Blog 6: Designing for Care and Connection— Design Frame Reflections from a “Light” Systemic Design Scenario
Artwork Blog 6: “A mother as creator” by Annie Wang, symbolising how our ancestors and our stories continue to show up in ourselves
Soundtrack Blog 6: Bloodflow — Grand Brothers
Read previous blogs in this series: Prologue, Introduction (blog 1), A Complex Matter (blog 2), Systemic Viewpoints (blog 3), Shapeshifting Design (blog 4), De-methodising Design? (intermezzo blog), The Relating Public Servant (blog 5), Relating Design Story (blog 6), The Collaborating Public Servant (blog 7) Collaborative Design Story (blog 8) and The Learning Public Servant: REWILD-ing the mind (blog 9) and Learning Design Story (blog 10)
Systemic design thinking and practices are gaining momentum by entering the field of government policies, services and program design. In the 10–part “Unbounded Affairs: Systemic Design (with)in Government’’ blog series a diverse collective of thinkers and practitioners explores the concept of “public systemic design” for a relational future. How to deliver “good” public services in an increasingly “complex” world?
In this blog, blog 6, Marlieke Kieboom and Laura Hebert, both Service Design Practice leads in the British Columbia Public Service (Canada), share their personal, heartfelt experiences and stories on being (or trying to be) “relational” public servants, on being designers and on being human beings in a highly complex design project about opioids and drug use.
The blog contains 4 stories (also recorded as short soundbites — see links below). The stories reflect their experience as public service designers who actively tried to design with “complexity” in a highly contested yet “light” design space that was initially focussed on service design for a digital product.
How to get comfortable with the complexity they found themselves in? How did their context require, enable or disable “shapeshifting” between different identities to influence complex systems? How did they widen people’s views, and expanded people’s approaches? How did they try to bring others along? What would they do differently, looking back? How is their story describing a “light” design scenario, and what does “relating” (see blog 5) bring to a scenario like this one ?
This blog can be used for educational purposes. Get a group of colleagues together and reflect together on the “shapeshifting” design codes (relating, collaborating, learning) and behaviours (chameleoning, jumping out/escaping, transforming) that made their design work at times both possible and impossible. Have fun in the “in-between”!
Notes of importance:
- Trigger warning: this blog contains stories about drugs, death, dying and intergenerational trauma— please seek help if you are in need of help. If you reside in British Columbia you can find helpful resources on Stop Overdose BC.
- The situation subject to the reflections is ongoing — since the declaration of the public health emergency in 2016 more than 11,195 deaths have been caused by illicit drug toxicity in the Province of BC alone. There is no explicit or implicit causation between the project discussed in this blog and the ongoing situation.
- This story does not disclose personal information from citizens — information that is shared here is publicly available and/or was previously shared through written consent from the storytellers.
- This story is aimed at learning from design practices in complex settings, it is not aimed at critiquing Government approaches.
- This story contains personal reflections and does not represent previous or current views of the BC Government. Permission was sought and provided to publish methodological reflections for learning purposes.
The situation
In 2016 a significant increase in drug-related overdoses and deaths prompted the Province of British Columbia to declare a public health emergency. In July 2017 the Ministry of Mental Health and Addictions was established. Soon after, Marlieke and Laura received their design assignment: conduct design research to inform both a new Provincial communication campaign to lower overdose deaths and the development of an app to lower overdose deaths amongst people who use drugs alone in their homes. At the time the statistical numbers were telling:
- 1,495 suspected illicit drug overdose deaths across British Columbia in 2017, and numbers were on the rise
- Almost 90% of the overdoses occurred indoors, more than 50% in private homes
- People who were most at risk were men, aged 30–59 and Indigenous people
Laura and Marlieke reflect on their design project brief:
“We immediately wondered: Why an app? Why jump to the solution so quickly? What is behind those numbers? Already in our first meeting with the Ministry we suggested zooming out first, and to ask people with lived experience in using drugs what they thought the drivers were behind those numbers, and ask for their ideas on how to lower overdoses. At first our Ministry partner wasn’t so sure. They expressed unease with the complexity and uncertainty of it all. One colleague said: “I don’t think we can do this, I don’t think we can find people who want to talk to us about this.” We understood that they had very little experience with design research. So we responded with: “Don’t worry about that, we will figure that out together, as long as you come along for it and support us in doing it this way.” And they agreed, they were really eager to work in a different way as it was clear that the current way wasn’t working.”
