Over a week has passed since the Panorama exposé of practice at Winterbourne View. Run by Castlebeck the facility is described on their own website as “a purpose designed acute service, offering assessment and intervention and support for people with learning disabilities, complex needs and challenging behaviour“. I am not going to go into detail about what the film covered, you can still see the episode here and there have been several excellent blog posts and commentaries published. There has been a lot of outrage, a few apologies, a lot of promises and a lot of anger.
What I thought I would just do was offer a few of my reflections on the programme – I’m not claiming these will be original, but they were what stood out for me:
1. Respect and Value As a society how much do we respect people with learning disabilities? What value do we place on their care and support – providing it in a building on the edge of an industrial estate. An industrial estate, seriously, how many of us would like to live on the edge of an industrial estate? I’m not sure what message that sends to the residents/patients/customers and their families and I’m also not sure what message it sends to the staff. If, as a society, we don’t show respect for and value people with learning disabilities, why would we expect the people who are paid the minimum wage to provide their care, to act any differently?
2. Boredom and underload The staff shown in the show were quite simply bored. They had too much time on their hands, they didn’t know how best to engage their residents and so they entertained themselves; as my Gran would say ‘Idle hands are the Devil’s playthings’. Rarely did the staff attempt to meaningfully engage the residents, and when they did they weren’t successful and got little feedback, so nothing would encourage them to persevere.
3. Aspirations The staff shown engaging in abuse at Winterbourne View were not people who aspired to be carers. One of them, Graham, had previously been the kitchen porter, I’m not sure how he came to be working as a carer but he certainly hadn’t applied to Castlebeck with that role in mind. One of the Senior Support Workers, the one referred to as the ‘ring leader’, Wayne, previously worked in a Young Offender Institution and had an ambition to open a tattoo parlour. These people were not people who aspired to be carers, that said they didn’t lack aspiration or ambition, but they were simply not doing a job that interested them. This relates to the earlier point about value, how much value do we place on care work? As a society do we value the work that Graham and Wayne do?
4. Isolation As an assessment facility, many of these residents were miles from their family, friends and support networks. These were not unloved, forgotten individuals though; they were not vulnerable and isolated residents with no support; they had supportive and engaged, loving families. However, the residents at Winterbourne View were kept on a locked ward, their families and friends never had access to where they lived, instead visiting in a visitors room. They were isolated by their situation.
5. Training These staff lacked training and support. They were working with people with complex needs, idiosyncratic communication, and arguably challenging behaviour. They were providing support for all of their needs. A lot of the media backlash has laid blame at the individual’s involved – and yes they should know better – but in amongst the awful behaviour there were attempts to engage with residents.
Wayne, who was so awful at times, was also the one who sat holding Simon’s hand (in the scene were the horrific abuse of Simone was the focus); on another occasion, before snapping and dragging a resident from her bed, he had knocked on the door before entering her room and greeted her with a cheery “morning princess”. In one scene he threatens Simon with flushing his head down the toilet – he has his head suspended above the bowl and as Simon screams his complaints, Wayne offers the reasoning that ‘this is what other people feel like when you give them bear hugs’ – at some level, Wayne’s behaviour could be interpreted as the attempts of a man who knows no better, trying to teach Simon a lesson.
Simon’s learning difficulties, and the difficulties of other residents, mean that they will not learn through tough love, no doubt the approach that Wayne’s parents or superiors took with him, would not work. I’m not so sure that he knows any better way of doing things.
I’m not suggesting that Wayne’s behaviour is forgiveable, but I do think he lacked support to do a better job. Remember this is a man who wants to run his own tattoo parlour, who has worked their for three years, who earns £16k a year, who has no qualifications for the role he performs.
We know what needs to change. We should have learnt these lessons by now, at least with regards to institutional abuse. There was a reason why long stay hospitals were closed down in the 80s, we know what causes institutional abuse.
