Business as usual will no longer suffice…

A version of this post has been published on LinkedIn.

While carolers recently proclaimed “tis the season to be jolly,” twas also the time of year to be easily reminded of the excesses of capitalism, from Black Friday to its expansion in many cases to Black Friday Week (and longer) motivating purchase of things not needed, to the distaste for and dehumanization of the poor exhibited by A Christmas Carol’s Ebenezer Scrooge and It’s a Wonderful Life’s Mr. Potter (both with their many modern day counterparts).

But the holidays are not needed for such reminders, particularly these days, with reports of the unethical behavior of major tech companies continually in the news along with reports of the damage their products continue to inflict. And denials of climate change in the face of irrefutable evidence and predictions of likely doom; as Marc Benioff (CEO of Salesforce) tweeted in August:

Benioff’s highly visible support of a tax on large San Francisco companies to help the city address its major problem with homelessness was a recent bright spot in the world of tech and capitalism and apparently key to the proposition’s passage.

However, this is all about corporations giving money to others to help others address societal problems. Corporations also do this via various philanthropic programs, but as Marc Wexler (Co-Founder of Not for Sale) argues, the model of corporations doing whatever they need to to make money and then giving money to others to address societal (or environmental) problems is broken. Indeed, corporate behavior often perpetuates the problems corporate taxes and philanthropic contributions go towards fixing. Wexler calls this “soul crushing.”

Some have argued for the need for a different approach to capitalism. For example, Michael Porter and Mark Kramer have stated:

“Capitalism is an unparalleled vehicle for meeting human needs, improving efficiency, creating jobs, and building wealth. But a narrow conception of capitalism has prevented business from harnessing its full potential to meet society’s broader challenges. The opportunities have been there all along but have been overlooked. Businesses acting as businesses, not as charitable donors, are the most powerful force for addressing the pressing issues we face. The moment for a new conception of capitalism is now; society’s needs are large and growing, while customers, employees, and a new generation of young people are asking business to step up.”

The concept of “conscious capitalism” has received considerable attention. From the Conscious Capitalist Credo:

“Conscious Capitalism is a way of thinking about capitalism and business that better reflects where we are in the human journey, the state of our world today, and the innate potential of business to make a positive impact on the world. Conscious businesses are galvanized by higher purposes that serve, align, and integrate the interests of all their major stakeholders. Their higher state of consciousness makes visible to them the interdependencies that exist across all stakeholders, allowing them to discover and harvest synergies from situations that otherwise seem replete with tradeoffs. They have conscious leaders who are driven by service to the company’s purpose, all the people the business touches, and the planet we all share together.”

Sebastian Buck (Co-Founder of Enso) argues for a need to move from “extractive capitalism” to “generative capitalism.”

“Generative capitalism contributes new value to the world; extractive capitalism reallocates existing value.”

To date, Porter’s and Kramer’s concept of “shared value” — “creating economic value in a way that also creates value for society by addressing its needs and challenges” — has probably received the most attention, perhaps in part because it involves, as stated earlier, “businesses acting as businesses.” Unlike corporate social responsibility or philanthropy, “it is not on the margin of what companies do but at the center.”

And, as Porter and Kramer stated, “customers, employees, and a new generation of young people are asking business to step up.” One sees evidence of that in, for example, Amazon employees using their shareholder power to demand corporate action on climate change and in employees elsewhere spearheading diversity initiatives.

Some businesses have responded, including Walmart (whose Chief Sustainability Officer proclaimed in 2017 that “business exists to serve society,” and the company has increasingly acted in accordance with that view) and other companies identified by Forbes as “using the profit motive to help the planet and tackle social problems.” 

“The profit motive” appears to be key, so when environmental or social problems can be talked about in terms of money….

Or to put it more simply:

“Businesses acting as businesses…”

Yet, businesses have not responded as much as some predicted. SO much more can and needs to be done.

