It’s easy to criticise health and social care services for how they involve users in their service improvement work.
To criticise them for when their user participation is tokenistic, or when they ask people what they want, but then can’t deliver it. Or even worse when they deliver what people say they want… but it turns out to not be what they need…
But criticism is unfair. Participation work is often underfunded and service cultures still resist user-driven change. And no one’s told them why they would be better off using human centred design principles instead.
No one’s explained to health and social care services why human centred design improves services more than user participation does.
Even today, 5 years on from my first experience, I still find it refreshing to experience design led approaches. Whether you’re working in health or social care services; tech or service design; running participation groups or usability testing: here’s why I believe human centred design creates better services.
1. Human centred design is more flexible
Health and social care services lack shared participation principles. There’s no minimum expectation of how or when to involve users. It’s up to each service’s discretion.
Because of this user participation usually happens when it’s deemed advantageous by the service. This could be for consultation or feedback, to follow a new policy, or to show they are trying to improve.
But human centred design (HCD) follows a set of universal principles. And it doesn’t rely on the same group always being involved, or a minimum number of consultees. Instead it involves users throughout the design process in ways that suit them. Users can take part in user research, build user-driven personas, join ideation sessions, or build and test prototypes. And when different people take part in each event the process is even better.
HCD also records what happens at each stage, creating a continuous narrative. So when participants change it doesn’t matter; the narrative is robust enough for new participants to easily get involved.
2. Human centred design understands what people need, not what they want
User participation is good at giving people a voice. It lets them share their experiences and put forward ideas to make services better. This is important, especially for marginalised people.
But the approach is poor at understanding people’s experiences and why they want what they say.
Evidence consistently shows that what we say is rarely what we actually want.
It’s a tragedy, but by being focused on what people say they want user participation misses the chance to understand what they need. It doesn’t use good research, nor does it try to observe actual behaviour. And worst of all it doesn’t try to understand the context of people’s lives: the tasks they are trying to perform (e.g. use a smartphone to make an appointment), and the environments they are trying to do them in (e.g. a chaotic home life).
HCD is different. It tries to understand the needs, emotions and full context behind what people say. And it’s always asking ‘why?’. By doing this it builds a comprehensive picture of what it’s like to be someone interacting with the service.
This leads to the next difference.
3. Human centred design builds more empathy
HCD is always asking “what’s it like to be the service user?”. It’s the first and the last question a good designer asks. Inevitably it generates empathy.
User participation can also build empathy. But it’s difficult to get into the hearts and minds of service leaders if they disagree with service users’ views. While such disagreements can positively challenge the power imbalance between them they also create tension and can harden attitudes. In this environment empathy can’t flower.
HCD avoids this and instead focuses on building empathy for a user’s whole experience rather than only their views. It tries to build a strong body of empathy building evidence.
HCD does this by using tools such as personas, user journeys and prototype testing (even for services). It forces a spirit of humble enquiry on the designer and generates powerful insights. These can be expressed in helpful, de-personalised forms called user stories. These are easier for service leaders to understand, and when backed up with evidence from the design process are much harder to disagree with.
4. Human centred design is more thorough
User participation gives users a platform to voice issues they are unhappy about. It opens the door to more feedback (that’s good!).
But services often only ask people to talk about one element of their experience. By setting the agenda in this way other important elements are ignored.
HCD is more thorough because it seeks to understand the user’s entire service journey. It’s always interested in mapping journey stages, understanding how each one relates to the other, and uncovering the chain of cause and effect. To do this, it uses tried and tested tools.
But it doesn’t stop there. After implementing changes a good human centred design process measures the results. Then it iterates the design until the service is consistently delivering a good user experience.
Because human centred design is all about impact.
Which one creates more impact?
Human centred design is a method for creating a better service experience for users.
And user participation isn’t. It’s a means for involving people in services so they have more of a say.
You’d think both would lead to better services. But there hasn’t been enough research into either to prove it.
I’d wager that HCD creates more impact because designers are accountable for the end result being better services. Whereas participation workers are accountable for the result being that people feel more involved in service improvement.
A good design process will always generate a solid evidence base and a clear rationale for its recommendations. This gives leaders more confidence than people’s views alone ever will.
What do you think?
If you’re a participation worker or service leader, then I hope this article has challenged you to consider the role of design in your services. Have you ever worked with a service designer or tried any HCD methods? I think they might inspire you. Learn more here and here.
Or for an alternative view try this.
And if you want to go really wild then read about the case for going beyond Human Centred Design.