With this new, widened project brief that also gained support from their own Division, the public service designers set out to do design research. Marlieke and Laura continue to reflect:
“This project was so different from any other service design project we’ve worked on. This wasn’t about data or digital design. This was about a big, societal problem. But that wasn’t really reflected in our project constraints, in terms of being enabled to really work at that systemic level. The timeline was too short [6 months]. Also the problem space required us to collaborate cross-Ministerially, however the project “owner” was just one Ministry, and more specifically a communications team, not a policy or a regulations team. Our project team was super tiny. Just us service designers, a co-op student, a peer researcher, our manager and the comms folks from the Ministry. Our budget just covered our staff wages, some travel and stipends for the people we talked to. But maybe these constraints also helped us to stay very nimble and agile? Who knows.”.
Despite these constraints Marlieke and Laura set out to do the work. There was political momentum. They realized that there may never really be a project context that is perfect for “systemic design”. One just has to start “doing”.
The design approach
The project team took a very emergent, creative approach that was quite focussed on creating deeper “relating”: to each other, to the people, to the organisations, and ultimately to the situation we were trying to influence.
The first element of this approach was unique in the way that it shaped their team dynamics. Besides two designers, Marlieke and Laura got permission to connect with someone with active, lived experience in using drugs on a daily basis (heroine) and onboard them as a paid peer researcher on the team. It was the very first time in the history of the Public Service to take this approach. The peer researcher became a key figure in the project — which we’ll talk about in our first story below.
The project team then took a “networked“ team approach to establish their broader design team. What this meant was that the core design team was small and consisted mostly of Ministry people and the paid peer researcher. But the team was in constant connection and communication with a much larger team, consisting of Health Authorities, community action organisations and service providers (such as ambulance personnel, fire fighters, health care workers, harm reduction workers). The team was also in touch with a weekly “overdose task-group” that expanded the entire Province. This was the thought behind this “networked” model:
“It was kind of like a heart-shaped model. We positioned ourselves in the centre with our peer researcher, and then on the one side we had we all the service provider organisations, and on the other hand the community organisations. The different views and knowledges combined somewhat reflected or “mirrored” the complex situation that we were trying to influence.
It was a lot of work to keep everyone in the loop all the time, but in this way people could provide input on the next steps, and reflect on and use the insights as they emerged — something that was important because the crisis was happening in real time. It also created a sense of ownership over the findings.”
The second element was the way they designed their design approach. Marlieke and Laura called it the “golden spiral” design approach, after the Fibonacci spiral found in the natural world. What did that look like?
In the “golden spiral” approach the core-team first focussed on shaping their relations. Together they started learning and gaining insights with a smaller group of people with lived experience in using drugs and support providers (for example service providers, volunteers, ambulance and firefighters, parents). In a second round of co-research, co-analysis and co-design they then focussed on widening the collaborations and prototyping potential service designs.
“This was a very empowering, enabling approach, but the challenge was that this approach needed a lot of hand holding at the executive level, because people had to trust the process to see what would emerge, that it would snowball into something, without knowing exactly what the snowball would look like after 6 months.”
The team ended up talking to over 100 people: people with lived experience using drugs, people who had lost people to drug overdose, people in service provider roles, people in community action groups. One of the key elements of this work was to generate “stories” together and to let them travel: via people, via systems maps, via meetings in person. In this “story work” they made sure the “numbers” (for example % of Indigenous people affected by the situation) was reflected in their research approach. The team also physically travelled to 6 different locations across the Province and covered both urban and rural areas to gain a deeper understanding of the situation.
What follows are 4 short stories as told from Marlieke and Laura’s personal project experience perspective. The stories reflect the trials and tribulations of navigating the visible and invisible boundaries of “in-between” design spaces, and of public servants as humans who fully immerse themselves in the complexity and uncertainty of a systemic design project. Be prepared to read about hardship, controversy and celebrations of small “shifts” in the “in-between”.
We can use the visual below to help to see how the designers moved “in — between” different design spaces to shift systemic views and realities.
