Using Service Design, Music and Technology to help revolutionise dementia care

An in-depth interview about our journey from research, to product strategy and implementation in the healthcare sector.

Authors: Andreas Conradi and Ivan Entchevitch
Interviewed by:
Marc Stickdorn, Adam Lawrence & Markus Hormess

Introduction from Marc Stickdorn, Markus Hormess and Adam Lawrence:

Ivan and Andreas are alumni of our This is Service Design Doing (#TiSDD) Executive School. This is the learning experience which developed into the TiSDD book published at the start of 2018. Our alumni use a Whatsapp group to share progress, projects and the occasional baby photo. Andreas and Ivan started posting some photos and learnings from a project with Music For My Mind — a UK charity that supports people affected by dementia. MFMM is innovating and scaling the use of personalized music from their formative years to improve the health outcomes of the people living with dementia. It was an intriguing case study centred around using Service Design to drive innovation in an area that intersects non-profits, public health, policy and technology. We thought this would be a valuable story to share with the Service Design and Public Health communities, and this article is the result. We’ve never done a 5-person interview before (and might not again :)) but in the spirit of co-creation and experimentation, we decided to give it a shot!

TiSDD: Can you tell us how you got connected to this project?

Ivan: I was approached by Mark Williamson, who used to work at Spotify, and is now an entrepreneur and one of the trustees of Music for My Mind (MFMM). We both agreed that Service Design would be a powerful methodology to help MFMM define their digital product strategy and proposition. Mark then arranged a call with Prof. Keith McAdam — the founder of MFMM, who was involved with medical research in Africa in the 80s and 90s. Most recently, he founded and directs the Infectious Diseases Institute in Uganda, caring for people living with AIDS. Through his work, Prof. Keith McAdam understood early on that positive health outcomes can be supported by the arts and creativity. After we got buy-in on running a Service Design process from Prof. McAdam and MFMM, I reached out to Andreas Conradi and Red Badger to help co-facilitate the project. Earlier in the year, I had seen a case study of the PRIDE London app that Red Badger had designed and delivered as an open source, pro-bono, voluntary project, and I thought there were some nice parallels with what we were trying to achieve here.

TiSDD: Can you give more context around dementia for those who are not too familiar with this disorder?

Andreas: ‘Dementia’ is a broad category of brain diseases that cause a long-term decrease in people’s ability to think, remember and ultimately in their daily functioning. It currently affects 1 in 6 people over 80 years old… By 2025, the number of people with dementia in the UK will have increased to around 1.2 million.

TiSDD: Tell us why it was important for you to get involved in social projects and this project in particular?

Ivan: As designers, marketers, and strategists, we are deeply passionate about helping people and creating better experiences. However, the reality is we don’t often get the opportunity to solve problems that have true human impact and deal with pressing global issues such as the environment, inequality — and in this case public health. On a personal note, my father was diagnosed with dementia last year, though he’s probably had it since 2013. I’ve seen the impact it’s had — not only on him, but on my mother who has assumed a lot of caregiver responsibilities.

“The reality is we don’t often get the opportunity to solve problems that have true human impact and deal with pressing global issues such as the environment, inequality and in this case public health.“
PRIDE London app that Red Badger had designed and delivered as an open source, pro-bono, voluntary project https://youtu.be/TBT0evmWr0g

Andreas: When I started to talk about the project at Red Badger, I heard many stories from colleagues, happy and sad, about their own family members who are living with dementia. Nobody had spoken about it until then and I was amazed at the depth of these conversations. At Red Badger, many of us want to make a social impact in our day job. In simple terms, we care — so much so that it’s part of our brand and purpose. We want to use our skills for social good but also see it as a great opportunity to expand our domain knowledge in new sectors. Most recently, we have designed and released the PRIDE London app. We like to do, not just talk about social impact.

“We want to use our skills for social good but also see it as a great opportunity to expand our domain knowledge in new sectors. We like to do, not just talk about social impact.“
MFMM preliminary pilot study https://youtu.be/9KTgAs1sKHs

TiSDD: What was the main problem you were trying to solve?

Andreas: In a pilot study, MFMM observed the positive effects that listening to music from a person’s formative years (14–22) can have for people living with dementia. However only very few songs may be remembered, and a person with dementia might not be able to communicate well, so finding those few songs is like finding a needle in a haystack. Currently, discovering the right music can take weeks and involves a large amount of time from volunteers and/or carers.

