CONNECTING PEOPLE THROUGH DESIGN

By Elsebeth Gerner NielsenRector, Design School Kolding

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DEMOCRATIC DESIGN

Over the past century, all Scandinavians earned the right to a hospital bed when they fell ill and seats for their children in free

public schools. However, that is not the whole story. Scandina-vian designers and architects have also contributed to ensure

that the welfare state’s material dimensions were of a high aes-thetic and functional quality – to the benefit of everyone.

Scandinavian design has always been dem-ocratic, and it remains so if you examine the

development of welfare technology. In Den-mark, companies such as Novo Nordisk, No-

vozymes and Coloplast have made it possible to live with a number of common diseases – in-

cluding diabetes – thanks to good design solu-tions. Coloplast recently won a Red Dot Award for their SpeediCath Compact Set, a range of cathe-ters for people suffering from incontinence. They won because of their stylish, iconic and non-stig-matising design. At Design School Kolding, In-dustrial Designer Patrick Bennekov Bomholt Jo-hansen has created a prosthesis for veterans of war who return from combat without limbs. Jo-hansen says his personalised prostheses “are de-veloped around the interests, dreams, fantasies and activities of each individual. Instead of having to use the same silicone-covered leg every day, they should be able to select their favourite leg, in the same way we select shoes”.

Thanks to these sorts of welfare solutions, the Danish health and welfare sector is worth 3.6 percent of the Danish economy and is responsi-ble for 12 percent of its exports. These numbers alone justify why Design School Kolding should focus on welfare design and well-being as an area of specialisation for all students, regardless of whether they are fashion designers, industri-al designers or communication designers. We recently strengthened our investment through a partnership agreement with Hospital Lillebælt and the appointment of Denmark’s first professor of welfare design, Andrea Corradini from Italy.

CASE

While the established system only offers a regular prosthesis, Patrick Bennekov Bomholt Johansen has considered the over-

all life situation of the amputee: How can the missing limb be-come an asset for creating and expressing a new identity and a

different life?

Limb was completed as an MA project in collaboration with Aktive Unge Amputerede, Bandagist Centeret, Ecco, Meatshop Tattoo, 2014

LIMB

EMOTIONAL DESIGN

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GREY ZONE SOLUTIONS

Our focus is on the hospital’s so-called grey zones – areas where problems arise but there is no dedicated professional industry or business to call upon for solutions. Patient security is one of these areas. Improper medication costs the Danish society between four and six billion kro-ner every year. How do we solve this problem? In-dustrial Designer Hân Pham has proposed a new medicine handling system, which requires nurses who distribute medication in paediatric wards to wear a small diadem, which indicates that they are not to be disturbed. Assistant Professor Eva Knutz is working on another project called Shared Decision Making to improve communication with patients – regardless of their social background – so that they get involved in making properly in-formed decisions about the best course of treat-ment. In this field, design is about empowerment and resilience.

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CASE

Industrial Designer Hân Pham has created a set of design solu-tions to minimise the number of medication errors generated

by disturbances and interruptions. Studies show that it takes 25 minutes to get back on track and to focus, once you have been

interrupted and in this window, fatal errors can occur. The design solutions include safe medication checklists for doctors and nurs-

es, an iPad stand with video instructions, an awareness campaign about disturbances and interruptions, and a patient book for chil-dren aged 3-9.

Medicine Handling – Barriers Against Errors was completed in collaboration with Kolding Hospital, 2011-2012.

INDUSTRIAL DESIGN

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MEDICINEHANDLING

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CASE

Assistant Professor Eva Knutz has participated in a number of consultations about cancer diagnosis and examined how shared

decision making is practiced in hospitals. Through a number of design experiments Eva Knutz investigates the power structures of the consultations. The aim of these experiments is to make

inquiries into the hospital’s own conception of democracy and to use design activism to re-negotiate the roles and rights for pa-

tients thereby exploring various disruptive realities wherein the pa-tient becomes a citizen with democratic rights. The research results could potentially enhance democratic practices in patient-doctor consultations.

