Can design help shrink the ‘empathy deficit’?

24 June 2015 Written by By John Lappin Journalist

This article is part of The Design Economy series.

How designers are rediscovering their roots in social good and helping nations face the future.

In 2006 Barack Obama addressed Northwestern University’s graduating class: “There’s a lot of talk in this country about the federal deficit,” he said. “But I think we should talk more about our empathy deficit – the ability to put ourselves in someone else’s shoes; to see the world through those who are different from us – the child who’s hungry, the laid-off steelworker, the immigrant woman cleaning your dorm room.”

Empathy has since featured in more than 60 of Obama’s speeches and is also discussed in detail in his book The Audacity of Hope. Offering it as an overarching solution, the President has consistently positioned empathy at the heart of the political debate.

This certainly offers an insight into the President’s thinking and priorities, but how would anyone set about closing that empathy deficit in practice?

Design may be leading the way. In the UK and globally, designers are embracing empathy to improve not just objects, as they traditionally have, but systems and services – often with dramatic results.

While design today is most often associated in the public consciousness with stylish furniture and smart phones, designers’ renewed emphasis on empathy goes much deeper, borrowing from neuroscience, behavioural psychology, economics and mindfulness. In an era of multidisciplinary approaches to problem solving, designers are often leading projects that bring together a range of ostensibly more academic disciplines.

Mat Hunter, Chief Design Officer at Design Council, says: “Designers over the decades have worked out that it is not just about making things utilitarian. The whole point about beauty and aesthetics was about eliciting an emotional response. Over time as design and branding have come together, people have recognised that it's about relationships and emotions.

…there has been a realisation that design has an ability to respond to and encourage certain behaviours. The challenge is to get more conscious about what we do with it.

Mat Hunter, Chief Design Officer, Design Council

Hunter says historically design and designers had a social purpose, although one framed in a different way: “If you go back in time and look at Terence Conran, for example, he realised that while the government and financiers were grappling with the welfare state, designers should try to create products that would make our daily lives more pleasant. Design was about stuff, about consumerism. But there was always some empathy and social purpose. The thinking was we could ‘consume’ towards better lives. That began to feel excessive and less empathetic. Perhaps design did end up being more selfish for a while.”

Yet, he says, this is not surprising. Design always mirrors what is going on in society and business.

“Society went from being collective to being more commercial and design followed suit. But now we have a mixed economy and a mixed approach. There is a lot of design in the commercial world, but the question now is whether design can help us make more empathetic policy, products and services?

“There has been a huge rise in design for social impact. We are not only asking how we can design for businesses, but how we can design for people’s lives.”

Creating capacity for mindfulness and compassion

Joan Halifax, a US-based Buddhist teacher with a PhD in medical anthropology, has decades of experience bringing mindfulness into medicine, education and prison establishments to help both those in institutions and professionals working there deal with stress.

She says: “Mindfulness-based stress reduction is a protocol, which is based on a Buddhist set of practices and a Buddhist perspective but secularised. It was created for individuals who were suffering from stress. It is a way of allocating attention, developing steadiness and concentration and helping people perceive things in a non-judgmental way.”

According to Halifax, medical environments can be extremely toxic, combining unreasonable institutional demands with sometimes unreasonable demands of patients. An alarming number of medical practitioners report burnout and depersonalisation, which leave them feeling more callous towards their patients. This leads to patient dissatisfaction and increases medical errors, encouraging lawsuits and having considerable economic consequences.

For Halifax, the answer involves nursing and physician education, or designing curricula that embed mindfulness and allow practitioners to sustain themselves and flourish. “With greater capacity for mindfulness and compassion,” she says, “the downstream effects are considerable.”

A&E Design Challenge

One major system design project in the UK effectively echoes Halifax’s views. Hospital accident and emergency departments are lodged in the public consciousness as places of stress and tension. In 2011, the Department of Health and Design Council commissioned London design agency PearsonLloyd for a far-reaching project for Accident & Emergency. The A&E Design Challenge aimed to design out anxiety and build in empathy in a bid to decrease incidents of violence and aggression.

PearsonLloyd’s approach brought together a consortium of professionals – including an A&E clinician, a psychoanalyst and service design academics – with design as the anchor. Tom Lloyd, co-founder of PearsonLloyd, says: “We knew it wasn’t solely a design problem but, looking through the lens of design, we would try to make some calls about what to do... We didn’t know where the solution might lie.”

The initial feedback demonstrated the scale of the challenge. “The staff had initially said, ‘We don’t want any more training.’” Meanwhile, says Lloyd, the clinicians were primarily interested in health pathways or service pathways and tended to forget about the care coefficient. Estate managers and security personnel were focused on conflict resolutions, or even “ ‘how you hold someone down’ ”. Says Lloyd: “They were interested in how you deal with anger once it took place rather than providing an environment where it is not going to take place. They were not in a position to suggest how to solve the problem.”

