Rama Gheerawo is the director of the Helen Hamlyn Center for Design at the Royal College of Art. Rama is a global leader in people-centered and socially inclusive design. He's a serial innovator in the fields of technology, products, services, and transport with over a hundred projects to his name. In this episode we discuss the role of design in creating products, services, and systems that benefit people of all abilities, especially in terms of aging populations in healthcare, and why creative leadership is needed now, more than ever.
Links for Reference:
Helen Hamlyn Center for Design, Include Conference, Oxford Aging and Technology Project, Slow-Mo
Olga: [00:00:00] I'm Olga Stella, the executive director of Design Core Detroit. Thank you for joining us for season two of the Detroit City of Design Podcast. As stewards of Detroit's UNESCO City of Design designation, we aim to raise your awareness of how design can create conditions for better quality of life and economic opportunity for all. Designers are professional problem solvers, and in season two, we will discuss the value of design to business and society.
I'm excited to be speaking with Rama Gheerawo, who's the director of the Helen Hamlyn Center for Design at the Royal College of Art. Rama is a global leader in people-centered and socially inclusive design. He's a serial innovator in the fields of technology, products, services, and transport with over a hundred projects to his name.
Today, we will discuss the role of design in creating products, services, and systems that benefit people of all abilities--especially in terms of aging populations in healthcare, and why creative leadership is needed now, more than ever.
Rama, I'm so glad to be talking to you again. The last time we were together was when you were in Detroit in November, 2019 for The Include Conference, and we're just so happy to have you on the show. Thanks for joining us.
Rama: [00:01:16 It's an absolute pleasure and honor to be here and I feel like I'm sitting there with you in Detroit, one of the most exciting cities with an exciting collection of artifacts and objects at the Henry Ford. The Include Conference was so great because it was about design and inclusivity, something I breathe and love.
Olga: [00:01:37] This is one of the reasons why we've enjoyed partnering with you and your colleagues at the Helen Hamlyn Center, and continuing to explore topics around inclusive design, which you know is a really important part of our work through the Detroit City of Design Initiative. I was hoping that we could start off today by having you talk a little bit about what inclusive design is, and why the world might need it now more than ever.
Rama: [00:02:04] So, wow. Inclusive design is something that I'm personally passionate about and professionally, gives purpose to my work. It is about a very simple idea, and that is that every design, every idea, every concept that's produced within a creative process should be inclusive: inclusive of people regardless of their age, ability, gender, need, social circumstance. You know, the UK government has not always been famed for getting everything right, but one thing that they got right was a definition of inclusive design 20 years ago. They talked about it as being “design that includes the widest number of people,” and very simply put, which government, which organization, which community or neighborhood doesn't want that?
Olga: [00:02:59] That's right. And I think you've really shown that through the work of the Helen Hamlyn center, through the research projects, the design research projects that you've undertaken with industry to help improve people's lives. Why have you seen big companies, governments want to work with you on these issues? What is the value that they've seen that it will bring to them in their work?
Rama: [00:03:22] So, inclusive design is not just about good intentions. It's also about good business. If it started off as looking at design for the margins, people who are marginalized by mainstream design. But now it's just about good design for everyone.
It is about getting closer to your customer, your consumer. It is getting closer to human need and aspiration. It is understanding the full dimensions of a person's life.
Inclusive design used to be about trying to get one size to fit everyone. But now for me, it is about choice. It is about individualism, but it is about us as a global collective, designing together, working together, living together, and breathing together. That is so incredibly important.
You know, when we look at the events that have happened in 2020, we're at a point where inclusive design is needed, when no design should be happening that is not inclusive. And companies, organizations… whether they're small, medium enterprises, community-based or third sector, can all benefit from this.
We often talk about ourselves as being designers second, but human beings first. And inclusive design brings that to the fore. It brings that into conversations about business, it brings that into the boardroom, it brings that into the creative process. It has strategies and methods for helping you understand how populations are aging, how populations are shaping themselves around different ideas, around different needs.
