Seeing Tomorrows Services: A Panel on Service Design

Seeing Tomorrowʼs Services: A Panel on Service Design Sponsored by CMU Bay Area Alumni and Adaptive Path Hosted at Adaptive Path on 19 March 2009

What is service design? Why does it matter? What's critical? Shelley Evenson is Associate Professor and Director of Graduate Studies at Carnegie Mellon University where she has been writing, speaking, and teaching the practice of service design focusing on tapping into the needs of users of the service.

designing for service Seeing Tomorrow's Services: A Panel on Service Design Shelley Evenson School of Design | Carnegie Mellon University 19 March 2009

A luxury hotel Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services:

A luxury hotel + Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services:

A luxury hotel When delivery falls short of expectations… Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services:

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

JʼsUnitedStarbucksWestinWolfgangPuckPeetsHertzOnStarBlackberryAT&TZoneTagFlickrQuicken Our service experiences are multifaceted and co-produced Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services:

TwitterFacebookTwitterCuteOverloadGizmodoBoingBoingTwitterPerezHiltonTwitterDiggTwitterFlick rTwitterEtsyTwitterLivejournalOMGKittyFacebookMyspaceImInLikewithYouTwitterCore77Weather TwitterTreehuggerStarbucksTwitterAmazonAppleInsiderSomethingAwfulTwitterCuteAddictDeviant ArtPennyArcadeFacebookEbayTwitterYouTubeTwitterCriticalMassTwitterPotLuckDinnerHalo Many new service experiences are multifaceted, co-produced, and shared Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services:

TwitterFacebookTwitterCuteOverloadGizmodoBoingBoingTwitterPerezHiltonTwitterDiggTwitterFlick rTwitterEtsyTwitterLivejournalOMGKittyFacebookMyspaceImInLikewithYouTwitterCore77Weather TwitterTreehuggerStarbucksTwitterAmazonAppleInsiderSomethingAwfulTwitterCuteAddictDeviant ArtPennyArcadeFacebookEbayTwitterYouTubeTwitterCriticalMassTwitterPotLuckDinnerHalo Many new service experiences are multifaceted, co-produced, and shared NOW Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services:

people are changing… 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 and services Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 9

So is the work they are doing... Total US Employment New jobs in the U.S. 1998-2004 Number of employees in millions % 100% = 5.4 million Source: Johnson, Mayika, and Lee, Next revolution in interactions, McKinsey Quarterly 2005 number 4 Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 10

technology is changing… Web-based services have had a huge impact More will change as the world becomes ﬁlled with swarms of sensors with local embedded computation Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 11

business is changing… The kinds of experiences a company offers contributes to the performance metrics and valuation of the company Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 12

traditional 4ps of marketing Product—things you sell to people Price—determining what the value exchange will be Placement—how the product gets to its audiences Promotion—how people ﬁnd out the product is available Neil Borden 1964 Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 13

people product place process performance (after Lovelock and Wright) Photo Christopher Alexander Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 14

Important concepts journeys and touchpoints back stage and front stage Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 15

system interactions p2p p2m m2m person to person person to machine machine to machine Me & my doc Me & the mri My sensors/agents to systemʼs agent Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services:

The impression (the sum of the experiences) is the brand for both providers and customers. Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 17

brand customer service relationship provider (user) meta design design service medium A ʻservice as designʼ triangle (After Gadrey 1996a) Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 18

form the framework and strategy create | express discover socialize implement reﬁne After Robinson and Dubberly Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services:

We combine interdisciplinary teams, conceptual model-making, and design-centered methods over three research stages exploratory generative evaluative Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services:

designing for service is hard You are iteratively planning and constructing a service system or architecture to deliver resources that choreograph a design experience. but when a company provides the optimal mix— they will have produced a resonating service system that will deliver a clear experience advantage.

What is service design? Why does it matter? What's critical? Robert Glushko is an Adjunct Full Professor at the University of California at Berkeley School of Information where he teaches and writes on service design focusing on the contribution of the service's quot;back stagequot; where materials or information needed by the front stage are processed.

Designing “Service Systems” Robert J. Glushko UC Berkeley School of Information Information & Service Design Program 19 March 2009

Is “Service” a Homonym? Web Service Personal Service Self-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

Deconstructing Front Stage “Service” (Apte & Mason) Service encounters can include: • 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 Front Stage Back Stage

Benihana Experience Front Stage Back Stage

Amazon.Com Front Stage Back Stage Credit Authority Retailer Warehouse / Distribution Delivery Service Customer

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? In a teaching hospital I am. No, I am.

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

Service System Scope Time is a primary dimension of scope but not the only one Front Back - Time + Time Stage Stage Touch Point “Window”

The Restaurant Experience Touchpoints Service Scope Primary Producer Supply Chain Delivery The Stage

The Massage Experience Touchpoint Service Scope

The Amazon Experience Touchpoint Touchpoint Service Scope The Stage Warehouse Wrapping / Distribution Stage Again

Service System Scopes Back Front - Time + Time Stage Stage Amazon Massage Restaurant

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 Sequence Diagrams Ethnography Stakeholder Survey Blueprinting Model-based Integration Persona Use Case Usability Testing Data Modeling Prototyping Story / Scenario Document Analysis Iteration

How does an organization practice service design? Christi Zuber leads an internal Innovation Consultancy at Kaiser Permanente where her and her team have co-designed numerous new services with patients and clinicians that have not only lead to measurable impacts on patient safety and satisfaction, they have been spread across Kaiser's 32 hospitals and beyond.

