A New Kind of Med School

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Kicking off the first workshop on contextual inquiry at Jefferson’s new Accelerator Zone space

I recently had the pleasure to develop and lead two design workshops for first year medical school students at Thomas Jefferson University in Philadelphia at the invitation of Dr. Bon Ku, director of a new design co-curriculum in the medical school. The CwiC (College within a College) Design Track “seeks to foster creative thinking in medical students in order to assist them in developing novel and innovative approaches to challenges in healthcare delivery, research, and education.” This amibitious and visionary program will organize a series of design workshops, lectures, site visits, and capstone projects for a select group of students accepted into the program. This will be no small feat for the students to complete, given that this curriculum runs in addition to an already grueling schedule in the regular med school curriculum.

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Two medical students interviewing an attending physician in the ER

The first cohort of med students began the track in early February with a day-long design thinking introductory bootcamp led by David Janka, who is on faculty at Stanford’s d.school. After David gave the 15 students a crash course in the basics of design process, I then built on that foundation with two workshops focused on redesigning aspects of the patient experience in Jefferson University Hospital’s emergency department.

The first workshop helped them understand in more depth a suite of basic design research methods, and how these are so essential for understanding complex systems and services, and for building empathy with the people who are a part of them. With a set of contextual inquiry methods and tools in hand, the med students set off for the ER, shadowing physicians, nurses, other staff, and patients in different environments and processes. They returned to the following workshop with dozens of photos and pages of notes documenting what they saw and heard, as well as their initial interpretations.

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Students in the second workshop synthesizing their research data

With all of their raw documentation of the ER gathered, for the second workshop the med students began to make sense of the qualitative data through visualization techniques, affinity diagramming and stakeholder mapping. They created personas based on what they learned and who they had spoken to in their research, and then they used those personas to better understand the systems they were zeroing in on through user journey mapping. This helped them to identify a few pain points within the systems, which they then used to define a problem to address through rapid ideation and prototyping. Interestingly, many of the students had learned from patients about how frustrating waiting in the ER is (in various stages of the care process) and how uncommunicative the system is about wait times — not surprising for anyone who has visited the ER! What was so compelling was that each team of students had identified multiple and different underlying issues causing long waits and the associated frustrations. Each of their prototypes then attempted to either alleviate the symptoms of prolonged wait times, or tackle one of the root causes for wait times and poor communication.

These were very quick, albeit intense, experiences for the students, and they will continue to accumulate more of them over the coming semesters in the CwiC Design Track. The creators of the design curriculum believe that it will transform them as physicians and give them a new set of capabilities and mindsets rooted in design thinking, thus better equipping them to lead within an uncertain future for healthcare in this country. As an outsider looking in, I am impressed with how fearless and passionate the 15 med students are for embracing the design process. It’s exciting to be a part of such an important shift in how future doctors are trained.

Boundary Objects and Social Design

Boundary object from the project In a state far from equilibrium

Boundary object from the project In a state far from equilibrium

Below I share a proposal for a design research project that I am beginning in earnest this spring. The goal of this project is to research and define the concept of the ‘boundary object’, and then use a nuanced understanding of this framework to prototype new co-design tools for application toward complex social and organizational design problems.

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The boundaries and scope of problems addressed by designers has continued to expand over the last half century. Designers increasingly have applied their creative problem solving methods and “design thinking” process to issues beyond the realm of more conventional products and visual communication to encompass non-traditional design problems concerned with processes, systems, services, strategies, and culture. Even more recently, a finer distinction has been suggested by those designers who primarily take on complex social entities, relationships, and systems as a problem space in which to work; call it social design, design for social impact, or transformation design, to name a few of the new designations.

In this contemporary social context, designers require more developed skills of emotional intelligence and organizational adeptness along with appropriate tools focused on facilitation and collaboration with a variety of different stakeholders, most of whom are non-designers. This co-creative, participatory design approach is now often referred to as co-design, and it depends upon an open, invitational ethos that privileges the inclusion of various stakeholders throughout every step of the process, from the earliest stages of design research through rough prototyping to testing and evaluation of design proposals and outputs.