Ivan: To make MFMM viable in the context of care homes, caregivers need a quick way to create a personalised playlist. Simply speaking, this is like a Spotify for people living with dementia. While the MFMM team is world-class in terms of its medical, research and non-profit expertise, this represents a deeply complex technological problem that would challenge a tech company, let alone a medically driven charity.

“Listening to music from a person’s formative years (14–22) can have a positive effect for people living with dementia. However, only very few songs may be remembered, and a person with dementia might not be able to communicate well, so finding those few songs is like finding a needle in a haystack.”
Double diamond, This is Service Design Doing book

TiSDD: Why did you think a Service Design methodology was the right way to approach this challenge?

Andreas: Like many non-profits, the wider MFMM team is geo-scattered and had never truly all been in “one room” up until that point which can slow down progress. So we decided that organizing a workshop, with the key stakeholders physically present, would constitute a crucial step for driving the project forward. There is a famous quote by Arne Van Osteroom, who suggests that Service Design can act as a common language and glue between different perspectives and disciplines. This idea resonated with us when we started working on this project.

“Service Design can act as a common language and glue between different perspectives and disciplines.”
In-depth interview with Mark Williamson in advance of the workshop

TiSDD: Research is perhaps the most important activity within Service Design. How did you approach research for a project with such a widely scattered team?

Andreas: Yes, the workshop was only the most visible part of the project. First we devised a research plan which had to consider the main logistical constraints at hand: we were all in different parts of the world and only had 2 weeks to prepare for the workshop. To build our own understanding of the subject matter, we arranged 12 video calls with the MFMM team and specialists in the UK and US.

Ivan: We used Google Hangouts to conduct and record interviews so the MFMM team would be able to access all the “raw data” anytime they wanted to dig into it in more detail. For example, we spoke with a relative who provided us with a lot of hard-hitting insights into the challenges of caring for a loved one living with dementia. He was part of the initial MFMM pilot and spoke about his experience administering a music program from both the relative and caregiver perspective. It’s not as easy as just putting on some music, as there are challenges with engaging the person with dementia, as well training the staff on how to use a music program and the tech that comes with it. There’s even the potential of equipment being misplaced or stolen. Hearing all these insights first-hand had a big impact on the team and our approach around coming up with our playlist technology and audio solutions.

Dr. Anne Horsman, a former GP and volunteer care home visitor, speaks about the professional carer perspective she used to create a Journey Map.

TiSDD: What were your goals for the workshop? And how did you decide on those?

Andreas: For the workshop, we were able to bring in medical professionals & researchers, professional caregivers, and relatives of people with dementia. Their participation and co-creation was both rewarding and invaluable. Based on our conversation with the MFMM team, we defined the goals as:

  1. Create empathy and understanding of the needs of people living with dementia, their relatives and caregivers.
  2. Create low-fi prototypes exploring our hypothesis around playlist creation, music delivery and user adoption.
  3. Build a research backlog and roadmap towards the scaling and adoption of MFMM’s program and equip the charity with an actionable toolkit to move the project into the next stage.

TiSDD: How did you approach planning the workshop phases?

Ivan: As we got closer to the workshop, we were able to plan all the activities for the two days almost down to the minute, including where to use warm-ups, energizers and breaks. It was an iterative process of refinement, co-creation and healthy debate. For example, what method to use for insights? Or, how much time to allocate for prototyping and how to introduce the methods in a way that’s comprehensive, but doesn’t take up too much time?

Workshop agenda, draft

Andreas: At a very high level, Day 1 was dedicated to creating empathy, alignment and understanding around our personas, journeys and generating multiple insights that could be taken into the second day. Day 2 was focused around ideation and the prototyping of solutions. In the last activity, we built a roadmap for research and the first steps of implementation.

Ian Bullock, CEO of the Royal College of Physicians told us about the RCP Clinical Guideline processes

TiSDD: How did you kick off the workshop phase and what were some of the tools and methods you used?

Andreas: We began by giving a quick presentation on Service Design and our Lean approach to Product Strategy. I used some of the tools we already had prepared for our Red Badger Academy. Then, to share our learnings from the pre-research, we invited some of the people we interviewed to summarise their insights in a brief PechaKucha-like 7 min presentation. We added their insights to a research wall, so it could easily be accessed during the workshop.

The MFMM Team gave us insights from their pre-study, their project goals and a brief overview of other organisations working on creating positive health outcomes through music.

