Systems & Design Thinking: A Conceptual Framework for Their Integration.pdf Re lev ance to Design Practi ceHow well we deal with emergent problematic conditions depends on thequality of the approaches we use and try to implement. These approaches dependmore on our philosophy and «world view» than on science and technology.Design practices will benefit from consciously integrating the System's worldview into its methodology.Int roducti on: Conte xt, Syste ms World Vie wand Design Thin king DefinedWorld views integrate experience and influence the way we frame andapproach problems. A world view (also known as a mindset, mental model,or paradigm) controls what questions we ask and what answers we considerlegitimate. The demand to change the prevailing world view of any situationarises when we are unable to fit the facts, assumed problems or observationsinto the existing paradigm. Any of these anomalies can create a dilemma.Russell L. Ackoff (1981) defined a dilemma as «a problem, which cannotbe solved within the current world view». A set of dilemmas generates newapproaches to thinking about them. The anomalies are worked on and studied,and some are eventually addressed as a new and different paradigm emerges.Ackoff went on to note that a change in paradigm is underway in our societyand has been set in motion by a set of dilemmas.This sentiment has recently been echoed by many systems and designthinkers faced with the complexity of today's business challenges. During theCreative IndustriesConvention 2010, designers identified the growing interest in developingnew business models that can help them work in different ways. While itwas acknowledged that there is some fear in the pending paradigm shift, itis becoming clear to designers that change toward a collaborative way ofapproaching problems is imperative.The need for change in paradigm is further emphasized by the use ofEinstein's famous quote that says: «Problems cannot be solved by the samelevel of thinking that created them». Much of the confusion we encounter inproblem solving today results from misconceptions about the nature of changein social systems and their environments. Moreover, it has become evidentthat traditional organizational forms, planning methodologies and responsestrategies are inadequate for addressing complex problems.This is especially true when applied to emerging conditions having anincreased ate of change, increased complexity and increased uncertainty. Thisinadequacy, in large part, stems from the nature of the traditional paradigmwhich relies on existing knowledge -- knowledge gained by studying traditionalapproaches. Gareth Morgan (2006) posits that metaphors play an importantrole in understanding organizations and management. The use of metaphorimplies a way of thinking and a way of seeing that pervade how we understandour world generally. The resulting mindsets that develop are the products ofhistorical circumstances. Currently, most of the metaphors used to describeorganizations and their complex problems are derived from the "machine" ageand the mechanistic world view.The world views that we develop and the metaphors that we use to describewhat we see directly influence the underlying assumptions we make aboutthe situation we are looking at, and therefore, the approach we take. Sinceour understanding of organizations is informed by looking at organizationsthrough multiple metaphors or images, it is important to approach problemsfrom more than one framework.This paper, among other things, will explore two of the possible frameworksthat are used to approach problems: a Systems Thinking approach and a DesignThinking approach. Systems Thinkers look to formulate and subsequentlydissolve complex problems from a systemic world view, while DesignThinkers approach the same complex problems from a variety of perspectives.Consciously selecting a conceptual model that combines the differing Systemsand Design approaches to problem resolution will increase the probability ofsuccessful and sustainable implementation.Syste ms Thin king World Vie w«Systems thinking» or the «systems view of the world» is evolving asan alternative to the old paradigms. (Flood and Jackson, 1991). Mattesich(1982) writes that «systems thinking is first and foremost a point of view anda methodology arising out of this view point». It is a lens through which youcan look at the world and that lens determines what you see. Also, it oftendetermines what you do about what you see.Systems thinking as a mindset evolved from General Systems Theory,with the work of Austrian biologist Karl Ludwig von Bertalanffy in 1937.Systems Thinking has been adapted by many circles since WWII. In its currentmanifestation, it is used to provide a different perspective to understand theworld (including organizations) and our conception of its nature. Systemsthinking replaces reductionism (the belief that everything can be reduced toindividual parts), cause and effect (environment free theory of explanation),and determinism (fatalism) with expansionism (the system can always be asub-system of some larger system), producer-product (environment-full theoryof explanation) and indeterminism (probabilistic thinking). Additionally, itreplaces analysis (gain knowledge the system by understanding its parts) withsynthesis (explaining the role of the system in the larger system of which it is apart). Analysis is useful for revealing how a system works but synthesis revealswhy a system works the way it does (Ackoff, 1999).Many methodologies are derived from the systems thinking world viewincluding interactive planning, soft systems thinking, systems dynamics, andthe viable model to name a few. Regardless of methodology, the essence ofsystems thinking is encapsulated in the concept of systemic wholeness, whichis grasped by looking at the whole instead of the parts. As a result, when anorganization is considered a system, it implies an interconnected complex offunctionally related components. Failing to consider the systemic propertiesas derived from the interaction of the parts leads to sub-optimization of theperformance of the whole.One of the consequences of Systems Thinking is the willingness tosacrifice the performance of the part for the performance of the whole. Thisis in opposition to maximizing the performance of any one given part at therisk of sub-optimizing the performance of the whole. With systems thinking,managers and designers must learn how the parts of their organization interact,not how they perform independently. Otherwise, unintended consequences mayemerge as changes made within one part of the system may adversely affectother parts of the system not initially considered. Often, these new problemsare much worse than those addressed initially. It is for this reason that Ackoff(1999) suggests many performance-improvement initiative fail and actuallythrow fuel on the fires they seek to extinguish.Design Thin king DefinedIn recent years and independent of the systems thinking movement, therehas been a great interest in «Design Thinking». But design in managementis not something new. Design philosophy in management has its roots inEgyptian and Mesopotamian bureaucracies. Even Taylorism was considereda new design philosophy in the early 20th century! However, it is importantto note that design thinking does not adhere to a specific worldview. This is asignificant difference from systems thinking.Currently, there are many contrasting and even widely divergent conceptsof the design process and what makes someone a designer. Additionally, thereare many organizations that are cited as examples of companies promotinga Design Thinking culture (e.g., P&G). What does this mean? BuckminsterFuller, in his introduction to a book written by Victor Papanek (1971) saysthat design for him can mean either a mental conception or a physical pattern.The essence of design for him is the notion of a pattern of events organizedinto discrete and interacting elements. For him, «the opposite of design ischaos». The ubiquity of the design process and the variety of criteria used inits actualization is described by Papanek, who on «what is design» writes:«All men are designers. All that we do, almost all the time, is design, fordesign is basic to all human activity. The planning and patterning of any acttowards a desired, foreseeable end constitutes the design process. Any attemptto separate design, to make it a thing-by-itself, works counter to the inherentvalue of design as the primary underlying matrix of life. . . . Design is theconscious effort to impose meaningful order».To illustrate, however, that the general design function does have somestructure, Papanek further asserts that the general design function mustincorporate considerations of: Methods (tools, processes); Use (does it work?);Need (real vs. evanescent requirements); Telesis (reflection of the times andconditions surrounding the project); Association (psychological connectionswith aspects of the project); and Aesthetics (shaping colors, textures, etc. intopleasing forms).According to Nigel Cross (2006), designers have specific abilities to«produce novel unexpected solutions, tolerate uncertainty, work with incompleteinformation, apply imagination and forethought to practical problems anduse drawings and other modeling media as means of problem solving». Hefurther argues that designers must be able to resolve ill-defined problems,adopt solution-focusing strategies, employ abductive/productive/appositionalthinking and use non-verbal, graphic and spatial modeling media.Architects are examples of designers who operate from this mode ofthinking. Bryan Lawson (2004) has conducted research which shows thatwhen the same problem is given to architects and Ph.D.s, architects developthe best solution in no time. Boland and Collopy (2004) experienced moreor less the same thing. When working with architects they noticed that these«design thinkers» do not adhere to the traditional model of decision making/problem solving. Instead of developing options and evaluating the alternativeoptions, they design the best option from the start!The term Design Thinking, as recently defined by one of its proponents,is now generally referred to as applying a designer's sensibility and methodsto problem solving, NO MATTER WHAT THE PROBLEM IS. Tim Brown(2009) explains that it is not a substitute for professional design or the art andcraft of designing, but rather «a methodology for innovation and enablement».There are many who argue that Design Thinking is the third culture (area) ineducation besides science and humanities (arts) (Nigel Cross, 2006).It seems that lately some in the management sciences think that there is alot to be learned from the way that designers think (including the abductivelogic) and the way they "know" that could help us with innovative solutions(compared to the role of research in science). Jonathan Baron (2008) says that«thinking is important to all of us in our daily