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Within these expanded contexts for design and while using a process that is highly social and collaborative, designers have come to rely on design tools to support any number of activities at any stage of the design process where different stakeholders are asked to participate. While it is conceivable that nearly any physical thing might be such a design tool, the utility of the tool is judged by the degree to which it can make visible aspects of the design process to its participants and create clear pathways for designers and non-designers to share knowledge, build trust, and learn from each other to meet the stated goals of a given design project. In light of this, a design tool might be a matrix of key questions about a routine service experience onto which participants place a set of predetermined cards with different qualities, or it might be a large format map of a neighborhood on which residents identify important assets, issues, or locations. (See examples at the end of this document.)

In my own design practice and teaching, I create tools that are highly visual and physical in nature (and public) which activate participants in an embodied mode of thinking and learning. And while the data and insights obtained from such tools are genuinely valuable to a purposive design project, these social tools often reveal their greatest value as frameworks for conversation and building shared understanding.

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A few years ago while teaching a graduate design studio, I discovered a body of research from the fields of information sciences and sociology describing boundary objects. Essentially, a boundary object is a means of translation existing at the intersection of multiple social worlds (communities of practice) and may include such things as documents and models, common languages, and shared routines and processes. As a more concrete example, consider the role that a set of architectural drawings plays in facilitating the collaboration of a range of stakeholders in the construction of a building: designers, engineers, builders, building inspectors, local zoning boards, and so on.

Boundary objects are objects which are both plastic enough to adapt to local needs and the constraints of the several parties employing them, yet robust enough to maintain a common identity across sites. They are weakly structured in common use, and become strongly structured in individual-site use. These objects may be abstract or concrete. They have different meanings in different social worlds but their structure is common enough to more than one world to make them recognizable, a means of translation. (Star and Griesemer 393)

Clearly, for me there was a strong connection between boundary objects and the types of design tools I and my students were creating to facilitate the most social aspects of our collaborative work with many diverse participants. The terminology quickly become a part of the culture within Design for Social Impact (at that time MID), most notably for its descriptive power and expediency: our social design tools are objects that operate at the boundaries of different individuals and social groups and serve to build shared understanding across those potential divides.

While the terminology has been useful and added a needed dimension to the development of design tools in my work and the work of the graduate students, I do believe that a deeper dive into the original body of research is needed for two primary reasons. First, there are a number of subtleties within that scholarship that are ill understood by designers (myself included) and are specific to their originating fields. These nuances must be better marked and then translated for application by designers. Second, the utility of the concept of boundary objects for design is very exciting, yet the articulation of the framework needs to be more formally adapted and defined within the context of design. This application of boundary objects will need to retain the initial outlines of the concept but augmented with a more detailed explication of how it functions within a collaborative design process.

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The ultimate goal of this research on boundary objects and its formulation within a design context is to prototype new co-design tools for application toward complex social and organizational design problems. I believe that there is value in adapting the boundary object framework because it will lead to a more rigorous theorization of the particular elements of these design tools including the structure of how multiple stakeholders from often very different social groups interact, share knowledge, and participate meaningfully in social impact and organizational change initiatives.

In order to accomplish the project goals, I will build upon existing partnerships with practitioners working in the fields of organizational development (OD) and community-based social change work. Within the Design for Social Impact graduate program, I have partnered with organizational development consultants to provide more focused instruction for students on leadership and facilitation, emotional intelligence, and organizational cultural change. In conversations with them, we have identified key areas of overlap between social design and OD, and I have developed relationships with several willing partners who are interested in co-developing and testing design tools in support of organizational change initiatives.

The goal is to work with OD practitioners to iterate bespoke design tools as boundary objects, evaluate their effectiveness, and develop a set of case studies for sharing the efficacy of this framework. I will then translate documentation of this body of research and case studies into formats suitable for publication and presentation within various design, organizational development, and social innovation forums, as well as on this blog.

References:

Buchanan, Richard. “Wicked Problems in Design Thinking.” Design Issues 8.2 (1992): 5-21.

Cottam, Hillary et al. RED Paper 02: Transformation Design. UK Design Council, 2006.

