Seeing Tomorrows Services: A Panel on Service Design

Seeing Tomorrowʼs Services:A Panel on Service Design

Sponsored by CMU Bay Area Alumni and Adaptive PathHosted at Adaptive Path on 19 March 2009

What is service design? Whydoes it matter? What's critical?

Shelley Evenson is Associate Professor and Directorof Graduate Studies at Carnegie Mellon Universitywhere she has been writing, speaking, and teachingthe practice of service design focusing on tapping intothe needs of users of the service.

designing for service

Seeing Tomorrow's Services: A Panel on Service Design

Shelley EvensonSchool of Design | Carnegie Mellon University19 March 2009

Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © EvensonSeeing Tomorrow's Services:

A luxury hotel


+A luxury hotel


A luxury hotel

When delivery falls short of expectations…



JʼsUnitedStarbucksWestinWolfgangPuckPeetsHertzOnStarBlackberryAT&TZoneTagFlickrQuicken

Our serviceexperiencesare multifaceted andco-produced


Many new serviceexperiencesare multifaceted,co-produced,and shared

TwitterFacebookTwitterCuteOverloadGizmodoBoingBoingTwitterPerezHiltonTwitterDiggTwitterFlickrTwitterEtsyTwitterLivejournalOMGKittyFacebookMyspaceImInLikewithYouTwitterCore77WeatherTwitterTreehuggerStarbucksTwitterAmazonAppleInsiderSomethingAwfulTwitterCuteAddictDeviantArtPennyArcadeFacebookEbayTwitterYouTubeTwitterCriticalMassTwitterPotLuckDinnerHalo


Many new serviceexperiencesare multifaceted,co-produced,and shared NOW

TwitterFacebookTwitterCuteOverloadGizmodoBoingBoingTwitterPerezHiltonTwitterDiggTwitterFlickrTwitterEtsyTwitterLivejournalOMGKittyFacebookMyspaceImInLikewithYouTwitterCore77WeatherTwitterTreehuggerStarbucksTwitterAmazonAppleInsiderSomethingAwfulTwitterCuteAddictDeviantArtPennyArcadeFacebookEbayTwitterYouTubeTwitterCriticalMassTwitterPotLuckDinnerHalo

9Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © EvensonSeeing Tomorrow's Services:

• seeking fulfillment and meaning• but there is too much information to cope with• more actively and more consciously participating

in design—

they want to co-produce their products andservices

t

people arechanging…


So is the work they are doing...

Total US EmploymentNumber of employees in millions %

New jobs in the U.S. 1998-2004100% = 5.4 million

Source: Johnson, Mayika, and Lee, Next revolution in interactions, McKinsey Quarterly 2005 number 4


Web-based services have had a hugeimpact

More will change as the world becomesfilled with swarms of sensors with localembedded computation

t

technology ischanging…


The kinds of experiences a companyoffers contributes to the performancemetrics and valuation of the company

business ischanging…


traditional 4ps of marketing

Product—things you sell to peoplePrice—determining what the value exchange will bePlacement—how the product gets to its audiencesPromotion—how people find out the product is available

Neil Borden 1964


peopleproductplaceprocessperformance

(after Lovelock and Wright) Photo Christopher Alexander


Important conceptsjourneys and touchpoints

back stage and front stage


system interactions

p2p p2m m2m

person to machineMe & the mri

machine to machineMy sensors/agentsto systemʼs agent

person to personMe & my doc


The impression(the sum of the experiences)is the brandfor both providers andcustomers.


A ʻservice as designʼ triangle (After Gadrey 1996a)

serviceprovider

customer(user)

designmeta design

brandrelationship

servicemedium


form theframeworkand strategy

discover

implement

create | express

refine

socialize

After Robinson and Dubberly


exploratory generative evaluative

We combine interdisciplinaryteams, conceptual model-making,and design-centered methodsover three research stages


we use lots of methods to addressthe issues...

stakeholder modeling | competitive analysis | technology trends | extremes |era analysis | analogies | social trends | economic forces | ethnographic |directed storytelling | blueprinting | prototyping | enactments | service relabeling

designing for serviceis hard

You are iteratively planning and constructing a servicesystem or architecture to deliver resources that choreographa design experience.

but when a company provides the optimal mix—they will have produced a resonating service system thatwill deliver a clear experience advantage.