Ian Bullock, CEO of the Royal College of Physicians told us about the RCP Clinical Guideline processes and the steps it takes to achieve clinical approval through NICE. We learned that a more qualitative/narrative approach could achieve the NICE approval just as well as quantitative studies.

A Google Hangout interview with Nicc Johnson of Muru Music.

Nicc Johnson, founder and musicologist at Muru Music explained how the Muru API works and how Muru personalizes and “scores” music playlists based on listening habits and personality type.

Dr. Fiona Costa, PhD, Honorary Research Fellow, University of Roehampton presented some of her research findings relating to the effectiveness of music in the care of older people, the compilation of suitable music playlists and working with carers.

Marcel Gehrung, PhD candidate, Machine Learning in Healthcare at the University of Cambridge spoke about using physiological data and pattern recognition as an assessment technique for health interventions.

Chris Palk, Managing Director of Dabapps spoke about technical feasibility and learningsfrom building music player digital applications.

TiSDD: We know that familiar formats like PechaKucha can be used to ease participants into a workshop. How did that work for you?

Ivan: Some of the PechaKucha presentations worked better than others. The ones which recapped familiar information seemed to lose the audience and had less value. My advice when organizing research recaps or onboarding sessions as presentations would be to make sure that the information is truly insightful and is presented in a dynamic way. Some of the biggest insights and value were actually derived from the discussions between stakeholders and personal sharing moments — not just from the presentation of the information itself.

TiSDD: That has been very true in our experience as well: the less passive listening and the more co-creation, the better the outcomes. How were you able to guide the participants to translate the initial research into insights about core users and their needs?

Stakeholder and Value exchange maps

Andreas: Based on these real-world insights, the participants created 3 initial Personas, and Journey Maps. This helped us create empathy and shared understanding. We learned what a day in the life of each of the personas looks like, where they struggle and what creates positive experiences. In a Stakeholder Map we defined the relationships and value exchange between the wider set of stakeholders, such as care homes, insurance companies, and the NHS (UK National Health Service).

TiSDD: Sounds like you really pushed the participants to be very active and hands-on. That’s not easy, especially if they are not used to working this way. Can you tell us how you created ‘safe space’ and drove participant engagement?

The “3-Brain” warm-up in action

Ivan: When we talk of creating “safe space”, we mean setting up conditions where all participants feel VERY comfortable with experimenting, making mistakes and actively participating. We actually started our workshop with too many passive activities, and that affected the energy levels. To fix that, we got people to do the “3-Brain” warm-up, one of the facilitation methods we picked up from you guys at the TiSDD Executive School in Amsterdam. This helps participants feel safe enough to contribute ideas, without the fear of failure and judgement — especially from their bosses and management. It’s also fun and brings a lot of laughs. Once people see their boss “fail” in the warm-up, it sets the tone and makes it ok for them to “fail” too and not be perfect. This idea of having a bias towards “doing” and not being fixated on immediate perfection was a core part of the workshop.

TiSDD: It sounds like MFMM had already gained some insights from their previous research and has ideated solutions ahead of the workshop. How did you weave them into the workshop without going into “solution mode” too soon?

Andreas: Prof Keith McAdam and the team had collected great insights from the research-pilot in care homes with real participants. To fully understand where the team had already gone in the solution space, and make the current project assumptions explicit, we ran a co-creative insights session. We mapped out 4 core focus areas: Musical, Medical, Tech, and Carer, and for each one asked the group “What needs to be true for this to work?”. Each participant placed their ideas in one of 3 classes of certainty: Insights [what we know already], Assumptions [what we think we know] and Risks [what we don’t know yet]. This gave us a shared understanding of the problem space. It formed our backlog of experiments, prioritised by the level of uncertainty and the value or risk these may deliver.

Ivan leading an Octopus Clustering exercise with the team to help them identify key ideas and insights.

TiSDD: How were you able to translate the insights into experiments? How did you get into the ‘doing’ part of the workshop?

Andreas: We divided the group into teams of 2–4 participants, who explored the 3 problem areas which we had collaboratively identified. Each team framed their challenges in ‘How Might We’ questions, sketched ideas, formulated a hypothesis statement with a test plan and ultimately built prototypes to learn.

Ivan: We let the groups pick as many insights as they wanted to work on from the boards above. Then we used Octopus Clustering to group them into core problem areas for ideation:

1. How might an initial personalized playlist be created using a digital app that is powered by the recommendation engine of streaming music service API (such as Spotify)? We investigated how a playlist may be created in an assisted (by a family member or carer) or non-assisted fashion.

