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from elsewhere: Barbara Armstrong on design thinking

Writing on, Kahler Slater’s Barbara Armstrong posted: It’s Time To Bring Design Thinking Down From On High

I love this post. Armstrong references Tim Brown’s TED talk on design thinking.


…design thinking is a process of integrative thinking, a process rooted in the ability to examine and exploit opposing ideas and constraints to create solutions. Design thinking, says [IDEO’s Tim] Brown, “moves the design process from consumption to participation.”

…the design-thinking process has three primary attributes: it is human centered; it is collaborative and participatory; and it is driven by experimentation. And the process begins with a single query: “What is the question that we are trying to answer?” As Brown says, “Rather than thinking to build, build to think.”

Armstrong, a veteran healthcare experience and space designer, doesn’t pull any punches when she digs into healthcare.

In today’s health care industry, there is a push for evidence-based design, a human-centered approach to design aimed at increasing the quality of patient care while simultaneously decreasing costs.

Too bad healthcare leaders had to be in crisis before they put people at the center of their problem solving. So do it now at your company. Proactively, you can drive innovative business solutions with broad, human appeal.

What I love about design thinking, particularly for healthcare, is its emphasis on empathy, participation and rapid prototyping; three concepts which have a great affinity with healthcare. For instance, I’ve never seen a hospital mission which doesn’t include some variant of empathy - compassion, caring, healing, etc.

We’re also speaking more — at least starting to speak —about participation. Ideas like shared decision-making and participatory medicine.

And, clinicians are fundamentally trained in testing ideas. Its how new techniques are developed and new treatments come to market.

But, for some reason, the business side - the systems, resources, policies, and leaders —have been slow to smash the these things together. If Reese’s were a healthcare company, no one would ever get peanut better in someone else’s chocolate.

Design thinking is about bringing those core tenants of healthcare together —empathy, participation and prototyping— to surface meaningful, desirable solutions to challenges.

In healthcare we seem value having answers. People who have answers are smart, they are sharp, and they are going places. We even pay prophets from other lands big bucks to come tell us answers.

Fundamental to the process is the belief that solutions to challenges can be uncovered by a team. That’s another reason I love design thinking in healthcare.

In design thinking, we is more important than I. Value is found in asking teams —including front line employees, for ideas, not answers. There is excitement around building on each others ideas. There is a willingness to test the ideas we co-develop and find out what actually makes someone’s life better. None of that is about being the person with an answer.

Here’s Tim Brown’s TED talk:

From Elsewhere: The Bossless Office

Bossless Office (Photo: Illustration by Marc Boutavant)

…“Management is a term to me that feels very twentieth century, … That 100-year chunk of time when the world was very industrialized, and a company would make something that could be stamped out 10 million times and figured out a way to ship it easily, you needed the hierarchy for that. I think this century is more about building intelligent teams.”

—Simon Anderson, CEO of DreamHost

One of my biggest concerns about the future of healthcare is the industry’s attractiveness to bright young people. Let’s face it, unless you are doig cutting edge clinical work, there’s not a lot in healthcare which compares to Google’s sushi bars, segways and wifi-blanketed busses.

The hospital workplace is still one of the most conservative environments in corporate america. Dark suits, wood paneled board rooms and hierarchy are the norms. I haven’t spoken to many college-aged young adults who are anxious to flock to that kind of workplace.

Enter the Bossless Office. A feature this week in New York Magazine looks at an emerging trend in management, or the lack of it.

There’s a lot to like about this idea and its application to the healthcare environment. Could it help entice more of the start-up, rapid pace, rapid reward crowd? I think so.

This structure—largely flat and very flexible—is especially appealing to those new to the workforce, twenty-somethings who tend to approach work differently from their parents. “The way workers are motivated is changing,” says Anderson of DreamHost. “Twenty years ago, it was about higher pay. Now it’s more about finding your work meaningful and interesting.” As more and more millennials enter positions of power in the business world, Anderson believes we will soon reach a point where hierarchy itself is “passé.”

We are all hardwired for empathy

Oh, they're just not cut out for a service job... You've heard someone describe someone else like that haven't you? It's what we say about someone who comes off grouchy, or unpleasant, particularly in a role dealing with customers. Maybe its a phrase like: some people have it, and some don't... or the way hiring managers word it: we hire for customer service talent. The gist of phrases like like these is that customer service is a skill some people have and other's are incapable of.

I've been mentally wrestling with that question myself. I'll take it a step further. I believe the root of customer service is a combination of empathy and ability to act on empathetic feelings. I often wonde if some people are empathetic and others aren't. Why is one nurse willing to go the extra mile and other thinks the call bell is a bother? You know the old joke about restaurants? This would be a great place to work if it weren't for the customers. Not exactly an empathetic feeling is it?

But, some people really seem to feel that way, like customers are actually an annoyance. So, are they born that way, or is there more to it?

I had a great, inspring conversation this week with someone knows a lot more about this stuff than I do. She turned me on to a video from RSA Animate - The Empathic Civilisation. It's a visually compelling look at a researcher's thoughts about empathy.