lives. The way we think affectsthe way we plan our lives, the personal goals we choose, and the decisionswe make». We've already mentioned how at one end of spectrum you haveanalytical thinkers who hone and refine their existing models even as they getless and less valid. At the other extreme are intuitive thinkers who say it's allgut and deny they are using any logic at all. Einstein stated that «The workingsof intuition transcend those of the intellect, and as is well known, innovation isoften a triumph of intuition over logic». (Holton, 1997)Charles Sanders Peirce (Hawthorne, 1958) was most interested in theorigin of new ideas. It was this interest in new ideas that ultimately led him toargue that no new ideas could ever be proven via the application of Deductiveor Inductive reasoning and that it required what he called a «logical leap ofthe mind». He further argued that when new data exists, and that data does notneatly fit into a currently understood model, the first activity to be performedby the mind is to wonder. Wondering, as opposed to observing, is the key toAbductive reasoning. It is the act of creatively thinking about what can bedone with the data in order to orient it to the environment that sets Abductivereasoning apart from Deductive or Intuitive reasoning. Since the data is new,there is no method of reliably determining the appropriate method of dealingwith the data; therefore, a practitioner must rely on, as stated earlier, a "logicalleap of the mind" to make sense of the new data.In a recent interview, Roger Martin (2009) was asked «What do you meanby the term design thinking?» He responded that «design thinkers are willingto use all three kinds of logic to understand their world». We infer this tomean that he was referring to deductive, inductive and abductive thinking.Martin says that Design Thinking is the only mode of thought that will allowan organization to move knowledge through the Knowledge Funnel, the pathtaken when an organization travels from mystery to a heuristic of its businessenvironment, and finally to a reliable algorithm for its behavior within thatenvironment. Further, Martin says that it is the interplay between these twoextremes of the exploration of a mystery and the exploitation of an algorithmwhere Design Thinking emerges.Martin to greater extent explains that neither Analytic nor IntuitiveThinking alone is enough to sustain competitive advantage since each, whileproviding tremendous strength, also create scenarios of systemic weakness ifapplied in isolation. He also makes clear that the goal of abductive reasoningis not to declare a conclusion to be true or false. Instead, it is to posit whatcould possibly be true. And so it is theorized that design thinkers are usingabductive logic but failing to make it explicit to themselves or anyone else. Itis this mode of thinking that allows a designer to seek out new ways of doingthings, challenge old ways of doing things and infer what might be possible.It is the careful, balanced application of the reliable lessons of the past and thelogically valid leaps of what might be in the future.The design thinker bridges these two worlds, and works to make the abductivelogic which design thinkers use more explicit so that it can be shared and refined.Fred Collopy (2009) recently wrote in Fast Company: «So if thinking is at thecenter of the activity that we want to encourage, it is not the kind of thinking thatdoctors and lawyers, professors and business people already do. It is not a feetup, data spread across the desk to be absorbed kind of thinking. It is a pencil inhand, scribbling on the board sort of thinking».And while that may be obvious to those close to the process already, weare afraid it is not what folks conjure up when they first hear the phrase designthinking. From this perspective, then, it is ultimately the Design Thinker'sresponsibility to know which method to apply and when. However, it has beenpointed out by many current practitioners, including Roger Martin, that thereis little or no formal training provided in our institutions for executives ormanagement in the creative design process.The appeal of Design Thinking lies in its human-centered heuristics andgrowing track record of success. Numerous examples of these successes can becited, such as IDEO (a design company in California that has designed manysuccessful products). As more is written about the application of design thinkingin the business world, what is becoming clearer is that it is most commonlyapplied to product-oriented problems despite its clear value to the design ofinnovative services, systems and processes. While successful applications doexist in this area, they are less commonly highlighted. Language matters. Wecannot help thinking that we are selling our ideas short given the momentumbehind the current choice of language. And, we wonder, how much designingand/or thinking has actually gone into DESIGN THINKING? While the strengthsof taking a design approach are seen in the successful outcomes, the term designthinking is becoming so common that this approach is facing the risk of becomingyet another meaningless fashionable term without true business value.The Role th at Design Plays in Syste ms Thin kingDesign in Systems Thinking is not the same as design in Design Thinking.We acknowledge that there are many divergent views on design within thesystems process; however, there is agreement upon a number of underlyingprinciples that systems thinkers