As I’ve stated elsewhere, part of the problem is the difficulty corporations have understanding social and environmental issues adequately and working effectively with others already working on such issues. As I’ve also stated, designers schooled in effectively designing for social or environmental impact have skills that can help corporations address this difficulty. I’ve identified some of those skills; Mike Youngblood elaborates on how anthropological thinking — an essential component of good design — “can help make business greener”; and Jared Spool highlights another of the essential skills below:

But as I’ve argued in multiple talks (e.g., at the Interaction Design Education Summit in Lyon France last February) and as Marc Rettig argues in my conversation with him about what it takes for companies to move toward social and environmental responsibility, designers need to elevate their game. At the same time, companies have to elevate their understanding of design and of the role designers can play in business.

However, Calvin’s Hobbes so sadly concludes:

But we are at a point of crisis. Business as usual will no longer suffice…

Perhaps the final Calvin and Hobbes strip ever published offers a ray of hope:

Here’s to a happy new year!

Leveraging design to help overcome key challenges to creating shared value

A version of this post has been published on Medium.

Design is used extensively to “reimagine social change” (the tagline of the best known “shared value” consultancy), yet design is largely ignored in efforts to create shared value (i.e., to expand the connections between social, environmental, and economic progress). Tis perplexing given the increased acceptance of the need for “design thinking” to play a role in creating business strategy, though perhaps understandable given the persistence of outdated concepts of design and of the role of designers in business.

Plus, the benefits of employing design have been rising, since great progress has been made in understanding how to effectively design for positive social and environmental impact. And those benefits are needed now more than ever, as social and environmental problems seem increasingly insurmountable while corporations, seeking innovative ways to differentiate their offerings and improve shareholder value, struggle to understand them adequately to determine whether they can address any of them as part of their core business strategy. Indeed, shared value goes beyond typical corporate social responsibility (CSR) projects, which are peripheral to core business and exist largely to manage brand and reputation. Hence, corporations are not accustomed to addressing social and environmental problems in this way.

Non-profits, governmental institutions, and community groups — i.e., organizations conventionally considered to have greater responsibility for addressing social and environmental issues — are also not accustomed for corporations to address social and environmental problems in this way. As Michael Porter and Mark Kramer have stated,

 “Leaders in both business and civil society have focused too much on the friction between them and not enough on the points of intersection.”

Indeed, shared value partnerships with corporations can more greatly than corporate philanthropy or CSR ease the financial strain such organizations often experience while achieving greater impact than would otherwise be possible.

More from Porter and Kramer:

 “Capitalism is an unparalleled vehicle for meeting human needs, improving efficiency, creating jobs, and building wealth. But a narrow conception of capitalism has prevented business from harnessing its full potential to meet society’s broader challenges. The opportunities have been there all along but have been overlooked. Businesses acting as businesses, not as charitable donors, are the most powerful force for addressing the pressing issues we face. The moment for a new conception of capitalism is now; society’s needs are large and growing, while customers, employees, and a new generation of young people are asking business to step up.”

And businesses have begun to step up, as suggested by Fortune’s recently published list of companies changing the world “using the profit motive to help the planet and tackle social problems.”

But figuring out how to achieve shared value and doing so is difficult. Corporations excessively focused on short-term economic gains may lack the patience required to make this work. Figuring things out often requires consideration of entire ecosystems, the meaningful participation and collaboration of many, and determining how to align the purpose of multiple stakeholders. Corporate executives and managers must shift their mindset from being in total control to one that empathizes with people and business partners that they typically haven’t had to engage with in the past.

Designers schooled in effectively designing for social and environmental impact know, among other things, how to:

• consider entire ecosystems, facilitate the meaningful participation and collaboration of many, and facilitate the alignment of purpose of multiple stakeholders;
• achieve an adequate understanding of social and environmental issues, suspending often false presuppositions in order to appropriately and creatively frame those issues;
• generate insights that identify opportunities to “reimagine social change” (and/or environmental change) and accompanying business strategy change;
• explore and test potential opportunities for creating shared value without risking damage to the social or environmental sector or a corporation’s reputation.

The integration of such design expertise with expertise more typical of business innovation process but specific to the concept of shared value and its successful implementation should greatly help organizations overcome key challenges to creating shared value.

— — — — —

Unsure about the ethics of the concept of shared value? See Porter and Kramer’s two publications referenced above and Phil Preston’s recent “Answering the Critics of Shared Value.”

