Now Reading: Change by Design – How Design Thinking Transforms Organizations and Inspires Innovation, by Tim Brown


Change by Design, Tim Brown with Barry Katz (link to Amazon)

Since I know that I’m not that smart and my ideas aren’t that unique, I am always seeking out others’.

In this case, I asked my personal “design dream team” (national experts who I happen to know): Chris McCarthy ( @McCarthyChris ) at Kaiser Permanente’s Innovation Consultancy, Jeneanne Rae co-Founder of Peer Insight (who I visited earlier this year with @Lygeia) , and Jason Schupbach, Director of Design for the National Endowment for the Arts for theirs. I asked about recommended books to read to learn more about design thinking, and was steered to this title.

I’ve been referring to design thinking on this blog for over two years, yet I humbly asked Chris at our last Innovation Learning Network meeting, “what actually is design thinking?” hence my desire to really understand it. This book really helps.

Some Definitions of Design Thinking

The most basic definition that I found here echoes what Chris told me – “a human-centered approach to problem solving.”

Here are a few more helpful references that I found:

The intrinsically human-centered nature of design thinking points to the next step: we can use our empathy and understanding of people to design experiences that create opportunities for active engagement and participation.

Design thinking requires bridging the “knowing-doing gap.” The tools of the design thinker – getting out into the world to be inspired by people, using prototyping to learn with our hands, creating stories to share our ideas, joining forces with people from other disciplines – are ways of deepening what we know and widening the impact of what we do.

How do you do it? The value of observation.

The book goes through the basic approach of design thinkers, which involves inspiration, ideation, and implementation (with the idea that the definition of innovation = “a good idea executed well.”

Observation is given a lot of emphasis in this process, and probably explains why I am drawn to design thinking – ever since discovering LEAN and the philosophy of respect for the customer and those who provide them services, I have understood the importance of going where service is provided. In health care, that’s where the patient is.

I like the way Brown describes it:

Observation: watching what people don’t do, listening to what they don’t say

He says, “good design thinkers observe. Great design thinkers observe the ordinary.”

I have learned that speaking with care providers and patients outside of the care experience can be problematic, even disrespectful.  I agree with Brown’s statement that “Even with the best of intensions, people’s memories are faulty and their answers are likely to reflect what they think should be the unvarnished facts.” Not to mention that in health care, sitting down to talk with a physician or nurse means taking them away from pressing patient care responsibilities that they will need to attend to later. So why do that? This is the rationale and approach I used in visiting @KpNorthwest recently (blog posts here).

To people who wonder if observing a few people/care providers is scientific or representative, I wonder back, is looking at data representative? There are many examples where it’s not, some very tragic, such as this one in England, where a health system literally swimming in data did not understand the devastating experiences the patients and families under its care went through until it was too late. Brown says, “Reams of market data are no substitute for getting out into the real world.” I agree.

Observe at the extremes

If you decide to observe, how do you know who to observe? Brown brings up the value of looking at extreme users, for this reason:

By concentrating solely on the bulge at the center of the bell curve…we are more likely to confirm what we already know than learn something new and surprising. For insights at that level we need to head to the edges, the places where we expect to find “extreme” users who live differently, think differently, and consume differently-a collector who owns 1,400 Barbies, for instance, or a professional car thief.

Thinking more about the experience of health care

One big “a ha” for me was the impact of experience in health care – while I have understood the importance of experience as its own outcome for a long time, I hadn’t thought about experience as supporting all of the things that health care wants to do. For example, you don’t often hear health care quality organizations referring to the “experience” of lowering blood pressure or having a low blood pressure, just that it needs to be lowered in a population.

As I read this, I had a flashback to the book “Punching In,” which I read in 2007, who’s author worked incognito at several well known companies a la Barbara Ehrenreich. The author noted that each of the well known companies where he went to work didn’t seem to be selling the product we think they are selling – Gap is selling lines of credit, Apple is selling warrantees, Enterprise is selling auto insurance, Starbucks is selling the third space between home and work. He said the Gap is two companies, one, the company of ideas, another, the company of folding (clothes). Through the lens of this book, I think what these companies are doing is selling experiences around their products, which makes the use of their products more effective/profitable. Is this translatable to health care – would a focus on the experience of chronic illness care (from the perspective of the patient/family) or population care (from the perspective of patient/family) result in better outcomes, delivered more efficiently?

Involving those who you are designing for

Another area of interest for me is around the importance of designing “with” rather than “for” people, and Brown brings this into the discussion in several places in the book. I think this quote will find relevance with a lot of people who read this blog:

…too many of our  large-scale systems fail to deliver a respectful, efficient, participatory experience.

Enough said, I like this design thinking, and even though I am not a designer, I am comfortable thinking like one. Are you?


Sigh. So much reading. So little time. I've added to the list, but this thorough review gave me a good start.

Regarding your question: can health care talk about chronic conditions in terms of experiences? Dr. Bill Marsh tells the story of a patient with severe asthma. He asked her: what is your goal? She answered: to travel to see a distant friend and be able to stay with her awhile. He said by moving his frame of reference away from "managing her condition" to "achieving her health goal," his suggested course of treatment was affected.

Dear Steve,

As usual, an awesome comment from you, in terms of its authenticity and storytelling quality…you must do this for a living :).

It touches on why I blog, which is less "call to action," more "personal memory device." I realize that few people (or at least I) follow-up on book recommendations without an intrinsic interest in the topic. This is is just here for people when they go on a 2 year journey like I have and then ask, "what is this?" So I say you're fine waiting until this is part of your professional discovery. Speaking of which, will we see you at an upcoming Innovation Learning Network in person meeting?

That is a great story about thinking about a person's asthma in terms of their life experience instead of their medical experience.

How does a system / your system take that awareness in providing health services? What's the health care version of going from thinking of airline travel experience as starting when a passenger gets on the plane to starting when a person decides to go somewhere?

Thanks for bringing out more of the conversation as always,


[…] In Tim Brown’s book for design thinkers, “Change by Design,” he says, “observation is watching what people don’t do, listening to what they don’t say,” which speaks to this, and also, in my experience, to watching what your hosts don’t do, listening to what they don’t say. With this in mind I state the preference (about being in the practice), and then let the host make the choice of where observation is best, it always works out. […]

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