Design In Aged Care Can Solve Your Problems: And Why Repackaging Orthodoxies Should First Piss You Off!

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“It is difficult to get someone to understand something when their salary depends upon them not understanding it.” — Upton Sinclair, The Jungle

Strip the colourful post-it notes, butchers paper, scented markers, Lego blocks, and a host of other design thinking workshop paraphernalia, it’s important to understand that design (in its generic sense) is everywhere in the age services industry.

We designed a policy framework that—to quote the Aged Care Royal Commission—has stifled innovation. We designed an industry where over half of residential aged care providers are operating in the red. We designed consumer-directed care reforms where it’s been reported that approximately 16,000 people have died while waiting for their home care packages to be approved. We designed our operations where, collectively, we are not delivering uniformly safe quality care for older Australians.

Whether through conscious action or not—as policy-makers, regulators, or age services providers—we’ve designed our industry to behave exactly the way it is behaving today. In a world where design and innovation can mean a 100 things to 100 people, it’s no surprise that truly innovative organisations and initiatives get drowned out.

We are still not getting the front-end of innovation right, and as a result, committing the cardinal sin of falling in love with our solutions rather than the problem, and in turn, jumping to solutions too quickly.

It’s perhaps not coincidental that a recent McKinsey study of 1,700 organisations found that 90% of companies aren’t using design talent to their full potential, and only 17% of design leaders felt they were able to add full value to their respective organisations.

Design can be a force for good, but design can also cause harm. It’s value-neutral, and what we choose to design, what we choose not to design, and who we include and exclude in the design process amounts to nothing short of a political act. Equally, being empathetic doesn’t absolve us from our biases—there are elements of power and agency at work here.

To quote the Austrian-American designer, Victor Papanek: “You are responsible for what you put into the world. And you are responsible for the effects those things have upon the world.”

The American philosopher, John Rawls, proposed a thought experiment for determining the ethics of a situation called the Veil of Ignorance. The exercise posed that if we didn’t know our place in society—such as our social status, age, wealth, and health—we’d decide on moral considerations rather than on class interest. Hence, if designing an aged care service (or industry), we’d design one that benefits the elderly, simply because we might end up needing those same services.

The recent ascendancy and popularity of design thinking and empathy work in our industry has been much needed. The emphasis on giving older persons a voice as experts of the services they receive is refreshing.

Yet, in an age services context, when change needs to happen at an organisational level, and policy changes are structural, it’s important to differentiate design from innovation. Design thinking processes are powerful and applicable in solving problems, but we need to go beyond designing services and products to creating great businesses ignited by services and products that people want.

If we can agree that design’s role to innovation is akin to needing air to live, then we can also agree that life needs more than air.

Much of innovAGEING’s focus to date has been on encouraging organisations to think in terms of solving and addressing consumer needs and wants. However, as commercial necessity still dictates decisions, many great consumer-centred ideas and initiatives have never seen the light of day.

Many misconstrue the issue of scaling innovation to be one of lack of money and resources, yet in many instances, it’s the failure to align consumer needs with commercial necessity. In this regard, designing something innovative, and making this viable are not the same thing.

The French filmmaker, Jean-Luc Goddard once said, “Change nothing so that everything will be different”. The flip-side of this comment might be to change a few things so that everything remains the same.

With the constant reviews, calls for submissions and regulatory changes in our industry, the latter position seems to hold true. Perhaps the true innovation to occur is to change how we’ve been required to change.

Vivienne Castillo, Senior Design Researcher at Salesforce offers the following:

In the early 1900s, some psychiatric hospitals gauged patients’ readiness to integrate back into society through a simple and peculiar test. The patient was ushered into a room with a sink, where the hospital staff would place a plug in the sink, turn on the faucet, and wait for the sink to overflow. As water bubbled over the ledge and splashed onto the floor below, the patient was then handed a mop and the staff would leave the room, closing the door behind them.

If the patient turned off the water, unplugged the sink, and mopped up the water that had spilled onto the floor, they were deemed as ready to go home and enter back into society. But if the patient opted to frantically mop as the water gushed over the sink, failing to turn off the faucet or remove the sink’s plug, they were deemed insane and prescribed more time in the psychiatric hospital: they failed to acknowledge and address the root of the problem.

Many of us have been frantically mopping. Professor John Pollaers characterised the outcome of this as an industry that’s been set up around the notion of guilt, and frustration and anger when something goes wrong.

Sure, putting the mop down and addressing the root problem is tough—but it might just be the one real option we have left.

Published in Fusion, Autumn 2020

Merlin Kong is Head of innovAGEING, Australia’s national innovation network for the age services industry.