1+1 = 3, when Architecture meets Service Design
Working together to transform organisations and create Care experiences that matter.
Imagine you are a cancer patient suffering a lot of pain, stepping into a hospital that has a bright and warm lobby making you feel welcome. You register at the front desk with a friendly nurse who indicates where you have to go. And now, imagine entering the chemotherapy room of the same hospital and finding a cold and cluttered space where you are supposed to sit for 3 hours, alone, surrounded by equipment while your loved ones have to wait for you outside. You feel forgotten. You feel afraid.
With many years of ethnographic research experience in hospitals and care organisations, understanding people’s behaviours and needs at different moments along the care journey and analysing the spaces through which they move, we have encountered many stories like this. Just at the most difficult and fearful moment in the patient’s journey at the hospital, when they need the most comforting environment, the space fails to support their real needs.
A gap to be filled
Probably, this problem arises because of a gap in design processes. We believe that the ‘hardware’ and ‘software’ of an organisation are usually designed separately. The ‘hardware’ is the physical space that allows a service experience (the ‘software’) to be delivered meaningfully. The space layout and flow, its qualities, materials, colours, lighting, and the equipment and furniture within it, create the context and scenario where the different interactions, attitudes and processes of a service take place. The space shapes the journey, behaviours, mindset and feelings of the people in it, therefore influencing the work dynamics and culture of the organisation; and in the case of hospitals, the experience of care. So, no matter how considerately we might design the space and service, without working together the experience as a whole falls short.
Yet, in a space design project, the service design, if at all considered, is often invited too late. The focus is on addressing the needs described in a functional plan — most probably written according to general requirements from staff — which responds to the ‘What’ (what needs to be designed, what are the functionalities that the space and furniture need to fulfil…). From our point of view, this process usually misses the ‘Why’, which will allow a more meaningful and sustainable result. A service design approach starts with the ‘Why’, understanding people’s needs, behaviours, emotions and desires in an holistic way, to define the right goals and values to design a positive experience.
In our past projects, we have hit the wall many times trying to merge multiple disciplines and collaborate. We have observed that as a project team, organisations assume that each discipline involved needs to work separately because of our different capabilities. This results in all of us working in silos: one task gets passed onto the next stakeholder, who has a different goal, different expectations and different planning than the previous one, and on to the next one, who again has their own objectives. In this way of working, it is difficult to engage effectively with one another and collaborate, it is not enough to plan a few sessions together where we exchange information and tasks.
A missed opportunity to create more value
The process of moving to a new building or remodelling an existing one is usually a transformation in itself for an organisation. We believe that by bringing a more participatory approach in the space design process, by thinking about it as an organisational transformation and not just as a standard building process or facilities refurbishment, much more can be achieved for both the organisation and its service users. We see this as a valuable missed opportunity for organisations to transform more meaningfully, and for architects, space designers and service designers to bring more sustainable value to each others work. The space redesign is also a natural moment for an organisation to reposition themselves differently to the outside world, accommodate new relationships and ways of working, and introduce an improved caring environment and culture; in this way a space transformation can become a stepping stone for a more significant transformation.
However, to achieve this, the design processes that drive the transformation need to be reframed. That is why it is important to work together — architects, families, organisations, service designers… — to bring in the different perspectives and viewpoints and create a common goal, which takes into consideration the values and target experiences of the organisation.
How might we close the gap and seize the opportunity to create an organisational transformation together?
Our experience has taught us, after many projects and many surprises working in different teams with both healthcare and social care organisations, that the answer is starting all together from the Why. Working together with the frontline care teams and the real users — in our case, healthcare professionals, patients, caregivers and families — setting up a common vision. By considering the perspective and experiences of all the people impacted by the service from the start, the results have shared ownership amongst the care teams, patients and caregivers.
This sense of ownership will allow them to engage with an often lengthy project process and continue to get the maximum value from the new space, service and organisation well after the project is finished and the keys handed over.
To facilitate the engagement of all stakeholders and guide this transformative journey, service design can play a valuable role. Before considering how to change, and defining the goals and values of an organisational transformation in a meaningful way, initial assumptions need to be challenged. We as service designers go into the field and look at how the organisation delivers its service on the ground, observing the higher resolution of people’s interactions and micro-moments at eye level, and uncovering insights that help to challenge and validate these assumptions. Ethnographic research — including shadowing staff and users along their journey — considers experiential issues and unveils human insights and needs, that otherwise would not have been addressed distinctively in a conventional space design process. The impact of spatial elements are also studied in this initial research phase, to understand how they affect people’s attitudes, behaviours and processes, adding valuable insights to the bird’s-eye space planning view that forms a part of the traditional architectural practice.
The next step encompasses the visualisation of all these insights in an actionable way, so that it is relevant to share between all stakeholders, creating a common language and framework. Experience journeys look at the whole timeline of a service and map the behaviours and needs across multiple channels (time, space, people, costs…), allowing to zoom in to small details but also zoom out to the holistic service experience. This tool acts as a bridge between different organisational teams, helping to co-design the principles that will guide the transformation. This way, by facilitating co-creation sessions where all the stakeholders and teams can equally bring in their perspectives, and using tools that enhance mutual understanding, we can ensure to work in the same direction from the start, and generate the positive energy that comes from a stronger alignment.
A chance for a sustainable transformation
From this point, the relationships between stakeholders and collaborators have been established to better engage with an iterative process to co-design the service experience — behaviours, culture, processes, interactions — in harmony with the physical space — environment, layout, flows, equipment. But this process should not end once the new building or space has been built up. The power of the collaborative and iterative approach is to design-in the tools for the building to evolve and adapt as the new service is launched and fine-tuned. The shared ownership of the process that has been nurtured along the design process allows for the organisation to keep evolving and responding to the inevitable changes it might face in the future, and for the transformation to remain continuous and sustainable over time.
These are some of our thoughts and reflections so far as we explore how organisational transformation can happen through service design and architecture. So, how do we do this together?
How can we unveil the value for organisations to frame such transformation from the start?
How can we define a shared design process that brings the best of our capabilities?
How can we design new tools, techniques and practices to deliver this change in organisations?
In The Care Lab, as designers — turned — Care activists, we believe that by proactively partnering up we can work towards a common mission to create experiences that matter for people and thus transform the landscape of Care.