Margolin, Victor. “Expansion or Sustainability: Two models of development.” The Politics of the Artificial: Essays on Design and Design Studies. Chicago: University of Chicago Press, 2002. 78-91.

Sanders, Elizabeth B.-N. and Pieter Jan Stappers. “Co-creation and the new landscapes of design.” CoDesign: International Journal of CoCreation in Design and the Arts, Volume 4, Issue 1 (2008).

Star, Susan Leigh. “This is Not a Boundary Object: Reflections on the Origin of a Concept.” Science, Technology, & Human Values 35.5 (2010): 601-617.

Star, Susan Leigh and James R. Griesemer. “Institutional Ecology, `Translations’ and Boundary Objects: Amateurs and Professionals in Berkeley’s Museum of Vertebrate Zoology, 1907-39.” Social Studies of Science Vol. 19 (1989): 387-420.

My Lost Art of Writing Electronic Mail

I was not an early adopter of email, or internet browsing in general. Like a lot of people of my generation — those of us who attended college in the early 90s — my first experience with email and the Internet occurred as a college student. The most tech savvy of my peers at the small art school I attended in Philadelphia were huddled around PC terminals, logging on to text-based MUDs or communicating with old high school friends on distant campuses via Telnet email. Although I had grown up around PCs in home and at school, at the time I was too preoccupied with some other version of life in which the analog tactility of spaces, objects, images, and sound consumed by life. I suppose that the black and green text-world of those early interfaces proved too opaque for a visual artist whose conservative art education gave little import to the coming digital revolution.

Soon enough, though, the GUI of Windows 95 and the oddly segmented Internet within its realm (eg. AOL’s “you’ve got mail!”) encroached on my world. This more accessible and graphical interface coincided with a greater number of my friends going online. (The language we used at that time is so awkward — “going online” — the image of Keanu Reeves’ Johnny Mnemonicdonning VR googles and gloves haunts me.) Finally for me, email began to make sense. I had always been a letter writer, and here was a much more immediate and equally gratifying medium of correspondence. Let me qualify “more immediate”: I would sit down at a desktop computer once or twice a day, boot it up, unplug the phone in order to plug the line into the computer modem, open the ISP software, dial up, and finally access the browser. The friends I exchanged email with did more or less the same with varying frequency — very much a “pull” technology; our brains had not yet been rewired to crave the dopamine rush of instant gratification that pings and vibrates in our pockets today, that incessant “push.”

My point of reference for this new communication, this electronic mail, was still the writing and sending of letters via the postal service. And that activity was essentially a literary one, a matter of crafting through careful language very precise expressions of ideas, imagery, emotion, and memory which were meant to affect the recipient. I carried this craft into the digital domain of email, ignorant of the intrinsic properties that we have come to value and loathe in the medium. Email had not yet become such a tool for coordinating daily routines, arranging meetings, and planning everything, much less the singular organizing and managerial force in our contemporary work lives. The choice of my first email address is telling for its overt bookishness: pursewarden@juno.com. Pursewarden is a second-tier character in Lawrence Durrell’s tetralogy, The Alexandria Quartet, books which loomed so large in my imaginative life at the time that I needed to roll them into my first online identity. I must have chosen Juno.com because it was a free email service, but I’ll claim the reference to classical mythology in support of the literary motif.

I unexpectedly recalled these early days with email while listening to an interview with Errol Morris on Reply All. The interview recounts Morris’ very personal investigation into the life of his brother, Noel Morris, a brilliant computer scientist who worked at MIT and invented the first electronic mail system there with his colleague, Tom Van Vleck. During a conversation with Van Vleck, we learn that when testing the system he would write whatever fragments came to mind: “I used to send scraps of poetry and stuff like that.

Scraps of poetry. It was that quick, inconsequential aside that pricked my memory. I, too, once sent scraps of poetry via email in those crafted messages of nearly two decades ago. I haven’t done that in a very long time. I wonder if it’s me who has changed, or if the medium has changed, or perhaps if my sense of possibility in the medium has just been so diminished by its profound banality. It doesn’t have to be that way. I could email you some scraps of poetry.