How we ﬁt HOW DOES THE INNOVATION CONSULTANCY FIT WITHIN KAISER PERMANENTE? Innovation Consultancy Innovations in Frontline Care IAT Innovations in KPConnect INNOVATION Advanced EHR Innovation AT KAISER PERMANENTE Technology Innovation Learning Garﬁeld Innovation Network (ILN) Center Knowledge Sharing Innovative space for Innovation collaboration and simulation + Many, many more 1

How we do it We are driving innovation at the frontlines of healthcare by bringing together best of class methods in innovation, design and implementation. There are 3 key parts to this. Frontline Collaboration Prototyping & Development Implement & Assess Synthesize Brainstorm Prototype Storytell Field test and Observe & implement Inquire We collaborate and work with our We use a proven methodology We use IHI best practices to frontline care providers and created by IDEO, a world renown implement and evaluate the patients. They are a critical part design ﬁrm to develop and impact of our innovations of our team throughout the prototype ideas based on human process. needs. 3

Roles: Innovation Consultancy, Nice to Meet You! + 7 brand-new team members Christi Zuber Scott Heisler Chris McCarthy 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 2 Email: Innovation.Consultancy@kp.org

What we do Innovation and Design Thinking on the Frontlines of Healthcare We leverage design-thinking to develop human-centered solutions to impact patient care and the work experience of our care providers. How you might know our work... tools Medication Administration: Interruptions dropped by 50%, Process reliability increased, Medication errors reduced; spread across KP and abroad Design NKE spaces processes Thinking . Nurse Shift Changes: Nurses got to see patients at the start of their shift 3x faster under NKE pilot. Patient satisfaction measuring “I understood my plan roles of care” increased. Sought out by outside institutions as best practice in nurse shift changes. 4

KP MedRite Making hospital medication administration safer - together Christi Zuber christi.zuber@kp.org 5 Director, Kaiser Permanente Innovation Consultancy Adaptive Path-Service Design Panel 3.19.09

Creating a Case for Change 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 Patient Care • West Los Angeles Services Innovation Consultancy • South Sacramento Quality and KP Safety HealthConnect 6

Observations and Storytelling Nurses were asked to draw the ﬁrst thing that came to their mind when they thought of “Medication Administration” 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.” 7

Brainstorm, Prototype and Enact • 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 the analogous observations – Pharma TV – MedBed – Self-Administration – Sacred Zones – Sterile Cockpit 8

Field Testing – “No Interruption Wear” evolution Hayward Hayward West LA Deep Dive SoSAC 6/07 6/07 9/07 4/07 5/07 9

Pilot Solutions Process No Interruption Wear Sacred Zone 10

Pilot Outcomes and Spread Pilot Results: 2 hospitals, 4 units –50% reduction in the number of sta! interruptions to the medication administration process –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, KP MedRite is spreading to all 32 Kaiser Permanente hospitals Pe rce nt of Me d Pas s e s w he re all five bas ic s te ps w e re com ple te d (n!68) 100% 90% 84% 81% 80% 79% 74% 74% 70% 68% 66% WLA - 2A 60% WLA - 3W 50% HAY - 3CW 40% 37% HAY - 3E 33% 32% 30% 28% 20% 10% 11 0% Baseline OneMonth Tw oMonth

Creativity in the Implementation A slide made by an Assistant Nurse Manager to show how she adds in some fun 12

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

My ﬁnal thought… If Service Design is HARD (and it is…) then implementing and spreading these designs must truly be ROCKET SCIENCE. 14

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 service emergency calls, perform commissioned projects, and provide quotes. Given broader 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. Their potential new offerings might include efficiency assessments, instillations of more efficient 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 how they 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 towards greener homes

Service Goal: Make homes more 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

Service Approaches Self-service technology • For consumers who want the experience of “being greener”, install Back stage technology devices that they control or that keep track of their energy usage •Install devices that reduce energy use, but aren’t visible to consumers (tankless water heaters, insulation…) Remote Monitoring • Can these devices be accessed remotely? • Can they be controlled remotely? • Integrate into Internet service?

How I would approach the problem form the framework and strategy create | express discover socialize implement reﬁne After Robinson and Dubberly Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services:

our charge was …help homes become more energy efﬁcient... but there may be a bit of a problem with Wattʼs assumptions... Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 25

People see the world through their own lenses... Service group Equipment group Armament group Wing group Electrical group Aerodynamics group Empennage group Powerplant group Stress group Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 26

home and energy electric water gas ... composed of a variety of systems people (families) heating cooling cooking wasting ... Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 27

redeﬁne the charge to something like …help people live their lives in a more environmentally sensitive and energy efﬁcient way? customers service providers (Watt & Co) utilities government agencies ... Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 28

and Iʼd look at how other transformations have happened in the past… gas -> electric lights (related) outdoor -> indoor plumbing (sewer systems-big shift) ... Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 29

Ok—but what services for Watt? perhaps Watt becomes the integrator for all green related service provision? or they install sensors and provide ways to visualize behavior? or sponsor community competitions for clean energy generation? Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson Seeing Tomorrow's Services: 30

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Seeing Tomorrows Services: A Panel on Service Design

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Seeing Tomorrows Services: A Panel on Service Design Presentation Transcript