Design thinking is gaining support in K-12 education. Most acknowledge the model developed by the d.school at Stanford, but the idea has been around for a while, and there are other models that share similar attributes. I learned about instructional design models the last (and I mean last) time I went back to school, and many ID models rely on the process of design thinking. While there, I also took a class in computer science and learned about scenario-based design by one of its early proponents, Dr. Jack Carroll, and much of the literature I read those three years was related to human-computer interface (HCI) design. A related concept is that of human-centered design. All of these practices incorporate tenets of design thinking.

Recently, the concept of design thinking received a push by being included in the ISTE Standards for Educators (see Standard 6, Facilitator). It’s a common pattern where things developed in industry move through higher education to later reach K-12. For design thinking, that time is now. I found it a little ironic that it shows up under the Facilitator standard rather than the Designer standard, but the intent is to help students understand and practice design thinking, so even though teachers can use design thinking principles for developing instruction, students will be able to benefit from design thinking principles in many subject areas. Computational thinking also appears in the standards, but design thinking is applicable in more situations, perhaps even when developing policy.

I have been musing over what might happen if design thinking was applied in different domains, specifically policy. What if legislators changed the prevalent, current practice of negotiation and instead adopted a design thinking approach to finding policy solutions? Recent, some might say volatile, political events in the halls of America’s capital have emphasized how important design thinking might be to those attempting to address the needs of a diverse constituency of citizens. Perhaps most discussed recently is healthcare legislation, in which legislators have focused more on assuaging and persuading constituents than designing a creative and innovative solution for real healthcare issues. Design thinking is focused on finding solutions for real people, not negotiating compromises. That type of approach doesn’t happen often in industry, at least in successful industries, because bad solutions don’t sell. If your product doesn’t meet the needs of an audience, few will buy it. Perhaps legislators at all levels of government could turn to a design thinking model to address this and other important policies, as based on my current observations design thinking is a process that appears to be little known or applied in policy decisions.

What is design thinking?

Whichever model you prefer, there are some commonalities across design thinking models. These include:

• Know your user/learner. This is a key component of design thinking. You’re designing something for someone, or a group of someones. That’s why design thinking is also human-centered or learner-centered, if you’re designing instruction.
• Get to the root of the problem. Jumping to conclusions can lead to short-term solutions that don’t address the full problem. Finding long-term solutions requires better understanding the root causes of problems, some of which may be cultural, philosophical, or psychological in nature.
• Develop prototypes/models and get feedback. The design process is an iterative one, meaning you design some stuff and then test it out to see how it works. And then you redesign it and get more feedback. Prototypes or models often change, sometimes completely, so you need to be open to change. Resistance doesn’t go far in design thinking.

So, how might the application of design thinking look when developing policy, specifically healthcare policy? I’ve never helped develop legislation, but I have used design thinking often[1]. Perhaps the following might provide some ideas for adapting this proven method in the arena of policy.

Step 1: Know your user

To begin with, in terms of design thinking, legislators would actually talk to people who need healthcare—different kinds of people with different needs. The d.school model calls this step developing empathy for the user. They would interview or read about or shadow different people to understand what kinds of healthcare needs they would have and design solutions for those people.

In instructional design, I use an audience analysis process (Dick, Dick & Carey, 2008) that helps me to understand what my users are like and how my instructional product might meet their needs. Sometimes I do this by talking with people in my user audience, but other times, if I can’t get to them, I try to talk with as many people as possible to try to figure out what a typical user’s day is like and how my product fits into it. I might also research users through a variety of resources, online groups, and publications. The ultimate goal is to come up with a story or picture (or stories and pictures) that help me understand whom I’m designing for and what they need.

One approach I use to get to know my user audience better is creating a scenario about the users, a component of scenario-based design. There are usually multiple types of users with different characteristics and needs, so plural scenarios are usually best. Some proponents of scenario-based design suggest you compose a “day in the life” story of your users and how whatever you are designing will fit into that day. You can also find or create pictures or even short videos to help make those stories come alive.

I’ve used these three stories or student profiles often (also see the image below). The first time was with a state education agency that wanted to develop a website to provide curricular support to students, their parents, teachers, administrators, and just about anyone who supports education. That’s a pretty big task with multiple audiences, so with the help of one of the SEA’s staff members, Kathy Boone, we used these three scenarios to consider the best way to design a solution for students with different needs. At the end of the day, the overwhelming consensus was that a phone-based solution would be more appropriate, and focusing on a website alone wouldn’t meet the needs of the intended audiences. That was just the beginning for John, Tara, and Bill, as these three scenarios and a few other I’ve developed have prompted great conversations in multiple districts and SEAs across the country.

