Why Does Design Thinking Work?
Sometimes a new way of organizing how we work uncovers developments we could not even have imagined. The total quality management approach that began to take hold in the 1980s introduced tools such as kanban cards and quality circles, creating a groundbreaking transformation in manufacturing. This approach showed that people on the production line could do far more sophisticated work than they were typically asked to do. The tools and insights applied to business processes can be described as social technology.
After more than seven years of research on 50 projects across a range of industries including business, healthcare and social services, I have observed that there is another social technology with the potential to create the same kind of paradigm shift in management that TQM brought to manufacturing: design thinking. Design thinking has the power to unlock people's creative energy, secure their buy-in and commitment, and radically improve processes. By now, many executives have either heard of the tools of design thinking (ethnographic research, problem framing and experimentation, building highly diverse teams, and so on) or already begun to use them. Yet there is another reality that few people fully grasp: design thinking offers the opportunity to move beyond human biases (such as the drive to preserve the status quo) and fixed norms ("This is how things are done around here").
In this article, I will address a number of human behaviors that make innovation difficult and show how the tools and steps of design thinking can help us overcome these challenges. Let us first look at what organizations expect from innovation and why their efforts often fall short...
The Challenges of Innovation
For an innovation process to succeed, it must deliver three outcomes: superior solutions, reduced risk and cost of change, and employee buy-in. Over the years business leaders have developed useful tactics to address these challenges. However, organizations attempting to apply these tactics have run into new difficulties and trade-offs.
Superior solutions. If you define problems in ordinary, conventional ways, the solutions you reach will likely also be ordinary and conventional. When teams begin asking more interesting questions, they can access more original ideas. The risk here is that some teams may spend too much time identifying the problem, while some managers may not tolerate a lengthy process of determining the questions to ask.
It is generally accepted that solutions are far more effective when shaped by user-based criteria. Companies may turn to market research to understand these criteria, but customers may not realize they want something that does not yet exist.
Finally, one of the steps in developing the solution is to introduce diverse voices into the process. If people with differing views discriminate against one another, this can become a difficult method to manage.
Lowering risks and costs. Uncertainty is inherent in innovation. For this very reason, innovators prefer to create a portfolio of options. A large number of ideas can cause loss of focus. To manage this tension, innovators must let go of bad ideas, as one executive I encountered in a study put it, "be able to call the baby ugly." Yet it is often easier to kill creative ideas (which are riskier) than weak ones.
Gaining employee buy-in. For an innovation to succeed, employees must support it. The surest way to win their buy-in is to involve them in the process of generating new ideas. The risk here is that people with many different perspectives may create an environment of chaos and inconsistency.
The trade-offs involved in achieving these outcomes create a far more fundamental tension. In a stable environment, productivity gains can be achieved by avoiding diversity and difference. But in an unstable world, diversity and difference become the organization's allies because they pave the way for discovering new paths to success. Yet when executives are under pressure to meet a variety of targets every quarter, who can blame them for clinging tightly to tools of efficiency, rationality and central control?
To manage all of these trade-offs, organizations must turn to social technologies that can address these behavioral obstacles and the biases and prejudices that drive human inefficiency. I will now try to explain how design thinking can open up this conversation.
The Beauty of Structure
Experienced designers criticize design thinking as overly structured and linear. However, the reality is that most of the managers who serve on innovation teams are not designers; they lack deep experience in conducting face-to-face research with customers, internalizing their perspectives, co-creating with stakeholders, and designing and running experiments. Structure helps managers try out and adapt to these new behaviors.
Kaaren Hanson, formerly head of design innovation at Intuit and now director of product design at Facebook, says, "If you are trying to change people's behaviors, you have to give them as structured a process as possible so they cannot fixate on anything. In fact, most of what we do is rooted in our habits, and changing those habits is hard. You can help people by creating very clear instructions."
Organized processes help people follow a path and prevent them from spending excessive time identifying a problem or taking the easy route of ignoring it. Many people fear making mistakes, so they focus on preventing errors rather than seizing opportunities. But innovation does not happen without action, which is why psychological safety is essential. The psychological elements of design thinking and its highly formatted tools provide that sense of safety and help innovation enthusiasts confidently take on the processes of discovering customer needs, generating ideas, and testing them.
