What is design thinking, and how can research teams use it?

In this Q&A, learn from CHIBE Scientific Director and Professor of Nursing and Health Policy Dr. Alison Buttenheim about what design thinking is and how she can support CHIBE investigators in carrying out design-informed activities within research projects.

What is design thinking?

Design thinking is an approach to innovation and problem-solving that puts humans – we often call them “users” – at the center. 

It asks practitioners and researchers to develop a deep understanding of those users’ needs, to define precise design challenges that respond to those needs, to generate lots of creative solutions across a broad possibility space, and to then rapidly prototype and test the most promising solutions in pragmatic, real world settings.

What does design thinking do?

Design thinking helps us build and deliver services, interventions, or processes that are based on what our users really want and need, rather than relying only on theory, on past experience, or on “gut feel.” Those approaches can unfortunately be biased.

What is the double diamond framework?

In the course I teach in Penn’s MPH program and School of Nursing, we organize our behavioral design work around the “double diamond” framework.  

In the first diamond, we use a divergent approach to DISCOVER insights about our users through empathy and contextual inquiry activities, like user interviews and observations. We then converge on a revised and more precise DEFINITION of our design challenge that identifies the behavioral barriers we need to overcome in pursuit of a specific and measurable outcome. We accomplish this through “sense making” activities like persona development and behavioral mapping.

In the second diamond, we again use divergent thinking to DEVELOP solutions to our design challenges through ideation activities that help us imagine lots of different kinds of solutions and early stage, low-fidelity prototyping that translates ideas into objects that we can interact with and further refine.

Finally, we converge again on solutions that we can DELIVER in real-world settings. We do this with more iterative and higher fidelity prototyping, assumptions mapping to see where we need to focus our efforts, and rapid-cycle tests to de-risk and validate. 

How can you help investigators use design thinking in their next project?

I can help CHIBE investigators with the following:

Proposal consultation

• Meet with PIs early in the proposal development process to identify opportunities to incorporate design thinking and human-centered design

Proposal development

• Support CHIBE investigators in writing grant proposals that include design aims and activities as appropriate to meet research goals
• Provide templated proposal language for Aims, Significance, Innovation, Approach, Budget Justification, Human Subjects and Clinical Trial Information, and Resources sections (or comparable sections of non-NIH grants) related to design activities

Project support

• Support CHIBE investigators to carry out design-related activities and analyses as part of funded projects. Relevant activities may include need finding, user journey or workflow maps, assumptions mapping/pre-mortems, persona development, design briefs, ideation, prototyping, and rapid-cycle testing

Can you walk us through an example of how to use design thinking within a specific project?

Sure, let me share how my students used the double diamond approach – along with principles of behavioral economics and behavioral science –  to tackle the problem of fecal immunochemical test (FIT) completion for colon cancer screening at Penn Medicine.

We started, as many health behavior change projects do, with a problem.

The problem:

Penn Medicine patients who are eligible and due for colon cancer screening but can’t get a timely colonoscopy appointment are not completing FIT screening as an alternative.

Some context:

This was a real-life problem at Penn Medicine during a period of time when colonoscopies were very hard –nearly impossible – to schedule. Many primary care providers were eager for their patients who were due for colon cancer screening to complete a FIT test while waiting for the colonoscopy scheduling bottleneck to resolve.

The first step – understanding patients’ experiences:

Our first step in tackling this problem was to understand those patients’ experiences. To do that, design teams interviewed 3 Penn Medicine patients who were not able to schedule colonoscopies but were also not completing the FIT tests their doctors had advised, ordered, or even sent directly to their homes.

What did the design teams ask the patients? They asked for stories: “Tell me about…”. They asked about behaviors and emotions. “What did you do? How did you feel?” When something interesting or surprising  came up in the interview, they probed: “Say more about that? And then what happened?”

Next – mapping:

All of those rich data were captured, first on sticky notes and then in user journey maps or behavioral mapping. Mapping helped us see how the patients went through the FIT test “journey” – what were the stages and activities? What were the users experiencing at each stage? Where were the pain points and potential gains? Where were patients procrastinating or creating work-arounds?

Next – developing personas:

User insights can also be distilled into “personas” or stylized, fictional characters that represent the behaviors, motivations, and needs of groups of users. In our design challenge, we created 3 personas representing 3 different types of patients who were struggling to complete and return their FIT tests: Visceral Vicky, Stubborn Stella, and Distracted Dino.

Next – creating an opportunity statement:

With those user insights and personas in hand, the teams then moved on to reframe the design challenge as an opportunity statement. An opportunity statement can be constructed as a “How might we…? Here’s an example opportunity statement for one of our personas, Visceral Vicky:

Given that Vicky is truly grossed out by the thought of collecting a stool sample and completing the other required steps to return the FIT test, how might we help Vicky to see the “poop” part of the FIT test as funny, manageable, and part of everyday life, so that they can successfully complete the test, enjoy the benefits of screening, and avoid those nagging text messages from their doctor’s office?

Next – ideation:

Our FIT test completion teams were now ready to ideate  – or develop a large bank of potential solutions to meet the design challenge.

In our ideation session, teams completed 5 separate rounds of solutioning, using different ideation techniques to elicit an expansive list of potential ideas to get those FIT tests completed and sent back in. 

Some specific techniques for ideation:

• We used a “blue sky” technique to get top-of-mind ideas captured with no constraints or prompts.
• We tried to “make it worse” – a reverse brainstorming technique that can uncover creative solutions by thinking about how to reach the opposite outcome.
• Inspired by Leidy Klotz’ work, we thought about “subtraction” solutions. What could we take away from the current process to make it better?
• We thought in analogy – How would a brand like Doritos, or Spotify, or Ritz Carlton address this challenge? 
• We used brainstorming prompts from the “EAST” framework. EAST is a behavioral design framework developed by the UK Behavioral Insights Team  that organizes a long list of behavioral economic intervention strategies into 4 big buckets that answer the question, “how do I make it more likely that a desired behavior will happen?” Well, you can make it Easy, Make it Attractive, Make it Social, or Make it Timely – EAST!

Next – choosing which ideas advance to prototyping:

Each team had dozens of ideas after the 5 ideation rounds, ranging from “celebrity endorsement” to “put a clear due date on the outside of the package” to “have the test kit play the jeopardy theme when you open it.” After ideation, teams did some work to cluster ideas into broad categories, and then prioritized just a few ideas to advance to prototyping.

How did they choose? For some teams, one great idea just leapt off the white board and grabbed their attention and imagination. That kind of signal is really important to pay attention to in the design process. Other teams used an impact-effort matrix to identify the ideas with the highest potential impact and lowest probable effort. Those are also worth investigating further in prototyping. 

Finally – building:

Finally, the teams got to build their ideas. In about an hour, our FIT test completion teams used paper, yarn, markers, playing cards, straws, chopsticks, beads, tape, and staplers to build an early version of their idea that they could pitch to the rest of the class: Here’s what the pamphlet we hand to the patient will look like. Here’s what the social media posts will say. Here’s how the box will open, and here’s what the patient will find inside. Here’s how we’re going to make the poop part easy, funny, and fun.

And that was the whole design challenge. In four 1-hour sessions, our design teams went from a big, vague problem to 5 fantastic, user-focused prototypes – all of which I think could truly move the needle on FIT test completion. And none of which might have emerged from a traditional behavior change intervention development approach, even one informed by behavioral economics.