Re-designing for better problem solutions in health care system?
The wider determinants of health developed by Public Health England show that in fact, things like someone’s education, their job, who their friends are, how they get on with family, and where they live can actually determine how long they will live – even if they’re using the same doctor as someone living down the road but who is likely to live 10 years longer.
In the last two decades, design has been demonstrating a refreshing approach to addressing such complex problems. This is because design provides the opportunity to re-frame problems and solutions.
It explores ways of doing things that haven’t been tried before, to address problems that haven’t been well understood before. But in this age of complexity and multiple dependencies, problems are constantly and rapidly changing too, and so must solutions.
We need to move away from the romantic notion that a solution – whether it’s a service, product or policy – needs to go through a one-off and well-polished design process, beyond which it will continue to be relevant forevermore.
Reality is very different.
So we’re making the case here that as designers, we have a mission to build the capabilities of non-designers who work within the organisations that are transforming our future. This means they are equipped with the problem-solving mindset to constantly interrogate, improve and innovate as realities quickly evolve, and things that worked yesterday soon become obsolete
Why this is important
Urgency for prevention and early intervention: There is a sense of urgency to preempt problems before they happen in order to save time, resource and often even lives.
The recent NHS Sustainability and Transformation Partnerships (STPs) demonstrate this urgency. With an ever-increasing population, public services are at breaking point. But since two-thirds of deaths among those under 75 are a result of preventable illness, there is a growing recognition that keeping as many people as possible healthy is the most sustainable investment.
This is where a lot of the STP plans are focusing their energy. Because design offers a lens into the future and a provocation for possible realities, it provides those committed to prevention and early intervention with the ability to understand future problems and to design solutions that can forestall them.
Systemic complexity:
We can no longer think of products, services and policies outside of the systems they exist within and interact with. For example, we worked with the Healthy London Partnership on a deep dive to understand the root causes of childhood obesity and to try out new ways of addressing this chronic challenge.
Our insight revealed that a one-pronged approach will never do. We need to create positive and synchronized triggers at different points in the system: we need behavioral nudges that change the habits of individuals, we need social movements that influence and inspire whole communities, we need levers that transform physical obesogenic environments, and we also need legislation and regulation such as the Sugary Drink Tax to reduce temptation.
Design invites diverse people across the system to confront problems collaboratively, by creating solutions that leverage the collective power of everyone’s experience, expertise, resource and authority.
Ongoing transformation:
In a time of austerity, we just can’t afford to keep slowly chipping away at the problem through little tweaks and tricks in the hope that it will one day disappear. We need to completely and continuously re-imagine how things might work better.
When working with a national charity, we realised that funding for children’s centres was at risk, and that they were struggling to reach diverse families.
This meant we needed to completely transform the service, into one where children’s centres can go (literally ‘in a box’) into the homes of those who most need them, for a ninth of the cost and nine times the reach.
A design approach to problem-solving offered staff the opportunity to experiment with transformational ideas at a small and safe scale, fail quickly, learn fast and build confidence in the direction of travel.
What capabilities
Organisations need to develop a number of problem-solving capabilities to future-proof their solutions. In a recent Touchpoint article, my colleagues Jocelyn Bailey and Cat Drew argue that these capabilities are presumably less about skill and more about mindset and culture. Armed with the right mindset, organisations can then develop (and even invent) the unique skills, methods and tools to solve all types of diverse problems. This mindset is characterised by:
Deep human understanding: the approach invites curiosity and determination to explore what lies beneath people’s actions, decisions and perceptions.
Re-framing challenges: the insight revealed through deep human understanding can help reframe the challenge to get to the bottom of the hidden root causes, rather than the visible symptoms.
Working with others: a design approach to problem-solving is humble. We admit that we don’t know it all, and we invite others who have experienced the problem in different ways or who are experts in related issues across the system, to come on board and shape the journey.
Learning by doing: the only way to test innovation is to give it a go. Design is a process of solving problems through doing, learning, improving and scaling. Starting small and imperfect can mitigate the risks of failure, and with every iterative cycle and every improved version, more investment and scale can be justified.
There are various ways that organisations can build the problem-solving capabilities of their workforce.
Last year, I wrote an article with Joyce Yee in the Service Design Impact Report that reviewed different design capability models that the public sector draws on. There is not a one-size-fits-all model, and each presents its own benefits:
Structuredtraining: this varies from one-day workshops to bootcamps. These are best for beginners who would like a taster of the mindset to assess whether it provides potential for the nature of their organisation’s challenges.
