Evaluation is a key part of design for health. We can’t claim to be improving people’s lives, health, or wellbeing if we don’t have any means of evaluating what we’ve created once its placed in the world. But what we end up depends highly on what we start with.

Welcome to The Design Loft #65 where today we’re going to talk about the importance of designing for the outcomes you want at the front end of your journey.

Taking account of the perspectives you want reflected in your programs or services ahead of time can save an enormous amount of energy when you come to evaluate it down the road. Let’s look at how we do this.

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The Evaluator’s Dilemma

Designers aren’t typically trained in evaluation. Evaluators are rarely trained in design. One of the reasons The Design Loft was conceived of was to address this disconnection (see the post below). We can’t elevate our designs if we have little idea of what they do once put into the world.

Evaluators have their own issues to deal with when dealing with a program or service that bears heavily on how things have been designed. I recently met a colleague for coffee and to commerserate about evaluation issues in health system programs and she we discussed the scenario that both of us have seen played out many times: asking for specific types of analysis in program data. Specifically, we’re speaking about the matter of using a particular lens on program data to inform the findings.

This could involve usng a feminist lens, a health equity perspective, or taking an empowerment perspective, among others. Evaluations of programs often apply lenses that place data in a perspective that is aligned with the goals and mission of the program or service. Many of our designs bring with them or are intended to reflect a particular set of values or principles, which is what an evaluation is intended to reflect.

Where things can start to get unnecessarily complicated is when our designs and the data we’ve gathered to assess them don’t match up. That happens a lot, and it’s one of the many reasons why design and evaluation work need alignment. It creates a dilemma for an evaluator when a program sponsor asks of an evaluation (after the data has been gathered) if we can apply a particular lens or theoretical approach to the data.

For example, we could explore a program or service by taking a decolonization perspective, which might look at how certain values are represented or excuded from the design. That is a far more difficult thing to do if you didn’t collect data with this in mind at the outset. All data gathered reflects values and these values might be expressed subtlety or unconsciously, or in a rather benign manner. Applying a lens post-hoc to data after it’s been gathered might be interesting, but is it useful?

What if one was to design the evaluation with this perspective at the outset? If it was, we might ask different questions and also learn more about our design in a manner that can support improvements. We might uncover certain strengths, weaknesses, gaps, or omissions in an intentional manner that can inform the ongoing development of the program. But if evaluation isn’t part of the discussion at the outset, that’s hard to do.

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What Are We Doing?

There are always tensions in health programs. Designing requires we balance needs, resources, pragmatism, and desired outcomes and effects. It is impossible to design for everyone and every context. Designers have to make trade-offs and these extend to the evaluations required to understand the influence these have on the final product. As noted in an earlier issue, linked above:

Evaluators can help designers in the clarification of what the intention of a program is, and what the implications are. For example, if we take a perspective that is aimed to elevate or amplify certain populations, situations, or abilities in our data collection, we can reveal hidden biases and barriers that might exist in the design that couldn’t be seen from the early prototyping.

Understanding the gap between our aims and context matters not only for our designs (the inputs), but our evaluations (outputs and outcomes).

If we are evaluating the impact of what we create — a program, policy, service, or product — we need to understand the role of different forces in shaping the outcomes. It is possible — and often the case — that we fail to see the desired outcomes from our work because of these countervaling forces that influence our designs.

Our perspectives can, if designed at the front end, shape the questions that allow us to see these forces. It’s because they are made explicit and we can assess what we create based on the lens used to evaluate the creation. If we have to guess, or we are applying it post-hoc, we are more likely to find that our data is poorly set up to reflect what we want.

To use the previous example, if we are using a feminist approach to evaluation, we may ask questions like:

1. Whose questions are being asked, who is centered in the process, and who holds decision-making power? For example, In what ways do participants co-design or control the data collection, interpretation, and reporting stages of the evaluation?

2. How do multiple social identities (e.g., race, class, gender identity, ability, age) combine to shape different experiences? For example: In what ways do program experiences and outcomes differ for marginalized or non-binary gender identities compared to dominant groups?

3. Is the program (design) addressing inequities and challenging inequality or merely treating symptoms? For example: Whose definition of "success" or "merit" is being used, and what competing definitions are being ignored?

Asking evaluation questions in advance can shape design questions and thus, what we end up putting into the world. This is another reason why evaluation isn’t just about accountability or evidence generation, it’s a source of design guidance and a means to ensure that we achieve greater health because of what we make and do.

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Practice Notes

My closing notes are to practice evaluation. Begin by starting to ask questions and reflect upon the answers you’re looking for (not the specifics, but the kind of information you want to learn). Evaluation data can be gathered through sophisticated means, or using simple tools like the above example.

Evaluation can be learned and practiced drawing upon many of the methods and tools that we might learn in a research methods course or seminar on social impact. My site Censemaking (see links in menu) has many articles on the application of evaluation, evaluative thinking, design, and design-driven approaches to evaluation and evaluation of design activities.

If you’re a health leader or health promotor, your aim is to create and facilitate programs and services that increase people’s capacity — whether its patients, caregivers or your staff — to thrive. Whether it’s healing sickness, rehabilitation, palliative care, mental health promotion, or organizational performance, we all want to create health and value in what we do. Evaluation is the means to knowing and realizing this value through our designs.

So practice. Ask questions. Start with evaluative thinking and go from there.

Thanks for reading!

References

If you’re interested in knowing why and how a feminist approach to evaluation might make sense for certain designs and context, I’d highly encourage you read the book Man Made: How We Designed a World That Leaves Women Out, and How We Can Make It Right by Karen Korellis Reuther

If you catapult a round ball, you can estimate where it will land with some practice and mathematics. If you catapult a pigeon, all you’ll get a bird flying away and eventually landing somewhere you couldn’t predict, no matter how many times you do it.

That’s the nature of complexity, and that’s where much of our work sits.

Welcome to The Design Loft #64.

In this issue, we’re going to look at complexity and start a conversation about what it means to design for living systems, including human behaviour. And to begin this discussion, we’re going to talk about pigeons.

Flying Blind In Living Systems

Complexity is part of living systems. It’s the reason why children are different from one another, even if growing up in the same household, even if they share the same genes. It’s why your garden vegetables grow differently from row to row, year to year. It’s why every patient experience is different from one another, even when people have the same underlying conditions.

There are many similarities and patterns, but the ability to predict and control much of what we experience in living systems is largely futile. Yet, we try. We use “best practices” when they are — at best - guidelines coupled with situational awareness. At worst, they are attempts to cover up what we don’t know.

In his new book, The Pigeon Test, Mark Eddleston illustrates how complexity is manifest in organizations using the example of the catapult mentioned earlier. The book is one that I highly recommend as an easy and breezy read of a topic that is anything but easy. That’s a compliment, because one of the biggest barriers to understanding complexity is that it is often poorly explained, or written in ways that are either polemical, highly technical, or inaccurate. There are relatively few good, accessible books that can serve as a starting place for people interested in complexity and serious about learning more.

The Pigeon Test meets this criteria.

What Eddleston leads with is a story told to him by one of his early teachers to frame an argument over why much of what we do is ineffective or at least nowhere as useful as we think. We — change makers, leaders, clinicans, consultants, advisors, and teachers — want to help people change from unhealthy, disfunctional, ineffective, or outdated behavioural patterns to something better.

We want to make a difference.

But are we? I’ve argued that evaluation — that data gathered from what we do — is critical to good design to know whether we are or not. But that’s just half of the story, the other half is whether our designs (our interventions in the world) are fit to create the change we want to see. Part of the reason for this is: complexity.

With complexity, we are often flying blind. And the first lesson in flying blind is knowing you’re blind. The second is that you’re flying.

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Knowing Your Transformation Space

What understanding complexity does is get us to think about what the role of our designs are. Are they to deliver a consistent experience? Is it to deliver reliable, valid, predictable outcomes? Is it to inspire change in human behaviour? Might it be to transform an organization or mobilize a community?

The answer to these questions can shape whether we are dealing with a system that is more amenable to designs that offer us prediction and ‘best’ practices, or something else. Which brings me to another book that’s just been released that can serve as the next in your complexity reading list: The Cynefin Company Field Guide (Volume 1) by Dave Snowden and colleagues. This gets into more about how to recognize and make sense of the systemic conditions you find yourself in.

More on that book in future issues.

For this one, I’d like to leave you with a quote from Eddleston’s book and offer the recommendation that you consider deeply what kind of system you’re working in and what you want to achieve. It’s too often that we designers seek to influence people with clever products or services to be used in predictable ways, when in reality , people are looking for things that adapt, shift, and mould to their circumstances in ways that require a different kind of design, and one that is far less ego- or style-driven, and more about living systems.

In other words: are we launching a ball or launching a pigeon?

Practice Notes and References

If you’re looking to learn more about complexity and don’t have a clear sense of where to start, or how to approach the topic, here are some recommended resources and people for starting out:

1. Censemaking. For nearly 20 years I’ve been writing a blog on complexity practice and design, written for practitioners.

2. Of course, Mark Eddleston’s new book is a great start. Links and references can be found on his Substack by the same name as the book.

3. Getting to Maybe is an older, yet still highly practical book for people trying to understand how we create change amidst complexity.

4. Jennifer Garvey Berger is one of my favourite authors of many books that take a complexity-oriented lens to organizations. Her work is scholarly, yet practice oriented.

5. I’ve appreciated the way practitioners Chris Corrigan and Sonja Blignault write and communicate about complexity in their work. They are great writers and bring much experience, humanity, and humility to their work in complexity. All three of us are deeply familiar with what was once called Cognitive Edge training materials and methods in the past and share an interest in creating change while attuned to complexity.

6. Cognitive Edge, now the Cynefin Company, and its founder (Dave Snowden) are behind the other book recommended above. Snowden is a wise thinker and leader in the complexity space. His work is a little more advanced — drawing on many areas of scholarship, theory, and philosophical positions — but often entertaining and sharp in intellect and tongue.

If you’re attention wanders off while reading this, it might lead you to the most significant insight or sense-making you’ll do all day. Otherwise, try taking a shower.

Welcome to The Design Loft #63.

Manoush Zomorodi, a multi-hyphenate, curious, and former host of the TED Radio Hour was invited to give her own TED talk on the work she was doing on curiosity, discovery, and the brain. Among the central findings looking at the research and speaking with the researchers doing that work was that boredom — doing less — can allow us to do more.

It might sound counterintuitive, but then, that’s how much of design’s great gifts are and why doing less matters in designing for health.

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Every time you shift your attention from one thing to another, the brain has to engage a neurochemical switch that uses up nutrients in the brain to accomplish that. So if you’re attempting to multitask, you know, doing four or five things at once, you’re not actually doing four or five things at once, because the brain doesn’t work that way. Instead, you’re rapidly shifting from one thing to the next, depleting neural resources as you go. - Daniel Levitin, Neuroscientist, musician, and author

This quote above came from Manoush’s conversation with Dr. Levitin, who has looked a the neurochemical costs of task switching and how every decision we make uses up energy (glucose) that could be used for something. His message: use your energy wisely. Even decisions to ignore something uses energy.

