Year 2009: reframing and solving problems
Story #4 of 16-part chronicle: ‘The evolution of my social design craft’
It’s the year 2009. It’s 7pm and I’m half-way through running a workshop with young people at a youth centre in Birmingham. This is the last of six insight workshops I was running over the last couple of weeks. I had not yet sat down with my team to analyse all the insight coming out, but I find it fascinating how the mind is able to distill lots of information regardless, and bring to the surface the most important bits — and we need to be able to better trust that innate ability. So with every workshop, one thing was becoming more and more apparent: the client (NHS Birmingham East and North) has given us (Uscreates) the wrong problem to solve. If I was hoping to design anything with meaningful impact, I was going to need to reframe the problem.
We had been asked to re-design an online Chlamydia screening service to increase uptake and completion of the test. The thing is, I was becoming convinced that the problem wasn’t actually the service. The problem was before the service. Here are the hints I got in the workshops:
- Awareness: “Chlamydia is a flower”. As an ice-breaker/intro activity, I asked young people to stand in a circle and throw a ball to one another. Whoever catches the ball introduces themselves, and writes down one thing they know about Chlamydia. I hadn’t defined Chlamydia to the group at that point, and the invitation to take part only mentioned sexual health as topic. It turns out that the majority of young people in the workshops knew very little about Chlamydia. One person thought it was a flower, another thought it was a nice name. Some thought that it comes with a horrible rash, and others thought that you catch it from the toilet seat. With so many unaware of what Chlamydia is, and with Chlamydia manifesting itself as symptomless on most occasions, young people simply didn’t (know they) need the screening service. But undiagnosed and untreated, Chlamydia could lead to infertility.
- Knowledge: Moving on from awareness, unsurprisingly many young people didn’t therefore know where and how to get tested. When given more information about Chlamydia and asked to share what they would do next to get tested, most suggested going to the GP or a sexual health clinic, or asking a friend, all of which some found embarrassing and best avoided. So young people were not even looking online to get tested. It’s just not the sort of NHS service young peopled expected to find online in 2009.
- Action: I got young people onto the website to try and order some self-test kits online. Many hesitated. It would go to their home address. Their parents open their post; “they would worry about me”, “they will know I have sex”, “they will think I’m not responsible”. I also brought some self-test kits along and invited young people to give them a go if they wanted to. Many thought peeing in a tube seemed easy enough; some had worried it was going to be a blood test. But many thought it was gross to send their pee back in the post. They certainly didn’t want other people’s pee with their post. So even if young people knew about Chlamydia and how to get tested, there were still some practical barriers to even starting to use the service.
Starting with these hints, I worked with the Uscreates team to put together a case to the client about needing to reframe the problem from redesigning a service to raise awareness and reduce behavioural, attitudinal and practical barriers in order to drive uptake of the service. From there, we collaborated with young people to pilot a number of approaches to normalise Chlamydia awareness and testing which won us an IPA Best of Health Award 2010. The things we designed and piloted included:
- A friendly brand co-designed with and featuring the young people involved in the insight workshops.
- A Facebook Page and paid advertising moderated by young people (campaign ambassadors), attracting over 600 fans per week within the target group.
- Self-test kits posted by default to every address where a young person is registered with their GP — along with an outdoor advertising campaign launching the initiative (to put parents at ease).
- Free cinema nights subsidised by Odeon (as part of their CSR health programme) where young people exchange a completed test with a popcorn and drink voucher in the toilets. We reached 100% screening rate on pilot night!
- Film competition across all creative courses at Birmingham colleges with winners filming an awareness raising trailer with a professional film company.
- Pick-up and drop-off test boxes in college toilets.
Moving on from that evening in Birmingham 9 years ago, I have continued to reframe problems to make sure whatever I’m designing is actually going to achieve the desired outcomes. There are countless ways to move and rotate that frame around the problem to understand it differently, perhaps more accurately, and possibly in such a way that makes it less daunting to tackle. I share below seven techniques I have used over the years to reframe problems. I draw on examples from a recent Public Health England Digital Weight Management programme I’m working on where I feel I’m using all of these techniques at once!
- Reframe by timing: Ask yourself; “when does the problem start and end, and at which point do I want to start to introduce a solution?” For example if designing to address childhood obesity, do you want to start with families with at-risk children, or families whose children are overweight and are/aren’t using a weight management service, or families who have completed a service but are struggling to sustain change?
- Reframe with outcomes: Not outputs. In other words, focus your problem question on what you need to achieve, not how you think you’re going to do it. e.g. focus on “how might we reduce childhood obesity?”, and not “how might we deliver more effective weight management services for children?”.
- Reframe with questioning: Start with your problem statement and keep asking why this is happening until you exhaust all causes, causes of causes, and so on. Then assess which of these causes are the best to problem-solve around depending on ease, impact, influence, etc. e.g. choosing to start with “chaotic family routines” rather than “obesogenic environments” to tackle childhood obesity.
- Reframe with perspectives: Explore how the problem is seen by different people; people affected by the problem, people causing the problem, people looking for a solution, people funding the solution, people developing other solutions, etc. That often helps you re-interpret the problem and unpick other more opportunistic problems that sit tangentially to it. e.g. for a health commissioner the problem may be that the rate of childhood obesity is on the rise. For fried chicken shop owners, the problem may be that demand for healthy alternatives don’t earn them and their families a living. For parents, the problem may be that they struggle to manage their children’s challenging behaviour (generally and not just in relation to eating and activity).
- Reframe by reversing: Generate solutions that can make the problem worse, and then reverse these solutions to see if they help you think of the problem or solution space any differently. For example, Shift designed Box Chicken as a healthy fried chicken takeaway alternative that tastes just as good and is just as cheap.
- Reframe by scope: Think about the least and most ambitious problem you can tackle, starting from doing nothing, to doing everything. Explore the spectrum in between as well; what if you just had to do one thing? What if you had to do it in partnership with someone else? What if you just created the space for others to do something? For example with Digital Weight Management, we’re exploring setting up a challenge fund to energise the digital health market around childhood obesity. We’re also exploring a partnership with CBeebies to maximise reach.
- Reframe with hats: I keep coming back to Edward De Bono’s brilliant Six Thinking Hats. Try and re-consider your problem with these different hats on: what the facts tell you (white hat), what your intuition tells you (red hat), what your optimism tells you (yellow hat), what your creativity tells you (green hat), what your cautious self tells you (black hat), and what this all means about what to do next (blue hat).
I would love to know more about other problem-framing techniques others have used that have worked for them, so please do share!
Other stories:
Read story #1 — Year 2000: deconstructing and reconstructing
Read story #2 — Year 2003: risk and persistence after failure
Read story #3 — Year 2007: curiosity and questioning