The “in-between” stories
Story 1 — The Inside/Outside Peer researcher
Listen to a recording of this story (2:07 min)— narrated by Marlieke
“For our project we were looking for someone who could join the design team as a peer researcher. Someone with lived experience using hard drugs, and who could help us in our project on a paid, daily basis.
We first met “Voices”, his chosen pseudonym, at a house where he was squatting with a friend. At the time the two of them were running an unregulated safe-injection site for people who use drugs. Understandably he wasn’t so sure about meeting these “white-collared” government folks.
We had an hour-long conversation. It wasn’t all about work. It was mostly about our personal lives actually. At one point he wanted to know if we had ever used drugs? We hesitated to say “yes”, until one of us did. And that was it. We made a connection and he started working on the project. He provided us with personal insights into using heroin on a daily basis. He helped us connect to people to talk to. He reflected on our project materials and he was a host at our co-design events. To us he was part of our project team.
But was he really? We had a hard time finding a way to compensate him for his valuable time. We couldn’t get him on the government pay roll, and paying him formally would interfere with his taxes and income assistance. So we paid him in VISA gift cards. It was humiliating for him to sit down in a cafe and sign all the paperwork, every time. Us, 30 somethings, and him, 50 something, exchanging plastic cards over a coffee. It just didn’t feel “right”, but it was all the “system” allowed us to do.
The same dynamic happened for going on field trips, for entering government buildings, and for having him join official, “higher-up” meetings. Access granted, access denied. “You hurt my feelings. J/k. Have fun”, he would write via text message in various occasions.
We got really creative though. We had a situation where we noticed the Ministry policy folks got a bit nervous about having him at a meeting with a Deputy Minister. “What if he derailed the meeting?” they said. So we recorded his voice, and broadcasted his speech. It was terrific. Access wasn’t granted or denied. This time his Voice represented access “in-between.”
Story 2: Cooking Up Drugs (…at a Co-Design Workshop)
Listen to a recording of this story (4.02 min)— narrated by Marlieke
“Story 2 continues to feature Voices, our peer researcher. This time in a star role.
We had to find a way to present our research findings to community members who use drugs and to co-design new service prototypes. We had identified areas of opportunity such as “design safe spaces to use drugs” and “design anti-stigma training for hospital staff.” But how do you go about co-design, when the community members are not trusting of anything the government does, and the government itself actively criminalises the personal possession of drugs?
Together with our peer researcher and harm reduction workers we found an art space in town that was temporarily hosting art made by the community who had lost lives over opioid overdoses. It was a perfect, inviting space. We set up some tables and provided food. We had gift cards to thank people for their time. We also invited partnering organisations to help us host. We weren’t sure if anyone would show up.
But the real host was Voices though. He was at the entrance and was the first person people would meet. He would take people’s coats, stash their belongings, and introduce them to the work we set out to do that day. He took on this role with great care. His network trusted him, and over 40 people showed up that day.
However, we were about an hour in, and he was nowhere to be seen. We looked everywhere, inside, outside. We checked the toilets. We had been quite adamant about disabling the locks on the toilets so that we could guarantee people’s safety. It was a government event after all and an overdose would have been terrible, from every angle. He wasn’t there either.
Then we noticed some vague movements from behind the garage door. And there was Voices, with a woman who had just entered our art space. She did not look well. She was sweating and looked anxious. Voices ushered us to go away. “Trust me,” he said. “Everything’s ok, I’m just helping, and I will explain later.” Ok.. we said. Moments later he appeared, together with the woman. She looked much more at ease and made her way over to one of the tables to provide her insights on our project.
After the event, Voices came over to us and shared: “So you wanted me to host, and to keep people safe, and to get people in a state so that they can work with you. So that’s exactly what I did. I cooked her up some drugs and she was good to go.”
He was right. Even though the story felt so “outside government”, the co-design event got us to 5 service design directions that would go on to inform policy to decriminalise the possession of drugs for personal use, inform a Province-wide campaign and the development of the “Lifeguard App” to get assistance in case of an overdose.
Reflecting on this experience later, we felt deeply the real challenge of working as public servants on a problem that holds controversy, involves illegal activities, and — most importantly — impacts people’s safety and lives.