The quote above was framed in the context of boredom: how removing yourself from the tasks, demands, stimulation, and requirements of our life — even for a short amount of time - can yield benefits by reducing the cost of what all of these things do to our brain.

Manoush goes on to say:

A decade ago, we shifted our attention at work every three minutes.

Now we do it every 45 seconds, and we do it all day long.

The average person checks email 74 times a day, and switches tasks on their computer 566 times a day.

This data came from 2017. Dr. Gloria Mark, who studies cognitive effects of task switching at University of California-Irvine and was interviewed for Zomorodi’s book, has noted that these figures continue to hold up, if not showing that they are worse.

If we want to design for health (of ourselves, the health workforce, and our patients), we might want to start designing for less, not more.

Design Better for Health Here

Designing For Health, Not Something Else

Designing for health and attention isn’t just confined to digital distractions, yet they are the amplifier. Why? Because they have been designed this way.

In the weeks and months to come, we’ll be sharing a new series looking at what people made and exploring the design ethos behind them. Many healthcare workers, social workers, rehabilitation staff, administrators, and educators don’t affect the health of their patients, clients, staff, and community as much as they could. In some cases, these workers create problems, not benefits for health. The reasons? The tools and systems they work in weren’t designed for health.

They were designed for expediency, cost controls, liability issues, convenience (for someone), or lack of consideration of who or what things were designed for. They weren’t designed for complexity or systems and the humans living and working within them.

This isn’t an issue of malice, neglect or incompetence, but a feature of a system that’s been designed for things other than health. These matters or considerations aren’t inconsequential, but what happens when they put together is that we end up “losing the plot” of why we’re doing the work we are.

The digital distractions we’ve discussed are a symptom of this. As we get more monitors, tools, equipment, regulations, and relationships built into the system, we increase complexity, and sometimes coherence and attention to the mission is the cost.

These features can be designed back in. It just requires a different way of working and thinking than it did when they were put in. That’s a big part of why The Design Loft exists.

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Practice Notes

Rather than flood you with recommendations, I’m going to model the message of this post: Do less to do more.

To quote Zamorodi as she wrapped up her talk, maybe the way to creativity, insight, and better attention is to do nothing, rather than do something:

So the next time you go to check your phone, remember that if you don’t decide how you’re going to use the technology, the platforms will decide for you.

And ask yourself: What am I really looking for?

Because if it’s to check email, that’s fine -- do it and be done. But if it’s to distract yourself from doing the hard work that comes with deeper thinking, take a break, stare out the window and know that by doing nothing you are actually being your most productive and creative self. It might feel weird and uncomfortable at first, but boredom truly can lead to brilliance.

Thanks for reading.

Go out there and (try) to do nothing.

Image Credits: Photos by Markus Spiske on Unsplash and Philip Oroni. Illustration created with Gemini.

Over the last few issues, we’ve been looking at the three foundations of what it means to design. These are design thinking, making, and deploying and the different skills, knowledge, and actions that take place as part of these foundations.

Welcome to The Design Loft #62, where this issue we’ll look at the practice context for building foundations for design. We will do this by looking at the individual, the organization, and the systems contexts for design practice while commenting on what it takes to generate a practice of design.

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The Individual Practitioner

Designing requires many different skills, tools, and a mindset around what it means to design. Most of the previous issues of The Design Loft explore this terrain. In practice, these foundations are built through persistence, commitment, and rehearsal.

It’s the practice of the practice.

What does that look like to the individual seeking to design for health and wellbeing? Among the central qualities that is nurtured through practice is confidence. Design involves enormous uncertainty and experimentation, where the number of unknowns are high, yet confidence in being able to navigate through this is what drives designers.

There’s debate on the role of confidence and its importance, but there’s little debate that being confident in finding and taking a direction and being able to see through the design process is a high correlate with success. Confidence is what allows us to take a chance, it’s not about knowing what will happen after we do. Confidence is in process and opportunities, not necessarily outcomes. That’s what distinguishes design from other areas: confidence is about the belief in being able to find and create a solution through uncertainty, not in a guaranteed outcome.

This is what drew me to design in the first place. I was amazed that designers who had skill, experience, and a craft would confidently claim they could design something that they’d never made before and then deliver. It’s not arrogance, but an understanding of the process needed to take new thinking and transform it with materials and what we spoke of in the earlier issues in this series.

Tied to this is the role of practice itself -- persistence and consistency in designing things. Design isn’t something you do on holidays and special occasions; it needs to be practiced regularly. How often, and to what extent is less clear; but it needs to be enough that you can gain some facility with tools, theories, and activities. A mindset isn’t nurtured by events, but everyday actions. Craft doesn’t come from lessons, but applying our thinking and making and reflecting upon that.

Organizational Practice

We practice individually within organizations, or at least an organizational context. Organizations are the institutions that deliver care, enact policies, and promote wellbeing. These are where many of us are employed or are the partners or clients working with us.

At the institutional level, leadership is critical. There has to be an expressed commitment and direction for design activities for us to practice. Without it, we are left creating experiments that are disconnected from the context in which their products are divorced.

This buy in to design also includes supporting the collaborative activities that most designs require. Organizations have to enable their staff and teams to think, play, act, and create together in service of innovation.

These are cultures of design, not just design actions.

We explored some of this in an earlier issue, looking at the case study of Sault Ste. Marie Hospital’s Emergency Room waiting app that was an innovation in design and delivery, and reflected a culture of design, not just a single act. Leadership, encouragement, and a place where there is openness to try things is what creates the space for design to thrive.

Individual innovation units rarely thrive beyond themselves, not because of their ideas or process, but because the culture of innovation doesn’t extend beyond it’s boundaries. It’s the culture of leaders, teams, and staff across the organization who are willing to try new things, support divergent thinking, and have the willingness to attempt something that might not work. It’s also about creativity, too.

Systems Practice

Systems are the greatest point of leverage and the most difficult to facilitate change change. Two fields of practice where we can draw some lessons from are the computer / digital technology space and education.

The former is largely tied to the highly competitive landscape and profit motive, which have created cultures of innovation that are sometimes described through such mantras as “move fast and break things” or “fail faster to succeed sooner”.

The latter (education), is a result of the constant transformation that comes from new knowledge, new students, and high demands placed upon educators and learners to adapt, grow, and change. This has created a culture that is much more open to new ways of working than others.

Neither of these cultures are immune to the effects of sunk costs, inertia, and lack of catalytic leadership or opportunities. However, they are spaces where systemic change is possible and has been exemplified many times over.

Social workers have to be creative to deal with the variety and complexity in their caseloads. Nurses and care workers often have little choice but to improvise in their care decisions. The same is true for childcare staff. These are all care contexts where there is a recognized dynamism and culture of practice innovation, within constraints.

These are examples of where systemic design can be nurtured. Too often, these innovators are not provided with the means to share and market their products. The knowledge translation doesn’t occur in a systemic way, rather a more informal approach.

Providing opportunities for learning and sharing across contexts can help. Enlisting the cross-juridictional and context-spanning resources of a professional association, regulatory body, or practice network is another way to build systemic capacity.

The American Evaluation Association sought to do this beginning with the leadership year of President John Gargani, who wanted to emphasize design during his term. That resulted in the first of many Design Loft training workshops and micro-conferences that took place within the annual AEA conference between 2016 and 2019.

Like many things, these three foundational facilitators exist like an index: the more of them you have, the more likely you are to succeed in bringing design to health. For starters, try whatever you can with whomever you can. But whatever you do, just practice.

Thanks for reading and designing with me.

If you’re looking to enhance your skills further and want to foster these design foundations in your organization or network, let’s talk.

Bring Design Skills to your organization

What if you made something that transformed the health and wellbeing of those in your care, but never put it into the world? Would anyone be better for it?

That’s the question (answered!) by the third in our series of Design Foundations: deployment.

Welcome to The Design Loft #61, where, just like a stool, we need that third leg to keep ourselves level.

Deployment is the last of the three foundations of design and is often the most ignored. How often have you been involved in a project that sounds great, has even been workshopped and prototyped, and then is greeted by “we’ll take that under advisement” ?

As a designer, I’ve created programs of many types, with research, stakeholder involvement and codesign, and lots of testing and market research only to see it die on the vine. The reasons are many, including fear (what if it doesn’t work? or what if it does work?), lack of planning (i.e., resources for design, not deployment), or a mismatch between what we create and when it is to be used and implemented.

Many of these issues are ones that are commonly called knowledge to action issues. But deployment isn’t just about knowledge or evidence, it’s taking that and the ideas for how to use it and putting it into the contexts in which it was intended. It’s about taking action.

It’s about taking our work and making it public. It’s what Seth Godin calls Shipping.

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Shipping Our Work

To ship our work is the act of courage of putting what we make into the world, and it’s comprised of the following activities:

Market. To market is to bring together intelligence about who you are selling to, what they will pay (in time, energy, money, attention, social capital) to acquire or use your product/service/policy, and how to ensure those audiences know about what you’re offering and how to access it. This is a lot, but it’s critical to ensuring that good ideas are put into practice. Among the biggest mistakes that designers make is that they assume great ideas, quality production, strong evidence and innovation sell themselves; it doesn’t.

Distribute. Another often overlooked feature of design is distribution. There are often times when you have the right product, a willing buyer, and few means to get it to them. Whether it’s digital delivery, physical transportation, or even localized within-organization distribution, there has to be pathways to ensure what it made reaches the people and settings where it can be used.

Implement & Activate. The last part of this production-to-distribution journey is in implementation. Just as product don’t sell themselves, so too do products acquired lead to use. A great patient recovery plan doesn’t help them if it’s not followed. Clinical practice guidelines aren’t useful if not integrated into systems. This is the implementation and activation of people and systems to ensure that they are put into practice as designed.

Assess. What happens when you do all of this? That’s what evaluation is all about. Evaluation is a structured approach to gathering evidence and feedback that’s used to determine what is being done (outputs), whether our design is working to achieve certain goals (outcomes), how (process and delivery insights), and to what end (impact). Assessment involves asking the question about the merit, significance, and worth of our efforts.

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Practice Notes

Many readers working in the health sector will note the similarities of the deployment phase to many of the knowledge X practices (e.g., transfer, translation, integration, mobilization). If those models work in your context, use them.

Among the most critical skills required for deployment are relational and communicative. Among the reasons to consider participatory and co-design approaches to developing things is that it builds relationship capital with those involved in the design process. That process is more likely to yield the kind of attention, focus, and commitment needed to market, distribute, and implement a designed thing into a setting.

Having a good business model helps. The work of Osterwalder and colleagues on the Business Model Generation canvas is a simple, direct tool that can help you design one in a short period of time (it’s freely available). Note that concepts like selling, buying and business model don’t necessarily mean for-profit healthcare.

Even charities and non-profits have to create such models and thinking if they want to “buy” attention, donations, volunteer hours, committment, action, political will (and no, this isn’t about bribery). For example, when you’re doomscrolling, you’re paying for something with your attention. Your clinical manager might be paying for a choice of action; and you, as a designer, are trying to give them a better, more preferred option.

