Design Thinking – Shelters for the Homeless

Reading Time: 3 minutes

Design Thinking – Shelters for the Homeless [3.5 minute read]

Here’s the next post, towards sharing stories and incidents around design thinking in daily lives, towards a better collective understanding. My earlier post was about taps at home, and why house helps might be wasting water. If you missed that, here’s the link.

Now, in developing India, as the nouveau riche buy vacation home after home after home, we are still home to an astronomical 18 lakh homeless (as of 2011)!

Now this post is not on wasteful spending, or on “prudent, realty investments” either. Actually on second thoughts, prudent realty related investments might be right at the centre of this one.

I had read about this story over 2 years ago, and was so fascinated with the design thinking connect, I’d shared it on Facebook. Thanks to Facebook’s random annual reminders, this one popped back up recently. It showcases a classic design thinking flaw, of thinking for the user, instead of simply observing and asking them.

New Delhi faces some really bitter winters. I’ve spent some time there on work over different winters, and on some of those nights, the cold was mind-numbing. So one can only try to imagine how tough it would be for Delhi’s homeless people. Right? Think again!

Some years ago, the state government in New Delhi, with good intentions for its homeless, built 218 shelters with a capacity exceeding 17,000 people! Impressive, right?

Now you probably imagine that as winters approach, these places must be getting mobbed with homeless folk rushing in to keep warm? Especially considering there are about 125,000 homeless people in Delhi.

To the contrary, even on the coldest of nights, apparently these places were sparsely occupied. As per government estimates back then, at its highest occupancy, there were only 8500 people at the shelters.

The homeless somehow preferred enduring the cold in the open, to these warm shelters. According to the statistics, for every person who huddled up in one of these shelters, about 15 remained in the open. The government even had cops spotting and taking any homeless to the shelters. But the homeless were like mischievous children, waiting for an opportunity to sneak out of this situation they didn’t like.

Does that even make sense? Who, in their right mind, would prefer to freeze outdoors, as opposed to being warm in?

Unless a bigger picture was missed out. About them and the lives they lived.

It turned out, the homeless were afraid of contracting fleas from other homeless folk packed into these shelters. Which in turn would make even their waking hours miserable. The shelters also didn’t have any storage areas for people to keep their few but priceless belongings safely. And the few belongings they probably had on them, were always at risk of being stolen at such places.

In total, a somewhat hostile place for them to stay in, even in the most unrelenting of winters.

In their empathetic and genuine concern for these people, the government somehow assumed many things about their lives, or conveniently skipped them out in light of the greater good they were doing for them. They forgot to actually involve the very people who would be using those facilities. To know what they could be like. To know if they’d missed out on some aspect. They too are, humans after all. Or if even that didn’t matter (as seldom does for our elected rot from across the country), at least to justify their investment in the project.

Some observation. Some asking. And then more of both, could’ve truly taken India a step closer to being a concerned and inclusive society.

You can read about it here: link

Would love your thoughts on it.

And if you’d like my to look at some complex business problem you’ve been grappling with, drop me a mail at shrutin[at]ateamstrategy[dot]in Hopefully, I’d be able to give you a fresh perspective in an effort to help you solve it.

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Design Thinking: What a Patient Wants

Reading Time: 6 minutes

Design Thinking: What a Patient Wants

Design Thinking is a relatively new concept in many countries including India. It is, however, already some decades old now. And having been practicing it for a few years now, I often get asked what it is about. And for examples of its applications.

For starters, design thinking is a mindset. One that uses empathy and a set of tools to innovate and pursue complex opportunities or solve complex problems. It aims at better understanding the needs of the end-user, or identifying the root cause of a problem, before beginning to innovate. And that always requires empathy, without which, we often settle for one of the first few logical seeming solutions that come to mind.

Like many management and quality initiatives of yester-years, design thinking too is currently receiving its share of a superficial hype. With time however, I believe the hype will pass; leaving people with a better understanding and more sincere appreciation for the power of design thinking.

Ordinarily, in a traditional problem-solving process, more constraints would almost lead to a dead-end or teams giving up. Such complex projects are where design thinking works best.

“Recognizing the need is the primary condition for design.” –Charles Eames

About a year ago, I had undertaken a design thinking exercise for the paediatric oncology department of one of Asia’s leading cancer hospitals. Sharing an overview of the same here, in case some of you are wondering what design thinking is all about. For me, design thinking is simply a humble means to achieve a goal.

Client: Paediatric Oncology Ward of one of Asia’s leading cancer hospitals

Objective: Improving the overall paediatric patient experience

Introduction:

I was at the hospital with two of my associates, to meet the expert medical oncologist regarding a project the associates and I were collaborating on. During interactions, the doctor expressed that patient feedback regarding the treatment has been positive. He and his colleagues, however, were always keen on knowing how they could further improve the patient experience. And given that the hospital offered free/heavily subsidized treatment to the poor, this was a humbling gesture. I offered to work on it.

The task involved interacting with patient families, doctors, administrative and support staff. It was necessary to get a good understanding of each stakeholder group and interactions between groups, in this bustling ecosystem.

Field Work:

Over the next 2 months, I spent several hours a day or entire days, speaking with paediatric patient families. I broad-based the sample to include new admissions, patients currently undergoing treatment, and those there for checkups 1-3 years after successful treatments. The wonderful administrative staff helped identify patients in different segments, as well as introduce me to some of them, to make for a more comfortable interaction.

