Does the design of medical products impact on the safety of patients and health practitioners? The answer in many cases will be, yes. For patients it affects everyday medical items like respiratory equipment. But the real issues are for health practitioners. That’s why we need design skills in healthcare.Authors of a recent paper discuss some of the issues. They note that when design unwittingly excludes whole groups of users it becomes bad design. Medical products and services designed to best fit a Caucasian male body type means a poor fit for others. The authors provide an excellent example of where a design is potentially dangerous. “In one example, the only green button on a defibrillator switched the device off, whereas the only red button was for shocking. In simulated emergency situations, it was no surprise that some participants pushed the green button and inadvertently switched the device off when intending to shock.” Co-design is considered the appropriate approach in healthcare services, products and building design. It enables stakeholders in healthcare sciences and delivery to provide input at the early stages of design. Although co-design is accepted as a good idea, design skills are yet to be emphasised and captured in co-design processes. The title of the paper is, Design as a quality improvement strategy: The case for design expertise
From the abstract
Bad design in safety-critical environments like healthcare can lead to users being frustrated, excluded or injured. In contrast, good design makes it easier to use a service correctly. Design impacts on both the safety and efficiency of healthcare delivery, as well as the experience of patients and staff. Co-design as an improvement strategy has gained traction in the healthcare quality improvement literature. However, the role of design expertise and professional design is much less explored. Good design does not happen by accident: it takes specific design expertise.We define design, show why poor design can be disastrous and illustrate the benefits of good design. We argue for the recognition of distinctive design expertise and describe some of its characteristics. Finally, we discuss how design could be better promoted in healthcare improvement.
Children with disability are often excluded from playing at playgrounds due to design limitations. Of course, one solution includes building playgrounds using a universal design approach. However, playgrounds with universal design features are not enough to make an inclusive space.
Universally designed playspaces bring play into the lives of families with disabilities. They also provide opportunities to champion disability advocacy, and support disabled children in developing critical social skills. However, additional work and resources are needed to achieve full social inclusivity.
Image: Livvi’s Place Carousel
Findings from a Canadian study can help guide designs of future playgrounds and other community spaces to improve inclusivity for everyone.
This paper begins with the playground experience and universal design and then applies this to other public spaces.
This study explores the experiences of parents of disabled and non-disabled children at playgrounds inspired by Principles of Universal Design. Participants were 29 parents (16 with disabled children). They were located across four Canadian cities with newly built inclusively designed playgrounds.
Three themes were identified which provide deeper understandings of ableism in community playspaces and the impact on children and their families. 1. Inclusive playgrounds also act as a platform for disability advocacy. 2. They provide opportunities for social and emotional development. 3. Inclusive play may influence family dynamics.
Findings highlight the value of universal design, but indicate that physical environments alone do not ensure social inclusion, as social barriers can continue to exist even in spaces purposefully designed for disability inclusion.
This project moves beyond accommodation for individuals with disabilities toward true inclusion in learning spaces. We collaborated with a community organization and public school district for the project. We employed participatory design to transform playgrounds into inclusive computational thinking environments for kindergarteners. Centering the experience of learners with disability was the focus.
These vignettes highlight how culturally sustaining design can empower marginalized communities, extend design paradigms, and create equitable educational environments that serve all children through inclusive play
Attempts to avoid catching COVID caused people to change their behaviour in many ways. Working from home and not being able to travel meant more people walked in their local neighbourhood. Open space was at a premium. This led to pop up cafes and parklets and a few more planter boxes to make places more appealing. Planners said “we can’t go back to the way things were”. In that case says Lisa Stafford, we have to discuss ableism in planning.
“Pop-up cafes and parklets used tape barriers and step-up platforms, while planter boxes or pallet seating were positioned to create what seemed like another obstacle course in getting about.”
Lisa Safford says that ableism is an insidious, unspoken prejudice that favours an idealistic view of an “able body”. It is not just having negative views of people with disability, it is a way of thinking about bodies that rejects difference. It’s thinking that “normal” is a real thing.
Ableism is entrenched in walkability metrics such as walking speed, our ideas of liveability, and approaches to older people. Stafford claims that ableism is rampant in planning and design decisions. The misinformed catch cry is that it’s only for a small portion of the population.
