Responding to Birger and to Don (and the discussion). This is a conversation I care about, as it relates to the core premises of my book Design for Care.
Evidence-based design is being reframed now, in different ways as we see Don is presenting here. This is not a monolithic practice that threatens design traditions. I'd say "it's not what we think it is." In practice, understanding the contributions of science and standards of evidence contribute to better design decisions in complex systems. This in itself doesn't ruin creative or interpretive design approaches. Most systems I've designed have included both types (or multiple methods) of design research. Certainly when working with development teams and product managers, the "harder" evidence - user data - is always more convincing than generative or conceptual design cases.
There's been a long tradition of evidence-based design in healthcare, based in studies of environmental design and architecture in facilities and care practices. Its major proponents have been doing safety and systems-oriented research and intervention since the early 1980's, and if you search "healthcare design" these are the precedents that show up. See the venerable Center for Health Design https://www.healthdesign.org Their studies have made a huge difference in quality of care and patient safety over the last 30 years, but also in decreased length of stays, improved quality of experience and softer outcomes. You can measure these things and make a convincing case for very expensive and significant facility changes. The current knowledge that "single patient rooms lead to better health outcomes" is both patient-centred and evidence-based. But hospitals would never accepted the expense of essentially doubling the number of rooms based on patients preferring it. They do measure hard outcome data, and outcomes are a major design criterion.
Evidence is not necessarily a positivist position, even if the tradition of EBD tends to be so. Evidence is merely "based on data" as opposed to expert judgment or collective agreement, which are interpretive modes. In fact, collecting interpretive data from users, rigorously, is evidence. Patient narratives are a type of evidence. If we don't collect data, we're at significant risk of interpretive risks in making design decisions that affect safety, human welfare and finances. So just as scientists argue about the meaning of data, so ought we.
Evidence and its alternatives are not an either/or proposition. In fact, there is no "or" to be found. My concern is that the "evidence in design" discussion is one that seeks to dismiss the value out of fear of epistemological contamination ;) Like it would take over one's design philosophy. But in systemic design there needs to be a balance of methods and perspectives, as complex systems (at least) are many-sided and many-functioned operations which no one person can understand in whole. Every contribution to knowledge helps.
In healthcare, the trend that is balancing evidence-based care is patient-centred care. But very few organizations have produced meaningful approaches that all understand as patient-centred. There's pretty good agreement around "levels of evidence" and research standards, there's almost none for patient-centred care. I've done some work on this and can say its seems to be getting fuzzier, not clearer. PCC is not patient experience, it's not patient satisfaction, PCC is interpreted very differently between clinical professions, and differently across institutions. Do hospitals really see a trend "away" from evidence and toward "patient centricity" when they don't agree what that is? And when they get closer to it, that real PCC tends to blow up the business model. I'd suggest Birger's concerns reflect different values positions, which may have validity in some settings, but are value-oriented and not based on "evidence." ;) If non-clinicians actually look at how the evidence behind medical practice is treated, they'd realize that no expert "lets the evidence decide."
The reliance on clearly established precedent and the "literature" is a starting point for clinical decisions - diagnostics, medications or surgical therapies are complex decisions and require the best known answers before expert judgment is applied. The risks are too high not to. Yes, in hospitals residents execute much of this and they don't build long-lasting personal relationships. They are residents. But nurses, who have championed patient-centred care and tend to practice it philosophically even if it's not standardized, demonstrate in many ways affective and interpersonal qualities we associate with PCC.
Certainly clinicians who actually work in healthcare are not going to wish away evidence supported decisions anytime soon. When we seek to deliver design value at organizational and social/policy levels, we're dealing with high degrees of complexity and the difficulty of sustaining a presence long enough to make a difference. Gaining agreement on courses of action is critical in these domains. Evidence helps us build the case for stakeholder agreement, especially across strongly contested views and positions, where power is involved or people have possible losses.
So I see the need for this balance, and I've always practiced this balance. I have papers in journals like Cognition, Technology and Work, and am trained as a psychologist, like many of us who started in HCI.
But service design and whole system (integrated IT and process) design require both evidence-based and x-based. And I'd like to hear more of what those other "x's" are, because I never saw a conflict between research-led design and exploratory design. They are usually different stages, but I will say that in corporate work I've found you rarely get paid to explore. In design school our students usually want to just explore and save evaluation for "later in the career."
If we want to be trusted to work with mission-critical services and integrated systems, we need to get beyond our own prejudices of what these categories might mean. We have to read studies, learn from scientific research and design research, from our peers and dialogues. And I would make a case for integrated methods and multi-perspectives.
Peter
PETER JONES, PH.D.
ASSOCIATE PROFESSOR
FACULTY OF DESIGN
E [log in to unmask]
OCAD UNIVERSITY
100 McCaul Street, Toronto, Canada M5T 1W1
-----Original Message-----
From: Don Norman [mailto:[log in to unmask]]
Sent: July 14, 2015 5:48 PM
Subject: Re: Discussions and critique of evidence-based practice
As a proponent of evidence-based design, here are a few things to keep in mind.
Design is a complex activity, involving many different components.
I believe that when we discuss the role of evidence or science, we need to be sensitive to the different requirements of those components.
I believe that design already has different levels of rigor. These vary
from:
1. Craft-based, sharply honed intuition.
2. Rules of thumb: heuristics
3. Best practices (case-based)
4. Design patterns (modified to account for the current problem)
5. Qualitative rules of practice
6. Quantitative rules
7. Computer models
8. Mathematical models
These are listed (approximately) in terms of rigor and precision required to develop them, but these are NOT meant to be assessments of quality, goodness, or anything else.
You can find different components of design today at all levels.
Engineering design tends to be at levels 6, 7, and 8. Interaction design
has components of 4, 5, and 6. Color theory has components at 8. Graphic
design probably has components at all levels.
I do favor evidence-based practices, but only where appropriate and where the results enhance rather than detract from the overall result.
In other words: the use of evidence is not a simple, binary, all-or-none thing.
Moreover, I think that Level 1 will always be with us, will always enhance the end result, and will always be an essential component of design, especially for the design of physical objects and graphics, but even for more abstract things such as services and procedures..
Don
Don Norman
Prof. and Director, DesignLab, UC San Diego [log in to unmask] designlab.ucsd.edu/ www.jnd.org <http://www.jnd.org/>
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