In many organizations, implementing design thinking involves seven activities. The output produced at the end of each activity is used by the next, transforming it into a new output, and this cycle continues until the organization arrives at a viable innovation. But at a deeper level, something different is happening that executives often fail to notice. Although design thinking is seen as a powerful tool for understanding and shaping customer experience, each design thinking activity actually enriches innovators' own experience in many ways.
Discovering the Customer
The best-known methods for the discovery process in design thinking generally focus on identifying "the job to be done." Adapted from the disciplines of ethnography and sociology, these methods aim to determine what is required for the customer to have a meaningful journey, rather than collecting and analyzing a specific dataset. This discovery process requires three sets of activities.
Understanding. In the traditional view, consumer research is an impersonal exercise. An expert familiar with established theories about customer preferences reviews input from focus groups, surveys, and behavioral data, if available, to draw conclusions. The better the data, the better the conclusions. The problem with this approach is that it reflects the existing needs the data reveals. The data is evaluated through the evaluator's own biases. And needs that people have not yet articulated remain invisible.
Design thinking takes a different approach: the innovator must live the customer's life in order to identify hidden needs. Consider Kingwood Trust, a UK-based nonprofit that supports adults with autism and Asperger's syndrome. Katie Gaudion, a member of the design team, would meet Pete, a patient with autism who could not speak. The first time she observed Pete in his home, she witnessed him engaging in some destructive behaviors. For example, he was trying to tear pieces of leather from the couch or rubbing objects he picked up against the wall. Katie began to document Pete's behaviors and framed the problem as "eliminating this damaging behavior."
The second time Katie visited Pete's home, she asked herself: what if Pete was not driven by destructiveness but by some other motivation? Setting aside her own perspective, Katie began trying what Pete was doing and discovered how satisfying those behaviors actually were. "I used to think Pete was damaging the couch, but now I understood that he saw the couch as an object made of fun materials to take apart. When I pressed my ear to the wall and listened to the vibrations, I felt a faint tickling in my ear. The motivation was not actually to damage the wall but to experience a pleasurable sound-vibration experience."
Katie's deeper understanding of Pete's world not only allowed her to grasp his struggles more profoundly, but also let her question the existing prejudice that the people at the treatment center are individuals who need to be kept safe and require help. This experience opened the door to new questions: rather than designing for safety and to eliminate the residents' shortcomings, how could a design be created to enhance their strengths and joys? This line of inquiry led to new living spaces, gardens, and activities that help people with autism lead a more holistic and joyful life.
Sensemaking. The understanding stage provides the raw material for deeper insights in the user experience process. Yet identifying patterns within a large body of qualitative data and making sense of them is a challenging task. I have often seen the initial excitement and enthusiasm in ethnographic studies fade away because of the sheer volume of data and the difficulty of digging for deep insights. This is exactly where design thinking can provide enormous value.
One of the most effective methods for making sense of the information uncovered in the understanding stage is the practice called the Gallery Walk. In this exercise, the innovation team selects the most important items from the data collected in the discovery process and prepares them as large posters. These posters typically contain information about the people interviewed, photographs, and quotations that capture their views. The posters are hung on the walls of a room, and key stakeholders are invited in to walk through them as if visiting a gallery. Stakeholders use Post-it notes to record data that can serve their new designs. They then form small teams and, through a facilitated process, share the notes they have collected, combine them, and group them to uncover insights. This process prevents innovators from being swayed by their own biases or seeing only what they want to see, because those walking through the gallery believe in the realness of the people whose views are presented. The exercise creates a shared database, and those who participate get a chance to interact, hear each other's views, and understand each other's personal perceptions, all of which create a barrier against biased and prejudiced decisions.