Another critical skill is systems thinking in action. Creating systems is as much about taking the individual responsibility out of the hands of people and putting into the system to make it easier to integrate what we make into practice, rather than relying on a series of individual-level decisions made by people who have limited sightlines on the topic or interest, no matter how experienced or well-meaning.

For those working in design contexts, I’d highly recommend the recent book by Scott Berkun and Bryan Zug, Why Design is Hard, for examples of the behavioural and social factors that go into selling, persuading, and pushing designs into the world.

Great designers ship, but make sure to design the conditions to make it so.

Need help or a place to start for your organization for design or a business model canvas, let’s talk (click below).

Connect for a conversation

We’ll be exploring all of these in future posts. Thanks for reading and hanging out with me in The Design Loft.

References:

Lipton, B., Bailie, J., Dickinson, H., Hewitt, B., Cooper, E., Kavanagh, A., Aitken, Z., & Shields, M. (2025). Codesign is the zeitgeist of our time, but what do we mean by this? A scoping review of the concept of codesign in collaborative research with young people. Health research policy and systems, 23(1), 54. https://doi.org/10.1186/s12961-025-01328-6

Straus, S. E., Tetroe, J., & Graham, I. (2009). Defining knowledge translation. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 181(3-4), 165–168. https://doi.org/10.1503/cmaj.081229

Wutzke, S., Roberts, N., Willis, C., Best, A., Wilson, A., & Trochim, W. (2017). Setting strategy for system change: using concept mapping to prioritise national action for chronic disease prevention. Health research policy and systems, 15(1), 69. https://doi.org/10.1186/s12961-017-0231-7

Remember the feeling of making something at school that you could bring home to show people? That’s the power of the second part of design foundations: making

Welcome to Design Loft #60 and our exploration of the practice of making things.

In our last issue on Design Foundations, I presented the first of three points on what is a Reuleaux triangle: Design Thinking.

This week, we look at the next point in that shape: making.

Making is the transformative practice of taking concepts, plans and raw materials and arranging them into a form. The quality of materials and craftsmanship coupled with an aesthetic appreciation for the domain, leads to great design.

And just like a great coffee, you can conjure it up, but if no one is making it, you’re no more stimulated than you were without it.

Making Things (Happen)

Making is the activity of transforming.

To transform is to bring together things into a form (trans-: “across,” “through,” “beyond,” or “to the other side.”) and formāre: “to form” or “to shape,” derived from forma, meaning “shape,” “figure,” “appearance,” or “mould.)

Design applies the intention and activities of thinking, which we covered last time, and takes it into action.

The core of making involves the following:

Craft. Craft is the application of expertise gained from knowledge, experience, technique, practice, and observation toward the making of something. A skilled maker is often called a craftsman (crafter, or craftsperson). They are someone who applies skill gained from experience, familiarity, and reflective practice.

Materials. While design thinking involves the outline of a design, making involves using materials. These may be physical (steel, wood, stone, plastic, plant matter) or digital. The materials are what goes into the actual thing we’re creating, not just ideas.

Tools. The means of moulding or shaping materials is done through tools. Tools can be used in facilitating design thinking (e.g., sticky notes, mood boards), but for making, the tools need to facilitate production of models, prototypes, and eventual products. Tools are the means of channeling our craft into the materials to shape and develop models, prototypes and products.

Shape. To shape something is to place form upon materials. This is where our sense of aesthetics comes into play. Far from being superfluous, aesthetics are what draws attention, captures interest, provides sensory benefits, and ensures that our products are used. This is about paying attention to our sense of style, purposes of use, and desired outcomes in a manner that is coherent.

Tinker & Fit. These could be two different features, but they are also jointly done. Until our designs are developed and put into place, there’s always a slight issue of misalignment that needs to be addressed. Tinkering with what we’ve made after developing a working prototype is where we make what we’ve created fit. Tinkering and fit come from using evaluative principles to assess what is needed to be adjusted and the tightness and fullness of our fit.

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Practice Notes

Making is the part of design that is the most difficult for many in the health professions. The tools of the craft are not ones we’re as familiar with as they might be with Design Thinking or putting things into the world once they are made (e.g., knowledge translation).

Yet, it’s in the making of things that we grow and see the potential limits and opportunities of what we create. In the making, we generate physical, digital, and other artifacts that translate evidence into products. We get more intimate with the choices made, the judgement, the aesthetics of our arrangements, and the materials. It’s often in the making of things and the products of that where we see the flaws in our services, policies, practices, and products.

Making is where prototyping takes places in earnest, not just conceptually.

One reason it’s difficult for health professionals is that its where our knowledge and skills find gaps that are often filled by others (e.g., graphic designers, archiects, UX and digital creators). That’s an uncomfortable place to be. But it’s also where we can learn the most about our designs and pick up some skills. To practice design doesn’t mean that you must master all three components of design’s foundations, but it does require we know them.

Don’t let the unfamiliarity with making things dissuade you. Get to know those you involve in the making of things. It’s in that process that you’ll learn to become more than a design thinker or a knowledge translator into a true designer.

Thanks for reading. As Seth Godin often says: Go make a ruckus.

Or, as I say: Go make health.

Welcome to The Design Loft #58

The foundations of design are tied to the capacity for people to create things of value for humans and the planet. This is where we can directly affect health and wellbeing: by creating better. This is the ethos behind The Design Loft.

Design is about creation of ideas, knowledge, and the things (products, services, policies, and systems) that emerge from applying focused thinking, making, and deployment of our energy toward a problem worth tackling.

The most widely discussed of these is design thinking. I’m not going to get into the many debates over the name, the role, the qualifications and function associated with how this term has been used. Rather, I’m going to present you with what I see as the core of design thinking as part of a larger set of design foundations, which I introduced in the last issue.

These are my ideas drawn from a career working in design thinking and innovation. I hope they make you think (and design).

Design Thinking

Design thinking is the starting point for design. Unlike what has been popularized, it’s not the end. Yet, without strong depth of design thinking, we will not have a clear sense of what it is we are seeking to develop, who’s needs are being served, and what kind of problem conditions we will face.

Thinking is more than just musing on something, it is about the ability to see something in the mind’s eye and work with it. This means being able to see things that aren’t there, in time and space that are fluid and dynamic. Design thinking challenges us to connect to our past (memory), exploring the present space where problems and situations are manifest, and imagine possible futures at the same time.

This involves seeing situations, envisioning options, and doing the work to explore the problem domain to guide a designed thing.

I’ve much to say on design thinking. Its array of uses, meanings, and the many voices promoting it or decrying its existence have made it far more messy than I’d like. It is sufficient to say that for my purposes and that of most people seeking to innovate, design thinking is an important vehicle for taking the abstract and transforming it into something real and possible.

Coaching for Design Thinking

Qualities and Features

Design thinking involves the following qualities and requirements:

1.Recognize. Paying attention to the world and the recognition that there problems exist and that they can be either solved or addressed in some ways to improve the conditions surrounding them is the first step toward design. Not all problems can be solved, but many can. Recognition is what separates King Cnut commanding the tides to stop (and expecting obedience from nature) from a Mahatma Gandhi who sees a pathway for people to live differently.

2. Identify. The recognition of a situation or problem takes us down a journey of identification of how or whether it can be addressed by design. Identification comes from taking a closer look to perceive imbalances, inadequacies, performance issues, or gaps where opportunities exist for something better that we can change through our efforts. It’s through identification that we spot opportunities.

3. Envision. Once we’ve identified something, can we see a better future? What does it look like? What might improvement look like in product, outcomes, or both? Envisioning the future is involves an ability to dream of something better and can serve as a force to seek that out and create the future we want.

4. Conceive. With a problem identified and possible futures envisioned, we must now conceive of what will get us to this preferred vision. Generating ideas, models, hypotheses, examples, or scenarios is part of conceiving something. Design thinking is most known for this part of the process; it’s where we begin with our ideas and convert them into conceptual prototypes that we’ll eventually make.

5. Research. is the means to honour the work that’s already been done so that what we do next builds upon it. Research helps us see what else has been done, what additional features need to be considered (or removed), and what factors might influence what we make and how it is received when implemented into the world. Research is also where we bring in empathy and perspective taking, gathering stories and generating evidence to support our planning.

6. Plan. This is where we take our research, ideas and aspirations and translate into a plan of action. This is also where design strategy comes in: where we connect the intentions, values, resources, skills, and requirements together and translate it into an approach as well as a set of tactical and operational actions that we believe will achieve an outcome.

7.Communicate. Design requires us to communicate our aims, intentions, plans and expected outcomes to those we seek to serve and those we aim to convince. This is the first space where persuasion comes into the design process, but not the last. Without an ability to translate abstract ideas into something understandable to others, our designs won’t go far.

8. Enlist. Design is a team sport, and rarely done all on our own. Whether its seeking input from a client, collaboration on the process, or full-on co-design, bringing people into the conversation and process is a critical factor worthy of noting as a design skill. Enlisting and enroling people in a process of integrity and purpose is one of the benefits of design.

Practice Notes

Design thinking is much like undertaking strategy: it requires an intention, focus, and connecting different parts of a system of activities together in a coherent manner. There is no single best practice for design thinking, however, there are some general principles for enkindling it and some things to avoid. Some of these are:

Give yourself time and space. Design thinking requires room for your brain and perceptive abilities to adjust to the conditions for creative exploration. Don’t rush things and expect great results. Don’t try to wedge creative exploration into crammed, unfocused schedules.

Embrace constraints. Limitless time, space, and resources are as harmful to design as suffocatingly tight limits. Embrace the constraints you have and work with them. Design is about creating good, not perfect.

Failure is the option. Relax the need to make things right the first time. Failure -- or rather, failure to meet expectations -- is a part of the design process. You’ll learn as you go.

Look and listen. Feedback is the means in which we learn as we go: we pay attention to what connects with people, what produces results we want, what’s extraneous, and what’s essential. We’ll rarely know this ahead of time.

If we understand design thinking, the next step in setting our foundation is making things. This next part of the design process is what we’ll focus on next.

Image Credits: Cameron Norman

Welcome to The Design Loft #57

We know health is of value to us, but whether we are able to maintain and promote our health, live in healthy environments and contexts, or receive care and treatment as needed is largely a matter of design.

This is why understanding design matters. Whether it’s physiological, social and organizational, or mental/psychological health, we shape the contexts that shape us by design; good and bad.

At the foundation of design are three activities: 1) thinking, 2) making, and 3) deployment. Design activities span across these, although not always in equal measure. In this issue of The Design Loft, we’re going to look at these three as the introduction to a short short series on Design Foundations.

Building the Foundations of Design

The foundations of design are tied to the capacity for people to create things of value for humans and the planet. To create something means putting to form something that has originality or newness to it, which could be a slight adjustment or enhancement given to an existing design, or taking something from one context and transplanting that elsewhere.

The SCAMPER method, highlighted in our earlier issue is one example of an approach to creating things that can serve as a platform for designing solutions to problems we face.

Within these foundations of design are clusters of activities that help us find, frame, and eventually address problems we face in the world.

We first need to think about design. This is the basis for much of what has been known as design thinking. Within the context of this framework, design thinking comprises our capacity to notice things, identify problems and opportunities, research and explore these situations, envision possible futures, generate ideas and options, and enlist others in our cause.