Two years ago, research in practice for adults published Safety Matters: developing practice in safeguarding adults - if you click the link you can see extracts from the Practitioner Handbook. This publication was the result of an action research project that I co-facilitated with Bridget Penhale (an academic and Joint Editor of the Journal of Adult Protection – alongside Margaret Flynn who will conduct the SCR for South Gloucestershire Safeguarding Adults Board), Paul Bedwell and Stephen Bunford from Essex Safeguarding Adults Board. We looked at the available research evidence, and combined it with practice knowledge about improving safeguarding practice, talking to professionals from across the country about their experiences and learning. The document, while in need of a refresh, still contains lots of information and ideas for practice. One of the checklists contained looks at pointers of institutional abuse, we should have been able to spot this, and prevent it, earlier:
I am delighted at the sense of national outrage in response to Panorama. I would be even more delighted if we could start by looking at the evidence we already have, and trying to use that to improve practice. As a society we have to ask ourselves some fundamental questions about how we value and treat people with learning disabilities and rather than pointing the finger at a few individuals uncovered by a journalist, we should ask ourselves what more or what different we could do.
I’ve been playing around with the idea of writing this post for a while, well I guess on and off for about a year! What started as a wish to understand more has, if I’m really honest, progressed into a minor irritation at the lack of clarity and then just before Christmas I had a phone conversation with Mike Baldwin where I found myself attempting to both define and defend/promote service design as a discipline. Mike was asking great questions; now I’m a little biased and think that Mike is a) one of the good guys b) intelligent and interesting and c) questioning and not ready to just accept an opinion without some substance to back it up. Mike is interested in health and value, he is also interested in research, evidence and rigour and several of our conversations have focused on health care and improving services, drawing heavily for me on my Dad’s experience of cancer, you can read more about that here!
Anyway, when I talk to Mike I realise I’m not the only person who is sceptical and looking for proof when it comes to service design. In fact maybe Mike is, like me, a service design agnostic! I’m not going to recount all of the conversation or questions that Mike and I were batting around but the starting point was pretty much as follows:
> What is service design?
> How strategic is service design?
> What functions is service design optimising? Is it a focus on efficiency, effectiveness, economic imperatives or something else?
For now I’m just going to focus on my attempts to answer the first question. Luckily for me I’d recently attended ServDes conference (you can read more of my thoughts on that here) and so probably felt as well equipped as I’d done in a long time to attempt to define service design as I’d been exposed to many different views and approaches to it. I’d also debated, discussed and extrapolated in the pub the very essence of what a service designer is, the consensus conclusion being there’s no such thing as a service designer! Those conversations had also exposed me to many of the subtleties behind the belief that defining the discipline limits its development – more of that below.
Perhaps most importantly though I had a secret weapon! I had in my possession a brand new shiny copy of This is Service Design Thinking which is available to buy now from the publishers and which I’ll blog about soon – it’s ace, go buy it. TiSDT was launched at ServDes and consequently a copy was given to each attendee at ServDes as a gift I’d already skim read most of it and devoured the opening chapter from Marc Stickdorn (Marc is one of the two editors – along with Jakob Schneider) and so I was confident he’d have the answer.
TiSDT definition chapter opens as follows:
If you would ask ten people what service design is, you would end up with eleven different answers – at least.
Service design is an interdisciplinary approach that combines different methods and tools from various disciplines. It is a new way of thinking as opposed to a new stand-alone academic discipline. Service design is an evolving approach, this is particularly apparent in the fact that, as yet, there is no common definition or clearly articulated language of service design. [Stickdorn, 2010, 29]
Marc goes on to explain their decision not to just define service design; this is based on an acknowledgement of the need for a common language alongside the concern that by imposing a definition the discipline is in some way being constrained or limited. TiSDT offers a number of different views of what service design is with definitions from a number of institutes, industry bodies, academics and design agencies. What is then provided as a really useful starting point are five principles of service design thinking. Service design thinking is: user centred, co-creative, sequencing, evidencing and holistic.
To set my stall out I think TiSDT is great, I love my copy, I think it has a wealth of information and ideas within it and has already helped me to have confidence to introduce service design to people and defend it when questioned. It introduces a number of fields of activity that implement a range of service design thinking, these include product design, graphic design, interaction design, social design, strategic management, operations management and design ethnography. Each of these fields have a chapter where they are briefly introduced and their relationship to services specified. For me this is really useful stuff. I do however struggle with the notion that defining the discipline would somehow limit it. TiSDT includes a quote from Buchanan (2001) that implies defining design would potentially lead to lethargy or death of the topic in hand and Marc offers the same concern “A single definition of service design might constrain this evolving approach”.