“Time and again I have heard universal design omitted in the provision of social infrastructure, due to budget shortfalls or inclusivity being too hard…”
Let’s talk about ableism
First, we do not lack literature, guides and other tools on the topics of disability, diversity, equity and inclusion. Planners need to talk about the issues with each other, welcome disabled planners and connect with disability communities and their expertise. Do some real co-design processes.
Ableism is just one lens and individual experience ableism and discrimination in different ways. Embracing diversity is critical for people with disability who are Indigenous, female, low income and LGBTIQA+
Planning can make social change – in shapes lives and livelihoods. If we want real change we must confront ableism and the idea of “normal” or “average”. The Australian Bureau of Statistics counts people with disability (18%) separately from people with a long term health condition that limits their daily activities (22%). It’s not a small portion of the population.
The sense of home is very personal, and as we age it is likely to become more personal as we spend more time at home. Younger people who build brand new homes are increasingly embracing smart technology. For older people, smart technology, especially that which collects data, disrupts the sense of home. So, from the lived experience perspective of older people, is a smart home a real home?
Older people want to stay in their own home. It is also the best place for people to manage the consequences of ageing such as dementia and physical conditions.
To age successfully and safely at home often means embracing a range of assistive technologies. They can be as simple as a raised toilet seat and using colour contrasts for interior design. But accepting these technologies is another thing. Grab bars are shunned because of the link with being disabled.
Assistive technologies impact on one’s sense of self – one’s identity. Assistive devices used outside the home feel particularly stigmatising and in too many cases these devices are abandoned. So can the same be said of digital assistive technology especially if it is monitoring your every move?
Tech and older people
Smart home technology in the age-related literature is more than a remote control for the window blinds. It is technology that collects monitoring data through sensors and wearables. The aim is to keep the person safe and improve their wellbeing. But who wants to have their life documented in a database?
A review of older people and the use of smart home technology looked at the issue of acceptance and use. The researchers wanted to find a way to make these technologies more acceptable to older people. They found that issues are not related to accessibility or usefulness but to an invasion of privacy and lack of human interaction.
Human-centred design solutions that take account of a person’s sense of familiarity and privacy at home could help overcome resistance. The researchers provide more detail about their research and the ethics of home monitoring devices.
Smart home technologies can support older persons to age in place, but adoption remains low in this age group. One reason is that they are not accustomed to having a home that is technologically enhanced. In this article, we focus on the older persons’ lived experience of “home” and show how this technology potentially disrupts it.
Humans rely on their physical body and they make decisions based on their perceptions of their physical body without the intervention of technologies. Smart home technologies potentially make the home seem unfamiliar and exposed.
By paying attention to the way smart home technology can disrupt the experience of home, the question of ethical use is brought into the frame. The design of these technologies has an important role to play in acceptance by older people.
The Commons Social Change Library has a new guide for disability messaging. The guide has tips based on research which shows effective ways of building public support. The document was led by a steering committee of people with disability and messaging experts.
The guide is supported by Disability Action Network Australia (DANA), Centre for Australian Progress and Common Cause Australia. Access via The Commons Social Change Libraryor download in PDF.
Key content
The guide begins with a note about language and why they prefer the term “disabled people”. The introduction covers the messaging principles such as the audience and speaking from the frame of experience. The overarching themes for talking about disability are self-determination and diversity. This is followed by the 7 top tips.
Story structure
Design Frame
Strengths language
Our story, not theirs
Bring NDIS back to values and benefits
Build empathy with human stories
Show change is possible
The guide has good examples to explain concepts and how to change old messages into ones that are more attuned to self determination. One example is to talk about being “led by disabled people” rather than “a seat at the table”. The reasoning is to replace inclusion and tokenism with self determination.
Another example is making passive sentences active. Rather than talk about how disabled people experience discrimination, say who is discriminating. And people like to be presented with solutions rather than problems so focus on these.
Clubs and societies bring together members with a shared interest which also provides a platform for social participation. The same can be said for disability organisations – with some differences. Disability organisations are a hub of social activity, political activism, and a resource of lived experience for planners. A paper from Sweden looks at this concept focusing on rural communities.
