Co-design in Health Care

Health care is a service and like any service, you want the best for your customers. Customer feedback is common with most services, but knowing the problems after the event is not very effective. The first step is setting up a process that is going to get the most useful design decisions. That means co-designing from the very beginning including co-designing the research method.

Entrance to the emergency section of a hospital.. Co-design in health care.

An inclusive design approach means listening.

A new paper documents the process of using an inclusive design approach to design the study. As a report of the process the paper necessarily includes many stories from participants. These stories are rich in information not limited by survey or interview formats and questions. It is up to the listener or researcher to guide these experiences into practical solutions.

The methods in this study are applicable to any public service, such as transport or education.

Storytelling and research design

Storytelling often goes beyond describing the immediate barriers and difficulties in using a service to reveal the impact on a person’s life.

“The inclusive design approach to the study was not rigid because inclusive design is about diversity, variability and complexity”

Three design exercises

The study reports on three options for design exercises:

Design Exercise Option One: co-designers talk about any part of the health care service that needs re-design. Then the group imagines a future where the barrier no longer exists.

Design Exercise Option Two: co-designers discuss their own or another’s experience during the Covid-19 pandemic.

Design Exercise Option 3: co-designers use the research centre’s “virtuous tornado” exercise. The virtuous tornado is a diagram with three circles, In the centre is the statement, “Like and Use”. The next ring has the statement “Don’t like or have difficulty using”. The outer ring has the statement “Can’t Use”. See the diagram below.

Three rings of a circle indicating the three statements.

Figure 1 from the report with the three options for activities

Co-design is a hot topic at the moment and this paper adds to the research and ideas of how to run co-design processes.

The title of the article is, Co-Design as Applied to Accessibility in Health Care and comes from researchers based in Canada.

Assistive technology is for everyone

A young man seated in a wheelchair is stacking a dishdrawer dishwasher. Assistive technology is for everyone.

“Assistive technology” isn’t always high-tech or for a niche group.

You wouldn’t call a dish-drawer dishwasher assistive technology, but that is what it is. People who have difficulty bending, or fill the dishwasher from a sitting position, find it very assistive. The label of “assistive technology” has come about from the old language of “aids and equipment for the disabled”. But all technology is assistive – it just depends on perspective.

One of the problems is the stigma attached to labelling items as assistive technology. For example, no-one thinks of a handrail on a staircase as being assistive technology. But as soon as one goes in the shower recess – suddenly it becomes a disability device bringing the associated stigma with it. And why the stigma?

Stigma arises from the notion that having a disability or reduced capability is something to hide. In many ways we haven’t moved on from last century thinking. Occupational therapists lament the number of devices left collecting dust in a cupboard. Aesthetics have taken a back-seat in many of these designs which doesn’t encourage use.

But assistive technology could be coming of age. An article in The Conversation covers a new report from the World Health Organisation. The article looks at Australia’s performance in this global report. The recommendations are: to better understand real life experiences, set up a national data-set, and improve workforce capacity.

Enabling people to stay home and live independently is one of the benefits of good choices in assistive technology. So home design is another technology factor – it’s not just about gadgets.

The title of the article is, From glasses to mobility scooters, ‘assistive technology’ isn’t always high-tech.

A previous article shows how technology can upgrade the simple walking cane.

Microsoft’s inclusive co-design space

Image for Microsoft Inclusive Tech lab.

Microsoft now has a dedicated inclusive co-design space where staff and community members work together.

The Microsoft Inclusive Tech Lab is a hub for product development where members of the disability community get to co-design, test, share, and create more inclusive and accessible products. This is where staff and community members work together to create inclusive products for Microsoft.

Microsoft announced new accessibility initiative at the Microsoft Ability Summit. The lab has every support to accommodate every disability. This dedicated space means more people can participate in the co-design process.

The lab is the next step on from the dedicated Xbox team and the Adaptive Controller. Some of the team members got together and created the space and then it evolved beyond gaming to other products.

The lab is described as an embassy for people with disability to demonstrate what is possible when products are intentionally built to be accessible for everyone. See more in the video below.