**Disclaimer** At this stage I had a really useful conversation with @fergusbisset – thanks Ferg. He nudged me in the direction of reading Buchanan’s paper for myself and also warned me about opening a can of worms that had seemingly settled down. I understand from him, from some of the people I spoke with at ServDes and from Buchanan’s writing that many hours have been spent on these discussions already, therefore continue this post with a little trepidation. I’m not wanting to rake over old ground but I have yet to find the answer I’m after and have not been involved with the discussions to date, so bear with me
To me Buchanan makes a far more balanced argument than the use of the quote in the book implies. In fact he follows his statement with the following:
However, I believe that definitions are critical for advancing inquiry, and we must face that responsibility regularly in design, even if we discard a definition from time to time and introduce new ones. [Buchanan, 2001, 8]
Buchanan addresses the purpose and use of definitions, classifying them as descriptive or formal. Descriptive definitions, as pointed out by Buchanan, are incredibly useful for acknowledging the influences on a discipline – TiSDT is great at doing this, throughout the book many descriptive definitions are offered and many insights can be gained from that. As I said earlier this is incredibly useful, especially for someone without formal design training or knowledge.
Descriptive definitions also tend to carry emotional weight, they are great for describing what something is or isn’t (stating the obvious I know), but I think for those of us who are more comfortable with an academic or research approach or who are seeking a more formal definition or who simply wish to present a pragmatic, rationed argument as to why they should invest money in something, a formal definition is required. Buchanan offers the following formal definition of design:
Design is the human power of conceiving, planning, and making products that serve human beings in the accomplishment of their individual and collective purposes. [Buchanan, 2001, 9]
Buchanan situates his definition within Aristotelian causes. Human power is the agency of action, conceiving, planning and making the final cause – the end goal that design is focused on, products (in the broadest sense) are the outcomes, the formal cause and accomplishment of individual or collective purpose is the material cause, as human needs, activities and aspirations provide the subject matter. If this definition is adopted the scope of application is pretty much universal and as wide ranging as it gets – I’m absolutely convinced that this could be adapted and used as a formal definition for service design, without limiting it’s potential.
But why do I care? I think by failing to offer a formal definition, rather than limit the development of the discipline by applying unnecessary constraints and restricting creativity, my concern is that there is a risk that the discipline is being limited by its inability to communicate it’s value and worth in a way that different audiences can understand.
Where does all of this leave me, and I imagine Mike? Well we’re not designers but we are interested in the potential of service design. We have an interest in science – physical and social, economics, psychology, health and social care, research and rigour, evaluation and value. We are both also interested in ethics and how these are addressed. It was no coincidence to me that many of the concerns and questions that Mike was raising in our conversation were ones I’ve questioned myself many times before: how do we know if service design is ethical and/or safe? how can we identify a good service design practitioner? is service design essentially just marketing? is service design essentially just ethnography? is it about aesthetics or something more? what is the relationship between service designer, client and end user? what evidence are policy makers using to decide on the role that service design can/should play? is there clear evidence that it works? how does service design represent uncertainty? what is value and how do we know if service design will bring good value for our organisations?
As I said at the start of this post, I feel that there is a value in looking at the design of services. I feel more confident now to try and articulate that value – in no small part with thanks to ServDes, TiSDT and conversations and questions with and from many people especially @fergusbisset @segelstrom @designthinkers @grahamhill @adamstjohn @rufflemuffin @mrstickdorn @iterations and of course @mikey3982. I would however still like to see a formal definition that I can readily wheel out when someone asks, even if in time it becomes outdated or unhelpful. For now I have the beautiful This is Service Design Thinking that not only contains a wealth of information but also dazzles anyone who looks at it by it’s layout and design….thereby convincing them of the value in and of itself; maybe that’s it, maybe @jakoblies work on TiSDT and the resulting beautiful aesthetically appealing design is actually all that is required, I guess time will tell, they certainly help
I’m sure that I’ll come back to these thoughts as I continue to try and incorporate elements of design and thinking around designing services into my own professional work, so I’d really welcome your thoughts, reflections and any definitions that you find particularly useful. Thank you for taking the time to read this epic post.