Researchers found that interviewees have extensive social lives and that disability organizations act as a platform for many social interactions.
Sometimes acquiring a disability such as rheumatism, prompts people to join groups such as the rheumatism association. Some disabilities cause people to leave paid work so this gives them time to channel their energies into these civic organisations. But it doesn’t end there. Members of these organisations also provide valuable lived experience for local authorities in planning.
There are three dimensions to disability organisations: social participation, political action, and a resource of lived experience. Just on the basis of participation, disability organisations provide good value for their government funding.
Disability organisations, and the disability sector as a whole, provide inclusive spaces in which to socialise. The strength of inclusive spaces is they facilitate participation on equal terms. On the other hand, disability-specific places are potentially more flexible and adapted to individual needs. Disability organisations are a form of a disability-specific space which form a base for recognition and a political voice.
Living rural with disability
Living with disability in rural areas is viewed as more of a problem than in urban areas. According to the researchers this is a simplification of how people relate to their environment. Rurality and disability are two different concepts which are not complicated when put together.
Disability organizations are places for social interactions and for the accumulation of knowledge about disabilities as lived experiences. They also form a platform for dialogues and political influence work in the local community.
Participation means being included in societal activities in a way that suits the individual’s capacities and ambitions. The role of the public sector also enables participation. That’s because, in Sweden, it supports disability organizations and opens up opportunities to influence local planning.
If more support is given and more disability-specific arenas are created, there will be more open arenas for possible participation. What counts as participation must begin with individuals’ own experiences and values of what they appreciate and need in their daily lives.
Is there such a thing as non-mandatory when it comes to the Disability Discrimination Act? Access consultant Bryce Tolliday writes a thoughtful piece in Access Insight on this topic. He bemoans the way building certifiers, designers and others who request design changes. This is because, they believe the consultant’s design advice is non-mandatory. They just think it is “nice to have”. However, in the mandatory vs non-mandatory debate, it’s the Disability Discrimination Act (DDA) they should be thinking about.
There is a misunderstanding of the laws affecting new building work as well as the value a good access consultant can bring to the project.
A mandatory requirement is something you must to do and is non-negotiable. Tolliday argues that it’s not possible to have a non-mandatory outcome under the DDA. That’s because the objects of the law are to eliminate, as far as possible, discrimination on the grounds of disability.
Which law comes first?
It’s the mix of different laws, standards and regulations that confuse people. Some are enacted at a federal level and some are enacted by states and territories. Federal laws always trump state and territory laws.
People who want to press the non-mandatory argument rely on the NCC being the primary building regulation in Australia. But this is not the case. Each state and territory has to adopt the NCC elements into their respective building codes. Consequently, the Commonwealth law, the DDA together withe Disability Standards, becomes the law to follow.
The problem for designers and certifiers is that the DDA does not specify design standards or outcomes in the same way as the NCC. How can one know whether a design feature will discriminate or disadvantage a person with disability? Tolliday’s response is:
If they cannot provide an evidence-based reason demonstrating that disadvantage will not occur then what the access consultant is proposing is a mandatory requirement under the DDA.
The outcomes expected by the DDA are not covered by Australian Standards related to disability access. This is due to the minimal requirements of the Standards that do not cover the full diversity of disability.
Case study confirms what’s mandatory
In the case of Ryan v the Sunshine Coast Hospital and Health Service the mandatory requirements went beyond the NCC, the Premises Standards and AS1428. The late Peter Ryan who was blind brought the action. He argued he was disadvantaged by the design of the Hospital. Shorelines, glare, and luminance contrast were not covered by the NCC but covered by other design guidelines and international standards. Tactile and braille signage for the entire hospital was not covered by the NCC or AS1428 either.
Ryan frequently got lost when he visited as an outpatient. He posthumously won the case and it will cost the Hospital millions to address the 17 breaches of the design.
The Judge found Peter Ryan and been indirectly discriminated against. The Hospital had not considered key features that could impact patients who were blind or had low vision.