Alignment. The final stage of the discovery process consists of workshops and seminars structured around a variety of questions. If we could do anything, what problem would this design solve? Teams that shift their focus away from the constraints of the current state and toward possibilities can hold much more collaborative and creative discussions about design criteria, or the core attributes that the innovation should ideally possess. Creating a mood of inquiry and exploration brings discomfort with the status quo and allows teams to reach consensus throughout the innovation process. Building a set of design criteria gives new and original ideas a real chance against simple ideas that are typically easier to accept when ideas are gathered together.
Consider Monash Health, an integrated hospital and health services organization in Melbourne, Australia. Mental health specialists working there were concerned about the high relapse frequency among some patients (especially overdoses and suicides). Yet they could not agree on a solution. One patient named Tom was an instructive example of this study. Between Tom's first arrival at the hospital and his relapse, he had three face-to-face interactions with different doctors, 70 contact points, communication with 13 different case specialists, and 18 forms to complete.
Team members ran a series of workshops with the specialists asking the question: do Tom's current situation and treatment align with the reasons you chose a career in medicine? As the specialists discussed their motivations for becoming doctors and nurses, they realized that one of the fundamental dynamics of Tom's recovery was how strongly they could maintain their sense of mission. Because everyone embraced this idea, a new treatment process was put in place. In this approach, the patient's needs were placed at the center rather than general procedures, and the process was implemented in a simple and sensitive way. After these practices, the rate of relapses dropped by 60 percent.
Idea Generation
After understanding customer needs, innovators move on to finding solutions that meet the criteria they have set.
Surfacing. The first step here is to start a dialogue about possible solutions, carefully plan who will participate, decide which problems to solve, and structure the implementation process. After conducting a series of personal brainstorming sessions in light of the design criteria, participants then come together to share their ideas and build a system on top of them.
When Children's Health System of Texas, the sixth largest children's hospital in the United States, led by Peter Roberts, concluded that it needed a new strategy, it decided to apply design thinking to define a new business model. During the discovery process, specialists were asked to set aside their bias that medical intervention was the most important issue. If people in Dallas do not invest enough time and resources to obtain proper medical support and cannot access sufficient information, medical intervention alone will be meaningless. Specialists also recognized that the hospital alone cannot solve all problems and that the community must be at the center of the solution. At this point the hospital invited all stakeholders to join in building a shared system whose boundaries and resources extended well beyond the hospital. The team decided to start with small steps and tackle a specific problem, coming together to develop a new model for the fight against asthma.
At this point hospital executives, doctors, nurses, social workers, parents of patients, school representatives, the YMCA, social housing authorities, and representatives of faith groups gathered together. In the first stage, the core innovation team shared the findings of the discovery process with this group. Then each participant developed ideas about how the institution they represented could contribute to solving children's problems and wrote them on Post-it notes. Each participant then joined one of the five groups around tables, shared their ideas, organized them under general headings, and began to imagine what the ideal experience would look like for young patients and their families.
The groups that will become the foundation of change usually emerge from these dialogues, and these groups play a critical role in the success of the change. (Good ideas are typically doomed to disappear if there are no teams working with the determination to bring them to life.) At Children's Health, the business partners invited to take part in the project enabled the community to engage with the institution that would build the new vision. The agency providing housing support tasked its inspectors with also assessing children's health status during home visits. (For example, these inspections began to report on whether homes contained mold.) Local pediatricians developed a standard for asthma protocols, and families with asthmatic children began to provide consulting services to other families through home visits.
Articulating. Surfacing activities typically generate a mix of compelling and unappealing ideas. In the next step, articulating, innovators surface their existing assumptions and predictions and challenge them. Managers usually struggle with this because biases such as excessive optimism, self-affirmation and fixation on an idea make them reluctant to question the ideas. When general assumptions go unquestioned, no real debate develops about which solution will work and which will not, and everyone clings to their own opinions and perspectives about how the work should be done.
Design thinking, by contrast, shapes the conversation around understanding what a world in which the idea is viable would look like. (See "Management Is Much More Than a Science" by Roger L. Martin and Tony Golsby-Smith, published in the February 2018 issue of HBR Turkiye.) The Ignite Accelerator program at the US Department of Health and Human Services is a fine example. At Whiteriver Indian Hospital in Arizona, a team led by Marliza Rivera, a young quality control specialist, set out to reduce wait times in the hospital's emergency room that sometimes ran as long as six hours.