We don't just look at functional need, we also look at aspiration. We like to think we look at how people are behaving now, what are their needs, what are their wants, and what are their perspectives... and use design to project that into the future. It's not about using design as a tool for dictating what it is that people want. It's using design as a support for giving people what they need. Even if they didn't ask for it. It's about being balanced. And it's about being measured. So it's not about over-delivering. It's not about oversubscribing. And it's not about overuse. So I think the final thing to say is, when we talk about a sustainable approach to design, we talk a lot about the environment. We speak somewhat about economics, but what is missing is one of the third legs of sustainability, which is the social. Quite often, inclusive design brings that to the fore.
And I think when we talk about inclusive design, there are two words and one is design. Design is at its most powerful when it's inclusive, when it's social, when it's rigged up to produce benefit for society, for individuals, for national and international application.
So the companies we work with see benefit across the board from the individuals that work in the company, to the individuals they are designing, creating for and selling to, but it's also this idea of adding value to human life. It's not just about the bottom line. It's not just about survival. It's not just about USPs. It's about being a positive global influence in this world today.
Olga: [00:07:05] Well, it's more important now than ever, just given how our world has been changed through the coronavirus pandemic and the very extreme disruptions that we've faced. So much of your work has been in the areas of aging and diversity, health care, social issues, and I think a little bit about one of the projects your team has recently completed with the Royal College of Physicians in Edinburgh around patient flow. Can you talk a little bit about that project, and especially given how the COVID-19 virus has really disproportionately affected people of color and vulnerable populations, how the kind of work that you've done in patient flow starts to provide solutions that are even more relevant today in a healthcare setting?
Rama: [00:07:53] So COVID-19 has just exacerbated, it's exaggerated difference. It's exaggerated the challenges that some of the most vulnerable, some of the most different, some of the most non-mainstream populations face. So older people, people with disabilities, people with different socio-economic or racial or cultural backgrounds--it's actually exaggerated those differences and those needs to a point where we cannot ignore them. The Center works typically in four different areas. So we have one research group looking at aging and the ability, which includes neurodiversity and mental health. We have another area that looks at healthcare in its entirety, from wellbeing to health, then we have two other areas, one focusing on business impact and the other focusing on social impact.
The particular project you mentioned, which we call “Patient Flow,” is particularly powerful given the events of 2020. It looks at ITU or ICUs, so intensive care units in hospitals, which we spent a year, pretty much, on these wards and observed many things going on. And this was in 2018/2019, so pre-COVID.
The things that we saw were, you know, there was the whole entirety of human life and emotion there. People getting married, people were going through some of the most difficult conversations and experiences of their lives, all within the surroundings of an intensive care unit. We've done a lot of projects in the hospital space--looking at accidents in emergency, looking at patient dignity. One of the big indicators of patient dignity wasn't whether you are sharing a room with people of the same gender or the same age or the same condition. It was being treated with dignity within the process: Where am I?
One of the powerful ideas that came out of patient flow actually looked at the discharge process, which starts when a patient is admitted, when a person is admitted. There was a number of instances and situations that we observed where medical personnel, when given the tools to be able to strategically plan where a patient would go and how to be able to map that journey, allowing for the uncertainties of a particular diagnosis. We importantly used inclusive design through a co-creative method. We actually got the clinical staff themselves to design some ideas.
One of the things they came up with was a simple traffic light system, which became a graphic that can be used digitally, or it could be used physically on a whiteboard, and a nurse standing at one side of the room could glance across it and see which patient are needed to go to the operating theater, which patient was closer to discharge than others.
It was this, at-a-glance kind of technique, it was an at-a-glance idea, which I think is all important in design within critical care. You know, right now we're also working with some of the hospitals in London looking at some of the pressing needs that have come up because of this crisis. We're seeing a lot of medical personnel, whether they’re final year students or retired clinicians, or nursing staff being asked to come back into the healthcare system to support. It means that a lot of people, a large percentage of people in hospitals turn up without knowing where things are situated. You know, where the supply closet is, where the cafeteria is, where do people go? How do you orientate a willing army of people who don't know where things are and have to work within a life-threatening situation where you know, the people they're caring for can be literally on life support of some form.