take when planning toward a desired future.While a full explanation of these principles goes beyond the scope of this paper,systems thinkers, generally, aim to do something today to improve the systemtomorrow.In systems thinking, design (based on Aristotelian/Singerian teleologicalimagery) is a core concept that is characterized as «creative act which attemptsto estimate how alternative sets of behavior patterns would serve specified setsof goals». In the Systems community, Design became the preferred approach toproblem solving and planning for a variety of reasons: the belief in the syntheticmode of thought; the belief that the future is subject to creation (design beingthe creative process); the belief that you need to dissolve problems (and notsolve) through redesign of the system; etc.Van Gigh (1978) and Warfield (1983) argue that «design» is to the systemsapproach as «continuous improvement» is to the scientific approach. Theypoint out that design is a process, which requires the ability to question prior orexisting assumptions regarding the whether he or she is a specific breed withsuperior cognitive capabilities.To understand the role of Design in Systems Thinking, it is helpful to lookat Ackoff's (1981) view on planning. Ackoff describes four orientations toplanning: Reactivism, Inactivism, Preactivism and Interactivism. Reactivistsare those planners who embrace the past. Inactivists are those planners whoare generally satisfied with the way things are in the present and seek toavoid making mistakes within the current system; they seek to avoid errorsof commission. Preactivist planners are unsatisfied with the past as well as thecurrent environment and seek change. The Preactivist planner seeks to understandall aspects of the future that may affect the success of the phenomenon theyare planning for; they seek to avoid errors of omission. Professional plannersforecast the future and organizational officers set objectives based on theplanners' predictions. Finally, Interactive planners believe the future is subjectto creation. They believe the best means of revealing a desirable future is byenabling the stakeholders to do it themselves.Not surprisingly, the Ackoffian systems thinker embraces the InteractivePlanning perspective. The Interactive Planner believes our failures are oftendue to misguided assumptions made when planning for how our future oughtto be. They believe knowledge of the past does not enable the ability to solvecomplex problems and they seek to avoid both errors of commission as well asomission.Given Papenak's (1979) view that «design is basic to all human activity»and Ackoff's view that the future is subject to creation, Interactive Planning isDesign. It is Interactive Design…more specifically, it is the execution of DesignThinking with a Systems worldview.On Designing , With and With out the Syste msWorld Vie wBausch (2002) says that: «Design literacy is the crying need of our age.To accomplish its goals, system design cannot be a top-down operation norcan it be expert driven. It must actively involve the stakeholders of the designin shaping a shared vision that represents their ideas, aspirations, values andideals».Taking this view, a Social Systems Designer, one who plans, redesigns,manages and organizes Social Systems, embraces a Systems world viewwhen designing the future of a given Social System. And given this, it isthe role of the stakeholders in the design process that separates the SystemsThinkers approach to design from that of the Design Thinker.We believe we have identified the core differences in the Systems Thinkingand Design Thinking approaches to problem resolution: Systems Thinking methodologies arose from the consideration of socialsystems. The stakeholders are the designers. Design Thinking methodologies arose from the consideration of productsand artifacts. The problems are ultimately resolved by people identified asa designer by trade. The stakeholders are observed and studied by thedesign team (cf. Deep Dive approach as practiced by IDEO)An integrated approach to problem resolution requires design thinkersto expand their understanding of good systems design principles with apurposeful consideration of the social systems they are working within.During the Creative Industries Convention 2010, Andrea Goetze (2010) notedthat today's design industry can no longer take a structured developmentapproach, where a single creative genius locks himself in a room for threeyears before emerging with a solution. Instead, she explained that designersmust find a way to change their role from one of the sole expert to one of aservice provider or facilitator. Goetze also commented that designers willneed to become more flexible and open to input from others and put theproduct in the middle of the process instead of the design practitioner. It isimportant to involve more people who collaborate together, including theusers of the product, because only this way will they have ownership andmake the implementation easier.These comments show that design thinkers are moving away from FirstGeneration of Design, where the act of designing is the prerogative of a certaintalented group called «designers». (Olsen, 1982) The First Generation DesignMethods rely heavily on professionalism, in the sense that the professional isviewed as the holder of knowledge that is critical to design, and inaccessibleto the user of the design. The professional creates a design and, because ofhis expertise and sense