We then need to take those ideas and transform them into something. Making is a key part of design and includes the use of materials and tools (which can be physical, social or digital), employ craft, shape our creations, tinker with them, and fit our final products into situations.

Lastly, we engage in deployment. This is about taking our ideas into the world, distributing and marketing them to whomever can benefit from them, share what we’ve done, persuade those in various positions to try and adopt what we make, and to both ensure that we implement our designs appropriately and assess or evaluate their effects and outcomes.

Within these three domains is the application of judgement, discernment, aesthetic appreciation, and taste that represent the foundations of design. Lest anyone think these activities are about merely decorative additions, our ability to make informed, strategic choices about what to make and how, are vital to ensuring what we make is effective and makes the difference we seek. At the very least, it ensures that our work does the most good with the least harm afforded by the situation.

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Designing Design

There’s a terrible definition of design by one of the great thinkers and scholars of design studies that goes:

I suspect Heskett was trying to provoke discussion about what design is and does through this quote, pointing to the way in which design represents many different things at once. I take this provocation seriously, but not this sentence.

Design is process. It is the journey of problem discovery, thinking about it, conceiving possible solutions, and creating plans. It is a process of uncovering problems, needs, options, and connections that link humans, their environments, and contexts with materials and relationships that tie them together.

Design is making. The craft of making something — from a product to a service to a system or policy — all requires working with materials, tools and people to shape and put form to our thinking. Sometimes, what we make are strategies and pathways for things to happen within systems.

Design is delivering. It’s one thing to find problems and conceive of and shape possible solutions, but things don’t change unless we deliver something of value that comes from our efforts. Strategy doesn’t matter if it’s not put into practice.

Design is also a profession. We are all designers, and some of us are professional designers. Some of us — paid professional or those who are professional-grade — are trained in design thinking, methods, tools, and production. If you’re a pro, it means you have real stakes in ensuring what is generated matters.

The Design Loft was founded to help those of you reading who make things that matter, level up your knowledge, skills, and awareness. Whether your professional title includes “designer” or not, if you have stakes in the designs you make (i.e., your reputation relies on it or others are depending on you to create something) this applies to you.

Many of those working to promote health and deliver healthcare are designing programs, services, and delivery models where there are stakes for them (reputation, risk) and for those they serve (patients, caregivers, colleagues, the community).

In our coming issues, we will explore these three foundations in the context of the practice of judgement, discernment, aesthetics, and taste.

We will look at what it means to think (process), make, deploy (deliver), and what it means to practice design with a level of professionalism that makes a difference to health and wellbeing. As noted (pun!) in our last issue, I’ll also continue to be posting articles and interesting finds from Substack and beyond using Notes on this platform. Specifically, I’ll be adding a practice notes section as well to most upcoming posts as well as on Notes.

Let’s elevate health by creating better designs through building a foundation. In our next issue, we’ll take this further.

Thanks for reading.

Connect with Cameron

Image credits: Cameron Norman (author)

Welcome to The Design Loft #56.

Let’s paint a picture of health. Not literally, but figuratively.

This expression should immediately present you with ideas and an imaginary experience of what it means to portray health. Give yourself a moment and visualize what this painting looks like.

Yet, what does health look like? How would we know what it is if we’ve never seen it? Or have we seen it before — in our minds eye, in our experience, or in the life we’ve live and the support we’ve given to the lives of others?

The point is that we will have opinions, ideas, and perspectives on this idea of what health is and how it is to be (or could be) represented. It doesn’t have to be based on anything we’ve witnessed before, only what we can conjure in our mind. That is the power of art.

I asked a simple question, and you had an emotional reaction to it. That’s the power of what artists bring. In today’s issue, we look at art and its place in design for health.

The Practice of Art

This piece is not about how to be an artist, nor is it about bringing more creativity to healthcare and health promoting work. It’s about what it means to learn from artists work. It’s not about technique, the medium of choice, the aesthetic influences, or the sources of inspiration. (This is all valuable, some of it has been covered in previous lessons, but that’s for another time).

It’s about the practice and what we can learn from that. Specifically, it is how artists work with five key features of what it means to create, maintain, and design for health.

Attention. We have a poverty of attention. For artists, they know that attention is the prize for any work — visual, movement, music or otherwise. If you ignore the work, the art is meaningless. Artists know how to grab attention and hold it. Maybe it’s to engage, pique interest, enrage, perplex, delight, relax or puzzle — whatever it is, artists know how to make things we pay attention to.

Emotion. One reason they can engage us is that art appeals to emotion. It invokes feelings and works from the perspective that we feel our way through the world, not just think about it. It’s connecting the heart to the head and the means in which we do this by stimulating something in us to feel. If we can’t feel or connect to the feelings we have about health and care, what can we?

Senses. Art doesn’t just get us out of our heads, it gets us back into our bodies. It invites us to sense — feel emotionally, maybe literally — things through creating things that are visual, auditory, textual, or olfactory. Much art is about bringing together different facets of sensory experiences like dance and music together, or the way lighting is used to help showcase a painting or to be a part of the work itself as it is in photography.

Space. Artists work in space. Whether it’s on a stage, or in a gallery, or out in the city or countryside. Art is about using space and working within space to shape an experience for the audience of the work. In health, our spaces and places are where we practice, they produce health, contribute to illness, and shape recovery, healing, and reflection. We rarely consider what these spaces are, yet they play such an important role in shaping what is done. Artists recognize the value of the studio and the gallery, the soundstage and the seats in the audience. They know that it’s not just the musical instruments, but where and how we listen.

Show. Art exists for someone. Maybe that’s only one person, or maybe it’s for the world. Artists create with an aim to show what they do and have done to the world. Art only works when it ships — somewhere to someone. It’s too easy to assume that if we are in the health business so it doesn’t matter whether or how we ‘reach’ or present ourselves to those in need. Yet, even the information desk at a cancer centre or primary health care clinic can benefit from hospitality and showmanship that engages people, welcomes them, and showcases what’s needed in that moment.

Thinking like an artist can make us a better designer. When we bring these features into our work, we see, create, and act differently in ways that enlist and engage people— and that’s what designing is about.

Become that Design Artist

Thanks for reading! Now become that artist; you’ve grown up.

Welcome to The Design Loft (#55)

It’s that ‘back to school’ season in many parts of the world. It certainly is for me.

Even though my September’s are usually about preparing courses instead of taking them, the feeling that I had from when I was a child and continued all through adulthood when I was a student always is felt fondly.

It’s not just that it’s the sign that autumn, my favourite season, is on it’s way. It’s partly because it’s this time of year that adds to autumn’s appeal. It’s much more than a pumpkin-spiced moment of sweet indulgence that follows a period punctuated by vacations (for us or others), patios, beach/deck reads, camping, BBQs and picnics or just an abundance of vitamin D. Autumn — and back-to-school — brings a focus back to the work at hand with the vigour that comes from a summer of a slower pace. (or at least it feels this way).

With that, I wanted to use this issue to share some plans for…sharing.

If you’re a regular Substack user, you might know that it’s evolved into a platform for more than just newsletters. While not a replacement for, or copy of, the platform has features that are similar to others. Did you know you can post short stories like on X/Twitter called Notes? Authors can have live subscriber chats like Slack? The platform enables podcasting and short videos like on YouTube, too.

I’ve been exploring these. And while I am not sure whether all of them are appropriate for you, I’m going to let you have a say. (Andi Bitay has an entire Substack devoted to all that the platform does and is planning for if you’re interested.)

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What’s Coming

Over the coming weeks and months, look for more opportunities to engage with content, learn, and develop your design perspective using these tools.

The thing that I like about what this platform is seeking to do is that — at present — there’s no need to use everything. If you are enjoying the newsletter and aren’t into video, podcasts or chat, then you’ll continue to get the value you came for. There’s no need to sign up for more. But if you want to get small bites or different media formats, this is a chance for us to employ some design thinking and experimentation to see how we can make the most of the platform’s tools to become better designers.

Here’s what you’ll see in the coming months:

1. Notes will be the most prominent vehicle for sharing articles, other Substack posts, and news.

2. Chat isn’t on just yet, but we’ll see. If you’re interested in it, let me know.

3. The Censemaking Innovation podcast has been on hiatus, however, new stories are in development and it is possible we’ll convert some of these to Substack.

4. You will see video shorts to complement what’s shared on Notes. The main reason is not just for new media, but to offer some expanded forms for people to access the original content and learn from.

Yet, as the image above suggests, the main mechanism will continue to be writing. We will continue to do AI-free, original, and practical writing on design for health.

Thank you for reading and learning with me. See you on the Substack app, web, or wherever you access The Design Loft.

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Photo by Benjamin Chambon on Unsplash

Welcome to The Design Loft #54

It matters little that what we aspire to, envision, dream, or even make if we can’t convert those products into action for those we’ve created them for.

Behaviour and related action (change) is among the most neglected aspects of design. Designers often believe if they do the research, have a good idea, bring it to life with craft and skill, and produce a superior product to what exists that people will adopt it. Those that don’t, simply don’t know good design.

It’s the same faulty thinking that informs scientists and health policy leaders who believe that more and better evidence will change people’s behaviour on it’s own. The science stands on it’s own, right? Well, if that was true, we’d probably not have the wicked problems we’ve created for ourselves right now.

Good design like good evidence does not, on its own, move people. We need to factor in behavioural strategies for change.

Today, we’re going to introduce some concepts that designer might want to consider if they want to convince people of health benefits.

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Going Beyond Information

Cognitive-rational models of behaviour assume that people are motivated by facts, evidence, and examples that change how we think. The idea is that if we lack information, providing it will fill that gap and people will change or do something with that information. It’s all based on logic and linearity. As designers, we know that aesthetics, feel, and performance qualities of any product are only one aspect of non-logical, non-rational infleunces affecting behaviour.

Human behaviour is about complexity.

Some other issues to consider when approaching how we create, share, and market what we make to influence behaviour:

1. Our views of the world are based on experience, habits and patterns, not just information.

2. Decision fatigue -- how it plays into what we create, what your audience or customers experience, and how they make decisions is a critical factor. Overwhelming people with more information can be counterproductive.

3. People will decide thing differently based on their energy level; which means ensuring you make your most critical decisions at optimal times.

Avoiding Magic Bullet Thinking

Social influencers love the ‘quick hit’ that showcase how doing X, Y or Z will produce change. The truth is that there isn’t a single method or approach that is sustainable, ethical, and effective in changing behaviour. Motivation is tied to social context, biological forces, and individual values. There is no “magic bullet”.

Dr. Harvey Skinner and I spent years working on something called the Likelihood of Action Index, which is based on a sound, thorough review of the literature on what makes people shift their behaviour. Our work on this has been published in Health Psychology (2008) and features as the core of Harvey’s (2002) book Promoting Health Through Organizational Change. Harvey’s original vision was that promoting health and change is more useful when viewed as an index, where the more of these elements you have in place, the more likely someone (person, organization, community) is to shift their behaviour.