The lab design

The Tech Lab team had to design the space from the ground up. The floor design has visually distinct patterns. Tactile surfaces like wood and carpet makes them easier to distinguish for people using canes. Felt baffles help with acoustics and lighting levels are controllable. Care was taken with the design of bathrooms, door widths and doorways.

Endgadget website has more on the story with more detail about the designers and the lab. Or you can visit the Microsoft website for their story.

Is citizen science the same as co-design?

People sit around round tables discussing questions. There are four round tables shown in this picture. Is citizen science the same as co-design.Co-design is a term emerging in the field of accessible and inclusive design. But co-design methods have been around for a long time in one form or another. Academics will recognise this as Participatory Action Research. And now we have citizen science in planning. Is citizen science the same as co-design? In this context, yes. The common theme is that the people affected by design decisions help to shape them. 

The Fifth Estate has an article that discusses citizen science as a method of community engagement in planning. It explains citizen science as a type of research that actively involved members of the public in the research process.  Regardless, it makes sense to involve users in the process of the design. This is something the universal design movement has been advocating for some time. 

“Citizen science has a long history in conservation and environmental monitoring, but has grown in momentum in recent years across a range of disciplines, including planning and urban design.

Walkability in Tasmania

A citizen science approach is where residents audit the the local environment for barriers to walking. Residents identify priorities by using a walkability assessment tool taking photos, and participating in workshops. The information gathered is not only useful at a local level, but at state and national levels as well. 

” Our use of citizen science is enabling researchers, policy makers and community members to work together to generate data and establish priorities to support walkability that reflects community needs.”

The article concludes that community engagement in planning is hard to do well. However,  citizen science and customised technology are useful tools to shape urban design based on resident experiences. 

The title of the article is, Using citizen science o bring people backing into planning walkable and healthy places. There is a link to more resources from Communities 4 Walkability. 

The Age Friendly Checklist for Councils was derived from many consultations across NSW in 2012. The process was workshops, photos and resident experiences shared with local government staff. The content is explained further in a short webinar presentation. Reminder – what’s good for older people is good for everyone.

 

Retire the retirement village

The Longevity by Design banner in pink and purple.Age-friendly communities where people of all ages live, work and play could be the way of the future. That means the desirability of age-segregated living could be on the way out. Many people will live 30 years after the age of 65 years. By 2030 all baby boomers will have turned 65 and Gen X will be joining the older cohort.  It’s time to retire the retirement village concept according to an article in The Conversation. This is based on feedback from older people in a Longevity By Design Challenge. This means we have to re-think the notion of retirement and approaches to urban design.

The Design Challenge asked:

How do we best leverage the extra 30 years of life and unleash the social and economic potential of people 65+ to contribute to Australia’s prosperity?

Sixteen cross-disciplinary creative teams considered longevity in the context of buildings and neighbourhoods. Together the participants concluded that design for older people is inclusive design. No matter how old you are you still want the same things for a good life. That means autonomy and choice, purpose, good health and financial security.

The title of the article is, Retire the retirement village – the wall and what’s behind it is so 2020, and explains how the challenge was run and some of the findings. Key points emerging from the challenge were inclusive infrastructure, people of all ages together, and a mobility “ecosystem” made up of different types of transport options. The underpinning principles turned out to be age-friendly communities, something the World Health Organization has promoted for more than ten years.

Boomers are over them

A scene from the charrette where people are sitting round a table discussing their project.

The ABC also reported on the Design Challenge and how to prepare and adapt Australian cities to capitalise on our longevity bonus. It seems walled and gated age-segregated enclaves might have had their day. Instead, the future might hold more age-inclusive neighbourhoods where older people continue to contribute into late age. So, no more need for doom and gloom about population ageing.

As an urban design challenge the design of homes suited for all ages was not included. The ABC article is titled, Retirement villages have had their day: Baby boomers are rethinking retirement

Banner for the Longevity by Design challenge in 2021.A second Longevity by Design session was held in 2021 with the theme, Feels Like Home. This one was focused on aged care and the key points are in the video below. 

