March 8, 2021
What started as an interview evolved into an interactive exchange of ideas on how to bring inclusivity into healthcare system design and equity into workplace environments. Both to ensure that everyone sitting at the table is given an opportunity to be heard and so that their unique perspectives are acknowledged and celebrated.
Claudia is an interaction designer at Unboxed with a passion for inclusive service design and we share a common interest in healthcare. “How to design a more equitable world applying both design and systems thinking?” We venture into the possibility of a world like this and some practical steps that might help make it a reality…
To start us off… I wonder if you could give readers a little background info on yourself and your role at Unboxed?
I’m a designer which has been a role that I’ve naturally progressed into over a long period of time through working on social impact and public sector projects.
I’m from Canada originally and have worked in various environments such as at a university on a medical education team, in a hospital as a service designer and at Ontario Digital Service on their health and web accessibility team.
Healthcare has been the common theme running throughout my career. I’d wanted to see what working at an agency would be like that still does a lot of public sector work so that I could apply what I’ve learned in healthcare to other systems so that’s why I joined Unboxed. But I’m sure that I’ll end up back in healthcare one day and I’m excited to see how the interesting work I’ve been able to do at Unboxed will apply back within healthcare.
Was the healthcare element a conscious choice or also a natural evolution?
It was also something I kind of fell into at first. After high school, I started off with a chemical biology degree which sparked an interest in science communication - this seemed to fit more of my skills and interest in science but I also had these other skills that weren’t necessarily prioritised in the scientific field such as illustration. I started reaching out to different labs to try and figure out how I could bring all of my interests together.
I ended up working in laboratories and health environments with a focus on stem cell and cancer research and then enrolled at Emily Carr University of Art and Design, intending to only attend for a year to advance my illustration skills but I just fell in love with design so ended up staying for 4 years and graduating with a degree in Interaction Design. So my focus is on design but my chembio background and interest in science communication is what’s kept the thread of healthcare running.
That’s amazing! That’s a solid interdisciplinary combobulation of skills. How does your varied background translate into everyday work life?
It depends on the project and the project scope. Sometimes my role is more user research driven and sometimes my work is more interaction design focused – data mapping and thinking about how to make data more usable and how it will impact other parts of the system. But I think having an evidence-based design approach comes from my science and research background, as well as being able to think more technically about some problems.
At Unboxed, we also apply Agile methodologies throughout all projects and so work in sprints. A sprint will launch with a planning session. Some of my work will then involve being on call for developers in order to make sure they feel supported with the designs that they have been given. Another component to my work involves proactively thinking ahead to what designs or user group tests might be required as we progress through the project. The sprint ends with a synthesis which will include me and a user researcher or another designer to find user insights. We then do a debrief with the rest of the core team in order to discuss feedback, impact, feasibility and answer any questions that may have cropped up.
Of the different projects that you’ve worked on which has stuck out in your mind as most interesting?
My grad thesis project. We had free reign on choice of project so I partnered with my workplace which, at the time, was the University of British Columbia’s division of Continuing Professional Development.
I’d noticed that the way we were representing patients within online learning courses needed a bit of investigation. It was a question of diversity but also how we could include patients within the process of creating education. There were multiple streams of work that I focused on. One was visual design, another was interaction design (implementing patient stories) and then some bigger questions around user research: what would be the most ethical way to generate patient stories as this would require emotional labour on their part.
Finally, it was about questioning the bigger whole… Questioning whether stereotypes are being perpetuated, what this means systemically in terms of power dynamics and then piloting different ideas in order to see how we could shift harmful plays of power.
That is so interesting! I worked as a junior paramedic in South Africa before doing what I do now and what you’ve just described in terms of addressing systemic issues and humanizing patients is really lacking. Adding design and systems thinking to healthcare could make such a huge impact because the system of progression in emergency medicine is designed according to old militant style thinking – people are so overworked, stressed and traumatized that nobody really has the capacity to think outside the box. People who have worked in healthcare but that aren’t necessarily entrenched within it as a career bring a different perspective which is hugely valuable.