What is service design? Whydoes it matter? What's critical?

Robert Glushko is an Adjunct Full Professor at theUniversity of California at Berkeley School ofInformation where he teaches and writes on servicedesign focusing on the contribution of the service's"back stage" where materials or information needed bythe front stage are processed.

UC Berkeley School of Information

Information & Service Design Program

Robert J. Glushko

Designing “Service Systems”

19 March 2009

Is “Service” a Homonym?

Personal Service Self-Service Web Service

If these are all “services,” are there any design concepts

and methods apply to all of them?

Service Design Patterns

• Adjusting the absolute and relative amount

of interpersonal, physical, and

informational interaction

• Adjusting the line of visibility

• Choosing a point of view

• Scoping the service system and the size of

the “touchpoint windows”

Service Design Contexts

• Front stage – the continuum from “Personal service” to “Self-service”

• Back-stage intensive

• Multiple devices

• Multiple channels

• Location-based

Each design context emphasizes different goals and constraints and has characteristic design methods

Service encounters can include:

Deconstructing Front Stage “Service”

(Apte & Mason)

• Interpersonal interaction

• Physical interactions

• Information processing and interchange

… Technology changes these proportions

• Person-to-person, technology-enhanced P2P, and self-

service form a continuum

• Information can augment interpersonal and

physical interactions

• And can also replace them

Telepresence & Telerobotics

Front Stage and Back Stage

Front Stage: where interactions with

service customer / consumer happen

Back Stage: produces information and

“stuff” needed by front stage

Placement of “line of visibility”

is a design parameter

The McDonalds Experience

Front Stage Back Stage

Gourmet Restaurant Experience


Benihana Experience


Amazon.Com


Retailer

Customer

Credit Authority

Warehouse / Distribution

Delivery Service

Point of View

Designate some actor or service as the

focal / primary consumer or customer

Typically the end of value chain or

information flow, or where “users” are

Often arbitrary, and other actors or

services could be alternative POVs

Who is the Service Customer?

No, I am.

I am.

In a teaching hospital

In a Cooking School?

Back Stage Front Stage

Multichannel Service System

Physical Store Virtual Store

Multidevice Service Systems

Location-Based /

Context-Aware Services

Location-based Service Context-aware Service

Service System Scope

• Design techniques for person-to-person services typically describe the service from the perspective of the customer and emphasize the “touch points”

• But the scope extends before and after these touch points

• The scope is more complex with multiple channels, multiple devices, or location-based services

• Complex service experiences are paths that traverse through multiple service systems

– Yahoo…Googlemaps…511…BART…Muni…511…OpenTable…Yelp… OpenTable…Twitter…511

+ Time

Service System Scope

- Time Front

Stage

Back

Stage

Touch Point

“Window”

Time is a primary dimension of scope

but not the only one

The Restaurant Experience

TouchpointsService Scope

Primary Producer Supply Chain Delivery The Stage

The Massage Experience

Service ScopeTouchpoint

The Amazon Experience

TouchpointTouchpoint

The Stage Warehouse Wrapping / Distribution Stage Again

Service Scope

Service System Scopes

+ Time- TimeBack

Stage

Front

Stage

Amazon

Restaurant

Massage

A Methodology?

• “Service system” is too broad for a

prescriptive design methodology

• Iterative scoping (and defining the POV in)

the service system determines relative

importance of each context

• Choose a portfolio of appropriate design

methods for the combination of contexts

Portfolio of Methods

Front stage emphasis

Back stage emphasis

Ethnography

Data Modeling

Sequence Diagrams

Document Analysis

Persona

Story / Scenario

Usability Testing

Model-based Integration

Use Case

Stakeholder

Prototyping

Survey

Iteration

Blueprinting

How does an organizationpractice service design?

Christi Zuber leads an internal InnovationConsultancy at Kaiser Permanente where her and herteam have co-designed numerous new services withpatients and clinicians that have not only lead tomeasurable impacts on patient safety and satisfaction,they have been spread across Kaiser's 32 hospitalsand beyond.

1

HOW DOES THE INNOVATION CONSULTANCY FIT WITHIN KAISERPERMANENTE?