The concept the team adopted as a starting point was the practice at Johns Hopkins Hospital in Baltimore, which relied on patients taking a number from a kiosk at the emergency room entrance. As team members moved through design thinking, they applied the practice of challenging general assumptions. It was then that they realized most of the patients, who were largely elderly Apache Native Americans, were not very willing to use the technology. A system that worked in Baltimore did not work in Whiteriver, so they abandoned the idea.
At the end of the idea generation process, innovators had arrived at carefully thought-through, diverse ideas. The assumptions behind these ideas were sound, and there were real possibilities to bring them to life. In addition, the ideas had been embraced and owned by the teams that would implement them.
Test Experience
Companies typically view prototyping as a process for refining a product or service whose main features have already been developed. In design thinking, however, prototyping happens far earlier than the finished-product stage. In fact, it aims to have users continually contribute to a product that is not yet complete. This means radical changes, such as a major design overhaul, can also occur during the process.
Pre-experience. According to findings from neuroscience, when people "pre-experience" something new, they can make much more accurate evaluations of the value that innovation will provide. This is why design thinking creates a simple, low-cost prototype that anchors the targeted user experience. These prototypes are not really prototypes in the full sense and are even more rudimentary than what lean enterprises call a "minimum viable product." These products are presented to users and easily shaped in response to their feedback. In fact, the very fact that these products are incomplete is something that boosts engagement.
These kinds of rough products can take very different forms. For example, at Kaiser Permanente, sheets hung from the ceiling were used to mark out the wall layout of a medical facility. Doctors and nurses were invited to interact with staff playing the role of patients and to provide their views on how the space should be designed. As part of Monash Watch (a telemedicine initiative aimed at lowering inpatient costs by treating some patients at home) at Monash Health, hospital executives and health bureaucrats were shown not digital prototypes but storyboard-style designs to help them understand the new concept and provide input.
Learning in use. Conducting trials under real-life conditions is crucial for evaluating new ideas and making them work. These tests also reveal benefits that are harder to discern: they help employees and customers overcome their fear of change.
Consider the idea proposed by Don Campbell, professor of medicine, and Keith Stockman, director of operational research at Monash Health. The two suggested forming, as part of Monash Watch, a group that would maintain ongoing contact with people likely to end up in the hospital. Selected carefully from among lower-income individuals, given extensive training in medical literature and empathy, and supported by a strong decision-support system and coaching structure, this team could help at-risk patients live healthier lives at home.
At first the proposal was met with skepticism. Many officials carried a bias that having someone other than medical personnel provide support services to patients with complex problems was not appropriate. However, using medical staff for this service was financially impossible. Rather than debating the issue, the innovation team identified the main concerns and built a structure to test these assumptions. By the time three hundred patients had been reached, the results were starting to come in: feedback was generally very positive, and the number of hospitalizations and emergency room visits had decreased. These results put the doubters' concerns to rest.
AS YOU CAN SEE, the structure of design thinking includes a natural process that runs from research to access. Understanding the customer experience produces data, that data turns into insights, design criteria are set on the basis of those insights, and brainstorming about solutions takes place. The general assumptions about the elements critical to the success of those solutions are questioned, rough prototypes are built, and teams are enabled to carry the innovation forward and prepare the solutions for real-world deployment.
Throughout this process, design thinking practices remove the human biases that block creativity while helping organizations overcome the difficulties of finding better solutions, reducing costs and risks, and earning employee buy-in. Considering that organizations are systems made up of clusters of people influenced by different perspectives and emotions, design thinking encourages determination, dialogue and learning. By involving customers and other stakeholders in defining the problem and developing the solutions, design thinking enables change to be implemented successfully. By bringing a structured foundation to the innovation process, design thinking also increases the chances of innovators collaborating at each stage and achieving the expected outcome. It does this not only by transcending the political positions at work but also by shaping the experiences of innovators and their core stakeholders at every step. This is how social technology works.
HBR Turkiye