Doctors had already provided considerable information from their perspective. I then spoke with administrative and support staff across the hospital. From admissions, to inquiry and even 3rd party social service representatives.

Initial Observations & Findings:

Based on information gleaned, and using Design Thinking and other tools*, here were some findings:

  • Patients/ patient families:
    • 90% of patients came from outside the city, 80% from outside the state
    • Nearly all patient families spoke one or more of 6-8 different languages
    • Wait-times to meet a doctor, were significant – between 2 – 6 hours or more
    • A slight delay in patient arrival could mean making another trip the following day
    • At least 2 family members accompanied each patient. It meant putting their normal lives on hold. It meant treatments that lasted between a few months to over a year or more
  • Staff:
    • Was well-intentioned, but mildly stressed and curt in responses to patient families
    • The staff dealt with hundreds of patients and family members on a regular basis
    • Some staff, on average, answered a request for direction to a particular building/room once every 2-4 minutes. Same was the case with some others about when their turn to meet a doctor would come, etc.
    • Some staff members were aware of their curt disposition. However, they admitted that in the region a bulk of the patients came from, they were accustomed to speaking in a curt manner. I too realized the same based on my observations and interactions with some of them. It was an amusing dilemma, the innate intention to be more polite, but an audience that might complicate your work if you yielded. A solution I proposed, aimed at solving that problem from the staff point of view
  • Hospital:
    • The funding enabled treatment to be completely or partially subsidized for the poor
    • Doctors had requested that solutions be cost-effective, if they were to be considered for implementing

Initial Verdict from Patients/ Patient families:

The overall feedback regarding the existing patient experience at the hospital was stellar. This included quality of process, staff, doctors, etc. However, I soon realized that this view was biased. Biased by gratitude for a hospital that covers all or a large part of their medical expenses.

I was back to the beginning. How do you improve patient experience when their treatment is paid for?

Back to trying to identify the opportunity:

I split the problem areas into three:

  • Patient Process:
    • Long wait times for paediatric patients to see a doctor
  • Hospital Process:
    • Duplicate room number problem
    • Multiple inquiries to staff for directions to a room/ward
    • Increased stress levels of staff
  • Customer Experience:
    • How can an already good patient experience be made better?
    • Without burdening the hospital resources?

Again, using Design Thinking tools, I came up with initially unidentified problem areas. I also stumbled upon a promising solution for improving the patient experience.

Cutting to the chase:

My recommendations were as follows:

  • Patient Process:
    • Split patients into morning and afternoon batches to make for easier sequencing and much shorter waits
  • Hospital Process:
    • Unique naming and numbering of rooms/wards (using words that cut across at least the 6-8 languages)
    • Colour coding of important rooms across buildings, with colour-coded stripes on the wall, to help patients ‘follow the coloured line’ (ideally with the colour names being identifiable across languages)
    • Colour coding would significantly bring down the number of times staff got asked for directions. (Patient families would be able to direct others. Colour/line/name-for-room would help overcome language barriers). It would reduce staff stress levels and making them more productive and happy
  • And most importantly, Customer Experience:
    • Proposed Tie-ups with companies (nearby to start with) for low-to-medium skill jobs that were individual-independent. One that anyone could turn up to do it. That would ensure work continuity while not limiting patient treatment schedules
    • Thought behind it: What was clear, was a free/almost-free treatment, and capable and polite doctors and staff. What design thinking helped me identify, is how family members put their lives on hold as their child underwent treatment. Earning some money while they were in the city, would help them buy small joys. It would help reduce the horrors of the disease and side-effects of the treatment on their child. That’s the only thing doctors and staff could not give
    • This would not burden hospital finances
    • I also proposed an alternate strategy option: where patients would pay a very nominal fee for services (from their salaries/stipends). This could bring new-found respect for the institution. The institution could also perhaps extend treatment to a few more patients with the same funds

Please note that coloured stripes and naming of rooms isn’t part of design thinking. What is, is identifying underlying issues such as staff stress and its causative factors. So is identifying possible areas to delight a customer in an otherwise perfect seeming environment.

“The goal of a designer is to listen, observe, understand, sympathize, empathize, synthesize, and glean insights that enable him or her to ‘make the invisible visible.’ –Hillman Curtis

Key learnings from this assignment:

  • Customers might not always articulate what they want
  • Be aware of tendencies where the ecosystem might bias a customer’s viewpoint
  • Often, solving or even addressing one problem area could have benefits across multiple areas

Anyone can learn and practice design thinking. It does, however, need a lot of Empathy and Involvement from you. It also requires an unwavering commitment towards customers, employees  and innovation. And it is especially for those who are comfortable grappling with lots of ambiguity, and can stay true to the larger objective.

Got questions on design thinking, or how it might help your company innovate and grow? Comment below, or get in touch with me via LinkedIn or Twitter (links below).

“Only those who attempt the absurd will achieve the impossible.” –M.C. Escher

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Look forward to your views. And if you liked this post, do follow/subscribe to my blog (top right of the page). You can also connect with me on LinkedIn and on Twitter.

* tools including (but not limited to) observation, interviewing techniques, design briefs, contra-logic, changing perspectives, forced connections, etc.