So we have been working very quickly to actually design some orientation maps, diagrams and processes using the good principles of inclusive design and graphic design to address that problem immediately. So what I love about inclusive design in the way we've applied it, is that it's accordions. It can be used within a kind of, week-long, hour-long day-long innovation process to meet the most urgent need, or as with the patient flow process, that took about a year and it was a deep dive research engagement with design outcomes that were co-created by the clinicians.
Olga: [00:12:55] It is really important to emphasize that even as the solutions aren't one size fits all, but really tailored to the problem that's being solved and so is the case with actually designing and implementing these types of inclusive outcomes. We are seeing just so many more people, especially our elders, isolated due to the pandemic, unable to engage in their regular routines. And some of the work that your team has done around hand coordination and the ability for our elders to be able to care for themselves on their own, in their homes, really rises to the top for me. And I'm wondering if your team, whether there are new projects that have come online, or if there's some learnings from insights from the prior projects, like the healthy hand project, that start to give us some insights as to how we can empower our senior populations to be able to live independently even more today in this time of physical distancing, and digital social life as opposed to the kinds of norms that we've been used to.
Rama: [00:13:23] Absolutely. I think that there’s so much in that question that I'm incredibly passionate about, and one of the magical things about being a designer, working in this inclusive space within, you know, designing with a social attitude, for want of a better word--is that you get your preconceptions challenged, and there's few better groups on the planet to do that than older people.
You realize that older age is a mixture of many things. It's not just a group of people who are retired and waiting to pass on. It's not a group of people who are devoid of aspiration or can't use technology. We've worked with hundreds, if not thousands of older people across the globe, and they are as diverse a group with diverse un-catered-for needs as any other group on the planet. Probably more so! You know, there's more over sixties in many developed countries than there are teenagers, but we have this youth-filled focus, which we need to step beyond.
It's not just a market opportunity. It's a social opportunity. So we talk to our designers, our young designers that go through education at the Royal College of Arts, and you know, the designers we engage with about designing for your future selves. So you're not doing “age-friendly design,” “geriatric design,” any of this. You're designing for your future self. You should never design something that you wouldn't use or you wouldn't be willing to use. And I think that's an incredibly important litmus test, when you create solutions for people of all ages and abilities.
The other thing is you shouldn't just design for people. You need to design with people. We have done projects across the world and a memorable moment was working in Hong Kong, in care homes where we actually had students use the hoist, sleep in the bed, eat the food that were in a care home. And they realized this was not an environment they would designed for themselves. What came out of this was to design a pod that was most like a first-class aircraft cabin because it's the same size as a care home bed and the footprint is the same. It was a magical moment when they realized they weren't just designing for desperation. They were designing for aspiration. Some of the older people turned around and said to those students, you know, you're all teenagers, or in your 20s or in your thirties and you look more miserable than we do. So…
Olga: [00:16:55] Maybe these are pods we should all be having in our homes right now. Can you help us understand a little bit more about how they work?
Rama: [00:17:03] Sure. Care-home beds around the world, whether it's Canada or China, you're given a footprint. You have to fit a person within a particular footprint, and that can accordion up or down a little bit, but there is an efficiency factor here. We realize one thing that we were hearing, time and time again in care homes, wasn't about efficiency or cleanliness or the indignity of having someone come and feed you. It was a couple of other things: it was the indignity of not being able to take a drink when you wanted to. Not being able to have a private moment with your loved ones when they visited. But the really big one was the statement, “I don't like the person I've been put next to.”
So if I was to say to you, Olga, “okay, I want you to meet John.” This is John, and you are going to spend the rest of your years on this earth next to John. And the reason we've done this is because you like the same TV program and you're both Aries, right? It's completely operatory! And, the reason people can't change the beds around so easily is because the curtain rails that go around the bed are fixed into the ceiling. So we thought, why don't you fix the curtain rails to the bed? And then you have a little self sealed unit. Which actually becomes more like a first-class cabin. It means you can move the bed around, it means you could self-seal if your husband or wife comes to visit.
And you know, one of the heartbreakingly beautiful moments that I saw in a car home was a couple in their nineties who had been together, been married for the better part of 70 years. He had moved into the care home and she was visiting him. And when she came in, she had to wait 15-20 minutes for the busy staff to find her a chair, and she just said, we spent 70 years waking up together and going to sleep together, and I don't have that with him anymore, but here, I would just love to be able to sit and have an intimate moment looking in each other's eyes and to be able to sit immediately.
