10 Nov The Elephant In The Design Process
Post Written By Josina Vink
There is so much hype around transformation in health care. Yet, I see few examples of radical innovation and fundamental disruptions to the status quo. That’s not because ideas aren’t being dreamed up. I think it’s because there is something getting in the way. There is an elephant in the design process that not enough people are talking about.
That elephant is POWER. Power informs our identities, guides our actions, and defines our relationships. It also constrains or enables innovation and transformation.
In the design process, power shows up when you’re in the middle of a design workshop and someone’s ideas are worth more than others. Power shows up when you decide who should participate in the process and where activities will take place. Power shows up when you go to implement a new idea and the ‘right’ people are not interested. Power shows up when there are subtle and overt instances of racism, sexism, heterosexism and all the other isms as we work.
Until the many sources of power are thoughtfully considered and incorporated into the design process, we can say good-bye to our hopes for transformation. It’s our lack of awareness about power and the current distribution of it that maintains the current state and holds back significant improvements to health outcomes.
I see hope for transformation in the concept of People Powered Health, but not the watered down version. At the core of People Powered Heath is a redistribution of power within communities and systems to enable co-creation. This is a big shift from the often paternalistic, consumption-based services that we see in health care today. It is not only about meeting needs or solving problems, but about building on people’s assets, supporting connection and helping communities thrive. When we assume that people should only get health services when they have a need they can’t met themselves, we remove 95% of the possibility for enhancing well-being at the individual and collective level.
People Powered Health starts with people rather than institutions. While most design approaches talk about being human-centred, People Powered Health goes further. Most current service design practices are constrained by the institutional assumption (see John McKnight’s video). This means that we assume the solution lies within an existing institution or that the problem should be solved by a change or addition to a current service or organization. We don’t stay and design where the issue and opportunity is – within the community.
People Powered Health is also about equity and engagement. Until we understand and measure these concepts, we can’t pretend we are getting close to people powered anything. First off, equity is different than equality, folks. It’s not about equal opportunity, but about leveling the playing field and removing systemic barriers. Also, meaningful engagement is more than having a seat at the table or participation in the design or delivery process. Engagement can be tokenistic. We can engage people as informants or we can engage them as partners. There is a spectrum with different levels of engagement. Until we measure and dialogue about everyone’s experience of being engaged, we can’t say we are really collaborating. For more on health equity and meaningful engagement, check out CAMH’s DIY Health Equity Kit.
People Powered Health relies on the inherent value of relationships rather than infrastructure. It acknowledges that all of us need each other. We can’t have health without interaction and exchange of service and support. Social isolation is one of the most influential determinants of health, yet it is all too often ignored. Studies have shown that relationships enhance both quality and quantity of life (see Putnam’s work on social capital). All too often our current models of health services disconnect people from their networks and miss opportunities for peer connection that would add so much value. Check out Participle’s overview of relational welfare for further inspiration.
There is no doubt that People Powered Health requires a shift in power. But there is another problem. These shifts in power are not just for the ‘subjects’ of the design process, but also for participants, designers and innovators leading the process. A real shift requires that everyone reflect on their own power and privilege. It also challenges the expert designer to shift from the role of solution builder, where they are designing for people, to platform builder, where they are enabling people to design for themselves. Check out Sanders and Stappers vision of design in 2044 for more on ‘design by the people’. We need to significantly change our approach and build in reflection on power throughout the process. Peer Positive’s Critical Reflective Practice cards are an example of one tool that could be used to support ongoing reflection.
To work toward transformation and enable co-creation, let’s start reflecting on power, measuring aspects of how it is showing up in our process, having conversations about it, and designing platforms that level the playing field. It’s then and only then that we will unleash the transformative potential of people and realize People Powered Health.