Of Systems Thinking and User-Centered Design

 

On Monday Ken Warman and I went at it again. We began this conversation many months ago, over breakfast at a hotel in Patna, in Bihar, but remained inconclusive, hanging, because the official meetings were about to begin.

We’d been talking about the innovations we intended to develop at the Bihar Innovation Lab. I described a suite of patient health information tokens we intended to develop, our planned work on village health and nutrition day logistics, and of course, the vaccine delivery kit.

Something I’d said prompted Ken to ask me if we thought our interventions were going to be disruptive, and I’d responded that I didn’t think the distinction was meaningful. What is disruptive, I’d asked? Who’s to say? One man’s disruption is another historians increment, cf. Kuhn, Shapin and Schafer, Knorr-Cetina, Diamond and many others.


Ah, but what about Christensen
, Ken seemed to be saying. Incremental innovation will only get you so far. If you’re not all about the disruption, the disruption will happen to you. Are any of the things you’re doing really disruptive?

Suppose we only get efficiencies or gains of 10 to 15 percent from the kit, I wanted to say, and we get maybe another 20 percent uptake from the health and nutrition day, and we get another increment from the information tokens. Each of these is interesting, valuable, sensible in their own right. But collectively, we will see tremendous change because the system as a whole will have changed. Moreover, the participants in the system will see that change as being multidimensional – its not that we airdropped a better kit into an old and unchanging system – the kit is a marker of and part of a greater systemic change. I only got to say this stuff Monday morning, with several months intervening.

Fair enough, Ken said in response. So you’re already thinking systemically. You have an end state in mind towards which each of these innovations are separately a part, and that’s what I meant all along. The thing you guys at CKS are actually good at is building a system-wide model based on user-centered thinking. That’s what’s most valuable to people who are trying to build something radically new. Ken seemed to be indicating that whatever it is that Christensen and others now mean by disruption resides in the relation between part and whole. If that elusive relation is being maintained or attended to in some way, radical, intentional, socio-technical change may well arise.

The elusiveness of the dynamic between parts and whole has to do with the difficulty of envisioning different elements of the system at similar degrees of fidelity or detail. The system as a whole can only be conceptualized in terms of its parts, and to have a really distinct and granular understanding of a future system you need to be able to envision the components in even richer detail. I know not everyone involved with systems thinking believes this, cf. Nilekani, Pitroda, Tughluq, but it is central to our way of thinking about user-centered systems innovation. And that’s why each of the component parts that we were working on in the Bihar Innovation Lab are discretely important to us, while also having a collective and comprehensive impact on the healthcare system as a whole.

It’s always a blast talking with Ken.

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