The narrator suggests we are, in fact, all born with a biological wiring towards empathy. He goes on to say empathy is what makes us special and may even be what will save civilization as we know it. I know, right? Big stuff!

I'm inclined to agree. And, if we're all hardwired for empathy, what does that say about those people we label as grouches? Maybe it has more to the with organizational culture - that's the second half of my equation: the ability to act on empathetic feelings.

Organizations, leaders and culture have to empower employees to act on their empathetic feelings towards others. The have to make room for customer service to happen. When we try to script or pigeonhole people's service presentation, it's no wonder some people react with negative attitude.


RSA Animate - The Empathic Civilisation - YouTube.

beach music or olive oil - inside out thinking from one of my favorite restaurants

"we taste 'em, the olive oils, usually three different ways - cold off a spoon, on a salad and then warmed, you know, not hot, but with a little tomato sauce... I'm still looking for the right one" "well, this is my second job and I haven't really tried the food. I hear the fish tacos are good."

You have a choice, pick a restaurant based off of those two quotes. Don't have enough info? One is a multi-million dollar investment, the other is a more modest joint. Still undecided? Ok, last clue, one has a tiki bar over looking the river and the other doesn't take most credit cards or reservations.

Last night Susan and I had an awesome date night. We kicked it off at the Virginia Museum which is winding down its Picasso exhibit. The collection is on loan from the Musée national Picasso in Paris. We had a great time exploring the same collection we had gotten to know well while living in Paris in a new but familiar space. Ironically, I lived across, like seriously front door to front door, from the Va Museum for two years and we almost never went. Since moving down the road we are going a lot more.

But back to the food. So after hanging with Pablo, we went to Mamma'Zu. We had the most amazing meal which wasn't a surprise to us, we've been there many times before. We had fresh ramps - a seasonal delicacy kind of like a wild leek. We devoured a bright green fava been puree. The courses went on and on, many off the menu. We were in foodie heaven. Why do we go back time and time again? Because its all about the food!

If Top Chef's Restaurant Wars has taught us anything its that the front of the house and ambiance matters, right? Some health care guy with a blog wrote about a hoity-toity dining experience in New York where the service, as much as the food, made the experience. Holistically, clearly the two go hand-in-hand.

Mamma'Zu is a little different. It is a bit like this place in Germany which blindfolds diners to heighten the food experience. When ambiance is removed, you focus solely on the food. Mamma'Zu has no blind folds - the place is simply dark and different. This place is a Richmond institution (need a primer? check this post). The paint needs touching up. Most of the tables are wobbly, maybe because there are some floor tiles missing. It is also a bastion of inside out thinking.

It is one of my top three or four restaurants in the world. Here is what I've learned from Mamma'Zu:

Inside out in thinking restaurant owners think: "What is the best dish I can serve tonight? Is this best olive oil to use? Can I make enough of these to serve or would I have to sacrifice quality."

Outside in thinking restaurant owners think: "Can I fit the tiki bar AND a faux beach scene on this same wall? Will more people come for drink specials or food specials? How does that guy across town make those pizzas, I want something like that."

See the difference? The inside out thinkers have a core, a focus. In this case, we are talking about food. Sinek talks about Apple and tells us Apple is first a design company. Everything they do is about making better designs. Compair that to Microsoft, a company founded on selling software. When Microsoft launched the Zune MP3 player, its as if they thinking "we are known for global dominance in operating system software, I know, lets make MP3 payers to compete with Apple." That is outside in thinking. It is away from their core competency, what some people call the "why". In the case of the two Richmond area restaurants above, one chef/owner has a clear why, food. The best food; nothing else matters. The other place seems to be motivated off shtick. Their why is unclear. Are they going for a great tiki bar? If so, why serve bland fish tacos at all? In their case, the end result is that neither the ambiance nor the food comes off stellar.

Outside in thinking does not have to occur to the determent of everything else. A novelty restaurant can be a cool tiki bar and serve great food. An italian place like Mamma'Zu could focus on both atmosphere and food. The difference for inside out thinkers is resources. If focusing on something else means you lose quality and focus on your core, then its out. Outside in thinkers have no problem with detrimental compromise.

You've probably guessed it, I'm on this 'inside out thinking' kick. True. Consider it with me for a moment. Inside out thinkers start with a why, core, reason, mission...whatever. The end result is almost always focused. As consumers of that finished product, we can almost always trace it back to its roots. In a great restaurant we say "wow, they nailed in the kitchen today." With technology we say, "it just works."

Since my brain doesn't easily shift gears, and since most of these posts are about healthcare, we'll briefly explore the inside out theme in the healthcare construct. Healthcare leaders, both clinical and non-clinical, have the similar challenges to restaurant owners. Is it mediocre fish tacos with bad beach music or an almost obsessive focus on olive oil? Is it a fancy waiting room or is it spending that one critical extra minute more with a patient? The experience at Per Se taught me when the resources exist, one can build an infrastructure of service and experience to go along with a myopic focus on quality. Bridget Duffy tells us when we focus on that inside core belief, the rest (revenues, clinical outcomes, quality) will follow.

If you want to experience inside out thinking next time you are in Richmond, visit Mamma'Zu.