Desire a better understanding of shared value from the perspective of non-profits? For two examples, see OE Strategy’s Susan Wolfe talk about Vayu, a non-profit delivering healthcare via drones in remote locations around the world (from the 12:15 time mark to 26:55, embedded within talks by Phil Preston and Derek Wood) and Mark Wexler’s talk about Not For Sale, a non-profit he co-founded with the mission to put an end to human trafficking.

Desire a better sense of the role design and designers can play? See slides from the March 2018 version of my workshop entitled, “Question everything — Designing more effectively for social impact,” my recent conversation with Marc Rettig “on what it takes for companies to move toward social and environmental responsibility, how we might help, and what that means for design,” and the entirety of the curriculum of the Austin Center for Design, where I am a member of the faculty.

I have begun to work with Phil Preston — who provided input on this post — on leveraging design to help organizations figure out how to effectively create shared value. What questions do you have about all this? Please share them via comments below or by contacting Phil or me directly.

Do I really need to write a book?

Last month, I was chatting with Peter Merholz at the Big Design Conference in Dallas. He was there promoting his new book, Org Design for Design Orgs: Building and Managing In-House Teams — an excellent book by the way, and we were talking about how interesting it is that it is still important to write a book to be sought out as a consultant; blog posts are not enough. “You’ve never written a book, have you?”, said Peter, “Why not?” (Interestingly, it was Peter who first asked me years ago why I hadn’t started my own user research firm.)

Should I have written a book by now? Probably, yes. (Should I have started my own user research firm years ago? Again, probably yes.) I certainly have a couple of books in me, but do I really want to urge them out? Is it really true that good blog posts cannot suffice?

Well, without answering those questions (at least for now), let me spend a bit of time proclaiming the merits of reading old blog posts — not just anyone’s, but mine! I’ve written lots about topics such as those Peter addresses in his new book, and though many of those posts have aged a number of years, their relevance remains surprisingly — perhaps disturbingly — high. And what makes my posts particularly valuable is that they present and contrast the experiences and perspectives of many; they are not solely about what I think and have experienced.

For example, consider the topic of design collaboration. Cross-functional collaboration is now highly touted as crucial to successful design, but I know lots of designers who still do their work largely independently. WTF? Some of my blog posts on the importance of collaboration and keys to its success include:

• “The three-legged stool of collaboration”
• Breaking silos
• “Check your disciplines at the door” when beneficial
• The need for good facilitation
• Soft skills
• Walls
• Effective collaboration and fun

Numerous posts address (additional) characteristics of a good research and design process, something with which many continue to struggle. They include:

• Are you trying to solve the right problem?
• On concept design, ethnography, MRDs, and product vision
• A(other) call to action regarding healthcare
• Utilizing patients in the experience design process
• Go ahead — ask people what they want
• Applying “design thinking” to, um, design
• Prototyping for tiny fingers

But what do you do when you can’t follow an ideal process? I had a conversation about just that about a month ago with a director at a company that strongly touts its ideal process, but can’t always engage in it. I pointed him to, Working “middle out,” an approach which ends up increasing the chances of following a more ideal process in the future.

Multiple obstacles to employing design in the most impactful way can surface. Some of the many posts about such obstacles include:

• Preconceived notions
• “Designing in hostile territory”
• “There is only so much air in the room”
• Making changes to a company’s culture
• What is holding User Experience back or propelling User Experience forward where you work?
• Roles and relationships
• Eliminating noise and confusion

Each post in the above list also addresses how to deal with such obstacles. Additional posts which do the same include:

• Framing change / Changing frames
• Secret agent (wo)man?
• Changing the course or pace of a large ship
• Partnering with power
• Calculating return on investment
• Perturbing the ecosystem via intensive, rapid, cross-disciplinary collaboration
• Convincing executives and other management personnel of the value of ethnography

The design and positioning of design organizations is still a hot topic, as suggested by the reaction to Peter’s book. Among the posts I’ve written on this topic:

• Where should “User Experience” be positioned in your company?
• Does it matter where User Experience is positioned in your corporate structure?
• On the importance of alignment, trust, loyalty, …
• Hail to the Chief!
• Getting the organizational relationships right
• Ownership of the user-customer experience
• The internal consultancy model for strategic UXD relevance
• Who should you hire?