And that became a brief where one of our designers designed a chair that could hang in the wardrobe, that was part of the bed solution that she could wheel out. It was the width of three or four shirts. She could wheel out, unfold and sit, and the height of the chair seat was the same height as the bed, so you could get that eye to eye contact. And in that story for me is the beauty of inclusive design. It's about enabling life, enabling humanity, enabling choice. So we all want choice, and inclusive design is about that choice.
Olga: [00:20:06] I think today, you know, we are all feeling a sense of what it means to not have that independence. You know, with so many restrictions and so many changes all outside of our control. And I know I was joking earlier about how we might need these pods at home, but when I think about the dignity that the pod brings in a nursing home and an assisted living situation, a care home, and how just having that same sense of privacy and control over one's environment, in these times when so many of us are living in close quarters with our loved ones, you can start to see how the benefits of that thinking around dignity and independence and privacy can translate outside of the care home, the nursing home and into our everyday living.
You know, Rama, I've been feeling a little bit, and I’m watching my own children doing all their schoolwork on Zoom classrooms, and Google Classrooms, and so on...this idea around kindness, social connection...your team has done some work in this space in the past that I'm wondering if you have some thoughts for our audience about ways that our technology companies and other service providers can help support each of us as we're learning to work in this new world of physical distancing, but digital connectedness.
Rama: [00:21:33] Yeah. I think there's a couple of things there. One is that technology is not the answer that humanity is. Technology provides us with tools, but it provides us with all sorts of other challenges. You know, video conferencing can be almost frustrating to the point of being hilarious when kids start crying, dogs start barking, neighbors start shouting, postman rings the doorbell...and I think, just the challenges of trying to have a 30-person conference meeting, when sometimes what people need is a smile from a stranger, they need the human touch. And I think we are in a danger of seeing a generation of designers or generations of designers creating, just apps for dementia or Facebook for older people, and I would just get on my bended knee and plea for us to step beyond that.
We may be in the era where social distancing has become a thing. But it isn't really about social distancing, it's about physical distancing. We need that social connection. We need that human touch. I think, you know, if I was to give a couple of soundbite words to designers, I would just say, “listen more.” That's your most powerful tool--and be kind. If you can't think of anything to do today, just be kind, or be kinder. And almost, you don't need an HR manual if you just follow the principle of “be kind.”
Inclusive design is just about listening and kindness and then using your skills as a creator, as a designer to act on that. And it's not about technology shoe-horning an answer into every conversation. It's about enabling human connection, creating human connection and what COVID has done...it's done many, many things, many devastating things... but it's also become a crucible for some of the pressing concerns that have happened over the last hundred years.
You know, we've gone through social, societal, technological, industrial revolutions. Can we go through a conscious one? Can inclusive design actually bring us more consciously together, as a community? Can we make more conscious choices and can we make more collectively conscious choice? So, inspirationally and stepping into, a sort-of helicopter view--which I'm physically not allowed to do, unfortunately--you know, stepping into the metaphorical helicopter, that is really a hope--a sort of quiet, whispered prayer from me. It is that inclusive design can bring a wholesome, and holistic slant to a conversation about how we can create solutions that are more balanced.
You know, one of the issues that we have is we are still dealing with today's problem with sort of outdated frameworks, outdated leadership, outdated creativity. And we're in a situation where many things are imbalanced, including our own personal lives, our own personal time. You know, you touched on isolation, Olga, and isolation is something we're all feeling to some degree. The network of people that we could physically touch, were isolated from. So in this kind of accelerated, pressurized situation, I think inclusive design is an answer to how we co-create our way through this and how we do build ideas and conscious solutions with conscious thought that can benefit us all.
Olga: [00:25:42] Yeah. You've done some work with people who experience paranoia and other mental health issues. Is there some practical, tangible thing that we can pull from that work that might help each of us today? You know, in terms of the types of solutions that your team has developed using these inclusive approaches for people who are experiencing mental health challenges.
