GUILLERMO WECHSLER

February 7, 2007

A Failing Transparency of Design Principles in Health Care?

There are three layers of design principles out of which people design. I have begun to articulate them in this document. As always, read this blog, take a look at the document, and send me your suggestions.

The three principles are:

1. Theoretical Design Principles: These are the discourses and theoretical distinctions to observe, evaluate and act in the phenomenological domain in which the design is taking place. For example, if you are going to design mortgage lending services, the underlying theoretical principles out of which you would design would be financial theory, risk theory, organizational theory, cognitive biology, phenomenology, etc.


2. Ethical Design Principles: These are the basic ethical values of a particular historical period which shape your design. For example, today, in the domain of Open Source, companies don't design and build proprietary products controlled and shaped by themselves. They instead share their intellectual property with users as a way of getting feedback, building a stronger network, and improving their service.


3. Projectual Design Principles: These are the principles that define the value proposition a particular company or collective is willing to deliver for a particular set of communities. These principles are often implicit in the business model of a company. Google promotes user-generated-services; consequently one of their projectual principles is to release the code of some of their services. Dell supports market standards; consequently one of their projectual principles is avoid defensive R&D and defensive functionality in their product development.

At the HAAS School's Business in Health Care Conference, there were many intelligent, innovative, and devoted members designing and innovating in the health care system. As I mentioned in this post, Suzy Jones from Genentech spoke about innovation in the company. She showed, among other things, that Genentech did not believe in separating the know-how from the people producing that know-how. And in investing in the people, Genentech not only got more know-how, but built a new sense of trust and collaboration with people thinking about the same problems. The company has this fundamental design principle for expanding collaboration into innovation networks. Now, they are designing new types of contracts--new protocols of communication--that have produced a new common sense and a new thinking about managing vast networks of collaboration with deals built on mutual trust, sensitivity to mutual concerns, and some alignment of priorities.

In contrast with this design approach favoring vitality and decentralization, we have the implicit design approach of most of the health care reform proposals.

Currently, the health care system is organized based on a centralized top-down design criteria. Teisberg and Porter declared three basic theoretical principles, which are 180°s from what mainstream players are thinking and talking about now, as fundamental to designing a health system. These principles are:

1. Redefining the relation between the major constituencies of the system and putting the patient at the center.


2. Stimulating value-added competition in opposition to zero-sum competition.


3. Promoting information transparency and customer access to personal data.

By working with these principles, it doesn't mean you can't review them later on, but they have been proposed as a new frame to designing health care services.

Currently, the health care debate is lacking the perspective of questioning the design principles that are in the background. We claim that there are implicit design principles which are harmful. By not listening to, and unsettling these theoretical principles, anything we build on top of them will produce more complexity and enormous waste, regardless of the good intentions and the magnificent skills of the thousands of health professionals working to improve the field.

Labels: design, health care