Step 2: Get to the root of the problem

Many teachers will tell you that one of the greatest difficulties in introducing problems to students is helping them to identify just what the problem is. The same is true with design thinking. You have to avoid your initial gut reaction—which can often be superficial—and instead be prepared to dig deeper. In my coaching work, I find that new coaches have to grow beyond jumping to conclusions right away without trying to better understand the root causes of a situation that may conflict with or negate initial solution ideas. The most effective coaching occurs when coaches take time to build a relationship to better understand the complexities of a problem, or an individual. Understanding the user is critical to design thinking.

My professional friend and co-author of our textbook, Dr. Peg Ertmer (1999), describes the differences between first-order and second-order barriers to change. First-order barriers are those things that are external to a person and you have the easiest control over. These are things like allocations of time or access to technology and other resources. Second-order barriers are internal to individuals and more complex to resolve. People’s philosophies and personalities can be the root of second-order barriers, but they’re also the most important barriers to change. In terms of problem solving, you can implement a first-order solution without also addressing some of the second-order barriers, and the result will not likely last long.

Many problems are complex, and simple solutions aren’t sufficient to address them. As one of my mentors, Dr. Sharon Harsh, has taught me, “complex problems require complex solutions.” Oversimplifying a complex problem won’t lead to sustainable solutions. They can provide a temporary solution that looks like the problem is being addressed, but ultimately these simple solutions fall apart. Education and healthcare policy are rife with stories of simple solutions that have been unable to address the complexity of the issues they are intended to solve.

Sample Scenarios:

What if we applied these first two parts of the design thinking process to healthcare? Consider the following two scenarios based on fictitious interviews:

Hello, Mr. P., thanks for coming in for your annual check-up. That’s really important for a person with a family history of cardiac issues. Right now, you’re healthy and things are looking good. Your faithful cardio routine and close watch of your diet are probably some of the best preventative measures you can employ with your health history, and I know you are trying to avoid relying on medication. That day may come, however, as sometimes our own personal genetic histories can thwart even the best preventative measures. You’re not at that point, but I assure you that if medication becomes necessary, we’ll find the best possible solution and thoroughly discuss the pros and cons before beginning any regimen. I see your kids are doing well. Keep up those annual check-ups that are covered by your healthcare, too, and hopefully they won’t need anything more than a sports physical now and then. Be sure to keep them in the loop on your family’s health history, and you should all do well.

or this one…

Mr. J., I’m glad you’ve taken the time to debrief with me after your last surgery. As you know, while we went in for a blood clot in an area where you’ve had some issues in the past related to repeated patches of melanoma, we did find evidence of an aggressive tumor in your brain. Unfortunately, this glioblastoma, or GBM, tumor is often highly malignant and can’t be cured. Our goal is to help you and your family work through the complications of this issue in the best way possible for all concerned. You’ve overcome several difficult health concerns in the past, including some paralysis in your arms that has required ongoing physical and occupational therapy, but you are entering into a new phase of your life. We have no way to actually eradicate this issue, despite your wealth and admirable healthcare coverage. Our goal is to make you as comfortable as possible by addressing some of the symptoms and complications of this disease. I know you want to stay in your home with your family as long as possible, which may require some physical modifications to your home and ultimately the need for some equipment like a hospital bed. We have excellent and experienced staff who will consult with you and your family to determine the best care that can be provided as you deal with this health concern.

These two fictitious interviews tell us a little more about the intended audience of healthcare. These two scenarios also suggest two very different kinds of healthcare needs, from a relatively healthy person and his family who needs little to no routine healthcare beyond preventative care to someone who may ultimately require significant physical, emotional, and psychological support to live the rest of his life with dignity. And these are just two scenarios.

Legislators interested in using design thinking would, of course, have to learn about numerous healthcare needs. They could interview or survey many different people, or talk with doctors and other healthcare providers, or read studies or briefs about the range of healthcare needs in this country. And those needs would shift based on age, gender, previous conditions, and even locale. That means healthcare needs in Wisconsin might be different from Arizona from Florida from West Virginia.