Patient Democracy is integrated into the partnership agreement between Design School Kolding and Hospital Lillebælt: Eva worked closely together with the Health Service Re-search Unit and the Oncological Department at Vejle Hospital. 2013-2014

SERVICE DESIGN

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PATIENTDEMOCRACY

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CASESERVICE DESIGN

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Architect Anne Corlin and a team of designers have come up with a number of recommendations for how to improve hos-

pital wayfinding in order to minimise patient anxiety and avoid interruptions of staff, which may lead to errors. Their approach

redefines the classic definition of wayfinding because it suggests that wayfinding begins even with the notice letter that the patient

receives, and which represents his or her first encounter with the system. Also, the Wayfinding project considers the fact that treat-ments are changed regularly, which means that the buildings and the design of the buildings must be flexible in order to meet shifting requirements. To solve this, the design team uses lights, colours and pictograms because they are cheap, effective and flexible.

Wayfinding, Middelfart Hospital was completed in collaboration with Middelfart Hos-pital, 2013-2014

WAYFINDING

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DESIGNING RELATIONSHIPS

Vejle Municipality asked Design School Kolding to help design social relationships. The concrete case was Skansebakken, a large institution that cares for individuals with severe physical and mental impairment. The designers went about the challenge employing a series of design meth-ods in order to create an understanding of the residents and staff; define and formulate recog-nised and unrecognised needs and desires; come up with ideas; prototype a model, and finally test it. Together with Skansebakken’s staff, they de-cided to design a better way of ‘having guests’.

It is not easy to greet guests, or even be one, but thankfully a number of people have taken up Skansebakken’s invitation to visit. The staff has already realised that there are benefits to increas-ing the volume of visitors and that hospitality pays off. Furthermore, evaluations show that here the residents’ quality of life has improved; they now have more relationships with friends, acquaint-ances, and civil society.

GETTING CIVIL

SOCIETY INVOLVED

In other words, Danish welfare design is far more than prostheses, catheters, insulin in-

jections and other product design. Service design is at least as important, given the chal-lenges that the Scandinavian welfare model

faces. In recent years, many of Design School Kolding’s projects for the public sector have fo-cused on finding new ways to involve civil soci-

ety by, for example, helping children learn more, allowing mentally disabled people greater free-dom in their own home, or providing better care for the physically handicapped. The projects arise because of the realisation that we can no longer afford to let the state bear all the responsibility for resolving social issues, and that there are also humanistic and existential problems associated with the Scandinavian welfare model. Loneliness is one of our greatest health issues. We seem to focus more and more on individualism and state dependence that turns citizens and humans into clients and patients whose needs are considered in terms of their economic and human costs. In Denmark, at least there is an enormous demand for solutions that hand back some of the respon-sibility of care to civil society, supporting a move-ment from welfare state to welfare society. Let me give you a specific example.

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ACCESSIBILITY RATHER THAN CONTROL

But what is the point of getting more guests to visit Skansebakken? Because all human life is created through our relationships with others. Developmentally challenged people have the same needs as others, but the modern welfare state has not realised this. On the contrary, peo-ple are treated as individuals instead of people-with-a-relationship-to-the-world. As a result, social institutions lack the social communities that people need and this leads to some people only having social relationships with people who are paid to care for them. Another consequence is that our social institutions become very isolat-ed. When neighbours, friends and families are not present on a daily basis, the care staff not only loses the opportunity to gain the recognition they deserve for their impressive work, they also lose the benefit of being observed. Being observed not only increases motivation but also makes working more meaningful. When dealing with problems that social institutions face, politicians normally choose to increase state control and oversight. Nevertheless, we could achieve the same results by improving how accessible public institutions are to the public by making them more hospitable places to visit.

Hardly any Danes are aware of the fantastic work that thousands of care workers perform every day in looking after our fellow citizens. This in itself threatens the legitimacy of the Scandinavian wel-fare model and calls for change; a type of change that designers can help facilitate and support.

At the same time, design clearly remains an aesthetic tool that can make everyday life more beautiful and functional for the weakest mem-bers of society, as well as their staff and guests.

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CASE

The project Designing Relations shows how the conventional political response to problems – the demand for “more control”

– could be changed to “more hospitality”. This would allow more people to become part of places like Skansebakken and it would

give citizens with limited lifestyles the chance to experience the basic human relationships that any human being requires.

In 2013, the project won the KL Innovation Award. The KL Innova-tion Award is awarded by the Danish National Association of Mu-nicipalities.