Rama: [00:26:06] So I think Olga, that you have come from the future because you're saying many things that I hope would be signaled and be realized in the future. And one of this is the essential principle of inclusive design, which is what we may designe for the most extreme users within a situation, whether it's due to age or ability or gender or culture-- actually is better for us all. So if you create a solution for people that have extreme needs, you create something that's better for us all, typically, and many companies have understood that. When we look at mental health, it took us a while to actually apply inclusive design in that space because we didn't know how its application would fi. Would it actually bring something of value to the conversation, and the answer is yes, it does. Within mental health, we've looked at projects around autism, around dementia and paranoia, psychosis, and even suicide have been some of the powerful projects that have been going on.
We've been doing two different projects: One with Kings College in London and the other with Oxford university in Oxford. The project with Kings was actually instigated by them, where there's around 600,000 people in the UK, which you know, has a population North of 60 million, 600,000 are diagnosed with some form of paranoia. And we were looking at, could we create a digital service, an online service that supports people's mental resilience and their strength? When they go and see a doctor or have a clinical appointment, their mental health increases, but then they can go outside and something can happen to them, someone could ignore them or they could hear a cross word or an argument across the street that could trigger negative emotions. So how do you keep mental resilience and a sense of self?
We got it wrong because we thought it was just for 600,000 people in the UK. It's actually for the 65 million of us that live in the UK! And that's one of the beauties of inclusive design. You know, what we came up with was something called Slow-Mo, which is “slow down for a moment,” and it's just about using graphic visualizations to put your negative thoughts down, and slow them, slow them down physically with your finger using your smartphone or a web application.
You know, I'm saying things in a very simplistic way, but it's a complex web service that's going through clinical trials and it's much more than that. But that was the idea behind the title “Slow-Mo.” The project we're doing with Oxford uses virtual reality. VR has gotten pretty good to the point where you can actually start to feel a bit nauseous if you're in there for too long, because it can feel so real. We have looked at people with some form of psychosis, that might find it difficult to go out and perform everyday activities such as going to Starbucks or going to shop in a supermarket. And things like COVID has just made those things even more difficult for people across the neurodiverse spectrum.
And what this does is create six virtual environments with a number of different levels. The first level is you actually have to walk inside the cafe. Right through to where you may be a part of an aggressive interaction, and stages in between where you need to stand in a queue or the coffee, et cetera. The virtual environment is actually showing, you know, in clinical tests to help people train themselves on how to act in certain situations.
But again, I see a huge application. I'm just thinking here of the first date, cause you actually rehearse some lines at a first date, a job interview, your driving test, any sort of thing. Could this actually help us role-play in a way that allows us to test out some of our skills? But of course, this is a training zone. This does not replace real life or real experiences, but it supports a human's ability, a person's ability to live every dimension of the life that they want to.
Olga: [00:30:48] Just think about when we all start to reenter, going to the market, going to restaurants, and even just being able to prepare ourselves for the difference that those physical realities will have, from what they were, you know, last year, or months ago.
You know, we could go on and on, Rama, with all the projects you've worked on - so many projects in inclusive mobility, and just so many topics. And I'm wondering whether for our audience, maybe you can help inspire us a little bit around, some of the work that you've been doing in creative leadership, especially as we'll all need to work together, whether we're in business or government, nonprofits, individuals, to start to create some solutions to adjust to our new paradigms. What is creative leadership, and why does it matter now more than ever?
Rama: [00:31:39] Sure. So creative leadership is a subject that's really close to my heart. It came from the gentle power of dissatisfaction, and I think as a creative, as an inventor, as a designer, as an entrepreneur, as a human being, and we all have creative ability...you should have a little sense of dissatisfaction with things in order to make them better, but this shouldn't be the ruling trajectory in your life.
It's gotta be gentle. Gentle enough that it doesn't get you down, and balanced with the need to inject a little bit of joy into your everyday life! So creative leadership came from my gentle dissatisfaction, which actually was quite powerful at one point. And that was with looking at two things: one was, you know, I honestly believe that design can make every conversation better, but often it's not included strategically in business. People think design is just “make things look pretty.” No, we don't. We are about understanding how people behave, what need is, what aspiration is, and creatively approaching that.