And I’ve authored posts on so much more. Indeed, there is gold to be found in these many blogposts.

Design leadership is a hot topic these days, and many of these posts could form the foundation of a very good book on the topic. But, can’t the blog suffice? Do I really need to write a book?

Well, things would be better organized in a book, and I’d update and extend the posts’ content, and I’d fill in some gaps, and…

OK, maybe I should write a book. But while I do that or consider doing that, look through the lists of posts I've presented above for those that might be of help to you now. Use the tags for help accessing others. As I mentioned earlier, even the older posts continue to be of relevance.

What designers need to know/do to help transform healthcare

A version of this post has been published as an interactions magazine blog post.

I've been immersing myself in all things focused in some way on dramatically changing the U.S. healthcare system and the patient experience. This has included attending lots of events. Last week, I attended the Health Technology Forum Innovation Conference. Two weeks ago, I attended the Second Annual Great Silicon Valley Oxford Union Debate focused on whether Silicon Valley innovation will solve the healthcare crisis. Near the end of March, I attended both a panel discussion about "Improving the Ethics and Practice of Medicine" and hxd (Healthcare Experience Design) 2013. ... (The list goes on and on.)

I've also been writing and speaking about this topic as well. Recent examples include the blog post I wrote for interactions in December entitled, "The Importance of the Social to Achieving the Personal" (in healthcare) and my presentation at hxd 2013 entitled, "Preventing Nightmare Patient Experiences Like Mine" (subtitled, "Avoiding 'Putting Lipstick on a Pig'").

As most agree, the U.S. healthcare system and patient experience are badly in need of disruptive innovation, a transformation, and/or a revolution. Hence, the subtitle of my hxd 2013 presentation implies that there are things (UX) designers need to be aware of or do (or not do) so that they can do more than only contribute to modest improvement of the status quo.

What are those things? The things I addressed in that presentation:

1. too many designers are too enthralled with technology and too focused on digital user interfaces to have a great impact on transforming healthcare;
    
2. human-centered design as often practiced is better suited for achieving incremental innovation instead of the disruptive innovation most needed -- Don Norman and Roberto Verganti have written a great essay about this;
    
3. design research too often falls short of revealing the nature and dynamics of the socio-cultural models at play that need to change;
    
4. design research too often focuses on common cases instead of the "edge" cases which can more identify or reveal emergent and needed innovation;
    
5. essential to solving the "wicked problem" of healthcare is reframing it, something not all designers do adequately -- Hugh Dubberly and others addressed this particularly well in an interactions magazine cover story;
    
6. designers need to get picky about the kinds of healthcare projects they work on.

(See the presentation for more on each item in the list.)

What would you add to this list? Is there anything in the list you question? Let's have a conversation. Please comment below or contact me via email at riander(at)well(dot)com.

And if you hear of any events you think I might be interested in attending...

On what holds UX back or propels UX forward in the workplace

A version of this post has been published as a blog post for interactions magazine.

Among the teaching that I've done: UX management courses and workshops via the University of California Extension, during conferences, and in companies. And a topic I have always addressed therein: what holds UX back and propels UX forward in the workplace -- or to put it another way, what increases and what decreases the influence of UX on the business.

Last month, Dan Rosenberg authored an interactions blog post in which he states that a root cause for a lack of UX leadership in business decisions relates to "how the typical types and methods of user research data we collect and communicate today have failed our most important leadership customer/partner/funding source, the corporate CEO." (Dan will be elaborating on this in the March+April 2013 issue of interactions.) In my courses and workshops, we identify all sorts of reasons UX isn't as influential as it might or should be, and we often do so in part via use of a simple "speedboat exercise" as I described in a UX Magazine article entitled, "What is Holding User Experience Back Where You Work?". (A variation of the exercise can be used to help identify what has propelled UX forward in workplaces.)

I've also often addressed this topic in my blog, sometimes referring to discussions that occurred during my management courses or during conference sessions. For example, course guest speaker John Armitage made the following point:

"There is only so much air in the room -- only so much budget, head-count, attention, and future potential in an organization. And people within the organization are struggling to acquire it -- struggling for power, influence, promotion, etc. whether because of ego or as a competitive move against threats of rivals. People will turn a blind eye to good ideas if they don't support their career and personal objectives. Hence, if user experience is perceived as a threat, and if they think they can stop it, they will, even if it hurts the company."