The project was completed by Design School Kolding in collaboration with Vejle Mu-nicipality and the National Board of Social Services, 2012-2013.

SOCIAL DESIGN

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DESIGNING RELATIONS

CASEINTERACTION DESIGN

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SOCIAL GAMES AGAINST CRIME

Assistant Professor Eva Knutz and Associate Professor Thom-as Markussen together with Delft Technical University, The De-

sign Against Crime Research Unit (London), and the Danish Pris-on Services, have set up a research project entitled Social Games

Against Crime. The project addresses the delicate situation, which occurs when inmates receive family visits in prison, especially from

their children. Markussen and Knutz believe that game design, fic-tion and emotional design can mitigate the situation and give the in-mate and the child a chance to experience their social condition in a different light. The goal is to create a new type of game that uses play and humour to detaboo imprisonment and the fact that ”Dad is in prison”. The game will create a space in which the inmate and the child can share emotions and enjoy each other’s company de-spite the difficult circumstances. By strengthening the relationship between the inmate and his family, the game enables the child to grow a relationship with his or her father despite his absence.

Assistant Professor Eva Knutz and Associate Professor Thomas Markussen teach game design at Design School Kolding and have previously initiated events where research-ers meet to discuss issues of imprisonment; e.g. the workshop and seminar Designing Emotions for Games and Narratives in 2012.

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VISUALISING THE SOLUTIONS

Designers and architects are trained to ana-lyse wicked problems that are so complex that rarely a single solution will suffice. As opposed to other fields, designers are also able to visual-ise solutions to which both investors and us-ers can relate. At Design School Kolding, we regard the latter as being of vital importance for the functioning of a well fare (in Danish: vel færden) whose many stakeholders need to see the potential of welfare technology, rather than being gripped by fear and conservatism. Design can liberate man. Designers ultimately support humankind to unfold its full potential: To be creative.

DESIGN AND

PURPOSEDesign School Kolding believes that design-

ers and design need to be more involved in the development of the welfare state. We of-

ten see that the focus on welfare technology is more on its ability to improve efficiency and re-

duce staff and less on developing the culture and behaviour that makes it possible for people to val-ue welfare technology in the first place. You could say that the logos, that is direction and purpose, in relation to welfare technology has been some-what neglected; and indeed this represents the focus for designers. While engineers tend to focus more on ensuring that things work technically and economists are preoccupied with businesses pro-ducing a profit, designers think in terms of logos; that welfare design has a purpose and gives the users a sense of meaning. When he is at his best, the welfare designer can create processes that get technology, economics and human purpose to meet and form holistic and meaningful solutions.

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NEED FOR CONVINCING BUSINESS CASES

There are plenty of barriers that need to be overcome before design is valued as highly as technology and economics in the development of the welfare society. The most significant barri-er is that man’s need for purpose and meaning is not traditionally factored in as a precondition for growth and innovation. It is also not immediately clear how to capitalise on the value of service design. How do you earn money on making sure that citizens are better at taking care of them-selves and others? We need convincing business cases.

DESIGN CAN GIVE US A HEAD START

Still the possibilities are vast. Denmark and the rest of Scandinavia have a proud tradition of pri-oritising people, regardless of their social back-ground, in society’s development. This tradition can be used to differentiate us from our interna-tional competitors who, thanks to lower wages, can quickly defeat us on mere technological development. Therefore, if we get even better at including culture, social organisation, values and meaning into the development of welfare and well-being, we can gain a head start on the glob-al market that is drowning in welfare problems. This head start can also provide a significant tax boost to support our own welfare. Scandinavia can design meaningful welfare systems that improve the lives of many, but it requires includ-ing design and designers in more of the decision making – particularly concerning the DKK 40 billion that has been set aside for new hospitals over the next decade – in Denmark. To convince the export market of the viability of our solutions, we need a domestic market that is well function-ing and developmentally orientated. Many places are taking advantage of the ability to experiment and try out new Danish welfare design solutions, with a view to exporting the successes. For example, the Region of Southern Denmark has established living labs in its hospitals where staff, patients, businesses and knowledge institutions all work together to develop the welfare state version 3.0 – but this time with the world in its sights.