Urban planning for population longevity

A row of two storey houses painted in different pastel colours.Urban designers are potential champions for improvements for population ageing. That is a key theme in an article that proposes ways for helping older people stay put in their home, and if not, in their community. The article discusses current innovations to make neighbourhoods and homes more supportive both physically and socially. These include: enriching neighbourhoods, providing collective services, building all-age neighbourhoods, creating purpose-built supportive housing.

The title of the article is, “Improving housing and neighborhoods for the vulnerable: older people, small households, urban design, and planning”. Open access available  from SpringerLink,  or  via ResearchGate.

From the abstract

Currently preferences and policies aim to help older people to stay in their existing homes. However, the majority of homes in the U.S. and many other countries are not designed to support advanced old age. Also, they are not located to easily provide support and services.

The paper examines the existing range of innovations to make neighbourhoods and homes more supportive, physically, socially, and in terms of services. These include: enriching neighbourhoods, providing collective services, building all-age neighbourhoods, creating purpose-built supportive housing, developing small scale intergenerational models, and engaging mobility, delivery, and communications innovations.

 

Racial segregation by design

Aerial view of a major highway intersection within an urban area. Racial segregation can be caused by design.Is urban planning racist?  We could also ask if urban planning is ableist or sexist. The answer to all three is probably, ‘yes’, but to what degree. Lisa Stafford argues strongly that planning is ableist, and transport planners have been considering gender for a while now. In a FastCo article, one architect believes there is racial segregation by design. 

Segregation by Design in the United States aims to document the destruction of communities through urban renewal and freeway construction.  Australians are familiar with this as ‘gentrification’ where certain groups of people are excluded and their social networks decimated. And it is likely to segregate other groups too.

Segregation by Design highlights 80 American cities destroyed by racist planning. It does this though annotated satellite imagery, historical ‘redlining’ maps, and archival photos. Redlining is a term for race-based exclusionary tactics in real estate in the US. 

The title of the FastCo article is, Segregation by Design: How one architect is vizualising the legacy of America’s racist urbanism. The case studies usefully illustrate the arguments and there are links to other references. 

“Segregation By Design joins the conversation at a time of unprecedented spending on American infrastructure. The Infrastructure Investment and Jobs Act of 2021 unlocks over $1 trillion to remake cities with the promise of a better future. While more money is not the only answer to the mechanisms of oppressive public planning, it’s a promising start. For Susaneck and his passion project, understanding urban planning’s racist past is the key to constructing more equitable cities in the future—filled with accessible public transit, pedestrian-friendly roads, and ample public space for all.”

 

The benefit of designing for everyone

Front cover of the report the Benefit of Designing for Everyone.The assumption that designing for everyone will cost more often goes unchallenged. Even economic arguments for business benefits rarely cut through because of this. If economic arguments for inclusion worked we wouldn’t still be talking abut it. A Centre for Inclusive Design report analyses inclusive business practice and covers some areas not covered before. The report analyses education, retail and financial services and argues inclusive design can drive financial, economic and social improvements. PwC was commissioned for the report, The Benefit of Designing for Everyone.

Jeremy Thorpe from PwC says, “Inclusive design is a no-regrets process that creates significant benefits which are currently being left on the table. It is an overlooked step in maximising the potential of Australian business and ensuring a more productive Australia.” There is also an infographic with the key information, and a summary report and a Word version

Infographic listing some of the key economic data within the report.The report analyses three key industries in Australia: education, retail and financial services. Each one can benefit from taking a universal design approach to improve their bottom line. 

David Masters, Corporate Affairs Director, Microsoft Australia, said,

“Accessibility is often focused on compliance, and while that is incredibly important, this report clearly shows that inclusion drives economic benefit too. Embedding inclusion in the upfront design phase ensures organisations are delivering products and services for everyone. Inclusive design is driving innovation at Microsoft and is a concept that all organisations should be embracing.”

It is good to see more work being done on the economics of inclusion. However, such arguments over the last ten years have yet to make their mark. The inclusive tourism industry is testament to that as well as the housing industry. Let’s hope someone is listening and willing to act.

 

Shared spaces as successful places

Artist impression of evening in George Street Sydney showing a shared street.
An artist’s impression showing the QVB stop in the George Street pedestrianised zone

What role do shared spaces play in “successful places”? And what are shared spaces anyway? A report compiled by the Transport Research Centre at UTS for the NSW Government attempts to answer these questions. The focus of the report was to understand how shared spaces can enhance the development of “successful places”, a key strategic priority of Transport. 