of responsibility, is under no obligation to go further.This approach is the one typically taken in the past in the design of operatingsystems. It is frequently described as an «over the wall» approach. In thisapproach the designer develops an operating system design on paper, andsupplies all the documentation and blueprints to a contractor who convertsthe paper design to a physical system. This mode of supplying is, figuratively,to throw the design over the wall that separates the professional designorganization from the contractor or user.Designers today more often operate from the Second Generation of Design.As Goetze (2010) noted, they recognize the need for collaboration amongdesigners and external perspectives to guide them. Deep Dive methodology,as practiced by IDEO, for example, has made it standard practice for designersto gain input from many different stakeholders, including the end user. Thedesign team observes and interacts within the larger system environment (inorder to immerse themselves in the situation) before going back to the designtable to piece the data together and design a solution. There is no questionthat such ethnographic and anthropological studies have added tremendousvalue to the solutions that are generated. This is where Design Thinking todayseems to incorporate some aspects of Systems Thinking.There is still risk with this approach, however. Even though there are manyperspectives involved in parts of the design process, they are observed andgive feedback in parts. The stakeholders give input based solely from theirindividual experiences and never see how it fits into the whole system. Itis still, therefore, the role of the designer to piece it all together. They needto get into the heads of the stakeholders and attempt to interpret what theythink. Because neither the organization nor the end user has been involvedin the entirety of the design process, there is a need to elicit their buy-in.There is also the risk that a key stakeholder group will be missed. We cautionthat there are often unintended consequences when interdependent pieces ofthe larger system have not been consciously considered in the context of thewhole system.As mentioned previously, Tim Brown's (2009) defines Design Thinkingas «an approach that uses the designer's sensibility and methods for problemsolving to meet people's needs in a technologically feasible and commerciallyviable way. In other words, design thinking is human-centered innovation». Itis in the use of the «designer's sensibility…to meet people's needs» where theDesign Thinker strays from the System Thinkers worldview.Even Brown (2008) worries about this risk when he says:«One of the principles of design thinking is that it requires empathy forusers to inspire ideas. Normally we think about getting that from ethnographicstyle research. Diving deep into the lives of a relatively small number of people,understanding the environment they live in, their social networks, seeingthings first hand. We have lots of evidence that this works, but I sometimeswonder if we aren't also missing something. The problem with looking deeplyat a few people is that you miss the opportunity for insights that might comeby connecting more broadly across cultures».This reliance on professionalism is strewn throughout the Design culture.Take for instance a recent blog post by Designer Kevin McCullagh (2010):«Let's agree that all of humanity are designers, and that design is one of thethings that separates us from the apes. As Jonathan Ive put it: 'Design is notimportant. Good design is important.' First, when we talk of designers, weusually mean professional designers, who have reached an accepted level ofcompetence. They have survived a Darwinian selection process (there are farmore graduates than jobs) and have clocked up well over 10,000 hours ofpractice on projects. We should remember that designers learn by doing, notby learning and practicing a theory, designing involves a lot more tacit knowledgethan in other areas of business. It's therefore hard to believe that seniormanagers can lifetime after a workshop or two working with designers. And,to be frank, to suggest as much devalues what designers do.Additionally, a key factor in creating good design that really does make adifference is great designers. These talented individuals are few and far betweenand provide critical competitive advantage. Let's forget about designthinking as a magic process, and focus on how designers and managers shouldbest work together to deliver great quality outputs».The Systems Thinking world view offers a method of doing just that. Wepropose that by taking this approach, Design Thinkers can move into a ThirdGeneration of Design, which builds in a purposeful consideration of SystemsThinking principles. It therefore addresses many of the challenges of trying toget into the heads of others. A successful design is not one which is imposedon or provided to the organization from a source external to the system. Thebest way to ensure that the design will serve the purpose of the organization isto include the stakeholders in the formulation of the design.Hence, the success of a design is directly in the development of the design.In the Third Generation related to the level of stakeholder participation ofDesign, the stakeholders are the designers. They are not external sourcesof input. Instead, they are the concept generators and concept implementers(Barabba, 1995). An underlying principle of interactive