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11RECOMMENDATIONS

FOR IMPROVING

WELFARE TECHNOLOGY

1. SET CLEAR GOALS AND A COMMON DIRECTION Many initiatives are developed in isolation and are not prepared for being connected to larger strategic priorities. Every initiative needs to contribute to the strategic direc-tion and have clear goals so that everyone is on the same page. You need to be able to answer the questions: Why should we intro-duce welfare technology? What do we hope to achieve? Who will it affect?

2. KNOW YOUR TECHNOLOGY The greatest barrier in the use of welfare technology is technology that does not work. It is vital that technology is tested in a real context in order to determine which technologies best address the needs. Sup-port and maintenance – both during and after introducing the technology – are vital in the perception of the technology. Good solutions are based on a total experience.

3. AVOID PRECONCEIVED NOTIONS Many welfare technology initiatives are too focused on the individual products with-out taking the actual needs of the user into account, or identifying potential areas of improvement. It is therefore important to gather sufficient information about the technology and the people you are develop-ing for in order to develop a secure knowl-edge base.

4. CHALLENGE HABITUAL THINKING AND SUPPORT NEW THINKING The introduction of welfare technology of-ten stands in contrast to the belief that real people could do the job better. Technology challenges the professionalism and abilities of the staff and fosters insecurity about their abilities and future. It is therefore important to create a new narrative around care and support and involve staff in developing a new profile.

The Lab for Social Inclusion at Design School Kolding works with welfare technology. The LAB has come up with 11 recom-

mendations for people starting out with welfare technology.

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5. CITIZENS CAN’T LOSE OUT People are not all the same and the needs of citizens and patients can change as fewer hands become available to perform the necessary tasks. That’s why we need to reduce complexity, create a flexible system that takes individual needs into consid-eration and which give users a consistent experience that cuts between the layers.

6. FIND YOUR ETHICAL POSITION Ethics often becomes visible when technol-ogy replaces existing solutions but creat-ing general guidelines is one thing; putting ethics into practice is something entirely different. Decisions often have to be cho-sen from several options – decisions that impact people’s lives. The relevant question is therefore not simply what is it that we can replace with technology, but what can tech-nology not replace?

7. HELP USERS RETAIN WHAT THEY’VE LEARNED Giving people qualifications through a course is not the same as developing and applying new skills in a real context. It is im-portant to not merely change work process-es, but also completely change a culture. This cannot be taught in a classroom.

8. GIVE USERS ONE ENTRANCE The welfare system is complex and it is often difficult to develop an overview and figure out where to get the skills and knowl-edge you need. To ensure a good user expe-rience it is important to create transparency in the system and establish a self-explan-atory frame of reference as well as ensure that the right knowledge is readily available.

9. COMMUNICATE WITH THE APPROPRIATE PEOPLE If people use or are affected by an initiative, they should remain informed about its de-velopment and results. Involvement requires following up. Good communication can also foster success and increase the satisfaction of those involved, which will avoid surprises and resistance along the way.

10. INVOLVE USERS IN THE WHOLE PROCESS If users are not sufficiently involved in the entire development process, it can af-fect the sense of ownership that people feel toward these new solutions. It is also important to be aware that there may be large differences in expectations within the same professional and user groups. That is why you cannot expect that an initiative, which succeeds in one place, necessarily will everywhere.

11. EVALUATE AND SHARE YOUR EXPERIENCES Projects are often evaluated by their impact on a specific target group. However, often the things that do not work are not suffi-ciently registered. That is why it is important to evaluate the process with the ambition of learning from your errors and experiences. Experiences mean nothing if they are not shared and communicated.

DOWNLOAD REPORT:

http://goo.gl/qQKBSo

DESIGN SCHOOL KOLDINGAagade 10DK-6000 Kolding

T: +45 7630 1100E: dk@dskd.dkW: www.designskolenkolding.dk

INQUIRIESLaila Grøn TruelsenHead of LAB for Social Inclusion

T: +45 9133 3012E: lgt@dskd.dk

Editor: Marianne Baggesen HilgerFotography: Katrine Worsøe KristensenProofreading: Lotte Eggert KiilDesign: Kristian Lykke LarsenPrint: inprint

This booklet first appeared as a feature article in the magazine ‘Arkitekten’ May 2014.