Circles of Care

Designing for Care introduces the framing, if not the framework yet, of integrating design practices within healthcare as a legitimate practice of care. There are many notions of care we could draw from, and will review and consider in the book. But my intention is to contribute to a broader impact within healthcare enabling designers to position and act from a legitimized stance as healthcare professionals. In my view the call for this positioning is clear. Designers, whether digital, information, industrial, or device designers, are already serving in critical health support and institutional capacities, and are introducing artifacts and making decisions that have meaningful direct impact on people’s lives. We are both direct and complementary healthcare professionals. We care and provide care, both personally and professionally.

Occupying this position will take time, the evolution and exchange of design knowledge, and it will require us to create common vocabularies for sensemaking. If you consider the disciplinary history of healthcare professions, even nurses and pharmacists had to construct their position in the institutional ecology of care providing. It did not come automatically with the degree and certification. The historical notion that certain health professions are “allied health” (pharmacy, lab tech, therapy providers) indicates there’s an embedded hierarchy of relationships in this ecology. We don’t want ID/IA/IxD and other design professionals to have to define and traverse these professional definition boundaries. Rather, like good design researchers, we might just reframe the ecology so that we fit the context and meet the requirements of care providers. Yes, we are not primary care providers, but like other non-medical specialists, providers of critical services and organizing capacities that make a significant difference in actual care to people.

Today we are expected to speak the language of healthcare, both medical and institutional languages. I do not know of design residency programs, but perhaps an internship program would be advisable in the future. As any professional, we must learn about and understand the systems, activities, practices, and responses necessary to care for people’s health. Then we have design work to do in these contexts. Because our central concerns in design have their own language and traditions, many of us have taught our project teams the colorful tools and practices of design and field research. And we have had the luxury of separating ourselves from patient action while still contributing to care.

But healthcare problems are wicked, systemic, and widespread. Our next commitment must be a contribution to care, not just experience, interaction, usability, or function.

One way to initiate a simple and non-controversial framing is to adopt other models of care and determine our fit and value. The circle of care is one in which we can all participate.

Let’s consider the book contributors in Design for Care as a Circle of Care, a concept from community health that draws upon compassionate community members who are willing to extend themselves to others in the community). In the “new leadership” blog Slow Learning, they recently wrote on the 5 levels of the Circle of Care:

• Level 1: Care Passionately–This is critical for you. You are willing to go to the mat for this issue and may be willing to die on this hill to defend your position.
• Level 2: Care Enough to Influence–This is an important point. You are definitely willing to debate its merits and argue passionately, but civilly, about it. You may not be willing to die on this hill, but you’ll fight your ground.
• Level 3: Care Unless Career Ending–A somewhat important issue, but you are not willing to make this the issue you are known for.
• Level 4: Care, But You Can Release–You can go either way.
• Level 5: Realm of Careless–You don’t care at all.

Yet I don’t think this is exactly the circle of care I see for designing. Their post suggests the problem can be that of caring too much:

“Is it possible to care too much for the occasion? Is it possible to bring so much energy to a discussion or debate that the right solution gets lost in the drama?”

This view of care is that of an activity toward “others out there.” Care starts with the individual. A well-known Einstein quote describes the “circle of compassion,” a caring for all people and nature, addressed to all humanity:

“This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty.”

Einstein’s ideal is that of transcendental compassion, that elevates the individual through expanding intentional care to include all living beings. Our own circle of care probably lives somwhere between these two.