What More Can We Find?
Visual Thinking Strategies in Human-Centered Design
A note to the reader: This piece is co-written by Fred Leichter (Director of the Hive, a design center at The Claremont Colleges), Dabney Hailey (Founder of the Hailey Group), and Olivia Hewitt (Post-Baccalaureate Associate at the Hive), as they explore the impact of an undergraduate course taught by Fred and Dabney and in which Olivia was a student. The main body of the piece is written jointly by Fred and Dabney, sharing their collective perspective and insights. When you see italicized text, you are reading Olivia’s voice as a student.
“What do you see that makes you say that’s a dog?” my classmate Yurie asks me, taking a bite of her scone as we sit in our professor Fred’s garden. I almost want to laugh, but as I try to answer her I realize how complex of a question that really is. How can I explain how I know that what I’m looking at is a photograph of a dog? “Well, I see this animal has four legs, and the way its face is shaped reminds me of other dogs I’ve seen.”
The five of us who sat in Fred’s backyard that day were not, in fact, dog experts, nor amateur art critics. We were design students, learning Visual Thinking Strategies to better understand the work of one of the leading cancer institutes in the world. In order to get to the core of complex stories of healthcare, cancer survivorship, and information overload, we needed to go back to basics. Questions such as, “What do you see that makes you say that’s a dog?” helped us learn to articulate our most basic assumptions, and eventually led to questions such as, “What have you experienced that makes you say that the Dana-Farber Cancer Institute is a place that inspires hope?”
The Experiment
Olivia Hewitt recounts above her experience during a class we, Fred Leichter and Dabney Hailey, taught during Fall 2021 at The Claremont Colleges. As Fred planned the course, Advanced Topics in Human-Centered Design, he wondered: How might we teach this better? How might we slow ourselves and students down for long enough to find deeper insights?
He decided to conduct an experiment by combining the teaching of Human-Centered Design (HCD) with learning Visual Thinking Strategies (VTS), a facilitation method rooted in research from museum education and cognitive psychology. Fred invited Dabney (VTS consultant in the business world) to co-teach the Advanced HCD course by integrating her area of expertise, teaching and applying VTS in the business and healthcare worlds.
And so, our semester-long experiment at the intersection of HCD and VTS began. Fred worked locally with a team of five students in Claremont, California, and Dabney joined class sessions and taught VTS via Zoom.
The Methods
Human-Centered Design (HCD)
At the Hive at The Claremont Colleges (formally known as The Rick and Susan Sontag Center for Collaborative Creativity), Human-Centered Design (HCD) is at the center of how we teach. Our beginner class, E180: Human-Centered Design, is based on the Design Thinking Bootcamp taught at the Stanford d.school. Our students work in teams on ambiguous, real-world problems. Past project prompts include, “Redesign the disaster preparation or recovery experience”; “Redesign the art museum experience for a marginalized person”; and “Redesign the organ donation sign-up experience.” All of these are challenges with no singular “right” answer. Students are eager yet uncomfortable as they embark on these projects. They are often transformed by their design experience and emerge from the introductory class wanting more.
To meet this need, the Hive began offering an Advanced Human-Centered Design course for a small group of four to five students who were majoring or minoring in HCD. For this course, we find an outside organization with a need. The student team collaborates in research, definition, idea generation, prototype creation, testing, and iteration. The class culminates with students putting something real into the world. The final deliverable must be usable, provide tangible benefit to its users, and be presented to the organization. Post-semester next steps should also be developed. The challenge is always to go deep, find new insights, and make a meaningful and real impact in the small confines of a school semester.
Visual Thinking Strategies (VTS)
Co-founded by art museum educator Philip Yenawine and cognitive psychologist Abigail Housen in the late 1980s, VTS was developed to deepen museum visitors’ meaning-making abilities and sense of belonging while looking at art. A VTS discussion is carefully facilitated to balance rigorous structure and open, extended exploration, while also developing the critical thinking skills of participants. Dabney is a former curator who founded and runs Hailey Group, a consultancy that brought VTS to the business world as a leadership and innovation toolkit. We first worked together when Fred ran the design thinking team at Fidelity Investments.
Having worked together for years, we understood how VTS could develop the heightened attentiveness, critical thinking, and empathy fundamental to human-centered design. We had a hunch that learning VTS would help the student HCD designers slow down, notice more, and derive more insights in less time.
Our Fall 2021 Advanced HCD course is, as far as we know, the first course to integrate learning and applying VTS facilitation within human-centered design. Let’s hear again from Olivia on what learning VTS was like for her:
“What’s going on in this picture?” my classmate Alex asked, standing in front of a Frida Kahlo painting projected onto our classroom wall. Yurie, Sam, Claire, Fred, and I sat in chairs facing her and the art, and Dabney joined us via Zoom.
Alex was clutching a small piece of paper where she’d written down three questions:
- What’s going on in this picture?
- What do you see that makes you say that?
- What more can we find?
