2.2.1 General Overview
Design thinking is a process with mindsets to navigate uncertainty and arrive at insightful innovations (IDEO 2019). Design thinking mindsets are ways for the designer, as the practitioner of design thinking, to approach the problem and the various stages of design thinking. Mindsets guide the designer on how to embrace the problem and where to look for inspirations and solutions.
Often, people assume design thinking to be the holy grail of innovation. Simply employ design thinking and innovations will spontaneously spring forth, but this is not the case (Nussbaum 2011). As a disciple of design thinking, it is important to first to indulge the mindsets that unleash one’s creative confidence and second to ensure the space and support to employ innovative work through design thinking. Simply following the design thinking process will not bring about the intended innovations. One must buy into the processes with certain thoughtfulness to build one’s creative confidence (Kelley et al. 2019). Secondly, support systems, buy-in from leadership, diversity of skillsets, space for working, and time to create are all key ingredients in fostering the right ecosystem for design thinking (Waters 2011).
2.2.2 Defining Innovation
Innovation in design thinking is the intersection of desirability, feasibility, and viability. Desirability refers to the user’s want for the product or offering at hand. Feasibility refers to the ability of the team to create the product. Viability refers to the sustainability of the solution. The intersection of desirability, feasibility, and viability is innovation (IDEO 2019) (Fig. 2.1).
One caveat in the definition of innovation employed by designers is the expressed prioritization of desirability over feasibility and viability. In global health, one could constrain the innovation to whether it was feasible given the resources on hand or whether it would be viable after implementation. When designers prioritize desirability chiefly among the three, designers are hinting that it may be more beneficial to build an innovation that addresses a person’s needs rather than an innovation that can be allocated funding or be built with available resources. One of the fatal flaws of innovation teams is the creation of things that do not serve real problems. This fatal flaw has vast repercussions in global health. Occasionally, governing bodies, non-profit organizations, or ministries of health may be keen on implementing a solution, but the solution itself may not address a real need for the intended user. This problem leads to a solution that is not desired by the target population.
During the West African Ebola outbreak in 2014 as well as the recent 2019 Congo Ebola outbreak, occasionally all-white personal protective equipment (PPE) was used by frontline health workers when treating Ebola patients. All-white PPE conjured notions of ghosts and death, notions that hindered the ability of frontline health workers to treat patients (UNICEF 2019). Frontline health workers who donned the all-white PPE would instill fear in their patients during treatment. Patients would fear the frontline health workers who traveled into towns to extract sickly patients or avoid treatment altogether. In this scenario, the actions of the frontline health workers were hindered because patients did not desire the treatment provided. The nature of the Ebola epidemic was perceived to be one of patients not receiving medical care when the true nature of the problem was patients not finding comfort and security in the treatment available. A proposed solution to the challenge of comfort and security of the patient during the treatment process was the PPE Portrait Project. The PPE Portrait Project taped a portrait of the frontline health worker’s face to the outside of the all-white PPE. With the portrait adorned on the front of the PPE, patients could see the humanity of the person behind the ghostly white suit. This humanity connected the patient and the frontline health worker to lessen fears of treatment. The PPE Portrait Project taped a portrait of the worker to the outside of the PPE, enabling patients to connect with the frontline health workers and alleviate fears (Heffernan 2019; Crossan 2015).
2.2.3 Developing Empathy
Empathy is critical in the design thinking process, especially when a designer places an explicit emphasis on the desirability of an innovation. In design thinking, empathy is the process of uncovering the desires and aspirations of the users for the intended product or service. Without researching and learning what a user truly struggles accomplishing, a designer will be unable to know how to create a desirable innovation.
There are many ways to conduct empathy research and the methods parallel other qualitative research methods including those of ethnographic research and primary market research (Reeves et al. 2008). The key to empathy research is to engage a user in some way and then to probe deeper into the user’s perspective. One strategy employed by a top design consulting firm, IDEO, is to conduct The Five Whys during an interview (Design Kit 2019a). Through successively asking the user why they acted in a certain way, the interviewer is able to peel away at the internal motivations and underpinnings behind a user’s actions. In the KKU Datathon workshop, participants were asked to pair up and conduct empathy research in the form of 1 on 1 interviews. For three minutes one partner would interview the other person to uncover why their partner decided to attend the KKU Datathon workshop on design thinking and global health. A profound empathy interview that occurred during a different Datathon workshop went as follows:
- Participant:
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Hi there, why are you here at this workshop on design thinking and global health?
- Interviewee:
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I recently switched jobs from finance to healthcare and am hoping to make an impact.
- Participant:
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Why did you switch jobs to healthcare?
- Interviewee:
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My previous job became dull over time and I felt disconnected to people.
- Participant:
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Why do you desire to be connected to people?
- Interviewee:
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There’s something special about getting to know people’s health challenges and finding ways to help.
- Participant:
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Why is it so special?
- Interviewee:
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It’s not every day that someone opens up to you about their struggles, so you have to make the most of it when they do.
- Participant:
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Why do you have to make the most of it?
