Human Centered Design is appealing and yet, as so often, we’ve over-complicated it to a point of being ineffective.
We humanitarians are always looking for an innovative methodology or approach that can enable us to better serve people in need. Of course we are.
Human Centered Design, coming out of the exciting world of design (think Apple; IDEO) promises to develop solutions with communities, to enable them to lead in the design process, to enable us to fulfill the promise of localization through iterative, community-led design.
Unfortunately, the ‘customer’ is not always right (as Apple knows). It takes a lot of expertise and work to develop solutions. Why should we put that burden on the people we are there to serve?
And, it tends to forget that our work—what we are meant to do—is dirt simple. The contexts in which we work are crazy dynamic and difficult but what people need in crisis is pretty clear.
So, can Human Centered Design enable us to meet these needs a bit better or faster?
Human Centered Design (HCD) is a way to engage with and learn from potential users of products or services in ways that can create innovation through iterative development. In brief, people are invited to ‘play’ with different designs and concepts, quickly assessing what works and what doesn’t, until the most compelling design is achieved. Opportunities exist in the process to gain a much deeper understanding of peoples’ preferences so that products can be created that are physically, perceptually, cognitively, and emotionally intuitive.[1] This can lead to products that are seen as not simply desirable but essential. This has been especially prevalent in commercial product design where it became apparent that demand could be created through products that tapped into basic psychological reactions and needs.
Putting people at the center of our work is important. We recognize that dignified and rights-based approaches are not only the right way to work but also key to effectiveness. Yet, we have been flailing around looking for new ways to engage with affected populations that go beyond simple feedback mechanisms. We need to avoid the latest fad and look at precedents more aligned with our work.
The medical field is a useful antecedent. Patient-centered care transformed the medical field in the 1980s and 1990s.[2] It put the patient’s experience, beyond the examination room, front and center, not only because it would make the patient feel more dignified and respected, although that was a happy by-product (and worked against the Foucauldian sense of the power dynamics with doctors), but because the patient had useful information for diagnosis. As stated in a 2011 article on the subject:
“The originators of client-centered and patient-centered health care were well aware of the moral implications of their work, which was based on deep respect for patients as unique living beings, and the obligation to care for them on their terms. Thus, patients are known as persons in context of their own social worlds, listened to, informed, respected, and involved in their care—and their wishes are honored (but not mindlessly enacted) during their health care journey. There have been concerns that patient-centered care, with its focus on individual needs, might be at odds with an evidence-based approach, which tends to focus on populations. Fortunately, that debate has been laid to rest; proponents of evidence-based medicine now accept that a good outcome must be defined in terms of what is meaningful and valuable to the individual patient. Patient-centered care, as does evidence-based medicine, considers both the art of generalizations and the science of particulars.”[3]
So, patient centered care, putting the people we are there to serve at the center of our work is bound to not only be more respectful and dignified but it should also reveal important insights that make our work more effective. Yet, in the medical field that simply entailed getting doctors to get off their perch and actually talk with patients, to ask them about their lifestyle and needs, their medical history, and then to lay out the options for treatment and then engages in a somewhat informed discussion of what they want to do. The doctor then makes sure they are available for any follow-up or questions.
There is a lot in this in the moment, in the actual engagement and conversation, making sure we are creating enough space for the person to be comfortable enough to respond to what can be highly sensitive questions. Yet, the process—ask about needs and lifestyle; history; options and choices for action; substantive follow-up—is pretty straight forward.
Yet, we spend gobs of time complicating our work.
IDEO, a leading design firm, was an early HCD pioneer and has developed a training programme for development and humanitarian professionals.[4] The UK has worked with IDEO in using HCD for early stage-solutions to products and services across their humanitarian portfolio.[5] Other donors are also investing in HCD approaches. USAID has partnered with Dalberg Consulting to support HCD approaches in health programs globally.[6] UNICEF has created a field guide for HCD in creating demand for health services as well.[7]
The problem, as so often in our work, is that these guidelines and tools are so detailed and so prescriptive that they lose the essence of what makes HCD effective. For instance, the UNICEF guide includes over 25 complicated steps.[8] A programme we assessed for healthcare in Somalia had an entire ‘journey’ detailed that was taking over a year to develop a final prototype.
This misses HCD’s driving principles. Work fast and be nimble. This entire process should be completed in a short amount of time. It relies on quick trials and tests to move forward with confidence. Fail quickly, and then move on, is key to all of this.
[1] Joseph Giacomin; “What Is Human Centred Design?” The Design Journal, 2014; 17:4.
[2] For an early study on the subject, see: McWhinney I.R. “Patient-centred and Doctor-centred Models of Clinical Decision-making.” In: Sheldon M., Brooke J., Rector A. (eds) Decision-Making in General Practice. Palgrave, London; 1985. Of course, the notion of patient-centred care goes back even further. See: E. Balint; “The possibilities of patient-centred medicine.” The Journal of the Royal College of General Practitioners. Vol 17 (1969); pp. 269-276.
[3] Ronald M. Epstein and Richard L. Street; “The Values and Value of Patient-Centered Care.” Annals of Family Medicine; March – April 2011, Vol. 9, No. 2, page 100.
[4] Visit the IDEO website for more information, https://www.ideo.org/approach
[5] This is part of the AMPLIFY programme. Please see: https://www.ideo.org/programs/amplify
[6] See: http://www.engagehcd.com/
[7] UNICEF has an internet based ‘field guide; for using HCD in relation to demand creation for health services See: http://hcd4i.org/
[8] “Demand for Health Services Field Guide: A Human-Centred Approach.” UNICEF; 2018. Page 10.
