Health Equity Requires Common Sense Design Principles
As an ER physician and the new Founding Director of Health DesignED, the Acute Care Design and Innovation Center in the Department of Emergency Medicine at Emory, I often reflect on the design ideas and core questions that guide me personally. The design principles below are principles that I’ve developed over time through experience. In most cases, they also just reflect the fundamental elements of good design, or as like to say, common sense.
Account for Reality. The world and our systems are not ideal, and we must account for their values and track records.
Be explicit about implicit bias. Bias is implicit in the very design of our systems, organizational methods, research methods, and daily practices. We must acknowledge the elephant in the room.
Understand how your unique perspective (and its limitations) influences your interpretation of events, structures, and other people. For example, I am a first generation black Harvard education female doctor. I see the world from this view and understand that my lived experience helps to determine what I see and don’t see.
Actively generate stories of empathy as you design for others, with others. Embrace the fact that ideas that do not at first make sense to you may very well be the same ideas that propel your own thinking and creative process.
Practice mutual accountability. Contrary to the messages we’ve been given, we are not only responsible for ourselves; we are also responsible for each other’s health and well-being because we live in a community. We are accountable to each other.
Juxtapose the mainstream story you hear all of the time to the underrepresented tale. See what that reveals. Let this inform what you do next.
Define the real problem. Consider the most popular or common framing of the problem you are aiming to tackle. State your own assumptions, personal biases, and institutional biases out loud. Then redefine the problem.
Ideate with anyone and everyone. Be humble. Good design requires confidence and humility.
Prototype for the “base of the pyramid.” Products and services that meet core universal needs will stand against the pendulum of trends.
Account for one generation before and one generation after in your design work. As Indigenous peoples have taught us, aim to take the long view of how solutions may influence generations to come and the larger systems they live within.
How did I arrive at these specific principles?
I cannot remember a time when I was not thinking about how people experience illness based on the myriad socio-cultural factors that underlie wellness. In tackling complex health system challenges across an array of global contexts, my work has always been aligned with systems thinking and interdisciplinary frameworks. Indeed, I developed my health equity “lens” through systems thinking. I notice this formal and informal design lens in the work of thought leaders like Prashant Yadav, Timothy Peck, and Dori Tunstall. These are all design and healthcare leaders who are deep in the work of finding solutions in the midst of imperfect systems layered with human complexity.
As with everything, I am sure that through iteration, these principles will evolve over time. As my team members and I work to equitably redefine the frontier of acute care, I hope these principles can help guide us. More than anything, I hope we bring more humanity to our structures and let our systems and structures be molded by the diversity of lived experience among our patients.