Experiential learning: in other words, learning on the job. Often this takes the form of design experts facilitating a series of problem-solving sprints within an organisation, based on a real challenge. Staff are invited to shadow the process, reflect on learning, and experience the benefits first-hand.
Coaching: this model is suited for more experienced organisations who have potentially benefited from structured training and/or experiential learning. They would be keen to lead the problem-solving process themselves, with the support of a design coach for strategic guidance, alignment, and constructive provocation.
Internal disruption: a popular example of this is the lab model, where an organisation invests in an innovation team embedded within, with a role to create and grow a movement and a culture that embraces a design mindset to problem-solving.
In today’s complex and rapidly evolving world, organisations need to start thinking differently about how they are future-proofing what they do and how they do it. They need to invest in people, not solutions. By better equipping their people with a problem-solving mindset, they are creating the enablers for ongoing improvement, innovation and future relevance.
She leads on the development and delivery of service design, user centred innovation, design research, business modelling, communication and digital design projects. Joanna has worked with over 50 public and third sector organisations – including Nesta,
The Healthy London Partnership, the Health Foundation and South London and Maudsley NHS Foundation Trust – to help them better understand and address their challenges. She has expertise across a broad range of social challenges including health and wellbeing, social integration, social action, employment, education and social enterprise.
Joanna has a Ph.D. in design for social integration in design for social integration and is an RSA fellow. She is an associate lecturer at the University of the Arts London, Kingston University and Ravensbourne University.
Rohingya women face violence, rape by Myanmar troops
50% of refugees to Bangladesh are children
By Shweta Bajaj. 2017-11-18
Rohingya women and girls have faced brutalities, rape and violence at the hands of the Myanmar army as part of a campaign of ethnic cleansing, Human Rights Watch said on Thursday in a report.
Three days prior, on Monday, Myanmar’s army released a report denying any allegations of rape and violence by the security forces. However, the women in the refugee camps tell stories of gang rapes, assaults and unimaginable violence.
Rohingya camps are full of young women. According to some estimates, the female refugee population is over 50 percent, with many young men being killed in Myanmar, leaving many women widowed.
Sahera Khatun, 18, is in the final month of her pregnancy. She said, in August, when she was six months pregnant, she was raped by the Myanmar military in the same room as other girls.
“Soldiers entered and shut the door. They first took our ornaments and then raped us. We shouted for a very long time and then girls from our neighborhood came out to save us and then the military fled,” she said.
The rape left her seriously injured. She wasn’t sure if her child was still alive. Her husband and his friend carried her on a stretcher made of bamboo for 13 days to reach Bangladesh from Myanmar.
“We cannot even fathom the horrors,” Khatun said,
New refugees wait for a space to be allocated in the camp. /CGTN Photo
A clinic run by a local Bangladeshi NGO in a refugee camp has just opened. But the doctor here has a tough task; the queue is long, mostly women.
A patient enters and says she was beaten up by the military – her story is not rare.
There are many like her and women face acute health issues. Over the past few months, they’ve witnessed horrors and suffered physical abuse.
“They are living in unhygienic conditions, taking not enough nutrients,” said Sushant Maula Chowdhury, senior medical officer.
“Their psychological and social [conditions] there is very big imbalance and when there is some heart problem with the mental side, the body also follows it.”
Dr. Sushant Maula Chowdhury sees a patient. /CGTN Photo
Nuree Begum, 55, lost all her family members in the chaos of the violence – her husband, children and grandchildren.
She walked through forests and swam through a river to reach Bangladesh three months ago and has given up hope of finding them.
“Military was coming from all sides,” Begum said, “and there was noise of shooting and bombing.”
A doctor who saw Begum said she is a classic case of depression, but she’s not alone. She and thousands of other women are suffering from depression and have no will to live.
But for these women, who have lived through injustices, reports and governments are neither important nor relevant.
A look at them makes it clear that recovery for the Rohingya women is a distant dream, and being alive is a miracle.
Note: Just heard that China is stepping in to find a resolution to that human catastrophe. Hoping China will step in in Yemen too
The Upstart Saudi Prince Who’s Throwing Caution to the Winds
RIYADH, Saudi Arabia — With the tacit backing of his father, Saudi Arabia’s 32-year-old crown prince (wali al 3ahd) has established himself as the most powerful figure in the Arab world, rushing into confrontations on all sides at once.
Crown Prince Mohammed bin Salman ordered the arrest of 11 princes in his royal family and nearly 200 members of the Saudi business elite, and has begun to take power from the kingdom’s conservative clerics.