2. How might we assess and improve the efficacy of playlist selection over time? We explored how we can measure and codify reactions to songs through human observation as well as with AI pattern recognition software.

3. How might we support setup and continued use of MFMM in a care-home setting? We explored creating new hardware solutions as well leveraging “off the shelf” solutions such as Amazon Echo to deliver music in the care homes.

“Each team framed their challenges in ‘How Might We’ questions, sketched ideas, formulated a hypothesis statement with a test plan and ultimately built prototypes to learn.”

TiSDD: What were some of the prototyping techniques you used, and how did you introduce them to the participants?

Ivan: We used a number of methods, including physical lo-fi prototyping, paper prototyping, digital prototyping, wireframing, and a special technique called ‘Investigative Rehearsal’, which is borrowed from improv theatre and that we learned at the TiSDD Executive School in Amsterdam.

TiSDD: Investigative Rehearsal is something we at TiSDD use quite a lot to create prototypes — not only of service interactions but digital products and services as well. How did it work for you?

Investigative Rehearsal, a prototyping technique borrowed from theatre, was used to quickly create the question flow of the app onboarding menu.

Ivan: To be honest, we were quite nervous to try it as it had a component of “acting”. But we are glad we did. Based on participant feedback, it was the exercise they found the most valuable out of the whole workshop. We used it to establish the onboarding playlist question flow, which is the order and depth of questions needed to create an effective personalized playlist. We like it, as it is the leanest prototyping technique that engages the entire team. At any moment, any team member can shout ‘freeze’ and suggest a modification. After 30 minutes we had created a shared understanding and a first draft of the question flow and its delivery. Only at this point, the team grabbed pens and paper to create a paper-prototype, and then linked them together in a digital prototype using POP by Marvel, so they could be tested.

Andreas: To explain how technology might enable the playlist creation, we acted out how the systems might work together. Each system or function was played by a person. This helped to explore what each function might do and how they might hand off tasks to each other.

“We used a prototyping technique borrowed from theater to establish the questions, their order and depth needed to create the onboarding flow for building a playlist.”

TiSDD: How would you summarize what you achieved during the workshop phase? Was it a success?

Andreas: The key organizational outcome was to externalise the insights already gathered, so that they would stop living in the team’s heads alone, but would instead be formulated and tangible. We also gained clarity around the remaining unknowns. This allowed the team to define lean experiments, to better validate and/or scrutinize their own assumptions. Based on the above and the feedback from the participants, I’d say what we did was a big success, and that it helped MFMM progress significantly towards their goal of widespread adoption of music as a therapy for dementia.

“I have never been involved in this kind of process and I found it fascinating and exciting. I loved the way that you involved us, challenged us and encouraged us. I’m sure that we all felt that, in some measure, we owned the project.”
Dr. Fiona Costa, PhD, ARCM, Honorary Research Fellow, University of Roehampton
”The key organizational outcome was to externalise the insights already gathered, so that they would stop living in the team’s heads, but would instead be formulated and tangible.”

TiSDD: How are you ensuring that the work you created during the workshop phase will truly impact MFMM and be implemented in the near future? In other words, how do we go from Design Thinking and ensure that this is truly ‘Design Doing’?

Trello board which the team will start using for prioritisation, as well as to add acceptance criteria and create accountability.

Ivan: To conclude the workshop, we built a roadmap together with the MFMM team, that outlines the end goal and the first horizon. That is, the smallest/leanest way to learn about the project’s big assumptions. Andreas and I have prepared a Trello board which the team will start using for prioritisation, as well as to add acceptance criteria and create accountability. I have also continued to consult for them and guide the team on a weekly basis, as they look to build a first digital prototype of their app and test it with real users. This last step is crucial in helping the team by providing digital and innovation expertise, and ensuring they maintain the momentum generated by the workshop!

Andreas: Building great digital products is at the heart of what we do at Red Badger. To ensure that we ultimately build the right thing for our clients and their users we actively encourage our clients to test any assumptions as cheaply and in as lean a manner as possible before committing to write any production code. Day-to-day I find this the most rewarding part of my work.

We believe that “the best way to learn how to run the service, is to run the service”.