Of course, staff attitudes and emotions had an impact on patients. Lloyd says: “Staff might have had someone die on their watch and then find themselves dealing with someone with a cut finger, who might get annoyed at waiting two hours. With the stress staff are under, it is likely they might snap and stimulate bad interactions. It was interesting to think of strategies to help staff understand how to manage this.”

Other work involved tracking the journey through A&E. Lloyd says: “We realised that if you went to A&E, you get triage maybe, you wait, maybe you get an x-ray, then you wait for a consultant, then you wait and then maybe you get a plaster cast. Anger comes from frustration and lack of knowledge, which leads to a lack of empowerment. If only we could empower people with knowledge, they could perhaps look after themselves in terms of frustration a little more.”

This meant communicating that there could be waits at various stages, and people don’t get treated in order of attendance but rather in order of acuity. If people understood that some others had to be seen faster, they would begin to contextualise their own condition.

Ultimately, PearsonLloyd’s team arrived at two broad solutions.

The Guidance Solution was a communications and information package guiding patients through their time in the department using signage, leaflets and digital platforms with live updates on personal waiting times. It also included signage on the ceilings for patients confined to beds.

The People Solution worked with old and new frontline staff to ensure that the necessary support and facilities were available to understand, learn about and improve ways of handling violence and aggression, while maintaining high levels of compassion and empathy. This, says Lloyd, was achieved through communications training and reflective meetings.

The designs were trialled for a year-long period across three hospital trusts: Chesterfield Royal Hospital NHS Foundation Trust, Guy’s and St Thomas’ NHS Foundation Trust and University Hospital Southampton NHS Foundation Trust. The results proved extremely encouraging. An evaluation found that 88% of the public felt the guidance project clarified the A&E process, and a subsequent report found that for every £1 spent on design solutions £3 was saved. Threatening behaviour and body language fell 50%. The security staff are now big fans of the initiative.

Airport security checkpoint evolution

Beyond hospitals, another setting that people today commonly associate with anxiety is the airport. Increased security measures at airports post 9/11 led to increases in anxiety among the general public. This effectively confounded the government’s ability to identify people with hostile intent: it’s much more difficult to do so in an airport filled with stressed passengers.

In the US, the Transportation Security Administration in 2009 hired global design firm IDEO to calm the environment at security checkpoints, in turn making potential threats more apparent.

IDEO conducted ethnographic research including traveller and airport observations and more than 300 interviews. The research helped identify “key emotional characteristics, moods, traveller archetypes, and reactive behaviours typically found in various security situations”. After compiling the data, IDEO decided to create a calmer passenger experience by reworking the physical TSA checkpoint to smooth the transition from lobby through the airport. IDEO’s human-centred approach to security was successfully prototyped at Baltimore-Washington International Airport and has since been applied in other US airports and worldwide.

IDEO also explored how Transportation Security Officers played a role in traveller behaviour, which led them to design training for TSOs and their managers. According to IDEO’s website, “The newly crafted TSO training encourages a broadening out from rote-based procedures and workflows to a more flexible yet rigorous reliance on critical thinking. The new training includes an emphasis on understanding behaviours, people and security measures, while instilling confidence among colleagues and passengers.” IDEO’s designs proved effective and efficient: TSA is training its entire workforce of 50,000 employees at 450 domestic airports.

Helping people make better decisions

Ed Gardiner is a behavioural psychologist at Warwick Business School, where he has worked with the Design Council to create the Behavioural Design Lab. The lab aims to “help organisations use a scientific understanding of people to design better products and services with a social purpose.”

Gardiner says design and behavioural psychology can work together fruitfully on all manner of projects: “Design can help you understand who you are trying to benefit and what the problem is, whereas behavioural science can help you understand why. Between those two areas, you can help guide and support people to make better decisions.”

He sees much of his work about reframing the approach to very big societal problems. Why are warnings about alcohol or calories ignored? Why do health professionals’ urgings to eat five fruit and vegetables a day mostly fall on deaf ears?

Says Gardiner: “We don’t always behave in our own self-interest. There are a number of unconscious, social or economic factors that will affect our behaviour. A lot of people are designing policies or programmes on the assumption that if we give people information or incentives or punish them in a particular way, then we will get them to behave in a particular way.”

Design turns that model on its head, by saying we should start from the point of view of who we are trying to benefit and design for and with them.

Ed Gardiner, behavioural psychologist, Warwick Business School

Gardiner and the Behavioural Design Lab have collaborated on Knee High, a Design Council project run in partnership with Guy’s and St Thomas’ Charity and Southwark and Lambeth Councils in London. Knee High takes an empathy-led approach to public health issues for families with children under five; or, as its name implies, the project attempts to look at life from the child’s point of view.

Ella Britton, the programme lead on early years health and wellbeing at Design Council, explains: “Early years have huge influence on all of us for the rest of our lives. It is also where lots of inequality can reveal itself. Lots of children when they reach school are deemed not ready to learn or socialise; so we looked at what we could do to support families better in the years before this. We started [Knee High] with a lot of research, spending time with families that were more isolated, looking at the high and lows. Parenting is hard, but it is even harder when you have a lot of other challenging things going on.