This was her textbook for the next hour. She wouldn’t deviate from those questions, except to paraphrase back to us what we had said, to check for meaning. We had to trust that these three questions, though seemingly simple, would get us to a place of meaning and value, of surprise and delight. Slowly, the rest of us started chiming in. Yurie noticed that the two versions of the woman in the painting were wearing different clothes. Claire pointed out that the vein connecting the two figures was being clipped at the end, blood dripping onto a pristine white dress. Each time, Alex paraphrased back to us what we had noticed, making sure she understood and helping to ground the rest of us in what we’d just heard.
I remember how struck I was by this conversation. Normally, college class conversations feel like a competition. Who can articulate their thoughts the most eloquently? Make a unique point without sounding like you’re trying too hard? How little do I need to talk to still get participation points? It all can feel very performative.
But this conversation felt different. It felt as if we were trying to solve a puzzle, all together, with Alex as our fearless guide. I could simply point out that the sky in the painting was blue, and that would matter and lead us to a new thought. I remember feeling very held in that conversation, as if every thought, musing, question, would be caught gently and woven into a tapestry of all our different thoughts that at the end of all this would form a meaningful picture.
We began teaching VTS to our students from the very beginning of the course. As Olivia describes, each student facilitated the others as they discussed works of art and project-based materials. We both coached the students as they learned, emphasizing reflective practice, and Dabney facilitated VTS discussions throughout the semester about art, poetry, the students’ own experiences as a team, and more. VTS became a drumbeat, which is the most effective way to integrate its learnings.
Our students learned questions specifically worded to seek evidence and deepen inquiry. They honed their listening skills, focusing on listening to understand and paraphrase back what they hear instead of pursuing their own ideas or directing others to follow a certain line of thinking. They practiced suspending judgment and learned to create space to allow more and more observations and lenses to surface. We encouraged the students to apply VTS as a whole and integrate its individual techniques throughout the semester.
The Design Challenge
This course had a specific project at its heart. We arranged for the Dana-Farber Cancer Institute in Boston to provide a design challenge our students would explore throughout the semester. The Dana-Farber team, including Jess Cheng Schrepel, Senior Project Manager for Digital Health Innovation at Dana-Farber, and Pat Stahl, Director of Volunteer Services and Family Programs at Dana-Farber, asked our students:
“How might we help new cancer patients and their families navigate the information overload that often comes along with a cancer diagnosis?”
The Dana-Farber team knew that the overwhelming emotion of a cancer diagnosis and the ensuing treatment often prevent new patients from making use of the vast resources and information that the Center offers. Their challenge to our students was to find a way to simplify information and potentially identify an electronic means to deliver the right resource at the right time.
The Process
As our students began working through the HCD process, we layered in VTS. We encouraged students to apply both the full VTS discussion method and to integrate its constituent parts in their team and client interactions. The VTS framework and techniques became a shared language of inquiry and exploration for their intra-team work, their client-facing work, and each student’s self-reflection and development. Students learned to confidently hold silence, paraphrase to show understanding without judgment, ensure multiple lenses are surfaced, refrain from leaping to a right answer, and revise ideas based on evidence. Learning VTS was a way to learn about themselves, each other, the design process, and most of all, the clients and patients at the heart of the project.
As they practiced VTS together, they also experienced how VTS can help us move past assumptions, prevent premature conclusions, and gain comfort with ambiguity. VTS heightened and deepened components of the HCD process — empathic communication, patience and openness, separating inference from observation, and creating psychological safety.
Olivia shares more about the process:
We kept using those three guiding questions and kept learning more from Dabney and Fred. Using the Visual Thinking Strategies method, we analyzed interviews we had conducted with patients and volunteers at Dana-Farber, dug into a poem about a cancer diagnosis, and spent time with materials Dana-Farber distributes to patients.
Through this process, we were forced to stay in a space of uncertainty for longer. We would spend hours talking about specific quotes we had heard from volunteers at Dana-Farber, working as a group to piece together what might lie beneath the surface of their words. VTS asked us to slow down, to stay uncertain, to stay inquisitive. As we explored the challenges of information overload and resource distribution at Dana-Farber, we had to ask ourselves, over and over, “What more can we find?”
Over time, VTS stopped being an activity or tool, and started to become a mindset. It helped shape our team culture, and influenced how we interacted with both each other, and challenges we encountered.
The mindset shift Olivia describes was crucial to the students’ insights over the course of the semester. They began the project with a detailed focus on the patient. Here is their first take on mapping the patient experience to help them meet the design challenge:
They didn’t stop there. While realizing the patient focus is critical, they stayed in a place of inquiry and looked more deeply. The student team conducted more interviews, using VTS techniques to reflect back what they heard and check for understanding. Let’s hear again from Olivia:
We spent a long time reviewing and pulling insights from each interview, and while this is typical of the HCD process, this time, we brought VTS principles into our synthesis work, and encouraged each other to ground each observation in evidence. “What did you hear that makes you say this was a pivotal moment for this person?” “What do you see in their words that makes you say they are hopeful?”