planning is thatpeople must be allowed to plan for themselves (Jackson, 2003). In fact, toreach objectivity in social systems, the process must involve the interactionof groups of individuals with diverse values. It becomes the role of the designfacilitator to therefore create an environment where these differing views arehonored within the context of the larger system. Creating a shared vision ofthe future can also be described as finding «common ground», a place whereparticipants are able to get past the current situation and make decisions basedon what is good for the system. (Weisbord, 2003) In fact, designing creativesolutions becomes much more straightforward if the practitioner is able toaddress the conflicts that arise due to differing stakeholder values, beliefs andworld views (Jackson, 2003).By empowering all stakeholders from the beginning, it is possible to tap thecreative energy of every participant so that innovative ideas emerge from thecollective of the differing perspectives. This concept was described as «authenticengagement» in one of the seven laws of Dialogic Design. Laouris' Law ofRequisite Action, another of the Dialogic Design Laws, asserts that «actionplans that are not founded on authentic engagement of the stakeholders in the dialogueand deliberation are unethical and are bound to fail» (Christakis, 2006).One thing that design practitioners using a systems approach bring to thetable is ability to help an organization take ownership of the ideas that emergethrough the design process. This is a critical consideration for today's designers.It is much more likely that the ideas generated will be implemented and maintainedif the stakeholders involved were the one who came up with the solutionsin the first place. When people within an organization have had input throughouta change process and believe they have influenced the direction things are goingin, the resistance to new ideas dissipates (Rehm, 1999).It is important for designers to be able to help an organization and theparticipants uncover the underlying assumptions they are making about theproblem they think needs lved. Often cultural assumptions and traditionscontribute to the problem they are working on. (Shuman, 2006) Culturalassumptions include those specific to leadership, both formal and informal. Thiscan have a direct affect on how effectively they approach the assumed problem.A designer applying Systems Thinking principles can help participants recognizethe assumptions the organization and the individual participants hold. In thisway a designer can provide them with the means to develop a new frameworkand shared world view.Case Study : An Integ rated Ap roachto Problem Res oluti on in Acti onIn 2009 Johns Hopkins Hospital was anticipating their 2011 relocation tonew multibillion dollar quarters. Relocation projects, especially ones as largescaleas a hospital, always come with planning challenges, which in turn comewith different strategies to reach a plan.The hospital administration had a choice. They could simply move theircurrent operating procedures to the new location with a basic plan for relocationprocedures. They could bring in "design thinking" folks to look at the needs ofthe different units, gather some ethnographic data, and then lay out a plan withrecommendations for the relocation. Instead, Johns Hopkins took a differentapproach. They looked at the move as an opportunity to redesign their currentsituation into a more desired future. The hospital would upgrade its system asthey upgraded its physical environment. Their change would be systemic andnot purely geographic.Championed by a number of VPs, Johns Hopkins formed design teamscomprised of the hospital's stakeholders. They defined stakeholders to meananyone who could either impact or be impacted by the decisions made in thedesign teams. This included not only administration and management, butrepresentatives from all of the hospital's units, including, for example, doctors,nurses, technicians, customer services representatives, and custodial staff. Mostimportantly, the design teams included the end users: the patients.Before starting with the redesign of the subsystems, the design teams weregiven a short course on systems thinking. The orientation created a sharedunderstanding of how the hospital operated as a system.During the initial design meetings, information and data was also shared fromresearch that had been conducted prior to the design meetings. This research hadbeen done across different hospitals with the goal of finding out how patientsthought about and described the care they received. The trends showed that therewas more to a hospital stay than the level of care that was received. Patients whohad successful procedures with a high quality of medical care, in some instances,stated they would never return to that hospital again. Examples of some of thereasons provided included: poor treatment by diagnosticians; multiple roomswitches; unsanitary bathroom conditions; and long waits for transportationfor tests. It had nothing to do with the quality of the medical care provided bythe doctors. It had everything to do with how they perceived their experiencewith the hospital (experience was defined as a systemic property of the hospitalsystem that is derived from the interaction of the essential components of thehospital system).There were significant implications from these early steps in the designprocess; they gave people who often never communicated