Guest speaker Jim Nieters addressed the role that the positioning of UX personnel in an organization plays:

"You want to work for an executive who buys-in to what you do. If that executive is in marketing, then that is where you should be positioned. If that executive is in engineering, then that is where you should be positioned. Specifically where you sit matters less than finding the executive who supports you the most. If the executive you work for has reservations about what you do and wants proof of its value, that is a sign that you might be working for the wrong person."

Organizational positioning and the type of user research conducted were two of the factors debated by a stellar panel of UX executives and managers I assembled for a CHI conference session entitled, "Moving User Experience into a Position of Corporate Influence: Whose Advice Really Works?".

We also addressed this topic in interactions articles published when I was the magazine's Co-Editor-in-Chief. For example, in "The Business of Customer Experience," Secil Watson described work done by her teams at Wells Fargo Bank:

"We championed customer experience broadly. We knew that product managers, engineers, and servicing staff were equally important partners in the success of each of our customer-experience efforts. Instead of owning and controlling the goal of creating positive customer experience, we shared our vision and our methods across the group. This was a grassroots effort that took a long time. We didn't do formal training across the group, nor did we mandate a new process. Instead, we created converts in every project we touched using our UCD methods. Having a flexible set of well-designed, easy-to-use UCD tools ... made the experience teams more credible and put us in the position of guiding the process of concept definition and design for our business partners."

Forming the centerpiece of their UCD toolkit: an extensive user research-based user task model. The influence of the use of these tools extended to project identification, project prioritization, business case development, and more.

I encourage managers to employ the speedboat exercise to prompt diagnosis and discussion in their own place of work. Also, peruse my blog posts and past issues of interactions for more on factors that impact the influence of UX. And give particular thought to the role user research might play; along these lines, look forward, with me, to what further Dan Rosenberg has to say in the March+April issue of interactions.

A(nother) call to action regarding healthcare

A version of this article was published in UX Magazine earlier this month.

For years, I have been addressing how UX can move upstream to play a more substantive, stategic role in business. An example of this was my CHI 2007 panel entitled, "Moving UX into a position of corporate influence: Whose advice really works?" Another example was my Mx 2008 presentation emphasizing the challenges UX personnel face when attempting to move their work upstream.

Related challenges (and warnings) were emphasized more recently by Samantha Starmer and Greg Laugero.  Starmer argues:

"Given the current power of CX at the C-level, UX practitioners must step up our game, otherwise we will lose progress we have made to be more deeply involved in strategy beyond just performing usability services. We need to act now to be part of the broader CX solution. If we don't proactively collaborate across divisions and organizational structures, we will be stuck playing in the corner by ourselves. If we don't figure out how to manage partnerships with other departments in a collaborative, creative, customer focused way, the discipline of UX as we know it is at risk. CX management will take over."

Laugero argues:

"UX design has done a great job in the last decade of redefining (for the better) how we define requirements for products with digital UIs. There is no doubt about this. But this has come at a cost of upward mobility in our organizations. We're functional players that make tactical work more efficient. We're not strategic players that help our organizations transform themselves. The closer we look at UIs, the more pigeonholed we're likely to be.

...stepping up [to strategic challenges] may mean stepping out of our comfort zones. ...we can't go in waving deliverables -- our standard bulwark. We have to step out from behind our wireframes and prototypes and think strategically."

However, will such a strategic focus actually satisfy UX personnel who have so often complained of corporate marginalization? Jon Kolko argues that the answer will often be "no" since most are actually interested in doing work that is usually much more meaningful and socially impactful than found in most corporations and consultancies. Consequently, Kolko calls on designers to reject the confines of the short-term focused, often marketing-driven corporate world to become social entreprenuers so to get the opportunity to tackle some of the world's many "wicked problems."