This index is based on the concept that the person(s):

• Has knowledge and skills to take action

• View themselves as personally susceptible to a problem or issue (or as a beneficiary of action)

• Sees that problem or issue as serious

• Believes change will reduce risks, gain advantages

• Assesses pros as outweighing cons of change

• Believes that others endorse action (social norms)

• Is motivated to comply with others’ wishes

If we seek to inspire, motivate, and move people, the more we can design in our messages, products, and opportunities that connect these together, the more likely what we make will turn things into tangible benefits.

A more comprehensive model of this was published later and is called The Behaviour Change Wheel, which is worth a read. It brings more of the environmental and identifies more contextual factors that influence us.

Expand your design skills

Converting Ideas into Action

A few more things to consider is that the evidence is clear that, while our thoughts influence our actions, so too do our actions influence our thinking. Try the change first, then change the mindset. Link behaviour and thoughts together, which is called behavioural activation (act and the belief will follow).

Once changes take place, a way to sustain them is to Eevaluate outcomes - draw lines between causes and effects, small wins, daily habits. Evaluation, as the issue below discusses, is not just for accounting for change, but can be a motivator to change.

Find levers to influence and recognize that people may be at different stages of readiness to change. Not everyone is able to take action for reasons that have to do with readiness, not interest. Recognize that we sometimes have the right product, but that the timing isn’t ready for the market (the right time). Aligning these is important.

Foster questions about what it is that you see and explore whether it is an event, a pattern, or part of a systemic structure; leverage innovation accordingly. By having processes in place to identify trends, spot patterns, develop new ideas and put them in place, helps organizations reduce fear and recover from failure.

The path to behavioural changes is long, windy and complicated, but it’s also something we can grasp. We change and create change every day. As designers, this is our opportunity to learn more about ourselves and how our efforts to create better things can be honoured with action.

Good luck and enjoy the behavioural ride!

Behaviour Change Coaching

References:

Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science : IS, 6, 42. https://doi.org/10.1186/1748-5908-6-42

Schmidt, R. (2019). Broadening the Nature of Behavioral Design. Behavioral Scientist.(Link)

Schmidt, R. (2023). Three tensions that behavioral design must address. Behavioral Scientist (Link)

Skinner, H. A. (2002). Promoting health through organizational change. Benjamin Cummings.

Hello and welcome to The Design Loft #53. Thanks for reading.

Hope is a complicated concept, particularly in times of mass social and economic disruption, complexity, and the myriad challenges that come with it all. It’s for that reason, that it’s so valuable because, in such times of uncertainty, having something to aspire toward is vital to our individual and collective wellbeing.

But what does it mean to design for it? What does that look like? And what does hope itself look like?

In this issue, we look at hope and begin a conversation on what it means for design and why it matters.

Hope: Does It Kill or Save You?

You may have heard the phrase: “It’s the hope that kills you.”, referring to the idea that the collision of our intentions and aspirations with the brute force of reality is as harmful to us as anything we could ingest or do to ourselves otherwise. As we near the start of the English Premier League season, I know this phrase is often applied to football. (As a longtime supporter of a certain club that just escaped relegation on the final day of last season, I’ve felt the truth in this statement in ways I don’t wish on anyone.)

But to quote the TV character Ted Lasso (also a football reference), sometimes “It’s the lack of hope that comes and gets you.”

I side with Ted on this, but not just with him. As I’ll explain below, hope is more complex than a wish or a dream for something better, it’s an anchor for innovation and a means for us to do and be better through what we make. Hope is a means to galvanize, focus, activate, and enlist people’s senses, values, and actions in ways that make design possible. If we want a healthier, more vibrant world, what else can we do but design for it?

Certainly, sitting around waiting for things to get better on their own isn’t working.

Hope: A Personal Story

While hope is often framed as a desired outcome, it can also be a means to prepare ourselves for possibilities. Design is nothing if not about possibilities. Yet, what this means for us is that our best-laid plans, our models, and our aspirations might not be the thing we’re here to do or achieve. When I look at my life, I’ve got many examples of working hard for the thing I wanted only to find when I got it, that I didn’t want it after all. Let me share with you one such story.

When I describe my initial foray into academia and my first full-time academic appointment as a faculty member at a university, I thought I’d won the lottery. My whole adult life I’d aspired to be a professor, and to teach, research, and learn for a living. Yet, here I was at one of the world’s top universities doing the job I had prepared for my entire adult life, with a big lab with talented staff, lots of publications and awards, fully subscribed classes (with enthusiastic students and great reviews), more grant funding than most of my divisional colleagues, and yet I was miserable.

The design of my career — the systemic structures, professional culture, and situational variables that contributed to being a professor at that time and place — made it so that I was working 60-80 hour weeks and travelling more than 1/3rd of my year. In my last years in my full-time role, I was spending every single weekend when in town at the office, even for a couple of hours. The irony? I was teaching and researching health promotion, systems thinking, and design and yet I couldn’t manage to design out a healthy system for me, until I left.

This was a structural problem masquerading as a personal one. Because, as my Chair told me, I was doing everything right and doing it well. But, as she empathically and supportively told me, I was a “square peg in a round hole” — meaning my ability to care, deliver, and function in the way that was part of me, didn’t gibe with the environment I was in. Here I was doing the right things right, and (to paraphrase Russell Ackoff) finding the right things wrong.

That’s tough to hear, yet I knew it was true. As importantly, this was a message delivered with kindness, not criticism. I soon left my full-time job, devoted my energy to (again, ironically) going back to school to earn a masters degree in design, and devoted my energy to my strategic design studio and consulting practice. I returned to academic life years later as an adjunct professor, where I’ve been able to practice my craft as a teacher and scholar ever since, only it’s done (as the name implies) as an adjunct to what I do as a strategic designer, not as my core source of employment or identity¹.

1 - Lest I offer you illusions, academia is still a horribly exploitive environment - especially for adjunct or sessional faculty, filled with outsized demands, terrible compensation, bulging class sizes and classroom complexity, and lacklustre support for faculty. However, it’s a better experience when your hope is placed differently. I do this work with my eyes wide open, and that’s what hope offers).

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Designing Hope Differently

Former Czech dissident, scholar, poet and prime minister, Vaclav Havel had a perspective that is worth consideration when we consider designing for hope:

The kind of hope I often think about (especially in situations that are particularly hopeless, such as prison) I understand above all as a state of mind, not a state of the world. Either we have hope within us or we don’t; it’s a dimension of the soul; it’s not essentially dependent on some particular observation of the world or estimate of the situation. Hope is not prognostication. It is an orientation of the spirit, an orientation of the heart; it transcends the world that is immediately experienced, and is anchored somewhere beyond its horizons. Hope, in this deep and powerful sense, is not the same as joy that things are going well, or willingness to invest in enterprises that are obviously headed for early success, but, rather, an ability to work for something because it is good, not just because it stands a chance to succeed.

Havel speaks of hope being a state of mind, independent of the situation. His perspective shares much with the work of Austrian psychiatrist Viktor Frankl, who’s detailed psychological study of his (and his fellow prisoners’) experiences in a Nazi concentration camp. Frankl was able to maintain a form of hope that rings close to Havel’s definition, allowing him to endure previously unimaginable physical and psychological cruelty to survive.

When we design for those we serve, we wish better things for them. That’s a hopeful statement.

In health systems, this might be improvements in care experiences, treatment outcomes, reduced time to being seen in clinics, and the ability to be heard and understood just as people seek to hear and understand what’s happening. For personal wellbeing, hope might mean having a pathway to something that allows you to do something different, even if the outcome is uncertain. That difference, and the attempts to try something, is what innovation is all about.

To design hope is as much about mindsets as it is the skill and toolsets that often get greater attention. This is, at its clearest, what design thinking is all about. (even if many advocates the approach might see it differently.)

2 - Marty Neumaier was the source for this gem about design being the discipline of innovation. I’ve advocated for this understanding ever since he and I spoke about it.

Strategic Design Resources

Designing for Hope

So what does design thinking for hope look like in practice? Let me suggest a few starters, which we might need future issues (and past ones) to cover in more depth:

1. Bring in Futures Thinking. Getting us to engage in some foresight, through scenarios, research and detailed exploration of the possibility space is important. We can’t create a future we want without being able to see what kind of future is possible.

2. Bring in perspective. Designing for people means recognizing the distinctive ways we all see the world from our position in it. For example, Mothers and fathers will see a family different than sons and daughters. Immigrants, refugees, indigenous communities, settlers, and visitors may all see the same place, but their experience of it will be different. Bringing difference into the conversation through our exploration will point to areas where hope can reside.

3. Understand boundaries. Havel and Frankl knew that everything wasn’t possible, but they also knew that more was possible when they acknowledged reality and the boundaries around them. They saw systems and, because of that, they were able to make use of them to design in hope.

4. Create pathways from here to there. When you see a future you want, the next steps are to find and create the pathways that can help you get there. Take one step then another. It won’t always pan out, but that experimental mindset combined with systems thinking, can get you to imagine how certain actions, wisely done, could lead to certain destinations.

5. Bring in feedback. Hope can’t be sustained without some progress towards whatever vision you have for your life. Havel was a leader at a time of great social and political transformation in his country. Many things fell apart, and harms were inflicted on him and his people. And he saw things changing and moving ideas from conception into reality. He was evaluating as much as he was leading, and it sustained hope.

There’s more to this, but the takeaway is that hope exists. It’s not always about getting what you want, but what you can live with and what can serve you and those you care about. And lest we believe that there’s little reason for hope, consider what the alternative is.

That, if anything, should inspire us to seek, create, and inspire hope in our world.

Thanks for reading.

Image Credits: Photo by Nick Fewings on Unsplash

References:

Havel, V. “The kind of hope I often think about” in Disturbing the Peace: A Conversation with Karel Hvizdala, trans and intro. by Paul Wilson (New York: Vintage Books, 1990), 181.

Frankl, V. E. (2006). Man’s search for meaning. Beacon Press (Original work published 1946).

Welcome to The Design Loft #39.

In today’s issue, we are going to talk about impact and how we know we’re making it (or if we are at all). That means we are talking about something called evaluation.

Evaluation is the means for understanding what we are doing, what our efforts are producing, and the overall influence and impact of that work is on the world around us.

We make things because we seek to create positive influence in the world, but how do we know if this is true? How do we improve upon what we do and where does that input come from?

The answers to this are: evaluation.

What is Evaluation?

Let me start with the only evaluation “joke” I have, but one I tell often:

Evaluation is the longest four-letter word in the English language.

Most people bristle at the term evaluation.

Evaluation often evokes memories of grade school report cards, university exams, performance reviews at work, or the feedback you get from your art instructor. Yet, evaluation is a vehicle for innovation and learning. It is the mechanism for providing and receiving feedback on what we make, do, and share. Unlike opinion, evaluation uses evidence. It’s systematic and often systemic, and unlike research (which evaluation is a form of), it also requires a particular form of thinking to execute, much like design.

Evaluation is a structured, multidisciplinary approach to evidence generation, use, and learning that uses data to assess the merit, worth, and significance of a designed thing.

That thing can be a program, service, product, policy, or system; it’s anything that we have put into the world that people derive value from.

Evaluation is a means to aid us in learning about what we made, documenting how we made it, and ascertaining what kind of influence our creations have on the world around us. It is a form of determining the return on investment for our designs.

