Thinking About Life, Death and Design at Transform 2010

More than anything, the recent two-day symposium at Mayo Clinic – “Transform 2010—Thinking Differently about Health Care” – got me reflecting about how we make moral decisions as human beings.

This question was to me the sparkling golden thread running through the symposium’s 42 brilliant presentations offered by clinicians, surgeons, nurses, computer programmers, human rights activists, inventors, social workers and many others who brought their mighty passion for healing to bear on a single stubborn problem – the conundrum of human suffering.

Some speakers showed electronic devices they’d invented to increase health and decrease disease – pill bottles that play music reminding their owners to open them, or desks that double as treadmills to give office workers exercise. Others of a technical bent had written software programs to synthesize tons of health data into useful, attractive screen displays.

Other speakers looked more to the soft side of the human equation, seeing solutions to suffering in practices that bring human kindness, humor and wisdom to bear directly on disease. A nurse has started a clinic where patients weigh themselves, take their own blood pressure, and record their own medical histories. A clown-doctor in baggy pants told how he cries and laughs with his patients in the face of sickness and death.

Morality is how we make the big decisions in life – how we live in ways that decrease the harm we do to ourselves and to others; and how we regulate our thoughts, our speech and our actions to maximize happiness and health.

How many types of solutions to these problems were on display!

At Mayo Clinic’s Center for Innovation and other innovation centers in the U.S., “design-thinking,” a creativity discipline used by many successful companies, is one of the guiding intellectual frameworks. As used by creative designers, it powerfully taps creativity in institutions that might otherwise tend towards repetitive operational dullness. Design thinking’s focus on teamwork and collaboration also generates a powerful counterforce to the silo-thinking that can stifle creativity in large organizations.

As I watched the symposium’s presentations – designers very proudly and rightfully displaying their buildings, spaces, products and services that without the slightest doubt improved what they replaced – I thought also of the overall failure, so far, of any person or system to bring American health care back to earth in terms of cost, size, and indeed, simple humanity.

It made me wonder if perhaps design thinking itself – writ broadly, even beyond the few “design thinking” gurus to encompass most overarching design theories -- could use a partner, a comrade in arms, a complementary theoretical framework to enhance its own effectiveness. Especially, when the art of design is practiced to create not functional, aesthetic or consumer items, but in the very special, life-and-death case of health care design.

Because for all of its strengths, design thinking simply isn’t grounded in any systematic understanding of moral decision-making – i.e., in a scientifically-validated theory of how humans reach moral decisions. And yet, moral decision-making is the very quintessence of good medical practice.

Lorna Ross, the creative lead of Mayo’s Center for Innovation, winked broadly at the wider practical and ethical issues of this question in her conversation with Tuesday morning panel moderator Lew McCreary:

“Design in health care is so incredibly human,” Ross said. “Health care is so personal and it’s not very generalizable. Being able to represent that at a granular level is important. We always try to bring the conversation down to the individual.”

But if health care solutions to highly personal, localized problems are not easily scalable – i.e., subject to merchandising beyond their original markets – how are they ever going to succeed in a market economy?

Economics aside, if the solutions to health care problems as they arise in specific contexts and cultures are hard to translate to other cultures and locales, what hope is there for global good health to eventually arise?

This may be exactly where a disruptive, revolutionary, “new way of thinking about health care” must be firmly and consistently applied. Because if highly local solutions are usually the best ones in health care, and yet are not easily scalable, it would be absolute folly to keep trying to make them so.

So instead of focusing on final products, how about looking at the very process that produced them as the scaleable thing? If the process and not the product was then reproduced on a mass scale, local populations everywhere could adopt them and start producing their own localized best solutions.

And what would that scalable process look like? To me, it would look a lot like design thinking with its creativity-spurring, teamwork-encouraging practices. Yet it would complement that powerful method with principles grounded in practical, skilful moral thinking – again, the one critical area, although it is the essence of medical practice, design thinking largely lacks.

These complementary moral principles to design thinking would in turn need to be grounded not in religion, the traditional foundation of moral thought, because that would automatically limit their global reach and effectiveness. And, create much unnecessary clamor, friction and heat.

Rather, these would have to be moral principles firmly grounded in findings reached by the universal, objective methods of science.

I have a candidate to offer, which I’ll do in a later post.

This post was written by Doug McGill.