One of those wicked problems: a U.S. healthcare system declared "broken" by speaker after speaker at Stanford's Medicine 2.0'11 conference. This declaration has been echoed by many, including Donald Berwick M.D., who oversaw Medicare and Medicaid until this past December:

"Health care is broken. ... We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste, and unreliable. Despite the best efforts of the workforce, we built it wrong. It isn't built for modern times."

UX personnel have worked in the world of healthcare at the level of the UI for years. Yet, many medical UIs haven't benefited from the input of UX personnel and most of the thousands of healthcare apps available today are considered to have been designed for the wrong people, and it is not clear how many of them really work. Even if more apps were well-designed and did work, would that fix what is broken with healthcare? Jeff Benabio M.D. tweeted his opinion:

To put the problem in UX/CX terms, what is really needed is transformation of the healthcare customer experience -- i.e., what is often referred to as the "patient" experience. And what is truly needed is not "improvement," but "transformation" as captured by this graph from Forrester Research's Kerry Bodine.

Can UX personnel contribute to this transformation? As argued by Laugero (see above), not so long as UX personnel have an excessive UI focus.

A recent paper by Don Norman and Roberto Verganti is relevant. According to Norman and Verganti, human-centered design as practiced by most UX professionals can contribute to only incremental innovation -- "improvements" to existing products or services. Radical innovation (a.k.a. "transformation," to use the terminology used above), on the other hand (see the nearby figure), requires technology or meaning change, the second of which can be achieved only via the comprehension and change of the dynamics -- often subtle and unspoken -- of socio-cultural models at play. According to Norman and Verganti as well as Jon Kolko, the design research that is often a part of the human-centered design process typically doesn't reveal such dynamics. According to Norman and Verganti, the focus of design research is usually not on such meanings; according to Kolko, the amount of time typically alotted to design research is too short to allow for their discovery.

Kolko argues that participatory design -- the practice of designing with rather than designing for -- can provide the time via which adequate empathy can be built to reveal the deep, tacit knowledge holding "critical truths and assumptions about behavior, policies, norms, and values." But there are sometimes other sources of this information as well. Interestingly, in the field of healthcare, I've found TED talks to be a great source, and I've written about them (and other sources) in "In need of transformation: the patient experience." For example, four powerful TED talks disclose the great extent to which medicine is conducted in a culture of physician superiority (USC's Dave Logan), anti-creativity (Jay Parkinson M.D.), denial of mistakes (Brian Goldman M.D.), and treatment of diseases rather than of people (Abraham Verghese M.D.).

Some of these cultural characteristics are reflected subtly in the language of today's healthcare system, as pointed out by a group of designers led by Hugh Dubberly: 

"We call individuals 'patients.' We call physicians healthcare 'professionals' (HCPs). Professionals 'care for' patients -- by observing symptoms, diagnosing diseases, and proposing therapies. Their proposals are not just suggestions: they are prescriptions or literally 'physician orders.' Patients who don't take their medicine are not 'in compliance.'

In the relationship between HCPs and patients, HCPs dominate. HCPs do whatever is necessary, with patients playing a relatively passive role. In some ways, the system reduces patients to the status of children -- simply receiving treatment."

Dubberly et al., focusing on the level of meaning as described by Norman and Verganti, describe an alternative healthcare model of self-management that is contrasted with today's model in the nearby chart. (Such an alternative model is consistent with a growing "e-patient" movement supported by the new Society for Participatory Medicine working to achieve a time "in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.")

Much more work along these lines is needed. As stated by rebel Jay Parkinson M.D.:

"Going to the doctor, having routine surgery, buying bulk medications online -- all could be radically reinvented with the application of one type of medicine: designed disruptive innovation. Combining the principles of disruptive innovation with design thinking is exactly what health care in America needs. We need to disrupt the current business model of health-care delivery. And we need these disruptions to be designed experiences that are consumer-focused."

Recently, Valerie Casey issued a call to action in a short article entitled, "Healthcare Innovation: Time for Design(ers)." Her call to action was largely one of encouraging designers to respond to four innovation challenges issued by large pharma companies and healthcare organizations.

In my view, UX designers can do more. Learn about the problematic healthcare cultural characteristics that dominate and that need to change. Alter how you do design research. Don't limit yourself to incremental innovation and work that is narrowly focused on UIs. Question the advisability of doing projects that, in essence, only amount to putting lipstick on the very large healthcare pig. Escape your comfort zones in order to have the kind of impact on the world that you desire.