It’s interesting that you say that because I also came to the same conclusion as we were working with a lot of doctors and different kinds of medical professionals who had been indoctrinated into that style of thinking.
Even though they care incredibly about their patients, I do also understand why as a survival tactic it is common to think: "I have too many patients to think so individualistically." And if someone fits as an ‘outlier’ within medical research or who a doctor sees, it is more challenging for that patient to receive inclusive care because of how the system is designed.
As a designer, we must understand that context and we can't just pretend that those circumstances don't exist. But it's also about just challenging it a tiny bit and thinking from an educational perspective: “how can we slightly adapt?” So there were these bigger ideas about the system but the groundwork was specific to a course and the course was called "Gender-affirming Care." Using this course framework, we targeted physicians who have patients who are trans or gender diverse. The argument was that "we do need patient input" because these patients have been historically marginalised by the healthcare system. Thinking in this way enabled us to create a more inclusive design approach to the course, and thus the educational outcomes.
Along the same theme of inclusivity, is there a unique perspective that marginalised groups – gender or otherwise – bring to the table when it comes to complex problem solving?
I read some articles recently that have shown that world leaders who are women have had responses to the pandemic crisis that are more positive in terms of lower fatalities par with population densities than countries with world leaders who are predominantly male at the helm.
That made me think about how, especially within politics, people can say about women: “oh they’re too emotional” as a negative classification in relation to job capability when actually it is likely these exact traits that make them so good at what they do.
We need to ensure that people put in positions where they are required to problem solve are diversely represented. But we also need to ensure that diverse representatives are acknowledged and celebrated for their unique perspectives so that they are given the space and room to be able to contribute and make decisions in the ways that they know best.
So it’s about bringing diversity to the table AND making sure that each person has an opportunity to be heard while they’re sitting at the table? I imagine then if you’re in a meeting and irrespective of gender you have a softer disposition and you’re more of a deep-thinking, introverted personality type your opinion is more likely to be dismissed over a more outspoken, extroverted and domineering personality?
Exactly! If we work in environments that are dominated by only, kind of like a, white male way of viewing the world, it won’t matter whether there is diverse representation and unique styles of thinking - thoughts and individual ideas may still go unacknowledged. Although this can be gender non-specific because, often as women, we are trained to achieve workplace success by mirroring masculine traits. If the environment is then only allowing for superficial inclusion, all the benefits of diverse representation will be counteracted.
Do you think that there’s still a role that unconscious bias plays against merit-based hiring of women in tech?
It depends on the discipline. In design, women have quite high representation because “empathy” in design has become a buzzword and empathy has historically been considered a feminine trait. Again, the struggle is not getting your foot in the door as much as it is having the mechanisms to be heard once you’re inside. However, my opinion originates from a white cisgender perspective, I have been formally educated and am relatively young without children or dependents.
Someone who doesn’t have the same privileges, like a formal education or who has a family that they need to prioritise over their career may have a much harder time during the hiring process and I don’t want to diminish anyone else’s experiences at all.
Do you have advice for, specifically, women entering the space based on your experiences?
Reflecting on how I’ve gotten to where I am, it’s undoubtedly been because I’ve had strong mentors.
I’ve had 4 female mentors throughout my career who have really helped me understand how to navigate difficult conversations, which jobs to apply for and what to mention in my applications. Then, when you’re a bit further along, you can give back by supporting others in the same way. Something else that might be helpful is that if you’re ever unsure about what to do in a situation, think about what x person would do. Often, I say to my friends who are wondering about what to say or do: “well what would a white cisgender male do?” And they might respond: “they would do xyy…” and I’ll say: “okay, do that.” Even though it’s so outside of our comfort zone, it’s still quite important to do but then, again, the problem with mirroring re-emerges. But if it’s to get an opportunity, do it.