The key issue for Tolliday is that the Australian Building Codes Board, which looks after the NCC, has said it will not regulate internal fitouts. Office buildings, for example, are not fitted out at completion, so that is reasonable. However, schools, hotels and hospitals are fitted out at completion.
The Queensland Government has produced an accessible events guide for organisers that covers everything from conception through to the finale. As indicated by the title, the focus is specifically on disability access. However, to be accessible and inclusive, other underrepresented groups also need to be considered. So this post has a list of other event guides as well.
“A successful, accessible and inclusive event is one where all attendees have an opportunity to access and experience every aspect of the event and leave with a sense of enjoyment, togetherness and satisfaction.”
Universal design principles underpin the guide
The guide begins with the usual introductory sections including definitions of disability, and design principles of universal design and co-design. The seven principles of universal design are listed with examples of where each principle might apply. However, these principles are not intended as a checklist. Rather, they are concepts to consider in all designs. The key to designing universally is to co-design with users.
“Consultation is key to the universal design process. Without it, designers and creators are limited by their personal experiences and imagination.”
The Communication section covers all the details – everything from Easy English and colour contrast to using CamelCase in social media. The next section of the Guide outlines the practical steps for accessible events – major and minor. It covers indoor and outdoor events from registration through to transport, catering and exiting the event.
Online events
The online environment is good if transport is an issue or the attendee needs to feel safe in a familiar environment such as the office or home. Online events include award ceremonies, seminars, meetings and workshops. Commonly used software is best especially if it has in-built accessibility tools such as captioning. This section of the guide has a case study that explains the key elements of a successful event.
The City of Sydney Inclusive and accessible event guidelines includes information on why events should be inclusive. It has information on the different types of disability people experience. It has four sections covering indoor and outdoor events and a set of checklists:
Accessible venues and spaces
Opportunities for inclusive participation
Accessible materials and information
Staff awareness and attitudes
The Victorian Government has an accessible event guideline and checklist which is downloadable in Word. However this is looking a little dated. The Brisbane City Council has a webpage with basic informationwhich is a good place to start.
The Zero Project guidelinesare based on real experience of running conferences. The Canadian guide is detailed, and explains the development of the guidelines.
Accessible conferences: Why you should care!
A Pulse article posted on Linked In by Nicholas Steenhoutcovers the basics. His personal experiences have made him acutely aware of how the little details count for so much. He covers websites, name badges, venue, registration desk, conference rooms, amphitheater, bathrooms, carpets, hallway, dining halls, presentation, cabaret style seating, interpreters, slide designs and font sizes, handouts, social events, and transportation.
Good for a quick grab for the essentials – you never know who you might be missing out on and that means both speakers and delegates.
Architectural “products” involve many stakeholders which makes a complex process even more difficult. So where do architectural competitions fit in and do the winning designs reflect the diversity of society? A group of Austrian researchers checked out 15 competitions with 76 entries to see if they included universal design concepts.
A major finding is that there is room for better consideration of universal design in the early phase of the building process.
Almost all people spend a large part of their lives in a built environment whether their home, their work or leisure activities. Therefore architecture concerns everyone, not just architects and interior designers. An inclusive approach should be a necessity – a non-negotiable principle. But is it?
In the German speaking area of Europe the construction industry is highly regulated. To get attractive and economically viable designs, the competition method has evolved. Competition is an integral part of the the project as well as the tendering process. Once the competition process is over, a new process begins to realise the design. The aim of this method is to provide transparency in decision-making as well as good design.
Researchers found that at the competition stage of the process, universal design was reduced to wheelchair users. Also, while the term “accessibility” is used in documents, it is not reflected in graphic representation. Indeed, many graphics showed barriers to access. Accessibility emphasis, where it existed, was on entrances and sanitary facilities.
Another issue was found in jury statements which focused on specific architecture aspects without addressing diversity or disability. Accessibility is reduced to minimum standards such as the number of designated parking places.
Are competitions a good thing?
The overarching question of this research was whether architectural competitions are a good way to consider the diversity of disability. On a superficial level, organisers and participants deal with some basic access features. However, there is little space in competition entries to flesh out the detail beyond that of wheelchair users.