It does this by generating evidence.

Showing Our Work and Demonstrating Our Impact

The common refrain from designers is that they work to the brief. Their job, as some see it, is to create what’s been asked for and that’s it. The way its used (or whether its used at all) and its effects are up to the buyer or client.

This is much like health researchers who might be interested in answering important questions, but feel the responsibility to ensure that the evidence they generate is used is beyond their remit.

Just as we looked at the role of science and creativity in our last issue, we must also confront the conceits of evidence in the role of design and health work. By that, it means looking at what designers do and what evidence does.

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Designers are good at making claims about what they make. Whether you are a product designer, a non-fiction book author, a scientist doing applied research, or a service creator — everyone of these roles is about making claims about the product or “thing” being created. Evaluation is the means to test those claims with evidence.

Evaluators do this through many different means. This might be a design-driven evaluation approach, which connects evidence generation to the decisions made about something’s use and usefulness. It could be through any number of methods and approaches. For more on this, I’d recommend you check out the Better Evaluation platform for methods, theories, and approaches.

Whatever the methods and approaches you choose, evaluation generates evidence and makes it transparent to you as the designer and to those who are affected by or will use yoru creations. That’s important because not every design will yield positive benefits. Some may (unintentionally) cause harm. Some might have greater impact than anyone realized.

We won’t know unless we evaluate.

Where Does Evaluation Inform Design?

What does evaluation offer designers? Here is an incomplete list and some things to consider.

Decision making. Evaluation helps ask: What are we doing and what could we do next? Rather than being arbitrary, why not use data and a structured process to inform your decisions about next steps in the design process or where to continue innovating.

Seeing the future. An understanding of what we’re doing and the effects that arise from it allows us to apply foresight to better imagining what could happen, how that connects to our strategies and decisions today, and reinforce or support what we do today to influence tomorrow.

Design. Evaluation data provides the feedback necessary to undertake design work and design thinking. Without good data to support the design process of research, ideation, prototyping and implementation design thinking is an art project with a purpose . John Nash has illustrated how evaluation and design are linked in his book on design thinking and schools.

Asking better questions. Few things will engage people like good questions. Evaluation questions what we are doing, who we are, and how we undertake our work and live our values.

Creating conversation. The asking and answering of questions in a manner that is transparent, potentially practical, and relevant to people’s lives is what fosters engagement between people. This taps into what makes us distinct, what brings us together, and the curiosity and purpose people have about the world.

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Speaking truth to power. Data, democracy, rights, and responsibilities are all part of evaluation of the designs we make.

Honouring our work. Evaluation data allows us to recognize the effort that goes into making something and helping inform how to make it again (scale) or make it different.

Learning. Evaluation data provides a focus for attention and engagement. It is also the one outcome we can guarantee when innovating. When used across an organization, evaluation can be a catalyst for organizational transformation.

Leading system change. Complex systems evolve and adapt based on feedback. Evaluation is the means of providing and structuring that feedback. We can either have the winds of change blow us anywhere, or we can sail with the winds to where we want to go. Evaluation data also feeds and helps shape the systems models we need to inform any systemic change and design.

Telling stories about who we are as people. The stories we tell ourselves and each other is based on data (even if we don’t think of it as such). Evaluation provides the means of making that data a little more systematic to help translate the story of one person or group into meaning for another.

Promoting health and preventing harm. What contributes to our well-being? What actions promote harm? How do we know? Simple cause-and-effect situations can be easy to assess. What happens when we aren’t sure — like with drug education programs, the effect of eating certain foods on our health, or the role of social technologies on our mental health.

Reinforcing democratic ideals. Work from Katri Vataja and Pinka Parkkonen illustrate how Finland are using evaluation as a vehicle for fostering democratic engagement around social policy and what it means for the future. They argue that evaluation has an ethical imperative to understand people and the designs we create.

Design and innovation. Evaluation data is the lifeblood of innovation. It is the innovator’s secret advantage. Over at Cense.ca there is a whole series devoted to exploring this and why great innovation can’t succeed without good evaluation.

Provoking curiosity. It’s a big job, but evaluation provides a means to focus on what is happening and invoke curiosity about the world by giving us something constructive to contemplate.

Recognizing humanity. If it’s not obvious from the other points, one thing that evaluation does really well is recognize our humanity. It provides a means to allow us to celebrate, to improve, to recognize where we fall short and where we exceed our goals. Evaluators are looking at our place on the planet, how we can see into the future and be visionaries, and how we can lead and support change.

How about that for a sense of impact? Responsible design is as much about evaluation as it is creativity and creation. Link these together and you have real impact.

Thanks for reading. Go out there and make something great.

Connect Design and Evaluation Together

Thanks also to the work of Chris Lysy, the cartoon-laureate of evaluation for his work and creative contribution to the field. You can read more about him, his work, and his layered appreciation of both design and cartooning at https://www.freshspectrum.com

Welcome to The Design Loft (Issue #38).

This issue we’re going to look at the matter of applied creativity in the context of evidence-informed environments and the perceived tension between what we know, what we’ve done, what’s unknown, and what we can make.

Let’s start with two questions comparing scientists (including health professionals or anyone who regularly relies on scientific knowledge to do their work) and creatives (which is anyone who draws inspiration and guidance for their work from sources that are not based on scientific knowledge) :

Can a scientist be creative?

Can a creative be scientific?

The answer to both of these questions is an emphatic yes.

No is the answer I often hear from creatives and scientists (or doctors, CEO’s, marketing directors, designers, and more).

In this issue, we explore the bridge between science and creativity.

The Creative Scientist

Scientific inquiry is a creative practice in that it requires new ways of seeing, thinking, and working with constraints. These are the same conditions that frame a design challenge. Just like design, we’re undertaking a systematic application of ways of seeing, making, and applying knowledge about the world toward answering a question or creating a means to address a problem.

The difference is more in the manner in which we use tools and view constraints. But the fundamental character of a scientist’s work is to generate something from what they have in front of them. They have to sift through existing evidence, identify gaps, design a study to fill those gaps, execute, analyze and deliver some means of sharing and transforming whatever insights into meaningful, actionable communications about that research (even if it’s basic, non-applied research — it still needs to be actionable in the sense that it has to be considered).

This is the same thing as designers.

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The Scientific Creator

What about creators? I teach at a leading art and design institution and know firsthand the challenges that those who see themselves as creators may have with scientific work. The concepts, statistics, tools, and culture seem alien to many of them. The truth is that the same goes for the scientists I teach and train when they think of what makes someone creative.

But design (and art) and science have a long-established tradition of working together. Many great artists and designers use scientific understandings to inspire their work, inform the creation of things, and to frame the problems and solutions that they seek.

Kara Pecknold, formerly of Frog Design, wrote about how she became a better designer through her exposure to and understanding of scientific concepts. Pecknold works and writes on regenerative design and on matters of designing for ecosystem health. She realized that it was nearly impossible to do great work without understanding some fundamental points about the environment, nature, and how systems come together.

This is applied systems thinking, grounded in science from different traditions:

Questions about extinct species, indigenous subsistence techniques, plant associations, and fires expand the cast of stakeholders beyond end-users and clients to include ecosystems and more‑than‑human neighbours. Life‑centered and more‑than‑human design frameworks explicitly argue that designers should treat rivers, soils, species, and future generations as entities that designs must consider and sometimes “speak for.” This shift can change briefs from “increase engagement” to “reduce resource use per task” and evaluation metrics to include ecological footprint, not just NPS or revenue.

Pecknold refers to twenty questions posed in the work Where You At? A Bioregional Quiz, which was developed by Leonard Charles, Jim Dodge, Lynn Milliman, and Victoria Stockley and published in Coevolution Quarterly 32 (Winter 1981). This list is less an exercise in scientific inquiry as it is place-making and framing. This activity is meant to ground us in what’s around us to understand the world we wish to influence or understand.

Creatives, just like scientists, ground ourselves in where we are to seek how to move forward with our creations (what’s in need of exploration, expression or solutions). Scientists do the same to ask questions about how and what to study (what’s in need of more understanding).

Don’t let a fear of what you think the other (science/art & design) is to prevent you — as a scientist or as a creative — from embracing and learning about what the other is and does. Chances are, you’re already doing some of it. Chances are also that if you’re able to bring these together, you’ll create more health than you could without it.

Thanks for reading.

References:

Charles, L., Dodge, J, Millman, L., and Stockley, V. Where You At? A Bioregional Quiz. Coevolution Quarterly 32 (Winter 1981): 1.

Photo by Aleksandr Barsukov on Unsplash

Hi designers — Welcome to the Design Loft #37. Today, we’re looking at the concept of complexity, and how it’s often misunderstood in how it plays a role in design.

The Language of Complexity

The term complexity is being used more than ever — or at least it seems that way. Dave Snowden, one of complexity practice’s great champions and a prolific author, recently published a polemic on the ways in which the term and the ideas surrounding complexity are misunderstood and mis-represented in discussions, articles, and the overall discourse on systems.

The concept of complexity matters greatly for design in the health context.

Complex phenomena, systems, and situations are what much of health services, policy, promotion, and care deal with on a daily basis. Complexity is all about relationships and the interaction between different agents, working within the constraints of a particular context.

These interactions are what make every day at the clinic a little different from another.

Dave notes the inherent laziness in how we treat something as complex. I agree fully and see this over and again in my work.

It’s complex, so who can say what will work; best not to intervene. It’s complex, so management is basically impossible; don’t hold me accountable for an outcome. It’s all emergent, as if naming a phenomenon settles the matter and no further judgement, decision, or action is required. This is a convenient inversion of what the field actually argues. Complex systems aren’t unknowable, and they aren’t unmanageable: they have propensities and dispositions, tendencies that can be understood, worked with, and shifted, even without a predictive model of the whole. Acknowledging that a system is complex doesn’t mean you can’t act on it; it means you act differently: smaller probes, faster feedback, safe-to-fail experiments, adjusting actants, changing interactions. “It’s complex” is the start of a different kind of discipline, not a permission slip to abandon one. Used as an excuse, it’s just fatalism wearing a lab coat.

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Simplifying Complexity

One of the simpler ways to understand complexity comes from Dave Gray, who describes it this way in his book The Connected Company:

This three things, taken together, describe what makes something complex, it doesn’t provide the fullest description of all of the properties of complexity. But that’s not the point — because we can drown ourselves in technical descriptions and phrases and forget that we design for complexity every day. Our lives are filled with complexity, and seeing it throught the lens of these three qualities is a starting point to be able to understand what it might mean to design for it.

Within this definition using health systems, we might supplant companies for many things: symptoms, conditions, clinical specialties involved in care, care facilities involved, etc.. For connections, we might consider those referral patterns, aligned service groups, or the number of caregivers as examples.

Complexity concerns the many different connections and relationships involved in a system (as it pertains to a purpose, condition, or situation) and how they affect different things at different frequencies, intensities, and overall rates. This is what makes health systems complex.

Just like the knot in the cover image above, we often stare at complexity unsure what all is involved. Like the knot, we might wonder how many strands are there? Is it one rope that’s frayed? Is it many? How are they put together? And what, if anything, can help us to untie or untangle it?