Varied terminology on the topic of shared spaces is not helpful and needs a standard definition. Another issue is whose opinion counts most. Is it user perceptions or transport performance measurements? And implementation is difficult even though there are many guidelines and there are few case studies.

What is a shared space?

The report offers the following definition.

“A public street or intersection that is intended and designed to be used by all modes of transport equally in a consistently low-speed environment. Shared space designs aim to reduce vehicle dominance and prioritise active mobility modes. Designs can utilise treatments that remove separation between users in order to create a sense of place and facilitate multi-functions.”

 Findings

Broadly, high level critical findings include:

      • The shared space design concept is one tool for forming successful places across the community.
      • A spectrum of intervention and design options are available to transport professionals to achieve a shared space within the road network.
      • Defining relationships between design parameters and performance metrics are key to determining the factors leading to implementing successful shared space.
      • Current guidelines, standards and practical processes limit the application of novel shared space solutions.

The title of the Shared Spaces Review is, Evaluation and Implementation of Shared Spaces in NSW: Framework for road infrastructure design and operations to establish placemaking. Examination of existing Shared Space knowledge. The Transport Research Centre, University of Technology Sydney conducted the research for Transport for NSW. 

The report is comprehensive and detailed with some international case studies to illustrate issues and findings. The report provides recommendations and current best practice for Transport for NSW. 

Intergenerational shared spaces 

Having interaction between generations, particularly older and younger people is beneficial for everyone. Julie Melville and Alan Hatton-Yeo discuss the issues in a book chapter, Intergenerational Shared Spaces in the UK context

The authors discuss how the generations are separated by life activities and dwelling places. The design of the built environment is a major concern because is not conducive to sharing spaces across the generations.

While this book is not specifically about universal design, it is about inclusive practice and social inclusion.

Google Books has the full book, Intergenerational Space, edited by Robert M Vanderbeck and Nancy Worth.

Diversity and inclusion: Can we co-design our work?

A woman is sitting at a dining table typing on her laptop. When home is the workplace it can enable diversity and inclusion in the workplace.Employers are experimenting with managing the changing face of work and employee feedback is of course essential. So, will universal design principles and the practice of co-design come to the fore in designing work? Perhaps. Regardless, it’s the way to sustain and build diversity and inclusion in the workplace. 

Most employees currently working in a hybrid model want it retained. A report by McKinsey found this was the case across the board. They also found that marginalised groups wanted it more than others:

    • Employees with disabilities were 11 percent more likely to prefer a hybrid work model than employees without disabilities.
    • More than 70 percent of men and women expressed strong preferences for hybrid work, but nonbinary employees were 14 percent more likely to prefer it.
    • LGBQ+ employees were 13 percent more likely to prefer hybrid work than their heterosexual peers.

However, the McKinsey report highlighted potential pitfalls:

    • Hybrid work has the potential to create an unequal playing field if not done correctly.
    • Companies need to prioritize the most critical inclusion practices: work-life support, team building, and mutual respect.
    • Marginalized groups are more likely to prefer a hybrid work model and would be more likely to leave if it was not available.

Hybrid good for inclusion

In their survey, 75 percent of all respondents said that they prefer a hybrid working model. Only 25 percent said they prefer to be full time on-site. An employee who might be hiding a disability, gender identity or sexual orientation can avoid declaring it. Concealing this information takes a toll on employee wellbeing and performance. Until workplaces are truly more inclusive hybrid works well for many groups. 

As employers navigate their way through new ways of working they shouldn’t mistake hybrid as flexibility. Some organisations were able to manage issues of isolation and mental health during the pandemic. Nevertheless, these issues remain across the business landscape, particularly for some traditionally underrepresented groups.

The title of the report is, How can hybrid work models prioritize diversity, equity, and inclusion?

The article was re-published by the World Economic Forum with permission. Will universal design principles and the practice of co-design come to the fore in designing work? We shall see. 