- Interviewee:
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Well, someone helped me through a hard time and, I guess, I just want to do the same.
Without conducting an empathy interview, there would have been no way that the participant would have known that her interviewee had such a profound interaction with the healthcare system at a young age as to warrant a mid-life career change. It may feel strange to probe so deeply into the user’s nuances and complexities, but it is the duty of the designer to engage the user genuinely and to learn raw insights that will later evolve into impactful innovations.
2.2.4 The Data Behind Design Thinking
Empathy interviews are chances to create data points from real users. The data produced during the empathy stage could be from interviews, phone calls, user journals, shadowing the user, photo journals, or any other mean of learning the user’s perspective. From these insights, a designer would likely categorize the findings, seek patterns in the data, and discern insights from the observations. A simple empathy categorization method is an empathy map (Stanford D School 2010) (Fig. 2.2).
The goal of an empathy map is to distill the needs of a user in a routine and systematic way. An empathy map breaks down an empathy interview into four key groupings: the user’s thoughts and beliefs, feelings and emotions, actions and behaviors, or quotes and defining words. If a designer repeats this process multiple times with different users, patterns emerge among the collective body of interviewees giving rise to a growing need.
When finding patterns in the data, it is important to note than not all users are the same. People have vastly different needs and lifestyles leading to a dichotomy in the design community known as extremes and mainstreams (Design Kit 2019b). Extreme users are the minority who inhabit disparate opinions towards the project at hand. Mainstream users are the majority who carry the popular opinion towards the project at hand. Empathy is useful to uncover the varying needs and desires for different users, especially extreme users. In global health, an appreciation for the vastly differing needs of users enables more tailored innovations. In the Ebola case previously discussed, the fear of ghostly health workers wearing PPE may have been the opinion held by extreme users, but these extreme users may also have been the group disproportionately transmitting the disease. In this case, a tailored innovation for the extreme users would be most impactful.
2.2.5 Problem Definition and Problem Reframing
Following empathy, participants were introduced to problem definition and problem reframing. In design thinking communities, the problem definition and problem reframe are notoriously challenging. Defining a problem involves brutal honesty with oneself regarding the purpose of the design thinking project and the challenges facing the user. Sometimes designers believe they know the challenges facing the user without ever consulting the user through empathy. This leads to blind designing where products are built that completely miss the mark and do not address the user’s true need. To avoid this horrendous mistake, always define the problem facing the user honestly.
Reframing the problem is equally challenging. To reframe the problem, one needs to know the systems that generate the problem and have the perspective to identify the root cause of the challenge.
Example: Creating a Music Ecosystem
An example of a problem definition and problem reframe is Apple’s entrance into the music industry. When Apple decided to enter the music industry, the logical next step in product development should have been to create a device that would compete with the Sony Walkman. This device, by all means, would have built upon Apple’s expertise in the computer industry and have been a smaller, more portable Macintosh.
Apple did create the iPod, which performed much like a smaller computer with the ability to play MP3 songs; however, during the process of creating the iPod, Apple reframed the problem users faced with the music industry. During the time when Apple was creating the iPod, the music industry was having challenges with illegal music piracy (Silverthorne 2004). Consumers could freely download music from illegal websites and store these songs on devices for listening. Downloading music was not the issue for consumers; finding quality music and sharing this music with friends was an issue. During the process of creating the iPod, Apple also created iTunes, a platform that would become the largest in its time. Apple addressed the challenge of finding quality music so well that people would pay to download songs from iTunes even though free piracy services still existed. By reframing the problem from listening to music to finding and sharing music, Apple created a product and a platform that would dominate the music industry for years to come (IIT Institute of Design 2009).
2.2.6 Bold Innovations
As the final didactic teaching moment for participants of the KKU Datathon workshop, a framework was presented to help participants categorize innovations and to be open to bold, groundbreaking innovations. This framework categorized innovations as either step, jump, or leap (Fig. 2.3).
Often, ideas that are seen as bold innovations are simply not as disruptive as one might think. These ideas are predictable and are the obvious iteration. These are step innovations. Jump innovations are where the starting point for the innovation is known, but the endpoint for the innovation is not. A jump innovation may start with a clearly defined problem but end with a solution that was unexpected. The last category is the leap innovation. These innovations are groundbreaking in that once they are introduced, they alter the landscape and workflows of their field forever. A leap innovation example is Airbnb where after its introduction, all around the world people changed how they viewed spaces in their home, travel, and the definition of a hotel (Thompson 2018).
Leap innovations are similar to Clayton Christensen’s popularized term—disruptive innovation (Christensen 2012). These groundbreaking innovations are hard to materialize and often result in failure. Regardless of the risk involved in leap innovations, truly great companies, researchers, and entrepreneurs must take leap innovations and have a willingness for success and failure alike. Creative companies are known for encouraging leap innovations by rewarding failure (Acton 2017; Bodwell 2019). Incentivizing failure loosens the shackles of conservative innovation from teams and enables bolder ideas. During the KKU Datathon workshop, a preference for leap innovation was stated as this opened participants to opportunities and realities with the greatest potential impact.