Designing for Everyone

Crowd of lego people
Crowd of lego people

Whatever system, process, technology we’re implementing, shouldn’t we be designing for everyone? Or at least everyone in the target customer segment?

Background

In the last couple of weeks, I’ve read a number of articles that have consolidated and made me reflect on my thinking about designing for disabilities and what counts as normal.

Having spent a number of years working in the health and social care sector, I’m well-versed in the practicalities of working with people with disabilities. But I still hate the phrase “people with disabilities” and every other similar phrase I’ve ever seen. I don’t like the word inclusion, not that I don’t like the concept itself, but that I don’t like that the concept has to exist. Hence the title of this article as “Designing for Everyone”.

What’s an average person?

I read The Atlantic’s article on how we’ve ended up with a definition of a normal person. That’s at the crux of a lot of the disparity that we can see in the thinking of a lot of designers; they design for the average person or people similar to themselves. By using the term designer here, I’m not necessarily thinking of an artist or a creative, but rather the person responsible for delivering a changed process, a changed organisation or a changed way of working. They may have a creative background, but often are from their own professional background, e.g. in the front-line work or a change management professional. Fortunately, a more creative influence is coming into the change profession, for example we’re seeing newer methodologies such as Design Thinking, Service Design and Inclusive Design.

The problem with most of these approaches is that they develop solutions for the average person. There may be several average people in the target. These personas should have been based on the likely customers that the service wants to attract/serve. But considering how many conditions and disabilities there are in the world, there’s no way to account for all of them. Instead, we’re back to averaging again and possibly some Pareto analysis to account for 80:20 of the target population. That still leaves 20% who are not included in the thinking behind the design.

And that’s part of the theme of the article; that by defining a normal, we start to react towards the average as the ideal and the non-average as divergent.

How can we be completely inclusive?

Microsoft have released their Inclusive Design toolkit. The start of the toolkit is a touch simplistic, especially if you’re worked in health and social care, but it gets interesting part-way through. I’m also aware that the beginning portion could still be a incredibly valuable education source for those not used to having think from this perspective. So for that reason alone, I’m grateful to Microsoft for having released it to the world.

But more than that, there are a few nuggets of quality information in that method that I haven’t seen written down anywhere else. I’ve had to reign in proposals by pointing out difficulties of interacting in the proposed manner, so the 2 points below resonate with me.

The first is the potential to abstract away from individual conditions and dis(abilities) to perform tasks and instead focus on the interact between the person, the technology and the environment. That way, you can focus on resolving issues or improving the interaction between the person and other people in the context of the environment and the technology used.

The second is that disabilities do not need to be permanent. There’s a description of a spectrum from permanent through temporary through to situational. And there are more people in situational or temporary with difficulties than with permanent disabilities.

I’ve cropped the slide here and clicking on the image will take you to Microsoft Design Practice.

Disability Spectrum showing difference between permanent, temporary and situational disabilities
Disability Spectrum

How do we include views of everyone?

This is an old source for me, but one that I still point people to when they’re thinking of how to approach their change programme. Beware though, it only becomes inclusive if you included a wide range of people in the interviews and in the service design. It’s a concept of Experienced-Based Design that I’ve seen from the health sector. It’s the best example of a co-production/co-design methodology that I’ve seen.

There are two sources for this: The King’s Fund and the archived NHS Institute for Innovation and Improvement.

Conclusion for Designing for Everyone

Implementing changes for people with disabilities is difficult to achieve since you’re already on the back foot with that perspective. We can see this by the difficulties involved in making websites accessible when that’s been added as an afterthought. Instead, by bringing the focus on a more inclusive design up-front in the process, we have the opportunity to design changes that suit many more people.

Above, I’ve listed a few articles and methods that could help influence others around you. The main item to take away concerns perspective; anyone involved in change has to be able to shift perspective to include that of all customers in the target segment.

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Lean Cost Benefit Analysis of a Quick Improvement

Kanban prototype for an NHS Acute service
Kanban prototype for an NHS Acute service

Last week, I was provided with the short opportunity to improve a service within an NHS Acute Trust. I had 5 minutes to understand the problem and then I suggested a quick improvement. I’d like to take you through how we arrived at a solution and the resulting lean cost benefit analysis of that solution.

I don’t get that involved in the individual solutions anymore, instead I’m usually engaged for more strategic issues and end up mentoring others to make the changes across the whole organisation or enterprise. So it was fun to roll up my sleeves and suggest a solution that could work in a hospital. I fully expect the team to modify it to suit their specific needs and I’ll be on hand to help them improve it.

So let’s get to the calculations:

Lean cost benefit analysis

Analysis Investment

  • 5 minutes x 1 health professional explaining the problem
  • 5 minutes x 1 consultant listening to the problem
  • 5 minutes x 1 consultant developing a solution
  • 10 minutes x 1 consultant describing how the solution could work and what could be changed to make it more suitable
  • 15 minutes x 1 health professional understanding the solution
  • 1 x flipchart paper
  • 1 x pen

Potential Savings

  • 3.5 hours per day x 4 health professionals across a 5 day week = roughly 2,800 hours a year
  • The 3.5 hours is based on a reduction from 4 hours to 30 minutes for handover and prioritisation.
  • At roughly 1,400 working hours per year (based on 200 days per year and 7.5 hours per day), that equates to 2 FTE (full-time equivalent) posts saved per year.
  • So that could mean the service treating a lot more patients,  a potential cashable saving of roughly £70,000-£90,000 per year or – as is often more likely – a mix of the two

Not bad for a 15 minute session.

Practicalities

Implementation

The solution would need installing, but that’s the easy part. It would require some pens and a whiteboard or similar. That’s probably £200-£400 for a board and magnetic strip and counters plus £20-£50 per year for pens.

The implementation would usually rely on a critical core of the staff wanting to implement the change. In this case, by applying Lean Startup concepts, just one staff member could do it and then the others will learn about how it could affect their working lives and the impact on their patients.

What was the solution?

My suggestion was based on Lean, using a Kanban board. It relies on the principle of visual management. In this case, it’s easy to see at-a-glance where the work lies. It seemed a perfect fit for the problem. Due to the small amount of time spent with the service, there is a significant risk that the solution may not work for all the health professionals involved. I’d have liked more time with more of the team to mitigate this risk.

My aim was to improve flow. There was a blockage in the handover stage of the day and that’s what I wanted to eliminate. With more time, I’d have taken a more relaxed view of the entire process, involving other stakeholders, referring teams and teams that are being referred to. As it was, engaging with only one health professional, I focussed on what could be achieved quickest to remove the blockage.

The kanban board isn’t the end of the solution; it’s the start. I expect the therapists to find that the bulk of their work is being stuck in one or two stages or that they are not able to provide services to low priority cases. I don’t actually know what they’ll find, but that’s what I would be looking for. After the therapy team have been running the board for a week or two, they should be able to see patterns. Then they can act on those patterns.

Perspective

So which appeals more; the lean solution itself or the numbers in the lean cost benefit analysis?

From my perspective, they’re two sides of the same improvement and I teach analysts to remember both sides (and some others) when engaging with teams and their stakeholders.

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