Inclusive Job Descriptions Toolkit

A deep red background to a sign saying "we are hiring".Diversity, equity and inclusion are the current buzz words in the workplace, and it all starts with recruiting. So, how inclusive are job descriptions? Using gender inclusive language, meaning cisgender inclusive, now seems normal. Now we need to think about language for all marginalised groups. Grand Valley State University Libraries has an Inclusive Job Descriptions Toolkit to help. 

The toolkit is focused on university recruitment, but the information can be used in other contexts. They use the acronym IDEA – Inclusion, Diversity, Equity and Access.  

The first part of the toolkit outlines best practices and the second part provides an equity lens for reviewing the job descriptions. The appendices include additional language and job description templates.

The toolkit lists the components of a job description some of which are specific to the university context. However, all job descriptions should give an employee a clear guide to the role and what is expected of them. A job description answers the question “What does this role do?” The next section gives guidance on writing inclusive job descriptions. 

Writing an inclusive job description

Inclusive language reduces the likelihood of applicants from self-selecting out. Biased language can occur unintentionally and can have a negative impact on recruitment efforts. For example, a job being suited to a recent graduate may signal a desire to avoid older workers.

The section on tips for writing job descriptions has many of the usual points for clear communication. For example: conciseness, simple gender inclusive language, and avoiding acronyms. Other tips are on phrasing such as moving from “excellent communication skills” to “ability to communicate clearly and effectively”.

The toolkit lists gender, race, and ableist coded words that most people wouldn’t consider as non-inclusive:

    • Female-Coded Words: Agreeable, empathetic, sensitive, affectionate, feel, support, collaborate, honest, trust, commit, interpersonal, understanding, compassion, nurture, and share.
    • Male-Coded Words: Aggressive, confident, fearless, ambitious, decisive, head-strong, assertive, defend, independent, battle, dominant, outspoken, challenge, driven and superior.
    • Racially Coded Words: Excellent English-language skills, clear-spoken, native English speaker, cultural fit, nice, polite, Latino/Latina, professionalism
    • Ableist-Coded Words: Energetic, athletic, able-bodied individual, talking with students, walking through the building

The section that follows gives examples of how to make changes to phrasing. The section on ableist phrasing could do with some improvements, but it gives the idea. 

Equity lens for diversity and inclusion

Applying an equity lens is a reminder that an organisation cannot embody IDEA without reviewing and updating their job descriptions and recruitment practices. 

“It is explicit in drawing attention to the inclusion of marginalized populations, typically communities of color, and can be adapted to focus on other communities. … An equity lens will not tell you what action to take. Rather, the lens helps you discuss and reflect on the equitableness of the action and decision-making process.”

The document can also be found on the Library Reports and Communication webpage. Grand Scholar Works is a service of the Grand Valley State University Libraries. Michigan USA.

The Future of the Office in Australia

Sourceable reports on the changing face of the office – the place where hybrid work is possible. The article has a real-estate focus but includes a nod to access and inclusion:

“… employers are facing rising pressure to address environmental, social, and governance issues in their offices and policies. Buildings that are inclusive and accessible for all workers have become more prominent in the industry, with popular features of new office buildings including prayer rooms and gender-neutral facilities.”

Viewing products online with Coles

Front cover of Coles Online Product Image Guidelines showing a family at the beach having a barbeque. Anyone buying or selling online wants the best possible view of the product. Buyers want to see relevant size and shape and key information. Sellers want the maximum number of sales. Making visual information clear, and easy to read and understand is key. Coles supermarkets has devised an image guide for suppliers to make products more readily recognised. So viewing products online with Coles should get easier for everyone. eBay sellers should also note.

The Coles guide is based on work carried out some years ago by the Inclusion Design Group at Cambridge University. This work is updated as they continue their research. The Coles guide is easy to read and gives instructions about images that suppliers should send them. These instructions are good for anyone who has a product or merchandise to sell. 

The guide covers the use of 2D and 3D images, out of pack images and lifestyle images. The Coles website will feature a first image with the brand with the option for further images with a click. This gives the opportunity to see front, back, left and right side of the product.

A previous post, Smart Phones and Shopping explained some of the background and has a video explaining how it all works. 

 

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