before a commonlanguage and common point of reflection. It also took the risk of blame andfinger pointing off of the Johns Hopkins staff and redirected the focus to patternsthat were happening in the larger environment of hospital care in general. Fromthat point, even though there were initially people with different experiencesand frameworks at the table, there was a shared understanding that any designcreated and implemented must meet two systems thinking criteria: Identification and consideration of the essential parts of the system. Whatever the design, it would be decided by the amount of improvement tothe system as a whole, not just to individual parts or units.Once these criteria had been agreed upon, the group was charged with thenext question: If John Hopkins is a system, what does the hospital do to supportthe PATIENT EXPERIENCE versus simply considering PATIENT CARE?As doctors, janitors, technicians, and other hospital staff interacted withpatients, the interdependence of their contribution to the hospital as a wholebegan to emerge. This led to what can only be described as an "A-HA!" moment.The participants realized that two essential components of the hospital weretraditionally overlooked, yet had a great impact on the patient experience. Thosetwo units were Patient Transportation (responsible for moving patients fromone part of a hospital to another) and Environmental Services (responsible forcleaning services throughout the hospital).Realizing that these two units are the essential components of the system hada significant implication for the new design. The additional awareness that theydirectly impacted both the hospital experience and the bottom line producedexciting designs. But most importantly, all of these considerations resulted in anew approach to recruitment, training, and compensation for employees withinthese departments.Within Patient Transportation, an innovative and effective design resultedby measuring how long it took to move patients between various locationsin the hospital in a manner that was pleasant and timely. Additionally, thisconsideration helped the design team to determine where to place the wheelchairs in a logistically optimum place in the new buildings. This will result intheir ability to move patients quickly (e.g. diagnostics will no longer stay idlewaiting for patients). Furthermore, the design team was able to improve theinternal communication system. This will eliminate the additional work and timelost by the nurses trying to contact patient transporters (information regardingpatient's discharge by the attending physician will be shared with the patienttransportation services).The same types of new designs occurred with the Environmental Servicesdesign team. One solution improved the «bed turnaround» time (similar to planeturnaround in the aviation industry, hospitals don't generate funds unless thereis a patient in the bed).However, this improvement also means that patients won't be left waitingin the hall for a room at the new facility. What also emerged from this designteam was a new awareness that the Environmental Services unit does more thansimply change over the rooms. They also impact the overall quality of care inthe hospital, specifically as it relates to infectious diseases. This was an epiphanyfor everyone.The approach Johns Hopkins took shows the instrumental role that taking asystemic world view plays in design. It also highlights how important the designis to any consideration of the system. By starting with an overview of systemsthinking principles, everyone was operating from a shared mindset. By sharingtrends collected from the larger health care environment they operated within,Johns Hopkins was able to develop a shared context of the current situation. Inany design process involving systems thinking, such opportunities are designedbased on the organization's specific situation and tied to the purpose of thedesign process.Moreover, by bringing everyone to the design meetings together,stakeholders who rarely had a voice were heard, and throughout the designprocess they expressed that this was the first time they felt valued. There wasa level power dynamic for the first time, which was a monumental shift fromthe traditional hierarchy of respect with surgeons and doctors at the top of theladder. The perception of the employees in those two units changed. JohnsHopkins had achieved its goal of a system redesign with the ownership ofthose most impacted.If Johns Hopkins had simply brought in designers to look at the problem,interview various stakeholders, and design recommendations based onthe compiled feedback, they would not have achieved such a rich redesignof their system. They definitely would have missed the opportunity for theinterdepartmental perceptions of each other's value to change. There is ahigh probability they would have missed the impact of the two essential partsidentified in this process. The system would have likely been redesigned basedon the wrong assumptions of where improvement was needed. It was only byhaving everyone in the same room, under the same shared context of hospitaltrends in the larger environment, using the same systems language, throughoutthe entire process, that the resulting design had the input and ownership of theentire system.CO NCLU SIONIn today's business world Design Thinking and Systems Thinking are beingconsidered disjointedly. Specifically, the role of

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