How can we work authentically with people if we can’t look this problem in the eye for what it is? How can government attempt to solve a problem like this if we aren’t honest with ourselves about what people are experiencing and really listen to people to hear from them what they need? How might we be better, more open, more honest in this work to make it safer for everyone? One of our key takeaways as designers after this event was to include safe places to use drugs for future events.”
Story 3: Tissues For the Government
Listen to a recording of this story (2:36 min)— narrated by Marlieke
“This is a story about parents who lost their son at the age of 26 to a drug overdose in 2017.
We received a call on our field research trip, late in the day to inviting us over to a family’s home that night. They had lost their son months before and they wanted to tell their story “to the government”.
Nothing could have prepared us for our visit. Parents J. and J. let us into their home. We sat down at their kitchen table. We introduced them to the project. They introduced us to their son, who had passed away months before from a drug overdose at the age of 26. We listened to a heart-breaking story of grief. No one kept it dry. There were tissues for us, “the government”. Were we “the government”? Or were we just people, trying to connect and trying to make sense of what had just happened? We couldn’t be government workers with some kind of mask on. It felt so human to hear this story in their home, at their kitchen table.
It got late, we had to go. It felt good to share their story, they said. They asked us what we would do with it. We said we would take it to the Minister. And so we did.
At the time we felt we had done something tangible and meaningful. But was it? In the 5 years to come these parents would keep advocating for a safe drug supply to local governments, at schools and to politicians. They would keep telling their story over and over, on repeat. Many more tissues were handed over. But they feel nothing has changed. “It’s hard to continue with that energy — you feel defeated, disappointed and disgusted,” noted father J. in a recent newspaper article. “The systems in place don’t provide answers,” shared mother J..
To us it was a story within a project, a project that ended. To them this story is their whole lives. How could we convey this message to our leaders, who weren’t in that kitchen? And would it have made a difference, if they were?
Read “The One With the Pilot Light”, the story about their son, Ryan.
Story 4: The Unbriefed Executive
Listen to a recording of this story (2:37 min)— narrated by Marlieke
“Our last story is about an unbriefed executive, and how this event lead to a significant shift in our project.
It happened on a Friday afternoon. It was already late. By surprise an Assistant Deputy Minister from another department popped into our meeting room. He wanted to know what we were working on. “I heard you are on that “drugs” project?”.” Due to the sensitivity of the data we kept our response a bit vague. All of our research included consent from participants, in which we committed to only using the information collected for the purposes of the specified project.
But he insisted. When we finally started talking a bit more about our project his tone changed. “I want you to give up all your documentation, right now.” We froze and we felt overpowered, as humans, as designers, as women. But we stood our ground. We somehow instinctively knew that giving up our project information would seriously derail our project at a political level — and besides, this was an unusual way for a request like this to occur. So we politely refused again and referred the ADM back to our director. The Assistant Deputy Minister got verbally angry and then walked away.
Later we found out that this particular Assistant Deputy Minister wasn’t informed properly about our project, probably due to time constraints and the speed at which we were working. Apparently he had perceived our project as a “threat” to his plan for the next communications campaign, which centred on the idea: “Don’t do drugs”. His view was vastly different from our project insights, which would ultimately take the communications campaign into the direction of anti-stigmatisation of drug-use.
In hindsight we realised our own omission. We should have included him and his team from the get-go. We should have also taken the time to better uncover both our own assumptions as well the assumptions of people in decision-making positions about using drugs. We quickly organised a special meeting for him and his team. After that meeting everyone was “on board”. The campaign was called “Stop Overdose”, the first anti-stigma campaign of its kind, and is still ongoing today.”
Reflections on the Design Process
Marlieke and Laura’s stories highlight the importance of developing a special public service design skill set: one that enables designers to move and navigate “in-between” people with different views, assumptions and power positions, “in-between” different places, but also over different time-spans in order to “hold” complexity while “moving with” complexity.
What made their project a “systemic design” project, rather than a “service design project”? Marlieke and Laura reflect:
“We didn’t really focus so much on a single, end-to-end service level. We zoomed out and looked at the interrelatedness of policy, services and relationships, before zooming back in at the service level to design a “set of services”. By doing so we also focussed on building relationships, and building new collaborations for new services to emerge, instead of designing the “thing” itself, such as an app, or a new anti-stigma training for hospitals. We could have, but by working in this way the ownership over the prototypes we arrived at laid much more in the middle, in between government and society. So yeah, we were prototyping the relations, how to relate to one another, by learning and designing in the open, instead of prototyping the services right away.