If only it were a matter of the following:

Indeed, designers need to care.

No more worshiping at the altar of our cathedrals of business

A version of this article was published in the January+February 2012 issue of interactions magazine.

I've been reviewing an excellent manuscript for a book on design thinking and reading about a new game and kit developed by IDEO to help explain it. These things delight me, since for years, I've been focused on expanding the role of design/UX to be a full participant in defining business strategy and in being a catalyst for that change. More recently, participation in defining social strategy became an important part of that focus. Design thinking came to be advocated by business visionaries to be a major part of a fix to a broken strategy definition process. Jon Kolko and I published our and others' writings about such things in interactions when we were Co-Editors-in-Chief.

So, I have been intrigued by proclamations that design thinking is a failed experiment, that it is misguided to attempt to describe the process, and that design thinking must be recognized as the purview of the trained designer. Innumerable attempts at explaining the usually less ambitious "user-centered design" have been greeted by similar negative reactions over the years.

Just what is going on here? Why the negative reactions? Sometimes stepping aside to look at comparable happenings in a seemingly different context can provide some insight, so allow me to describe some of what is happening in the world of healthcare.

In today's world of healthcare, a ballooning number of patients seek at minimum full participation in defining their diagnostic/treatment strategy. Why? Because of an outrageous number of medical misdiagnoses, because of what is often an insulting patient experience involving doctors who don't listen to or even bother to touch their patients anymore, because doctors tend to just "regurgitate (knowledge) rather than think" and disregard limits to their knowledge and experience, because a system of referrals and approvals prevents direct and ready access to doctors with needed expertise, ... -- in short, because of a healthcare system declared to be "broken" by speaker after speaker at Medicine 2.0'11 held at the Stanford University Medical Center.

Patient efforts to meaningfully pierce the diagnostic/treatment process have been greeted with claims that patients lack the skills/training to do this successfully, that only doctors can diagnose and prescribe correctly, that anything patients learn via the internet is highly suspect, that reducing diagnosis/treatment to a process in which patients can participate ignores the fact that the practice of medicine is as much of an art as a science, ... -- reasons coming from members of a community (i.e., doctors) classified as a stage 3 (of 5) tribe: "I'm great, and you're not."

You should be seeing a lot of parallels...

In spite of proclamations against greater participation of patients, the "epatient" movement is growing rapidly, with peer-to-peer healthcare increasingly seen as an essential part of a fully functional healthcare system in which social media play vital roles. A Society for Participatory Medicine has been formed as part of this movement "in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners." I'm even seeing suggestions of a need for an "Occupy Healthcare" movement. Meanwhile, medical rebels such as Jay Parkinson are showing how a patient-centered healthcare practice can work in spite of active resistance from the medical community, and programs are being designed to train medical students how to listen and talk to patients.

The following observation by an attendee of Health 2.0 San Francisco 2011 speaks to all of this:

And as I write this, the Occupy Wall Street protests are going global. As Thomas Friedman states in The New York Times:

"Occupy Wall Street is like the kid in the fairy story saying what everyone knows but is afraid to say: the emperor has no clothes. The system is broken."

Indeed, the businesses in which many of you work are broken, operating and/or structured in ways more appropriate for an earlier era. Many of these businesses are faced with the need to become genuninely user- or customer-centered and connected/social. To achieve this, design/UX leadership is badly needed. However, as Samantha Starmer warned after learning that design/UX personnel are not the ones getting the many newly created Chief Customer Officer positions:

"Given the current power of CX at the C-level, UX practitioners must step up our game, otherwise we will lose progress we have made to be more deeply involved in strategy beyond just performing usability services. We need to act now to be part of the broader CX solution. If we don't proactively collaborate across divisions and organizational structures, we will be stuck playing in the corner by ourselves. If we don'f figure out how to manage partnerships with other departments in a collaborative, creatice, customer focused way, the discipline of UX as we know it is at risk. CX management will take over."

New social, user/customer-centered businesses are needed. "Citizen-centered" social strategy is needed. And design (thinking) can lead the way.