A couple weeks ago I had the absolute pleasure of attending ServDes, the Nordic Conference on Service Design and Service Innovation. Held in beautiful Linköping in the middle of the South of Sweden (Swede’s seem intensely proud of which bit of Sweden they’re from so I thought I better clarify that), the research conference was focused on ExChanging Knowledge. Acknowledging that most publications in the field of Service Design have focused on establishing the discipline, the call for papers for ServDes was an explicit invitation to those in research and practice who wished to contribute to developing the service design knowledge base to:
“…openly discuss challenges of the field. Changing Knowledge is about investigating the fundamentals in service design and challenging the knowledge inherited from the disciplines which service design has grown out of. Exchanging Knowledge refers both to integrating knowledge from other fields and the ongoing conversation between conference participants with their various roles; consultants, students, in-house, clients and academics”
The full conference programme, linked to all the papers presented, is available on the conference website. Better still you can view videos of all the presentations on the conference Vimeo site. The conference kicked off with an unconference day; myself and Fergus Bisset hosted a room exploring Evidence Informed Practice in the Design of Services. You can read our session outline here and we’ll report the day in another blog post shortly. I really enjoyed the day, we met some fantastic people with a range of views and we had some great input from people on twitter who weren’t able to be at the conference….but more on that later.
For now I wanted to just offer a few of my highlights, thoughts and reflections. I’m sure these will develop over time and more blogs will follow but this post in itself is way overdue now so I wanted to put this out there as a starting point. I have chosen to just offer random thoughts, grouped where possible, but not linked to the conference programme in any structured way – partly because I prefer chaos, partly because I’d like (at some stage) to comment on some of the papers in more detail and partly because it all merged into one amorphous collection of thoughts in no small part influenced by the pre-servdes chats and the learning and conversations outside the conference proper. When looking through my notepad of scribbles and drawings from ServDes I found a napkin on which I’d scribbled a bullet pointed list of the key terms and phrases that seemed to emerge throughout the conference – the top four for me were value, trust, transparency and shared expertise. As good a place as any to start methinks.
Value – what a biggy. Value came up again and again, with reference to the value of service design as a discipline and of design more generally. Katarina Wetter Edman reported her (PhD??) study on value in design, you can read her paper here. She referenced Graeber’s four (anthropological) perspectives on value: the concept of doing good, value in a monetary sense, value as meaning and meaningful difference and value as action. WetterEdman’s research found that designers don’t talk about value, not as an explicit concept, the v word was rarely mentioned with a preference given to talking about emotions, contextual understanding and helping others. Within that, designers tended to focus on value in use and/or economic benefits – the real challenge of this perspective of course is that value is a value-laden and individualistic perspective (apologies for stating the bleeding obvious) and therefore how designers understand and share ‘value’ is key to success.
Value is without doubt key to judging what the outcomes of good service design are. It struck me time and again at ServDes when I asked people why they were interested in designing services or what service design is (I’ll come back to that in a later blog post), that almost everyone made reference at some point in their answer to wishing to do good or to the fact that they wanted to make a difference. I admire, respect and whole heartedly support anyone’s intention to do good or make this world a better place – however as genuine as I am in that sentiment, I am also incredibly wary of the damage that good intention’s can do when left without recourse or measure! This may all sound terribly worthy (and at some level you’d be correct to view it as such) but in few other professions would young graduates be given free reign and direct contact with people relying on services without any support, checks or balances – personally I think this is less of a concern when relating to someone’s experience of their supermarket shopping trip than raising their hopes about their ability to influence their lives, their community, their health service or something else of significance for their future.
In my opinion one feature common to both the concept of value and the intention or wish to do good is ethics. Without a consideration of ethical standards I’m unclear of how anyone can have confidence that they aren’t doing harm, or indeed that they are making a positive difference and doing good. The topic of ethics came up a few times at ServDes – probably more in the informal break and lunch conversations than in the papers, we discussed it in our EIP unconference and Sarah Drummond made reference to it in her case study presentation, building on some of our earlier conversations and some topics we’d thrashed around the night before. Sarah was reporting the Getgo Glasgow case study and drawing on her experience gained through her Masters studies, you can read her blog post about it here. Sarah’s blogpost that followed her presentation drew heavily on Don Norman’s post, Why Design Education Must Change, which deserves a blogpost in its own right to continue the conversation. Don’s post complements the unconference discussions we were having around the use of evidence in design, he states:
Science is difficult when applied to the physical and biological world. But when applied to people, the domain of the social sciences, it is especially difficult….Designers, on the whole, are quite ignorant of all this science stuff. They like to examine a problem, devise what seems to be a solution, and then announce the result for all to acclaim.