You know, creativity isn't just limited to designers. It's the right of every human being to be creative. That's right. So understanding that designers could play a leadership role was important, and creatives need to be in leadership positions. But then I realize we also need leaders who are more creative. So we need creatives who are leaders and leaders who are creative.
The term creative leadership has been around for a few decades, but the definition we give for it, is really based on a couple of things. One is that everyone can be a leader and you start by leading yourself. If you can't lead yourself, if you don't understand yourself, how can you be expected to lead other people on projects, or other things.
From inclusive design and working for a couple of decades and inclusive design, three values really came up that informed the creative leader of the 21st century. So for all of you listening to this podcast, I want you to see if this rings true with you. So these three values are this, and we've done a lot of research with individuals and companies about this and people recognize them.
So the first is empathy, which I learned from being a human being. The second is creativity, which I learned as a designer. And the third is clarity, which I learned from an ex-girlfriend. And we’ve all had that relationship where you just come out of it and think, “Oh, what happened there?” So creative leadership is about having these three ideas, these three qualities in balance. And what they lead towards is a sense of authenticity. You're absolutely right. All I could talk for the next 24 hours about this, but these three values, you can measure them in terms of your individual capability and they will go up and down during the day. You can measure them in terms of a project, in terms of a group, in terms of an organization.
So, we've been working with a neuroscientist to actually start to put together this matrix, start to measure that, and start to train people. So creative leadership, it's not a process. It's a sort of transformational experience. We think it's incredibly needed because most of what most of us have been taught about leadership is wrong. It's typically the loudest, tallest male-est person in the room, and there was a very simple realization I had that, if you create better leadership at every level, you create better decisions at every level. So this isn't leadership for designers. It's a holistic look. We've been looking at what does a creative leadership office look like, smell like, taste like?
We've run projects with businesses, people who are on the Fortune 500 companies, right the way through to governments. And I think it just brings us back to that human element: creative leadership starts with yourself, but it's a ripple effect; it can have massive, massive impact. If you start with small numbers, you can have a big impact. So really to draw a line on what creative leadership is, it's just about listening carefully, selecting wisely and acting promptly, and again in 2020 we have seen that.
World leaders who have acted with a sense of clarity and empathy actually explained what is going on. You know, why we need to lock down. Why this thing that they don't want to do, but they have to do, is necessary for the benefit of the nation and the benefit of humanity. Leaders who have openly and empathically talked about that, have been believed, by and large. We see that, time and time again. So for me, there's two things: One is visionary, and the other is personal.
The visionary statement is that the rise of the empathic leader is unstoppable, and the demand for this type of leadership will only increase. So, those of us in the creative communities, those of us within design, have a little bit of a head-start because empathy is the Heartland of inclusive design. To be a designer today is an incredible thing, and I'm so encouraged when I see design students, early-career designers across the globe who don't want to hero themselves, they want to hero their projects, and they are the empathic leaders not of tomorrow, but of today, and we can all learn from them.
I think the final thing, which is a personal thought, is that you should inject a little joy into your day, every day, because this will make you a more creative, respected, trusted and clear leader.
Olga: [00:38:12] Well, I have been definitely inspired by those words and by our conversation today, because I think this advice just ties so directly into this idea of adapting, to how designers can help businesses, governments, organizations adapt to these trying times. While there are technical skills that designers have, it is this kind of mindset around empathy, creativity, clarity that combines with those technical skills to really create solutions and I really appreciate your perspective on that, Rama.
Thank you so much for your time today, and for helping to inspire our audience with both the examples of the work that you've done, and this very important call to action around creative leadership.
Rama: [00:38:59] Well, thank you so much. It's been a real honor and a blessing to talk to you, and I'd love to hear anyone's thoughts on inclusive design or creative leadership, or those three values. It would be most welcomed. Well, we will definitely include some links to the Helen Hamlyn Center and to your work, in our show notes, and will definitely invite our audience to engage.So thanks again so much and I look forward to talking with you again soon, Rama.
Rama: [00:39:24] Magic. Thank you, Olga.