Describing/explaining the design process for others to understand -- to enable their effective participation -- is essential for this to happen. However, more educational programs akin to that provided by the Austin Center for Design are needed. Perhaps a new professional association -- a resurrection of a sort of Computer Professionals for Social Responsibility -- fully focused on this kind of participatory design would be helpful.

We've reached the point of no more worshiping at the altar of our cathedrals of business. The marginalization of design (thinking) and UX is finally on its way to the rag pile.

It is a very good time to be a design( think)er.

Impact of the role of the Chief Customer Officer

Back in May of 2005, I wrote about the role of the Chief Experience Officer, beginning with Challis Hodge's 2001 description of the role (as first held by Marc Rettig) and culminating in Jeffrey Rapport's 2005 advocation of the creation of the role in modern companies. In mid-2007, I updated the story, describing additional advocations of the creation of the role, a conference panel discussion I led of the pros and cons of the role, and the 2007 highly-publicized hiring of a Chief Experience Officer by Cleveland Clinic.

Forrester Research's initial advocation of the creation of the role in 2006 referred to it as a CC/EO -- a Chief Customer/Experience Officer. Subsequently, the word "Experience" in the title lost favor, and creation of the role of the Chief Customer Officer has taken off. There is even a (somewhat dated) book available about the role and a member-led advisory network of CCO peers.

Who is filling these roles? According to Forrester's Paul Hagan:

"The majority are internal hires who have a significant history at their companies: median time at their firms among those we studied is nearly eight years. A third of the CCOs previously held division president or general manager roles, and almost as many worked in a marketing and/or sales position. On the flip side, about one-fourth of these CCOs formerly held operations positions."

As noted by Samantha Starmer in UX Magazine, UX people are not the ones getting these newly created C-level positions. Plus, all sorts of departments are expected to be scrambling to play a major role in customer experience (CX) moving forward. This has prompted Samantha to warn:

"Given the current power of CX at the C-level, UX practitioners must step up our game, otherwise we will lose progress we have made to be more deeply involved in strategy beyond just performing usability services. We need to act now to be part of the broader CX solution. If we don't proactively collaborate across divisions and organizational structures, we will be stuck playing in the corner by ourselves. If we don't figure out how to manage partnerships with other departments in a collaborative, creative, customer focused way, the discipline of UX as we know it is at risk. CX management will take over."

In her article, Samantha emphasizes the need for UX to partner with marketing, an entity with which UX has had a strained history. Such partnerships have the potential to work wonderfully well, as suggested by the successful merger of user experience research and market research to form a Customer Insights organization a few years ago at Yahoo! (see "User (experience) research, design research, usability research, market research, ..." and "Why Designers Sometimes Make Me Cringe").

Partnership with organizations other than marketing is also important. Successful examples, led by UX, include those described by Secil Watson in "The Business of Customer Experience: Lessons Learned at Wells Fargo" and me (and others) in "Improving the Design of Business and Interactive System Concepts in a Digital Business Consultancy" and "Perturbing the ecosystem via intensive, rapid, cross-disciplinary collaboration."

How do you partner successfully? Genuine collaboration is a key, and the keys to collaboration are many, as I've addressed in past blog entries. See, for example:

• "'Check your disciplines at the door' when beneficial" (also in UX Magazine);
• "Soft skills" & "The need for good facilitation";
• "Breaking silos" & "What to do about those organizational obstacles";
• "Work space" & "Walls";
• "'The three-legged stool of collaboration'";
• "Effective collaboration and fun";
• & "Collaboration sessions."

Learning about other organizations' needs, goals, ways of working, etc. is also key. Take a look at what Misha Vaughn did to enable UX to impact and be appreciated by Oracle's sales force.

All of this and more -- e.g., getting UX moved from a cost center to an investment center (Brandon Schauer, MX 2011) -- may be essential to ensuring UX plays a vital role in the ballooning world of CX and CX management and to getting UX management personnel recognized as among the stronger candidates to fill the CCO role.

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For more, see "Audio and slides for 'Moving UX into a position of corporate influence: Whose advice really works?'", "Ownership of the user-customer experience," and "Where should 'User Experience' be positioned in your company?".