IATInnovations inAdvancedTechnology

Garfield InnovationCenterInnovative space forcollaboration andsimulation

KPConnect EHR Innovation

Innovation LearningNetwork (ILN)Knowledge SharingInnovation

Innovation ConsultancyInnovations in FrontlineCare

How we fit

INNOVATIONAT KAISER PERMANENTE

+Many, many more

3

How we do it

We are driving innovation at the frontlines of healthcare bybringing together best of class methods in innovation, design andimplementation.

There are 3 key parts to this.

We use a proven methodologycreated by IDEO, a world renowndesign firm to develop andprototype ideas based on humanneeds.

Observe &

Inquire

Storytell

Synthesize Brainstorm

Prototype

Field test and

implement

Prototyping & Development

We use IHI best practices toimplement and evaluate theimpact of our innovations

Implement & Assess

We collaborate and work with ourfrontline care providers andpatients. They are a critical partof our team throughout theprocess.

Frontline Collaboration

2

Chris McCarthyScott Heisler

ABOUT the Consultancy

Our Kaiser Innovation Consultancy (IC) is a group of creative people who help

challenge conventional thinking to develop human-centered designs and solutions.

Our ultimate goal is to positively impact the work experience of our employees

and the health of our KP members. We test out the usability of new products, workflows and

space designs, and conduct simulations in real and mock patient environments. We work

together with our KP employees, physicians, and members to better understand challenges

and develop and prototype human-centered ideas using proven methodologies from

both IDEO and IHI

Email: [email protected]

Roles: Innovation Consultancy, Nice to Meet You!

Christi Zuber + 7 brand-new team members

4

What we do

How you might know our work...

.

Innovation and Design Thinking on the Frontlines of Healthcare

We leverage design-thinking to develop human-centered solutions toimpact patient care and the work experience of our care providers.

Design

Thinkingspaces

tools

roles

processes

NKENKE

Medication Administration: Interruptions droppedby 50%, Process reliability increased, Medicationerrors reduced; spread across KP and abroad

Nurse Shift Changes: Nurses got to see patientsat the start of their shift 3x faster under NKE pilot.Patient satisfaction measuring “I understood my planof care” increased. Sought out by outside institutionsas best practice in nurse shift changes.

5

KP MedRite

Making hospital medicationadministration safer - together

Christi Zuber [email protected], Kaiser Permanente InnovationConsultancyAdaptive Path-Service Design Panel 3.19.09

6

Quality and

Safety

Innovation

Consultancy

Patient Care

Services

KP

HealthConnect

In the United States alone…

………7,000 deaths each year are caused by medication errors*

………1.5 million people each year are “harmed” by medication errors

………1 medication error per day per hospital patient

………$3.5 billion is spent each year treating medication injuries

*1999 report “To Err is Human: Building a Safer Health System”

In 2007…

A cross-regional effort began which focused on Medication Administration.

Kaiser’s Innovation Consultancy, supported by Quality and Safety, Patient Care

Services and KP HealthConnect, was commissioned to frame the problem, and

generate and try out ideas with front-line staff from three Kaiser Hospitals.

• Hayward

• West Los Angeles

• South Sacramento

Creating a Case for Change

7

Nurses were asked to draw the first thing that came totheir mind when they thought of “MedicationAdministration”

These drawings by nurses in Hayward and WLA

summarized the voice of the nurses across the pilot

sites.

-Chaotic

-Interruptions

-Unclear Process

Ask 12 nurses how they “Administer Medications” and you

will get 12 di!erent answers…

“I open my medications in the med room so I can get them

ready to go for the patient. It makes it easier.”

“I wait and open each medication in the room. That way the

patient can see that it is clean, if they don’t take it, it’s not

wasted. If they do take it we can double check the medication

together.”

Observations and Storytelling

8

• For two-days in April 2007, over 70 people (nurses, doctors, pharmacists,experts and leaders) gathered at the Garfield Center to hear the stories,stretch thinking and then brainstorm ideas.

