch my suspended 8 year old, so that I could go to social services to get food stamps.

Everyone who participated shared similar thoughts…mostly amazement at the choices we were forced to make, and how complicated the safety net was. It built a whole lot of sympathy, and more importantly got the room thinking on how services might be more seamless, timely and precise. And that is what a good simulation should do.

Simulations can hard to pull off. This one provided three nuggets on how to make them better:

  • Don’t over simplify. We as designers and facilitators often try to make the experience as easy as possible. Why?!? Life is complex and we’re dealing with smart people. They’ll figured it out.
  • Allow sufficient time. I groaned at hearing the simulation was 2 hours long. TWO HOURS. Well, that turned out to be the right amount of time. Two hours, allowed the participants to not only get into role, but be the role….for a long time. About a third of the way through I stopped being me and was really worried about my simulated family. It also allowed me to start optimizing my life because I was in the simulation long enough.
  • Low fidelity works. This was a great reminder just how low we can go. For a pharmacy, there was only a piece a paper with “pharmacy” written on it. For a bank, “bank”. Simple, but such powerful associations that nothing more was needed. Why waste on time on tasks that our brains are so powerful at doing for us.

What are your nuggets?

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