But while there is much in complexity that makes it difficult, it’s not beyond our comprehension, even if it often outside our direct control. We still have influence within complexity, which is what has Dave Snowden so motivated to write on it, because he sees complexity as an excuse not to act, not to design (my term, not his), and to throw our hands up.

In design terms, this means designing for motion. Recognizing that we need methods and approaches that allow us to appreciate complexity as it exists, make sense of it, create with the aim of promoting adaptive capacities, mixed uses, and embedding a process of learning into it. We’ll get more into the specific in a future post (stay tuned).

Errors in Complexity

Underneath the vocabulary problem of complexity sits a set of recurring reasoning errors which show up constantly, often from people who’d tell you they know better. Snowden goes on to point out these errors:

Retrospective coherence is probably the most common. This is the habit of looking back at how something unfolded and narrating it as though it had always been heading there, as though the actors involved could have seen it coming, or as though there was a hidden logic waiting to be discovered. Complex systems don’t work that way. Outcomes emerge from countless local interactions, and the story only looks inevitable after the fact because we’re pattern-matching backwards from a known result.

Premature convergence runs alongside it. This is the rush to lock in an explanation, a strategy, or a solution before the situation has been allowed to reveal enough of itself.

Causality is the third recurring habit, and maybe the most stubborn, because it’s baked into how most management training works. There’s a persistent instinct to find the cause: the root cause, the lever, the intervention that explains the outcome, even in situations that are constituted by dense, entangled interaction effects with no single point of leverage. Complex systems don’t have root causes in the ordered-system sense. They have propensities, dispositions, constraints, and enabling conditions that can be understood and managed, along with effects that loop back onto their own causes. Insisting on a linear causal story in that setting isn’t just imprecise; it actively points people toward interventions that address a symptom mistaken for a source.

Snowden wraps up his polemic with a focus on the many ways in which people “sell” complexity to others, offering designs that aren’t fit for purpose and violate the very things that make something complex:

If you are selling a roadmap, you are not doing complexity work. If you are selling a plan you would stake your reputation on regardless of what the system does next, you are not doing complexity work. Complexity is not a label for what you were already going to do. It is a different kind of discipline, or it is nothing.

What it means is designing for complexity, not ignoring it. That means of addressing it directly and with technique, will be the subject of a future post.

Thanks for reading. For paid subscribers, read on to get into the key errors that Snowden gets into and how to spot them.

For more on complexity, design, and creativity, I encourage you to go back a few issues to read this post from July 8, 2026:

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A shortlist of the errors that follow from these habits, roughly in order of how often I see them:

1. Treating “complex” and “complicated” as synonyms: using the label of one to justify the method of the other. This is reducing in frequency mind you.

2. Narrating outcomes as inevitable after the fact: (retrospective coherence) and then presenting that narrative as evidence of foresight.

3. Converging on a solution before the system has been probed: skipping straight to a fix because ambiguity is uncomfortable for the client or the consultant.

4. Hunting for root causes: in a system whose behaviour comes from interaction effects, not a linear chain.

5. Front-loading a comprehensive plan: the assumption that enough analysis up front can substitute for iterative, real-time sensing.

6. Mistaking agreement for validity: a workshop full of consensus doesn’t mean the model of the system is correct; it often just means the room was primed to agree.

7. Context-free practice transfer: importing what worked in one context wholesale, on the assumption that success elsewhere implies success here, when context is precisely what complexity theory says you can’t abstract away.

8. Static framework fetishism: plotting a system on a 2x2, a quadrant, or something like Cynefin, once, and treating that placement as fixed. Complex systems shift domain constantly, so the exercise needs to be repeated, not filed away, and flattening a framework like Cynefin into four static boxes loses exactly the boundary dynamics it was built to capture.

9. Confusing complicated tools with complexity method: dashboards, network diagrams, and system maps that describe complicatedness while the actual sales pitch is complexity.

10. Locating emergence in “the whole” rather than in interactions: systems-thinking holism (parts and wholes) standing in for complexity science’s actual claim, which is about the properties of interaction between actants.

11. Ideological misappropriation: treating complexity as a synonym for niceness, openness, and flat consensus, as though self-organisation were a moral stance rather than a description of behaviour, and constraint were the enemy rather than part of the vocabulary. Making complexity into the good aspects of a Manichæian dichotomy, or dichotomies often with a religious overlay.

12. Complexity as an excuse for inaction: “it’s complex, so nothing can be done” or “it’s all emergent,” used to abdicate judgement and accountability rather than to justify a different, more iterative kind of action.

13. Uncredited borrowing: stripping ideas, diagrams, even cartoons, of their origin until the source is lost and the idea gets treated as generic wisdom rather than someone’s specific, hard-won insight.

Writing in the Monocle Daily, Tom Webb makes some astute observations on the connection between market research, brand development, and product delivery. His look at Netflix and it’s fall from focus serves lessons that can be imported into the health context. We’ll start by looking at marketing and branding and make the connection between how those two things — and the products that are at the heart of them — parallel to health systems.

Marketing and brand management might not be at the top of what health leaders or those in non-profits, foundations, or government services care about, but that is at their peril. For marketing and branding are core design activities. Their purpose is to understand, communicate, and deliver upon expectations, preferences, and desires.

There is no difference at a fundamental level between marketing a handbag or app add-on as there is opening up a new family health practice or delivering mental health supports to the community (which is different from the business and purpose of handbags, app add-ons and family practices or mental health supports).

Marketing is about communication of the elements of the thing you’re providing and connecting it to a real situation they face. As Seth Godin argues:

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Which brings us to the curious case of Netflix and Tom Webb’s article in Monocle.

Webb is reflecting on Netflix’s shift toward introducing short-form video, much akin to TikTok, Instagram Reels, and YouTube shorts. If you’ve been on Netflix lately, you’re seeing short videos, podcasts, and many more things that resemble little of what we (or at least me) signed up for.

Webb notes that this is brand, marketing, and design research failure rolled in one:

Ask people what they want from life and their answers rarely match their behaviour. We all say that we would like to eat better, read more and spend less time on our phones. But entire industries are built to exploit our impulse for mindless scrolling and feed us food or information that we don’t really want. Today, streaming platforms are no different – and in chasing our behaviours, they risk forgetting what audiences actually value.

He points to the rise of short-form video consumption and how Netflix is confusing what people are doing, with what people want and enjoy. Speaking with Evan Williams, the documentary filmmaker, they come to note:

There is a growing recognition that doomscrolling often leaves people feeling drained and, in many cases, depressed. While it might be highly consumable, it certainly isn’t striking or enjoyable.

Further, these short-form videos undermine the very thing that made Netflix stand out among others: longer-form, consumable content. That was what made them successful. He notes:

The strongest brands create spaces where creativity finds a home.

What does this mean for creativity in health systems and the brands that represent their purpose.

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In health systems, the strongest brands are those that deliver trust, quality, and care.

One example is when people wait ten hours for a hospital bed and when these wait times persist over weeks, months, and years, that is a failure to deliver on all three of those promises. This is as much a delivery problem as it is a branding issue.

Why?

Debbie Millman, professor, brand strategist, and renowned design educator and promoter (host of the long-running Design Matters podcast) writes in Brand Thinking and Other Noble Pursuits:

Genuinely good branding involves an examination of every single way the brand, the product, and the experience is viewed. Everything that you do, everything you release, everything you say—everything is the cumulative expression of your brand.

There is nothing in this description suggests that a brand can’t be a health service or part of a health system in a non-commercial way. Branding, in this term, is what we do.

What is Netflix doing right now? How does it fit with the brand? How does Netflix, in Tom Webb’s words, find a home for creativity when it pursues something that is, given its brand, the antithesis of it?

This is happening across health systems. When people are neglected or ignored, they are uncared for.

When people aren’t seen, they are left with conditions untreated.

When people are left to struggle on their own, without tools or help, or in settings that are harmful, they are unhealthy.

When staff are treated without care, poorly equipped or prepared, or left to work in environments that will not enable them to do aspire to do and be their best, they are left feeling unprofessional.

The absence of care, treatment, health, and professionalism is what the health system brand can be if we let it. By designing with the idea of what a brand is and represents we can start to recalibrate and connect to the purpose of what health systems are. A health system without care, without treatment for real problems, or without the means of promoting health (and the professional practice that distinguished it from other forms of care, treatment, and health promotion) is not what we aspire to.

Perhaps, thinking like a brand strategist and strategic designer might improve our perspective.

What does it mean to be creative in practice?

Creativity is more than imagination. It’s imagination coupled with craft. It’s the metaskill of making.

It envisions, embodies, elaborates. It develops, shapes, solves. It advances, iterates, proves. Note the lack of passive verbs in this list. Making is action. Unless you’re willing to get your hands dirty, your imagination will remain unrealized and uninformed.

Marty Neumeier’s definition of creativity insists that our imagination must be tied to the making of things, not just envisioning them. Making is at the heart of design, which is the discipline of innovation. As Marty notes, creativity is imagination coupled with craft. It’s not just about good ideas, interesting thoughts, or hypothetical possibilities done in the abstract. Creativity involves making something.

There are many who might argue with this, but at its core, design is about the manifestation of things (products, services, policies, programs, and systems) and not just the conception of them. Yes, a design could involve the creation of a map, a plan, or a guide, but that’s still something that’s tied to use and it’s value is determined upon the use. A theoretical plan never considered is an imagination, not a design.

Design is not coming up with ideas that aren’t enacted, attempted, or built upon. It’s about channeling creativity into the making of things.

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Connecting Creativity to Health Systems

I spoke about creativity in the second Cense Summer Series webinar. During that webinar, I showcased some of the latest thinking about creativity and its application.

Some of the key messages include:

1. Creativity is not just a vehicle for innovating in health, but health itself. A systematic review looking at the power of creativity through art(s) shows clear health and social benefits that extend to many conditions in both treatment and preventive contexts as well as health promotion. (Sonke, J., Tan, M. K. B., Lee, J. B., Pesata, V., Akram, S., Golden, T., ... & Sajnani, N. (2025). The arts for disease prevention and health promotion: a systematic review. Nature medicine, 31(11), 3907-3916.)

2. Creativity is not just a personal matter, but about the context, skills, and goals that channel it. Drawing the work of the “Four P’s of Creativity” I profiled how creativity is to the following four aspects: 1),The Person: The unique personality traits, traits, and cognitive abilities that make an individual prone to creative thought (e.g., curiosity, openness to experience)., 2) The Process: The cognitive steps and actions an individual takes to bring an idea to life, such as brainstorming, divergent thinking, and persistence, 3) The Product: The tangible or intangible outcome of the creative endeavor, such as a painting, a scientific theory, or a new recipe, and 4) The Press (Environment): The external factors, social contexts, and cultural influences that foster or inhibit creative expression (Tang, M., & Gruszka, A. (2017). The 4P’s creativity model and its application in different fields. In M. Tang & C. H. Werner (Eds.), Handbook of the management of creativity and innovation: Theory and practice (pp. 51–71). World Scientific. https://doi.org/10.1142/9789813141889_0003)

3. The SCAMPER model was introduced to those who attended. (See the earlier Design Loft lesson on this topic for details).