Reflections on “Light” Systemic Design Context and Outcomes
Laura and Marlieke’s systemic design project was situated in a “light” design scenario while working in a complex context. As reflected on in blog 5, a “light” systemic design scenario is characterised by:
- a positive momentum for collaboration and change — pressure to create good outcomes
- a strong focus on the development of a product or service, but less focus on the relations, values and ideas that will generate the design of the product or service
- a short time line, typically 6 months to a year
- there is a chance to do co-design, but there is little or no “time” or willingness to co-design the way people collaborate over getting to the product, policy or service (no co-navigation or co-design prior to co-design) — which reflective of an existing power imbalance
At the time they hadn’t specified the light, deep or far+wide systemic design scenarios, but they intuitively focussed on expanding, stretching and widening visible and invisible “boundaries” by creating more “relating” in many directions. What were the outcomes of this approach?
The project team managed to influence quite important directions for policy, communication and perceptions while building relationships that lasted long after the project ended. A year after the project had started they arrived at:
- A diverse set of co-designed opportunities
- Reframing the Ministry’s problem realm from a focus on “criminal justice” to a focus on “health-pain-trauma”
- Evidence-based, province-wide media campaign to reduce stigma that is ongoing today
2. Deeper knowledge about the situation and deeper relationships between people
- Strengthened relationships based on empathy between Ministries, Health Authorities, community action groups and citizens
- Better informed Ministry officials, Health Authorities and members of the public
- Openly available educational tools for understanding lived experience with using drugs, such as Journey Map, Systems Map, 25 Stories from people with lived experience and service providers, an Opportunities Booklet, a case study and a blog.
3. A more open and innovative B.C. Public Service and government
- Increased human-centred design capabilities with public services employees in the Ministry and in parterning Health Authorities
- Innovative design methodology that was shared publicly and can be replicated in other jurisdictions
Did their project influence or move a dial in the much “bigger picture” at all, they think? That is hard to say…
“In the context of the problem space, which took several decades to coalesce, evolve and emerge, our 6-month design project was more like “acupuncture”. The complexity and human loss continues: more than 10,000 people have lost their lives to an opioid overdose in B.C. since 2016. It is very hard to think about that…
The drug overdose numbers peaked during the pandemic of 2020-2021 and people who are addicted to drugs continue to experience major hardship in other areas as well, such as housing, income and health care. However, there is also something positive to reflect on. In January 2023 British Columbia became the first Province in Canada to decriminalise personal possession of opioids under 2,5 grams [CBC, 3 June 2022]. Maybe our project contributed to this outcome, it’s hard to say.”
Was there anything they would do differently? Marlieke and Laura share:
“The hierarchy in government is real. Throughout our entire project government decision makers were not part of the actual design research experience, nor was there any form of power-sharing happening. Maybe if we would do it again, we would try and start there, and really bring people in powerful positions along from the start, both from a government perspective as well as a community perspective, to really start shifting mindsets. We also didn’t have a pre-approved budget to continue the “magic” we had created post-project. That was hard, to see those relationships fade that we had worked so hard to create. It felt like we breached trust that we had so carefully built up.
Another thought we have is about the reframing of the problem space from “drugs are criminal” to overdosing being a “health, pain and trauma issue”. At first we thought it was very powerful and a real accomplishment. But after five years of not really seeing the numbers decline, we have to maybe ask ourselves a different, deeper question to start with: how is this situation an outcome of how we live, how we care for each other, and especially more so: how we are not caring for each other? How is this a “crisis of caring” in our society? How would we design public services for wellbeing, thriving, relations and collaboration?”.”
Marlieke and Laura have ideas for others who are thinking of working in similar ways:
- Recognise the level of complexity right from the get go, what kind of approach fits best: a more linear, “end-to-end” service design approach or a more “relational”, spiral shaped systemic design process?