It would also take more research to get to the root of the problem, or perhaps even to understand factors that influence healthcare needs for different people. In the scenarios above, Mr. P. and his family’s religious affiliation may influence their decision to not pursue medical birth control options for Mrs. P. and her daughter (not unlike my own mother). Mr. J. may have a military background and strong sense of self-sufficiency that may discourage him from participating in obtrusive forms of treatment, as he sees personal strength and not relying on others as a distinguishing part of his moral character (not unlike my own father). So, depending upon the audience, healthcare options may be necessary but not desired, or vice versa. A comprehensive solution requires acknowledging and supporting these and other individual differences.

Steps 3 & 4 and 3 & 4 and… Develop prototypes/models and get feedback

As an instructional designer, I have to be careful of assuming I know what my audience wants and how they want to learn. That’s why it’s important to develop sample activities and materials that can be used with people who represent the target audience to see if I’m on the right track. Sometimes I am, and sometimes…well, I always mean well. And I’m open to feedback.

It can be difficult to receive feedback on something you’ve worked on, perhaps something you’re extremely passionate about, but ultimately you have to give that product up and share it with its intended user. A product’s no good if it’s not used, or worse—if it’s used but is not enjoyed or is found ineffective. Waiting until the end to determine if a product is effective or not is too late. The best products go through a cycle of prototyping with user testing to determine the best solution. There’s no right number of times to go through this cycle. It may just depend on how much time or money you have. However, these steps can actually end up saving money by resulting in a superior product.

Evaluating products as they are being developed is considered formative evaluation, and the way you gather that information varies, based on the type of product and who will use it. When designing digitally delivered instruction, I often use the process of a think aloud, where someone from the target audience works through a scenario or situation with some of the content or media I’ve developed and talks out loud about what they are thinking and feeling as they interact with it. Of course, you can turn to focus groups, interviews, surveys, and a wide range of ways to gather input, but the most important aspect is getting feedback from a real user, not other designers or content experts. Content experts, and I include myself in this group, are often so passionate about their content that they tend to be biased and overlook the actual needs and desires of the intended users. The best news about usability testing is that expert Jakob Nielson (2000) recommends that you only need about 5 unique users, as after that variances in responses level off. Five people—that’s not so hard to find and a worthwhile investment.

In terms of legislation, healthcare or otherwise, these steps are where I believe policymakers may benefit most from using design thinking. How many members of the intended target audience routinely get to review and provide feedback on legislation as it is developed? I’m thinking zero might not be an inappropriate answer. In the recent national healthcare struggles, consider how policy makers do or don’t gather input from users and adjust to dissenting opinions or different viewpoints. How do legislators collect information about patient experiences rather than other legislators? What is the process in which outside voices are considered? Even dissenting input can generate a rich dialogue and support healthy debate through ideas from different viewpoints. Contradictions or negative feedback about a product aren’t personal if they come from the intended audience. Feedback like this should be considered constructive and can improve the ultimate product.

Finally, the design cycle doesn’t end with the launch of the product. In some ways, it’s just beginning. Design models often include summative evaluation after the product is launched, but this type of feedback is then used to improve the product over time. Consider how legislation might be improved if it didn’t stay static after all the signatures. If routine evaluation data was collected, it could be used periodically—perhaps annually or biannually—to improve legislation based on real user data rather than having to go through what appears to be more like a circus with much posturing and grandstanding that comprises the current legislative process. That’s not solving anyone’s problems.

In summary, I know this has simply been a thought exercise and doesn’t take into consideration all of the complexities of healthcare or legislation. But I do wonder if there might be a better way to develop products and services that impact so many of us. Design thinking works, and there are many ways you can apply it, and many fields to which it can be applied. If we’re suggesting its important for our K-12 students, perhaps we might eventually get a generation of legislators that have these powerful skills in their tool belts.

Resources

Dick, W., Carey, L., & Carey, J. O. (2008). The systematic design of instruction. 7^th edition. Pearson.

Nielsen, J. (2000, March 19). “Why you only need to test with 5 users.” Alertbox. https://www.nngroup.com/articles/why-you-only-need-to-test-with-5-users/ 

Ertmer, P. A. (1999). Addressing first- and second-order barriers to change: Strategies for technology integration. Educational Technology Research and Development, 47(4). 47–61.

[1] I am not a healthcare policy expert, but my nephew Patrick Ross is. I appreciate his support in reviewing this post and ensuring my comments are as realistic as possible, and keeping me focused on design thinking, not healthcare policy.