This allowed a richer understanding of our problem space to begin to develop. As we spent hours and days mulling over stories, experiences, and quotes we had heard from the Dana-Farber community, a picture began to form, and at the center of it, we saw a group we hadn’t expected: the volunteers at Dana-Farber.
Our students learned that Dana-Farber volunteers are a unique resource: most are either former cancer patients or close relatives of cancer patients. The volunteers’ work touches many different areas of patient care at Dana-Farber. They work closely with patients as well as administrative staff, nurses, caregivers, and more. Volunteers are uniquely positioned to help patients access resources, having navigated this journey themselves. Dana-Farber needed to amplify the work of volunteers, and bring greater attention to their vital role. The team reframed their stakeholder map and arrived at the key insight:
“Dana-Farber gives life. Volunteers give hope.”
As Olivia reflects:
If our challenge as designers was to help distribute resources more effectively, to help patients know about the profound and vast range of resources available to them, we didn’t need to create a new resource to add to the pile. We needed to amplify what was already Dana-Farber’s most valuable and life-altering resource: their volunteer community.
Visual Thinking Strategies played a key role in helping us identify this insight. Rather than jumping on our first or most obvious idea — perhaps improving the online resource database or doing more advertising around existing resources — we had to stay in a place of observation and listening longer to come to a less obvious but more resonant conclusion.
The impact of bringing VTS into our HCD work was felt by our student design team. Claire shared that VTS helped us to be more intentional with where we directed our focus, as well as helped us listen to others and generate ideas. Yurie shared that the VTS process helped her get more out of interviews, as she shifted her attention away from asking the perfect questions and instead focused on listening deeply. Reflecting back what she heard, she said, helped the people she interviewed to feel heard, appreciated, and in turn, share more. Sam shared that the mix of HCD and VTS helped her think more critically about the problem space, and pay attention to the tone and body language of the people we spoke with. Alex shared that VTS provided a helpful “pace and space” for inquiry, and helped us ground our observations in evidence. And as Olivia reflects below:
The success of our design work was not due to prior experience in the medical field (of which we had none), nor to stunning visual design skills, or breakthrough data analysis. What made our work successful was our ability to ask questions, to stay a little longer in a place of uncertainty, have the courage to look again, and work as a group to develop deeper, more layered meaning, and ask each other, “What more can we find?” And what we found at the heart of the institution were the volunteers whose work and role needed to be amplified.
VTS’s core questions became guiding principles in our work. Not just when we were analyzing text or images, but also in many small, daily moments. In moments where we felt stuck, we would ask, “What more can we find?”
In our client presentations, when we invited Dana-Farber staff to engage with us and our findings, we would slow down the pace, pause, and ask, “What is going on in this diagram?”
When we needed a way to challenge each other to back up our ideas with evidence, in a way that inspired dialogue, and not shutting down, we’d ask, “What do you see that makes you say that?”
VTS created a culture within our design practice where slowing down was worthwhile, where confusion could lead to insight, and where disagreeing might challenge us all to understand each other and our problem space more deeply.
The impact of our work was felt and expressed by the Dana-Farber team, as well. As Pat Stahl, Director of Volunteer Services and Family Programs at Dana-Farber, said, “The one most powerful thing you captured, even from a distance, was the impact that a relationship can have. You were able to capture and really understand the power of even the smallest thing, like the expression on someone’s face, or the personal touch, and the impact that can have in volunteers’ work with patients and families. Listening is so key to what our volunteers do for patients and families, and you did it for them, very clearly. I’m blown away by the quality of your work and what you’ve done, so thank you from the bottom of your heart.”
As one of Dana-Farber’s volunteers shared at our final presentation, “As a volunteer, I feel very very recognized with this presentation, and I would hope and like that it is shown to all the volunteers, because it’s a huge thank you to us. I can’t believe the job you have done, gathering all this information, pinpointing the littlest things that we do, and making us feel bigger.”
A common theme in this feedback was the student team’s ability to listen deeply, and pay attention to small details. It was no coincidence that this was the practice the team had been working on all along, slowing down long enough to pause in the face of complexity, and ask, “What more can we find?”
The depth added by VTS surprised us, particularly in terms of its flexibility across the design process and its impact on how the students showed up for the client and one another.
Learning and applying VTS contributed to their team dynamic and their sense of responsibility to one another and the Dana-Farber client team. The students shifted their stances — how they showed up for one another and the clients and volunteers.
We hoped VTS might provide a helpful tool for the students as they worked on this challenge, but what we saw was far greater. We saw VTS become a pulse, a design principle, and a guiding force in team dynamics.
The essence of design is to make meaning and to make that meaning in new and valuable ways. Impactful designers seek to look deeply, find more, separate inference from observation, welcome ambiguity, and be present and empathic with users, clients, and each other. We were surprised and delighted at how VTS not only supported these skills, but deepened them.