Yes, absolutely! That's something that I can really relate to because I’ve not been formally educated so I’ve just had to find my way around. I think that 90% of getting to where I am today has been mirroring people and 10% has been accidentally, haphazardly saying the right thing at the right time and then getting my foot through the door. I’ve worked hard to earn my seat but after a while, when you’re doing really good work and using the right terminology people don’t really ask anymore, they just assume that you got that knowledge through the formal route. So it’s important to push those boundaries and sometimes do things that you ordinarily wouldn’t do and then see where that takes you.
Yes! Curiosity and developing an understanding of how people navigate various things will take you very far.
So moving onto the technological innovation side of things. Are there any current problems within healthcare that you think technology could be used as a tool to address?
Data connectivity. In the public sector, that's always the limit - understanding which data should be connected and which shouldn't be. For example, scattered health records impede holistic care so consolidating all your records into one place would be beneficial, but you wouldn’t necessarily want healthcare records added to your employment record. Data best practices are rooted in practices that are purpose driven. Data should be accessible based on need alone and applied with intention along with an understanding of where the data will go. So transparency within the public sector, I would say, is our biggest need right now and technology designed with intention and mindfulness could aid via better data linking and storage processes.
I love that! That intersection between intention, holistic practice, technology and systems design and how we can bring it all together. What would you say has been the greatest transformation that you've witnessed in your career so far? A technological or social innovation that wasn't there when you first started but is there now? Could even be a different way of thinking…
There has been a shift towards standardisation of processes across the UK government which has been really good as a way to change the atmosphere and the way that we work by allowing for more agile processes. GDS (Government Digital Service) has done a great job in enabling this shift in governance structures and allowing other governments to draw influence. It will be interesting to see how these practices continue to evolve for services that aren’t public facing or transactional.
And looking to the future, nothing is impossible, what is the next big technological or social innovation that you would like to see achieved?
Leaning more towards social innovation – I’d like to see us figure out how to make services more inclusive and adaptable for different people.
How do we identify problems and then solve them by meeting people where they’re at by remaining respectful and considerate of contextual influences such as culture or language? I’ve heard recently of some work that has been done with refugees and people who don’t speak fluent English. They rely on their communities a lot more in order to access healthcare and so my thinking sits along the lines of: “how can we create the mechanisms to support this but not override it?” Because many of our current social problems are rooted in the fact that there isn’t always a huge sense of community because we live in such big societies. This leads to the even bigger question: “is there a way to create systems level support for local level intervention?”
I think that often the source of inequality and prejudice is that people from different groups dehumanize each other. For example, with refugees, their vulnerability stems from the fact that belonging and safety are things that are usually bought with money or identity reflection. If someone has no currency to exchange and they don’t look like you or speak like you or they have a different way of doing things, a different culture or belief system, it’s easier to separate yourself from their suffering. So I think the answer to your big question may lie somewhat in finding ways to enhance a sense of “we are all connected, if something is happening to that person, it could easily happen to me.” Is there anything that you think we can do to help build that kind of widespread empathy?
It's very challenging. From a social perspective, I think it's essential to build relationships with community leaders, someone who can advocate for their people and actually prioritise their community’s needs. From a policy perspective, it's about finding commonalities and understanding that though situations may be different, the need is usually the same and really just prioritising human-centred and inclusive approaches to understanding problems. But sometimes, when it comes to generating understanding, it's hard to get people to care. People don't often have the time or emotional capacity to care.
Yes. There are just so many things to care about. People don't know what to care about first, when and how. Compassion fatigue is a real thing.
Exactly! But there are still small everyday steps we can take. For example, my 2020 goal was to decolonise my bookshelf because last year I realised that I don’t read enough and the books that I had been reading were from dominant groups or books on the bestseller list. So I've been trying to make a conscious effort on what types of media I am consuming and who I am listening to. Casting a critical lens on the information that we consume and keeping an open mind by listening to different perspectives and opinions. I'm going to have to extend this reading goal to 2021 though because I still haven't read enough books, even with the pandemic… Perhaps even towards becoming a lifelong practice. But for now let’s just focus on 2021.
You can listen to more of Claudia’s thoughts on service design and community by viewing her Tedx Talk here.