DSI Thesis Intensives: Facilitation 101

Maggie Breslin. That’s why.
Among other things, Maggie helped build the Center for Innovation at the Mayo Clinic and continues to be a force in reimagining health care from patients’ perspectives. And she teaches Intro to Thesis at DSI.

DSI: What is design for social innovation?

I use the definition of design as creation according to a plan and social innovation is about opportunities for human flourishing. So where they intersect, that’s the space for design for social innovation.

DSI: What would you like to say to potential students about the program?

Design is about making — the act of bringing things into the world. The DSI program is the best fit for people who are excited, not only about studying and researching within a topic, but are actually willing to engage in the much riskier behavior of creation and bringing things to reality. The issues that come under the umbrella of social innovation are not likely to be changed by one person, or two, or three people in short periods of time. If this is what you’re interested in it means that you’ll be working with people across many disciplines and thinking on timelines that are more like decades.

DSI: How would you explain the work that you do?

When I left graduate school, I was really interested in working on complex issues, and felt like they were a poor fit for the traditional design consultancy models but organizations weren’t hiring designers to work on these kinds of challenges. Then, I heard through my advisor in graduate school about a unique opportunity at the Mayo Clinic. They were experimenting with an in-house design and research group- an innovation program with a strong design component. The idea of getting to spend so much time observing doctors and patients intrigued me. So I moved to southeastern Minnesota and stayed for 7 years. I got the chance to work with people from all over the world with different backgrounds and specialties. I helped figure out what it means to be an embedded designer and researcher within a healthcare environment. I was good at it and I really loved it.

I left to start my own practice and to have the chance to decide what I would work on. Now I work on a number of different projects: as a designer-in-residence at Columbia University, with physicians and health researchers across the country on tools for physician-patient communication. And I help lead an initiative called “The Patient Revolution” whose mission is to develop foundational programs, tools, and skills that encourage patients to see themselves and act as agents of change in healthcare.

DSI: You talk about communication; how important are communication and conversation in the healthcare industry?

A lot of the work I do is about getting physicians and patients talking to each other. The traditional model for communication in healthcare is patriarchal, meaning doctors make the decisions and tell you what to do. Maybe that made sense when the options for treatment were limited and the number of chronic conditions was few. But the landscape is very different now. Our knowledge about what people have and what we can do about it has grown exponentially. We no longer live in a society where it makes sense to hand-off decision making to the physician. Patients need to participate so that their values, goals, and needs can drive the care plan. But that’s easier said than done. There is a lot of history and rituals that keep those behaviors in place. Breaking that down and bringing patients into the conversation is a difficult and challenging task but such an important one.
If I can build a tool that encourages a physician and a patient to have a conversation about, let’s say, diabetes medication and the patient says “I don’t want to be on this medication, it’s not worth the trade off for me” or “I can’t afford that medication” rather than simply accept a prescription that they have no intention of filling, then I call that hugely successful.

DSI: You talk about healthcare and education as complex systems rather than problems. Can you say more?

Problem language suggests solution language; which troubles me because solution implies a single, knowable, agreed-on end state that we should transition to; this is what it is like today; this is what it could become in the future. In fact, when we talk about healthcare or education as a “problem” I think we are saying that the system that has emerged doesn’t seem in sync with our values as a society — which you can kind of understand how that happened. No one sits down and architects these systems. They are the result of millions of small decisions made over long periods of time and they come to constitute a system. Each decision at the moment it was made probably made sense but now parts are in conflict with each other and the result is no longer representative of the values we say we have. The way to work towards change in those places isn’t to offer a “solution” but instead to identify the values we have and work to design interventions that embody those values.

DSI: Is there a project that you can talk about in a bit more detail?

Part of my own practice and what I teach at DSI is an emphasis on real world experimentation; generating hypotheses and trying things out with people in their actual settings. If you have an idea to help people with diabetes talk about medications with their physician, you mock something up and take it to an endocrinologist and say “Hey, I have this tool, would you mind using it in your next visit?” Then you observe to learn what worked about it, and then go back to the drawing board.

DSI: Could you give advice for students entering the world of design for social innovation?

Practicing design in non-traditional disciplines is very much about building relationships and collaboration. If you are a designer who wants to work in social innovation then curiosity, a deep appreciation for research, and a willingness to be out of your comfort zone, are the key skills that you need. If you come from another discipline, it is all about embracing making- getting comfortable creating early and often before you have the answers and before you are sure. The ability and instinct to create is one of the most powerful tools that designers bring to the table. I encourage people to get comfortable with critique: giving it and getting it. In design school, you have to stand up and present something you’ve created and then hear what people think about it almost everyday. You really learn how to respond to feedback, what to listen to, what not to listen to. Critique is a scary idea for a lot of people so they avoid or ignore it. There’s probably nothing worse you can do in social innovation than ignore or avoid critique. Feedback is how things grow and move forward and get better.

Photo Credits:
Maggie’s portrait: Aubrey Hays
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