In summary: “Fundamentally, the term accessibility is considered important, but is very often only used as a superficial buzzword.”
How juries assess universal design in architectural school competitions is critical to the level of innovation that can be expected. Norwegian Leif D Houck gives an excellent analysis of the way competitions are run and improvements for the future.
Houck says the reason to organize an architectural competition is to achieve maximum quality in a project. The idea is not to have a competition to see if anyone manages to comply the regulations, building codes and the competition brief. The idea is to achieve qualities beyond the regulations.
As Houck says, an architectural competition will likely result in different designs and solutions. In addition, the whole process from design through to the building stage has stages where the project has opportunities for improvement.
It’s time for planning competitions to have residents involved in design decisions and planning solutions. A select panel of judges are not looking for the same things. Planning competitions are used as a way to determine alternatives and promote innovative solutions in the early phase of urban planning.
The book New Approaches, Methods, and Tools in Urban E-Planning, has an interesting chapter that outlines the findings of how e-participation can be implemented in urban planning competitions. You will need institutional access for a free read. The chapter is “Enhancing E-Participation in Urban Planning Competitions”.
From the abstract
This chapter describes how web-based public participation tools are utilized in urban planning competitions. Public opinion is included alongside the expert view given by the jury. This chapter focuses on how public participation can be arranged in competition processes. It shows how the contestants use the information produced, and how it has been utilized in further planning of the area.
Based on two Finnish case studies, web-based tools can augment public participation in the competition process. However, the results indicate that the impact of participation on selecting the winner is weak.
People with disability are often left out at the beginning of the research process when organisations want research done quickly. This reduces the level of power they have as members of the research team. To be effective, people with disability must be in decision-making positions before research proposals are developed. Co-design in research shifts the power balance between the researcher and the researched.
People with disability are expected to be involved as researchers and decision-makers in research projects. But co-design methods require respect for the process from the outset.
Researchers have to navigate tensions inherent within research institutions when involving people with disability from the beginning of the process. Improving the quality of the research is one of the aims of co-designing with people with disability. It also gives an opportunity to employ people who might not otherwise find a job.
A research team led by Flinders University use a case study to show how to engage with prospective co-designers. They looked at the different factors or conditions that enable or constrain co-design work, and how they relate to each other. The funding of commissioned work has an effect on the internal dynamics and relations within the team. They also found that authority and power can shift and change depending on how these components interact.
Clearly there is more to simply gathering a group of people with disability within a research team and thinking co-design will just happen. Factors such as institutional requirements, and authoritarian hierarchies can have a significant impact on co-design processes.
People with and without disability need to work together to overcome resistance when co-design work is not treated with respect by people or systems.
From the abstract
This paper explores tensions navigated by researchers and project leaders when involving people with disability as experts in co-design and in the core team.
Structural conditions of funding and institutional support were foundational to the co-design. These included accessible practices, core roles for people with disability and resolving ableist conditions.
Power shifts were easily undermined by institutionalised norms that disrespected the co-design contributions. The value of co-designing research was centre to articulating key issues, methodology and analysis.
How do you co-design with people who have limited communication skills? After all, co-design methods are built on conversations. The first thing then, is to find a way to overcome this significant barrier. This means finding non-verbal methods to find out how they experience the world.
Researchers developed a method called this “trans-create” because it was similar to translating one language to another. The used tangible artifacts rather than words, paper and pens.
Instead of co-designing with children without disabilities for children with disabilities, we tried the opposite. We co-designed with children with disabilities for children without disabilities. We used music, rhythm, lighting, tangible artifacts and new programmable possibilities to facilitate communication and co-creation, as an alternative to verbal language.
Co-design methods are a challenge with persons with significantly different prerequisites for communication. It’s hard to know if what we design is good for them in the way they themselves define it. We present a new process called “trans-create” based on translating between cultures.
The Mātai Moana project
Community-based projects expand teaching and learning, enabling the experience of practice-based education through the development of participatory projects. The Landscape Architecture programme of Te Herenga Waka/Victoria University of Wellington (NZ) has developed a methodology that facilitates service learning. It demonstrate adaptability to different types of partners, projects, design objectives and university courses.