“We aimed to see where services did or didn’t add value. We came up with three design briefs: emotional health for parents, a look at isolation and loneliness and, finally, play and stimulation for children at a very young age.”

The programme set out to find, fund and support people with new ideas for raising the health and wellbeing of children under five years old. Attracting ideas from a wide range of people – including entrepreneurs, artists, social activists and volunteers – Knee High moved through a rapid prototyping and proof of concept stage. Six projects were launched in October 2014 after 12 months of investment and mentoring. Three of those six have received further investment from Guy’s and St Thomas’ Charity to embed their products and services in Lambeth and Southwark and be part of a 12-month evaluation.

The Good Enough Mums Club

One of the original six projects is The Good Enough Mums Club, which has received attention from the likes of the Guardian and the Independent. Co-founder Emily Beecher had suffered from post-natal psychosis and, as part of her therapy, was advised to write about her experiences. She started to talk to other women with similar experiences and wanted to share her knowledge with other mothers. This led to the writing and production of a musical called The Good Enough Mums Club.

The work with Knee High looked at how Beecher’s project could be turned into a sustainable venture and an important point of contact for mothers facing mental health challenges or parental stresses.

“Emily and musical co-producer Sarah Shead ignited our imaginations,” says Britton. “It is great to see people who bring a creative spirit into the conversation. They wouldn’t see themselves as designers or entrepreneurs, but they have these capabilities and spirit. We said we can help you take this idea and turn it into something that can be mapped out as something that can be delivered sustainably and effectively.”

Britton continues: “We looked at how it could become a service that was linked to other types of support for women, how it could become a network and what tools and support she could design or create to enable more women to set up their own clubs.” Gardiner worked with Beecher to help her better understand the determinants of wellbeing for mothers over time in order to measure the project’s success.

Design Council also helped The Good Enough Mums Club examine a hybrid model of working so that it would not always rely on funding but could raise income in other ways.

Britton believes their work could have a wide application. She says: “It helps to think of different models of mental health support. It doesn’t always need to be one-to-one therapy; it doesn’t always need to be medical or sitting in a circle. They have value, but there are things that are joyful like Good Enough Mums is trying to do. There is a space in healthcare for that attitude.”

GPs have told Britton that, apart from mothers in very serious need, they often lack options for those who would benefit from assistance and support.

She hopes that in the future GPs might signpost mothers to the Good Enough Mums Club as an option.

Creative Homes

One of the three Knee High finalists is Creative Homes, a team of designers, artists, anthropologists and early years specialists who help children from complicated or difficult backgrounds establish good habits.

“What they are interested in is how hard life is if you live in cramped conditions or have loads of kids in a big room, for example,” says Britton, “In these circumstances it is hard to set routines and patterns, regular bed times, functional habits. If you are a parent in these circumstances, it is hard to set those habits.

“Creative Homes said we need to help, but we can’t do it by taking a social worker into a home and fixing this. It means bringing play and creativity to the process of forming good habits.”

The team works with housing associations and also visits homes. They ask families about what the triggers of stress can be – perhaps clutter, meal times, bedtimes – and then what parts of the day the family would like help with.

Say a family is struggling with toilet training: “Though it sounds a bit bonkers,” says Britton, “they arrive as a toilet sailor and convey how exciting it is for children to use the toilet on their own.” Or with tooth brushing, someone from Creative Homes turns up at the door as the tooth fairy. “There is a real sense of forming habits through play, narrative and creativity.”

The approach is welcomed by parents who see it making a difference – and are also happy to avoid the stress of tidying up before a health visitor arrives.

Says Britton: “It’s about how to remove that feeling of anxiety. There is something really powerful about that empathetic model. Health visitors and midwives are amazingly well qualified and empathetic too, but what if artists or others could deliver different types of help?”

Designing together to move forward

Mat Hunter of Design Council explains, “What design is doing is helping create artefacts, be they communication artefacts or spaces or products, which remind us all or enable us all to be empathetic or compassionate.”

From performers collaborating with community groups to psychoanalysts in hospitals, a wide range of thinking is now being devoted to designing in empathy and designing out anxiety. There seems to be a consensus: We must redesign our institutions to incorporate, or reincorporate, empathy, in order to render them more efficient, effective and capable of meeting the challenges of the twenty-first century.

With design placed at the heart of an empathy-led, multidisciplinary approach, these new ideas could have a revolutionary impact on the delivery of public services. Says Lloyd of the A&E Design Challenge: “We were given permission to look across multiple stakeholders. There aren’t many times in public service design when anyone does that. Often the professionals are in their own silos.”

In many cases, such as the A&E work, these new social design projects are demonstrating that better design also means better value for money. From Zen master Joan Halifax to IDEO and Design Council, a rainbow coalition agrees that combining empathic design and mindfulness training can help to close the 'empathy deficit' that Obama spoke of – and provide us with an additional set of tools for closing the financial deficit, too.