Evaluating the Influence of Human-Centered Design on Health Programs

Designing for “good” is often framed as social design: the process of applying human-centered design (HCD) principles, methods, and tools to improve human well-being and livelihoods. In a nutshell, HCD pushes designers to prioritize the human dimensions of health, health services, and health systems to help define problems and solutions in ways that prioritize the desires, needs, and experience of the people who are expected to benefit from improvement interventions.

While based in empathy, the approach is only a recent addition to public health programming. Designers, implementers, and evaluators are still in the early stages of learning how to optimize HCD to advance health system performance and health outcomes. As Cheryl Heller, the Founding Chair of the first MFA program in Design for Social Innovation noted at the 2017 Measured Summit, “The [social design] field is being driven as much by what we don’t know as it is by what we do know.”

As the field develops, it is critical that we also include measurement in the conversation. Pinning down the influence of HCD through measurement can help us to better understand the link between HCD and program impact. With such insight, we can inform and improve the practice, while unpacking how design can enhance public health work. Yet despite its importance, there has been limited focus on introducing measurement into the design process to help ground HCD in empirical evidence.

As both public health implementers and evaluators, we have begun to explore the relationship between HCD and health program and system performance over the past two years. Last week, we released the first of four case studies to document and explore the application of HCD in maternal, newborn and child health programs.  The study was done in collaboration with Concern Worldwide, Grameen Foundation, and ILC in the context of the Innovations for Maternal, Newborn and Child Health Initiative (Innovations). It focused on the design and introduction of a mobile phone application – CHN on the Go – that aimed to improve health worker motivation and job satisfaction among Community Health Nurses (CHN) in Ghana. Our HCD case studies represent one of the few attempts to pin down HCD with measurement and build an evidence base for both the design and global health communities. The case studies present a grounded theory, proposing a theoretical pathway of HCD influence on health program outcomes for consideration among our peers and collaborators in this space.

Equipped with this new perspective and understanding of HCD and measurement, in January 2017, we attended the Measured Summit hosted by the School of Visual Arts (SVA) that convened:

1. People who practice, teach and write on human-centered/social design
2. People who evaluate and analyze the impact of health programs
3. People who are trying to measure the impact of design.

The unique gathering aimed to advance efforts and learning related to measuring the effectiveness of HCD as a methodology for social change. We summarized some observations from symposium participants and presenters with a focus on what we, as a field of practitioners, know and do not know about applying HCD and measuring its contribution to health:

On designing for social impact:

• HCD is not a silver bullet, not “one and done” and not one size fits all.
• Much of HCD is centered around a product but in this space, the impact really needs to be on the system to create the outcomes we seek. HCD provides a bridge between people and systems.
• HCD in this social impact/health improvement space can be difficult because the scope for integrating design throughout the process is often limited.  Problems are usually predefined by funders as part of grant making.
• When designers are engaged, their role is often short term, rather than as partners in program implementation.

On the measurement of HCD:

• The pathway from HCD to an outcome is rarely documented.  
• There are no standardized measures of the effects of HCD. Also, no single metric that measures the impact of design (e.g., Net Promoter Score) is going to tell us the whole story.
• In product development, we measure effectiveness with sales but in the social sector, space sales do not equal impact. Social design requires different methods and metrics.
• In many cases when HCD has been used, the impact is assumed, possibly because of its novelty and presumed effectiveness. There is a need to better understand the trajectory of the social design process – what does it do and how does it influence social change?
• There is a need to build measurement into design practices, develop specific design-related metrics, and link them to standard metrics of health program and system performance.
• Measurement should also focus on sustained change. In addition to improving uptake of a health service or inspiring behavior change, we want to know if HCD contributes to lasting change related to improving health and health care delivery.

Our Innovations case studies and the Measured Summit represent important efforts to unpack the process and effect of using design for social impact, encouraging collaboration between designers and evaluators to improve our collective practice. We invite you to join us in advancing the field of measurement and design and exploring the pathway of the influence of the design in programs that aim to improve health and well-being.

Written by Anne LaFond and Nikki Davis