- Create organisational readiness for more emergent strategies, for embracing ambiguity and to “trust the process”
- Make the value of a project like this very explicit right away: strengthened relationships between government and communities, better seeing connections between existing and non-existing services, policies, programs to lower risk of designing the “wrong” services
- Support and build relationships after the “project” ends
- Take a “two-track design approach” that looks differently at the concept of “time”: focus on “long time” collaborations and outlooks to lower short term risk of “designing the wrong thing”, and produce “small gusts forward”, small wins on the short term, while understanding the “past” to acknowledge how situations can take decades to come to be (
- Do not only focus on “knowledge production sharing” but also on “power and decision making sharing”
- Introduce processes to facilitate the surfacing of our own assumptions about the complex situation at hand, for example about using drugs
- Position a project cross-Ministerially: not in comms departments, not in one Ministry but across policy/digital/comms teams, and across Ministries
- Try to get funding up front for prototyping new services and take the prototyping process into public settings, for example through a travelling art exhibition
- Embrace and facilitate for conflict and healing harm in the design process
- Re-position the project in a “place-based” way that helps people connect the complex topic to humanity, ecological environments and economic ideas such as colonialism and capitalism
Marlieke and Laura want to leave us with the following thoughts.
“There was a pressure to make an impact: to make something, make some changes, and to do it innovatively, and to do it fast. That was a challenge, because this work needs more space, more time. It’s a challenge for government, to give it the space it needs for all those unknowns. This [systemic design] approach really needs that kind of deep space, to see what can emerge. We don’t need deadlines, deliverables imposed on this space. It has to be truly emergent, but that’s contrary to how things go. It’s more like: go get money for something that you say you’re going to do, and then you go do that thing. That’s the opposite of emergence.”
“Systemic design really is some kind of art. It’s about being with and relating to complexity within ourselves and with others. The magic in systemic design comes when being able to practise systemic design by moving with complexity over time, the past, present, future, while making connections in the “in-between” spaces, between ourselves, with the project, in government, in society, and ultimately the world.”
We don’t need deadlines, deliverables imposed on this space. It has to be truly emergent, but that’s contrary to how things go. It’s more like: go get money for something that you say you’re going to do, and then you go do that thing. That’s the opposite of emergence.”
What’s next
This blog was an example of how we can work with complexity in a “light” systemic design scenario by designing for more “relating”. What did this story bring up for you and your work?
In the next 2 blogs we will speak about practicing inter-systemic design in a “deep” work scenario and we will share another practice story from the “in-between” by Ontario-based “institutional” architect Robert Boraks, about how re-designing prison spaces together with people with Indigenous worldviews can help to change the way governments, and society at large, think and act about our actions, such as “punishment” and “incarceration”.
Further reading / listening / watching
- BC Mental Health and Addictions Roadmap
- The Myth of Normal — Gabor Maté (2022)
About the Author, this Blog series and the Collective
Get in touch! My email is: first name dot last name @gov dot bc dot ca
Marlieke Kieboom (white, she-her, Zeeuws-Flamish-Dutch-German and “unknown” roots, MSc Political Anthropology + MA Complex Emergencies, immigrant settler* in Canada | Turtle Island) is a public service designer with 20+ years of experience and knowledge in the fields of social innovation, systemic (service) design, complexity science and public policy. Marlieke has led major collaborations between academia, governments, non-profits and communities in Europe, Canada and Latin America. She finds joy in developing new approaches for coming to see and relate to each other and the complexity of our worlds in collaborative, participatory and decolonised ways. Read more about what inspired Marlieke to write this blog series in the Prologue.
Marlieke wrote this blog series based on conversations with a like-minded and like-hearted collective — the “Ministry of Unbounded & Entangled Affairs” — whose people work and think at the intersections of design, public policy, complexity, social justice and deep ecology. The series was written over the course of 2022. Read more about the collective and the blog series in Blog 1.
Marlieke currently works for the Public Service of British Columbia in the field of public service and systemic design. This blog series was written in her personal time on personal title. Her personal views are mixed in with the collective she spoke with. They do not represent the political views of the government she works for.
Consider making a one-time contribution via Paypal or becoming a supporter on Patreon to get early access to upcoming blogs and express gratitude for 300+ hours of “free” research and to nurture future writing, community building and the development of open learning material on systemic design for public servants. Thank you!
* “A settler is someone who benefits from the privilege of having their worldview imposed upon the lands and the bodies of everyone living in these lands” — Chelsea Vowel (Vice, 2019)