He has blockaded neighboring Qatar, accused Iran of acts of war and encouraged the resignation of Lebanon’s prime minister. And in Yemen, his armed forces are fighting an Iranian-aligned faction in an intractable war that created a humanitarian crisis.
The crown prince has moved so quickly that American officials and others worry that he is destabilizing the region. Signs of potential blowback are growing.
Investors, nervous about his plans, have been moving money out of the kingdom. Prince Mohammed has sought to counter the capital flight by squeezing detainees and others to surrender assets. He has presented the arrests as a campaign against corruption, but his targets call it a shakedown, and he has turned for advice to a former Egyptian security chief who has been pilloried at home for brutality and graft.
Prince Mohammed’s supporters say he is simply taking the drastic measures needed to turn around the kingdom’s graft-ridden and oil-dependent economy while pushing back against Iranian aggression.
But analysts around the region debate whether the headlong rush might be driven more by a desire to consolidate power before a possible royal succession, desperation for cash to pay for his plans or simply unchecked ambition to put his stamp on the broader Middle East.
And despite President Trump’s enthusiasm for the prince, some in the State Department, the Pentagon and the intelligence agencies say they fear that his impulsiveness could both set back his own goals and destabilize the region.
“He’s decided he doesn’t do anything cautiously,” said Philip Gordon, the White House Middle East coordinator under President Barack Obama. But, Mr. Gordon said, “if the crown prince alienates too many other princes and other pillars of the regime, pursues costly regional conflicts and scares off foreign investors, he could undermine the prospects for the very reforms he is trying to implement.”
The extrajudicial arrests have spooked investors enough, analysts say, to extinguish the prince’s plans for an public stock offering of Aramco, the Saudi state oil company, in New York or London next year. It had been a centerpiece of his overhaul.
Photo
President Trump and King Salman joined Arab leaders for a family photo in Riyadh in May.CreditStephen Crowley/The New York Times
The crown prince’s threats against Iran and Lebanon have raised the specter of wars that the Saudi military, already bogged down in Yemen, is ill-equipped to fight. Riyadh would be forced to depend on the United States and ill-prepared Israel in any new conflict.
His corruption purge at home, meanwhile, risks alienating parts of the royal family and the financial elite at a moment that would appear to demand unity, either to smooth a succession or to face off against Iran.
As many as 17 people detained in the anti-corruption campaign have required medical treatment for abuse by their captors, according to a doctor from the nearest hospital and an American official tracking the situation.
The former Egyptian security chief, Habib el-Adli, said by one of his advisers and a former Egyptian interior minister to be advising Prince Mohammed, earned a reputation for brutality and torture under President Hosni Mubarak. His lawyers say he plans to appeal his recent sentence in absentia in Egypt to seven years in prison on charges of corruption.
Officials of the Saudi Royal Court referred press queries about these reports to the Embassy of the Kingdom of Saudi Arabia in Washington, where a spokeswoman, Fatimah Baeshen, said the embassy could not confirm or dispute them.
With the decline in the price of oil in recent years, Saudi Arabia has frozen projects and spent more than a third of its financial reserves, draining them to about $475 billion this fall from a peak of $737 billion in August 2014.
At that burn rate, the kingdom has only a few years to lift its revenue or slash its spending to forestall a financial crisis.
Against that backdrop, the prince’s supporters argue that the anti-corruption campaign aims to recapture hundreds of billions of dollars that have leaked from the state budget through graft and self-dealing — money he needs to fund his development plans.
Prince Mohammed had appealed to the kingdom’s wealthy for months to invest in his modernization program. But some groused that his plans — like a new $500 billion business hub “for the dreamers of the world,” built from scratch and fueled entirely by clean energy — were ill-conceived and grandiose, and instead of investing at home they quietly moved their assets abroad.
Now, he is no longer merely asking.
The Saudi government is pressing some of those detained and others still at large to sign over large sums in exchange for better treatment, according to an American official briefed on the crackdown and associates of the royal family. Employees of some of those arrested had been summoned months before to answer questions about their bosses, a sign that the purge was planned well in advance.
A senior Saudi official defending the crackdown said this week that it was meant to show that the old rules of business in the kingdom had changed.
Photo
Prince Mohammed kissing the hand of Prince Mohammed bin Nayef (sacked since then) at the royal palace in Mecca in June. CreditAl-Ekhbariya, via Associated Press
“Corruption is at every level, and there are hundreds of billions of riyals that are lost from the national economy every year,” the official said, speaking on the condition of anonymity to discuss sensitive government matters. “The point here was mainly to shock the system, to send a message that this will not be tolerated anymore and that nobody is immune.”