• They came up with hundreds of ideas, some of them inspired by theanalogous observations

–Pharma TV

–MedBed

–Self-Administration

–Sacred Zones

–Sterile Cockpit

Brainstorm, Prototype and Enact

9

SoSAC

5/07

Hayward

6/07

West LA

9/07

Hayward

6/07Deep Dive

4/07

Field Testing – “No Interruption Wear” evolution

10

Process

NoInterruption

Wear

Sacred

Zone

Pilot Solutions

11

Pilot Results: 2 hospitals, 4 units–50% reduction in the number of sta! interruptions to the medication administrationprocess

–15% faster per med pass from approximately 10:00 to 8:30 (minutes:seconds)–18% increase in On-Time Med Passes from 61% to 79%–Significant increase in process reliability from 33% to 78%

Financial Value of Innovation Consultancy’s KP MedRite Project–If we avoided 3 medication errors, the project has paid for itself.

Because of the increased nurse and patient satisfaction and the results above, KPMedRite is spreading to all 32 Kaiser Permanente hospitals

Pilot Outcomes and Spread

Percent of Med Passes where all five basic steps were completed (n!68)

28%

74% 74%

33%

79%

74%

32%

68%

81%

37%

66%

84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline OneMonth Tw oMonth

WLA - 2A

WLA - 3W

HAY - 3CW

HAY - 3E

12

Creativity in theImplementation

A slide made by anAssistant NurseManager to showhow she adds insome fun

13Slide from Alma Domingo – Asst Nurse Manager in Kaiser Hayward Hospital

14

If Service Design is HARD (and it is…) thenimplementing and spreading these designs must trulybe ROCKET SCIENCE.

My final thought…

Howʼd You Solve It?

William Watt Electricians is a Bay Area company providing basic repairs,installations, and troubleshooting for residential and small business customers.

Photo by I See Modern Britain, http://www.flickr.com/photos/27128437@N07/2534505446/

Out of two offices they dispatch their team of two dozen electricians to serviceemergency calls, perform commissioned projects, and provide quotes. Givenbroader economic trends, William Watt is interested in moving into…Photo by Editor B, http://www.flickr.com/photos/editor/320670284/

…the growing green market to help homes become more energy efficient. Theirpotential new offerings might include efficiency assessments, instillations of moreefficient equipment, and suggestions for improvements.Photo by mjmonty, http://www.flickr.com/photos/36295747@N00/1519998876/

Youʼve been brought in to advise William Watt Electricians on howthey should approach the development of this new service.

➜ How would you approach the problem?➜ And why is it the right approach?

William Watt Electricians

moving towardsgreener homes

Service Goal: Make homesmore energy-efficient

GOOD NEWS: huge number of service opportunities

BAD NEWS: huge number of service opportunities

Overall Strategy

• Use the 7 contexts to organize your design thoughts– Assess competencies wrt each context

• People, consulting (front stage) skills?• Troubleshooting, repair (back stage) skills?• Integration (multichannel) skills?• Technology user or technology driver?

– Identify stakeholders wrt each context– Brainstorm potential services wrt each context

Service Approaches

Person-to-Person• Consultancy• Qualitative Assessments• Energy Consumption Diary Technology-Enabled

• Assessments based on installed sensors, usage statistics•Connect to home network?• Proposals would show ROI

Collaboration with • Home builders• Utility companies (for referrals)• Local governments

Self-service technology• For consumers who want the experience of “being greener”, install devices that they control or that keep track of their energy usage

Service Approaches

Remote Monitoring• Can these devices be accessed remotely?• Can they be controlled remotely?• Integrate into Internet service?

Back stage technology

•Install devices that reduce energy use, but aren’t visible to consumers (tankless water heaters, insulation…)

Watt?


form theframeworkand strategy

discover

implement

create | express

refine

socialize

After Robinson and Dubberly

How I would approach the problem


our charge was…help homes become more energyefficient...

but there may be a bitof a problem withWattʼs assumptions...


People see the world through theirown lenses...

Service group Equipment group Armament group

Aerodynamics groupElectrical groupWing group

Empennage group Powerplant group Stress group


home and energy

composed of a variety of systemspeople (families)heatingcoolingcookingwasting...

electricwatergas...


redefine the charge to something like…help people live their lives in a moreenvironmentally sensitive and energyefficient way?

customersservice providers (Watt & Co)utilitiesgovernment agencies...


and Iʼd look at how othertransformations have happened inthe past…

gas -> electric lights (related)outdoor -> indoor plumbing (sewer systems-big shift)...


Ok—but what services for Watt?perhaps Watt becomes the integratorfor all green related service provision?

or they install sensors and provideways to visualize behavior?

or sponsor community competitionsfor clean energy generation?