After gaining initial clarity around user needs in the workshop and the preliminary study, we have yet to discover critical elements, like the optimal question set to finding the right music. In this case, we recommended building different versions of the questionnaire with off-the-shelf solutions like Google Forms. This setup supports a much greater learning speed than clickable prototypes and makes experimentation and iteration easy for researchers without coding or design knowledge. It keeps costs down and spares the client from creating rigid structures, by committing to a technical architecture, too early.

The Red Badger Product Strategy Process

Only when we have enough clarity around feasibility and viability from the manual ‘Rehearse’ phase, we gradually add tech. By this point we know how to prioritise the backlog, starting in the areas which are most painful to fulfil by hand.

TiSDD: Sometimes, as you get into a project, some of the assumptions change as the problem starts to come more into focus. Was there anything that surprised you and made you change plans during the facilitation of the workshop?

Ivan: We probably underestimated the importance of the third goal — building a Roadmap. On Day 1 of the workshop, some key participants expressed concern around what would happen after the workshop. In other words, there was an agreement that this ‘post-it stuff’ is great — but how do we make sure we don’t lose all the great work that happens during the workshop and ensure there’s a clear path to implementation? I think is a very important point for all Service Design and Innovation experts who are coming in as external consultants — although many people assume we start and end with sticky notes, real service design is not over until change is implemented.

“Real Service Design is not over until change is implemented.”

TiSDD: Taking what you have learned during this project to the next level: what are the opportunities you see for Service Design in the non-profit sector?

Ivan: We see the passion and expertise of the people who are dedicating their time to solving “real” human problems in social spaces such as public health, non-profit and social justice. Then we see the knowledge and skills of service design, strategy and innovation experts. Connecting these two types of people is an incredible opportunity for both sides.

Andreas: For the subject matter experts in the social space (charities), it’s a great opportunity to really increase the impact, scale and “speed to market” of their work. For Service Design professionals and agencies like Red Badger, it’s an opportunity to apply their talents and innovative methods to some of the most important problems that need solving today. This may happen in the form of short engagements that help an organisation moving to the next step, longer projects, or in the form of regular Jams where the charity can build and engage a community of supporters. If you are a design, product or brand professional reading this and feel inspired, we encourage you to get in touch with MFMM (info below) or your favorite charity. The work we are doing with MFMM is some of the most rewarding of our careers. There is so much more great work that needs doing, and needs the help of experts like you…and you might even enjoy it as much as we did!

”We see the passion and expertise of the people who are dedicating their time to solving “real human” problems in social spaces such as public health, non-profit and social justice. Then we see the knowledge and skills of service design, strategy and innovation experts. Connecting these two types of people is an incredible opportunity for both sides.”

ABOUT:

Ivan Entchevitch is a design and innovation strategist based in New York. He is a multi-disciplinary practitioner whose experience spans marketing and innovation programs at Sonos, teaching UX at Berghs School of Communication, and working as an Executive Creative Director at WPP leading work on accounts such as Verizon, the New York Times, and New Balance. | https://www.linkedin.com/in/ivanentchevitch/

Andreas Conradi is Design Director at Red Badger in London. He helps his clients to innovate and deliver digital products & services. He’s eager to create positive outcomes for people and is always up for a good challenge. Currently, he is growing the team and developing the new Product Strategy proposition at Red Badger. During the last 10 years, Andreas has been working for consultancies in Cologne, São Paulo, Amsterdam, and London. He volunteers as a mentor within the UXPA network and occasionally teaches at King’s College London. | www.linkedin.com/in/andreasconradi

This is Service Design Doing (TiSDD) is a comprehensive 5-day course on service design process, tools, methods, and facilitation for executives. Based on the course script, the facilitators have published a service design book and method companion under the same name. TiSDD is led and authored by Marc Stickdorn, editor of This is Service Design Thinking and founder of customer experience software start-up Smaply, and by Markus Hormess and Adam Lawrence, initiators of the Global Service Jam and founders of the European-based innovation consulting practice WorkPlayExperience. | https://www.thisisservicedesigndoing.com

Music for my Mind is an innovative start-up charity aiming to promote and enable the take up of personalised music to improve the wellbeing and quality of life of people living with dementia, their relatives and carers. For many years, it’s been known that familiar music has a powerful effect on people. Music for My Mind wants to enable system-wide adoption of music as an affordable therapy for people coping with dementia, through gathering scientific evidence of the beneficial effects of personalised playlists. To find out more about their current projects, Board of Trustees or to get involved by donating or volunteering, visit: http://www.musicformymind.com/