4. We also looked at the latest on AI and creativity, profiling newly published research that shows “Individually, AI often enhances creativity, particularly by enabling less experienced or less inherently creative individuals to generate more novel and useful ideas. But collectively, AI often “compresses” the idea space.” Boussioux, L., Doshi, A., Hauser, O., & Hosanagar, K. (2026, July 9). The hidden cost of AI-assisted creativity. MIT Sloan Management Review. https://sloanreview.mit.edu/article/the-hidden-cost-of-ai-assisted-creativity/

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   Takeaways

The takeaways are that we need to consider creativity as part of a system, and that when we design contexts that support it, we are more likely to see creative opportunities emerge in the health sector. These takeaways include:

1. Build curiosity outputs into working contexts

2. Nurture environments for creativity (trust, safety, curiosity)

3. Create habitual space for creative exploration

4. Connect creative thinking to making

5. Monitor, evaluate, critique, feed-back

6. Network and link creative connections; exposure to creative thinking, products, and outputs

7. AI can assist in warming the space up, especially for those with low confidence, but human leadership is needed

8. Remind ourselves that health is produced through tangible creation

We’ll continue to look at this journey of creativity and design in health over the summer months and in future issues of The Design Loft.

Thanks for attending the webinar and reading. If you’re interested in future events, register at: https://www.cense.ca/summerseries26/

Design is a participation sport. To invoke the spirit of the World Cup (on at the time of this writing): design means getting on the pitch, not sitting in the stands.

Design is the discipline of innovation, and discipline requires practice to achive it. We can commission design, but that still requires that we understand what we’re making.

Some of this has come into question with the rise and proliferation of artificial intelligence-enabled tools. The ability to create text, video, images and myriad combinations of artifacts has the appearance of creativity, yet if the person(s) initiating the creations with their prompts aren’t invested in the actual making of the product, are they creative? Or perhaps a better question is: are people benenfitting from what creative acts bring in deferring to these tools?

There is a middle way, and creativity isn’t a binary tech in/tech out thing. This post was written with a host of digital tools, and it’s enabled enormous creativity. But it was created by me, not an AI.

Design leader and multi-media digital artist Kirk Clyne knows the potential of AI to create, and where its limits lie. Kirk has been creating AI-supported art long before the various generative tools like Chat GPT and Midjourney became widely used and popular. He’s been at the forefront of understanding what these tools can do, and what is required for human imagination. His visual art, music, and commercial client creations reflect a craftsmanship that comes from someone who knows what tools do and what the skill of creation (human-driven imagination, productions, and craft) can achieve.

His art is made with AI, not because it can create things, but because he can. He knows that the art is as much about the making as it is the end product. It’s about the artist and the art. Or, as I’ve often said:

Design isn’t just about what we make, but what we become in the process of making things that matter.

Kirk’s work as a product development and design leader is shaped by his use of technology to bring to life his creative visions and that of his teams. It’s not meant to do the creation, otherwise, his craft would suffer, as would his judgement as a design leader.

Not everyone realizes this, and it’s certainly one of the fears I have as a designer working in health, but also one of the reasons The Design Loft exists.

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Creativity in Practice

Creativity requires we exercise the cognitive, perceptive, physiological, and emotional aspects of our being to bring an idea into the being. This is the essential quality of design: giving form to ideas.

It involves us having a stake in what we put into the world, because it requires our focus, attention, and energy directed into making something. It’s why commanding something into being through AI is hollow, no matter what is produced. It’s what separates the use of AI in the manner that Kirk Clyne has used from simplistic prompt engineering.

Marty Neumeier, quoted above, knows this as well. Marty is no stranger to digital creation and marketing, but he’s also aware of the limits of what these tools do, and what the human-powered creativity behind their use mean for good design. As he notes:

Creativity is more than imagination. It’s imagination coupled with craft. It’s the metaskill of making. It envisions, embodies, elaborates. It develops, shapes, solves. It advances, iterates, proves. Note the lack of passive verbs in this list. Making is action. Unless you’re willing to get your hands dirty, your imagination will remain unrealized and uninformed.

Marty says we need to get our hands dirty. We need to participate in the sport that is creating, designing, and putting things into the world.

At an insitutional level, this means creating spaces for you and your teams to explore, create, ask questions, and consider the answers. (For more on this starting point, see the earlier article. )

Creativity, it’s practice, and the organizational, institutional and behavioural factors that nurture it will be the focus of the next iteration of the Cense Summer Series, which provides an introduction into the fundamentals of design for health in the age of complexity. See the link for registration and information below.

We’ll be looking at this issue and the way that creativity intersects with design and the what it means for designing for and within the health context in our future issues. So please subscribe to keep learning, and we’ll see you soon.

Asking better questions is part of good design work.

And by good design, I mean creating products, services, and programs that are effective, attractive, and easy to use.

Yet, the mere asking of questions requires a space and time that’s not always available, or rather, it requires its own set of design conditions. That’s what we’re going to look at in this issue.

Starting Inquiry

Research is a fundamental component of designing for health (or anything), as it ensures that the frame we use fits, and that the problem or situation we’re looking to address is actually the one that is contributing to our need for something different.

This past week I hosted the first in a series of six webinars on design for health in the age of complexity. (If you’re interested in the schedule and joining in on a future one, register here). The focus for the first event was on asking better questions.

Some of what was discussed was profiled in two previous editions of The Design Loft, with an emphasis on asking:

What are you trying to improve?

Who are trying to improve it for?

At the core of our first session was the role of questions and how better questioning can lead to insights. We covered some examples of how question-asking can lead to exploring some of the fundamental assumptions we bring to a situation and the possibilities that the answers enkindle.

What we didn’t get time to cover, was that asking questions is, in it’s own way, a process that requires some design work. Freedom to question, time to explore, and space to reflect all require some form of intentional action in our systems, whether those are organizations, networks, homes or otherwise.

Question Asking Conditions

It’s easy to suggest that we ought to ask better questions and give ourselves space to reflect upon what we see and do. But ask any leader, clinician, or caregiver and you’ll find that the time, care, and attention necessary to do this well is often lacking because of the demands of the system that they are in. That system — the clinic, the hospital, or the home-life demands, all bring with it continued demands, expectations, and norms.

We won’t cover all of these in this post, rather we’ll look at some of what we know about healthy question-asking conditions, drawing on the work of Warren Berger and others, who have looked at the role of question-asking and how it leads to better (more useful) answers.

Psychological & Cultural Conditions

Setting the stage for people to feel safe that they can ask questions, take (and make) space to question things is critical. Amy Edmonson’s work on psychological safety is of critical importance here. Edmonson, and others, have argued that there must be a culture where people can fail, share disagreements, ask questions of the process, and consider alternatives without fear of repraisal.

This also means creating a culture where people can be emotionally honest, which is another key factor in shaping design and critical inquiry.

Structural & Process Conditions

Learning fails in poor systems. We often speak of learning, but to learn means to be open to new thinking and have a means to ask questions that can generate that new thinking.

As I noted on Censemaking, there are multiple issues we face with learning: 1) metrics that are poorly synced with outcomes, 2) an ingrained fear of failure, 3) credentials (and false attribution of skills based on them), 4) no pathways for knowledge to move, and 5) poor systems in place.

These also mean including slack time / “why” space, where there is a release from the pressure to “execute”. At it’s most innovative, Google instituted it’s 20% time policy, where employees were encouraged to develop projects adjacent to their work.

Creating cross-disciplinary spaces for conversations and collaboration. The work on Team Science is one example of where disciplinary transcendence in collaborative environments can yield better questions. This builds on what Berger found about the “beginner’s mind” that comes when we release the ‘expert trap’ that comes with experience in one area, yet might be limiting in others.

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Practice Conditions

Warren Berger has a list of four questions that he suggests asking to help you ask better questions as part of a personal practice:

These are the kind of questions that can immediately bring you new ways to explore things.

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Organizational Conditions

The final set of conditions are ones we’ll be exploring much more in depth in future posts. Setting up the conditions as an organization to structure, reward, support, and facilitate questioning and creativity is part of what the next session our Summer Series will cover.

Developmental Evaluation (DE) is a method of bringing together inquiry and questioning to the organization. To undertake DE in practice requires organizational changes that allow people to explore, sit, and make sense of what they see and provides a means to work with it.

Is your senior leadership on board with asking questions? Do you set aside time in key meetings or gatherings for question-making? Are there moments and systems to help you make sense of complexity when you encounter it (versus just trying to push through it).

Ask better questions and you can find your way to better design options.

Maybe ask yourself: how can I build a practice in my organization to consider the kind of question-asking and culture of inquiry that’s needed to innovate?

Stay tuned for more coming in the weeks ahead. In the meantime, join in our the summer series or check out the links here to find more about how you can innovate and design better for health.

If I can be of help, also reach out > https://www.cense.ca/censemaker/

Photo by Red Zeppelin on Unsplash

The line above is one of my most favourite definitions of design. It’s simple, short, and encapsulates why and how we design, while still leaving mystery for you to imagine what it means.

Another of my favourties comes from Liz Sanders and Pieter Jan Stappers, who visually represents design as the means of connecting our experiences (memories) with our dreams.

Design practice is about connecting these ideas together with inquiry (research), an sense of context and relationships (systems thinking), an understanding of how humans react to and respond to things (psychology), and a means to assess what our creations do once they are put into the world (evaluation).

This is design.

It’s both natural and intutive, as well as something we do all the time. We see situations we dislike, we recognize opportunities to do something different to improve the situation, and we get to envisioning how that might happen and what it will take to do it.

In the health sector, this can mean a lot of things. Health leaders — like many of you readers — have told me that you approach design with a sense of excitement and caution (if not downright fear). Design is the discipline of innovation, and that brings with it risk, opportunity, uncertainty, complexity, and attention. Most of these are challenging to deal with.

Fear not, the introduction you’ve been asking for is coming. Beginning July 2nd, 2026 and continuing every second week for six sessions over the summer months, Cense (the parent of The Design Loft) is presenting: Design for Health in the Age of Complexity.

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Upcoming Events

The agenda is as follows (all events are at 1200 Eastern Time):

Thursday, July 2: Understanding Design in Two Questions: An introduction to Designing for Health

July 16: Creativity and the Practice of Design in Health Systems

July 30: Complexity and Health

August 13: Connecting Health to Impact By Design: Evaluation

August 27: Designing for Health Behaviour and Change

September 10: Creating Better Services in the Health Context: Service Design

To register, go to the Eventbrite event page linked below or here.

Paid members of The Design Loft will receive additional materials.

This multi-part series is building up to the launch of the expanded and in-depth Design for Health curriculum that we’ll be delivering through The Design Loft in the autumn, yet is also meant to stand alone. This is a practical, bite-sized introduction to design for health that you can learn about over lunch (or whenever it lands in your time zone).

Lessons will be recorded and the link shared with those who register for the event, so if you can’t make it, you can still gain access to the content.

I hope to see you there. Visit the registration page above for more details or click the link here. More updates will also be shared here on The Design Loft as part of your Design School for Health.

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