Corruption has been so endemic for so long — from inflated government contracts for large projects to simple bribes to obtain passports — that countless Saudis have participated. Yet, some princes with reputations for conspicuous corruption appear to have been left alone, raising questions about who is being targeted, and why.
Other signs suggest that Prince Mohammed may also be seeking to thwart perceived rivals.
In June, he and his father stripped the titles of crown prince and interior minister from Prince Mohammed bin Nayef, 58, temporarily confining him to his palace. Admirers of the ousted crown prince were relieved last week when a video surfaced showing him moving freely through a family funeral, receiving kisses on his shoulder in a show of deference and loyalty from a procession of well-wishers.
That display of his continued popularity, however, may have been too much for the younger Prince Mohammed, who the next day ordered the seizure of the former crown prince’s assets, along with those of his wife and daughters, according to two family associates.
Ms. Baeshen, the Saudi embassy spokeswoman, said she could not comment on any potential investigations.
Some American officials suspect that Prince Mohammed may be rushing to lock down the levers of power in anticipation of a formal abdication by his father, King Salman, who scholars and Western officials say could be suffering from dementia.
When President Trump visited Riyadh for a summit meeting last summer, the king remained seated as he struggled to read a prepared statement. His speech was at times weak, halting or slurred. He seldom speaks publicly. Saudi officials, however, insist his mental capacities are sound.
Prince Mohammed’s supporters argue that Saudi Arabia’s recent threats against Iran and Lebanon came in response to provocations beyond his control.
As he was preparing his anti-corruption roundup, they say, Tehran’s allies in Yemen launched an Iranian-made missile in the direction of Riyadh, where it was intercepted over the outskirts of the city (the damage shown by videos prove otherwise).
The Lebanese prime minister, Saad Hariri, resigned his position the same day with a televised speech from Riyadh that accused Iran and its Lebanese client Hezbollah of sowing “discord, devastation and destruction” in the region.
But many, including current and former American diplomats, say Prince Mohammed’s boldness also reflects his conviction that he has the support of Mr. Trump.
Photo
Mr. Trump meeting with Prince Mohammed, center, in the Oval Office in March.CreditStephen Crowley/The New York Times
Even in the last days of the Obama administration, another Persian Gulf royal who had already forged deep ties around Washington, Crown Prince Mohammed bin Zayed al-Nahyan of Abu Dhabi began to promote his Saudi counterpart to the incoming Trump team as a useful ally. Both princes appear to have formed a particular bond with Jared Kushner, Mr. Trump’s son-in-law and adviser, who at 36 is a contemporary of the young Saudi prince.
Mr. Trump chose Saudi Arabia for the first foreign trip of his presidency, and Prince Mohammed and Mr. Kushner have built such a strong rapport that other American officials say they are not briefed on what the two discuss.
“Jared is a bit of a black hole,” said one State Department official, speaking on the condition of anonymity to discuss frustration with the White House. “There is no sense of the positions he has advocated. We can only guess, based on what he has done and where he has been.”
The official added: “The Emiratis and the Saudis have been very careful to cultivate him and bring him along” toward their “confrontational posture in the region.”
A White House official who also insisted on anonymity disputed the characterization of Mr. Kushner, saying he regularly briefed the State Department and National Security Council on his trips and conversations.
Mr. Kushner made his third visit to the kingdom this year ( and many to Israel)— this time unannounced until his return to Washington — in late October, when American officials say he stayed up late talking with Prince Mohammed at his ranch.
The sweep of arrests unfolded days later, and Mr. Trump was quick to applaud, although several White House officials said the Saudis gave Mr. Kushner no heads up on what was about to take place.
“I have great confidence in King Salman and the Crown Prince of Saudi Arabia, they know exactly what they are doing,” President Trump said on Twitter after the arrests had begun. “Some of those they are harshly treating have been ‘milking’ their country for years.”
Ms. Baeshen, the embassy spokeswoman, said that Saudi Arabia and the United States “enjoy a wide range of cooperative discussions” but that “domestic affairs are just that: domestic affairs.”
The State Department official, though, said that its diplomats, the Pentagon and the Central Intelligence Agency all felt “growing alarm” that Prince Mohammed “is behaving recklessly without sufficient consideration to the likely consequences of his behavior, and that has the potential to damage U.S. interests.”
How to go about this
Adonis Diaries 