I’ll discuss this further in a later post but would like to think that the time is coming when designers will freely, openly and confidently discuss the ethical implications of their work. Which brings us on to trust and transparency. I’ve been digging around trying to learn more about service design for just over a year now; the notion of designing for services make sense to me, I am certain that service and experience of service is as, if not more, important than product – my interest is in the journey, not just the outcome, and yet I was tentative about attending ServDes. In part this was because I had followed the SDN (Service Design Network) conference in Berlin from a distance, dipping in and out on twitter, and was even more sceptical about service design at the end of it. Throughout that conference the twitter stream was predominantly self-promotion, lots of patting on the back, lots of bigging each other up, very little critique, discussion or reflection – obviously I wasn’t there but from the outside I was left underwhelmed and sceptical about the value of attending ServDes!
For those of you reading this with an understanding and unquestionable belief in service design I’m sure this may come across as quite harsh or unduly cynical, however I consider myself to be a service design agnostic – I’m just waiting for more proof! I was a little nervous about how I would find ServDes and how open people would be to discussion and debate, to questioning and challenge. It is fair to say the whole conference experience far exceeded my expectations from this regard; I met some fantastic people who seemed equally ready to have these discussions and I think some were even seeking them (that or they were all just exceedingly polite with me). I found a humility about service designers which on the whole I had not felt before – maybe that is what comes from immersing yourself in someone else’s discipline, maybe it was the effect of people being able to be honest and let their guard down (in the absence of many clients), maybe it was an environment created by the explicit focus of the conference on openly discussing challenges in the field or maybe it is just the stage in development that the discipline is at, I’m not sure which but I was blown away by how honest (some) people were about not having all the answers. For me there is a real need for trust and transparency – designers don’t have all the answers, none of us have all the answers, so the earlier we admit that the easier things are. From what I heard at ServDes there is very much a focus on multi-disciplinary working and/or gleaning tools and techniques from many different established disciplines and for this to be successful, people need to be honest. To build successful and ongoing relationships between customer and client, between designers and users, people need to trust each other and be transparent in their dealings.
Which leads on to my final reflection about shared expertise. In my experience to date in life, most progress is made working in a team, with a range of people who between them hold a broad spread of skills, abilities and approaches. I can’t imagine that successful design is any different. There is an absolutely solid evidence base about what factors help and hinder multidisciplinary working and lead to best use of shared expertise. Common challenges are around identifying a shared starting point, a common language, a way of working and creating an environment where people feel able to question the status quo and admit when they don’t have the answer. ServDes was a great success for me in this regard – the designers, marketeers, students and academics I met were all open to my alternative approach, in fact I felt very welcomed into the conference (no small achievement for someone with a below par starting point, a different professional language – evidence anyone?, and an irritatingly challenging approach to learning new stuff – which is a glossy way of saying if I don’t understand something I tend to ask too many questions); I very much hope that the conversations that were started at ServDes – both in person and through twitter – will continue to develop over the coming months.
A massive huge TACK to everyone from the Cognitive Science Dept at Linköping University who arranged ServDes; to all the volunteers and especially to Stefan, Johan (on the left) and Fabian (on the right) for the very generous Swedish welcome and the awesome conference.
Pick what you’re interested in…
- We need to relearn the art of #dying: We could learn something that will strengthen us for the rest of our lives telegraph.co.uk/technology/soc… tweeted 5 hours ago
- @C0tt0n1 Dont know that it'll ever wear thin either :) The smell of autonomy with coffee in the morning :) tweeted 5 hours ago
- @C0tt0n1 Wind yr neck in Mr C, unless you've a home for Lionel? Go on, he's like ya, bit scratchy, attention on his own terms :-p @HanLRees tweeted 5 hours ago
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