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Simple, elegant and dignified: my favourite service design

18 December, 2011

It is with much surpride (intentional portmanteau) that I share this blog has just passed 50,000 visits. Wow. Whodda thunk it?! In the web scheme of things I have no idea what that means but it means a lot to me that there is a design industry out there (especially in Europe me thinks from hits data) and I’m contributing to the dialogue in some small way.

I wanted to mark this amazing milestone in this repository of what inspires, inflames and resonates with me design-wise with my favourite piece of service design that I’ve wanted to capture since I started at the beginning of 2010.

It’s a simple, dignified, and elegant solution from Dusseldorf, Germany. It’s from 2008 and it’s a fake bus stop outside of a hospital that ‘catches’ Alzheimer’s patients. I think it is a beautiful testament to design’s ability and innate intent to humanise outcomes, let people be people from understanding and the power of conscious design to facilitate creative solutions to human problems.

The best telling of the story can be heard through RadioLab’s: A Bus to Nowhere with Lulu Miller. It’s 14 minutes and well-worth the listen.

But here’s a quick overview (although if you’ve read this blog before you know I don’t do anything quickly).

People with dementia often get disoriented and panic “Where am I? I have to get home!” so they do what you or I would – they try and get home. In the Dusseldorf story there were examples of people getting 20 miles away, dressed only in what they were wearing when the panic set in. From personal experience I had a grandmother who used to wander, and an old family friend who would escape from her locked ward.

You can lock people away, you can drug them into submission – but these are human beings. I always found it offensive when people would talk about ‘how crafty’ they were to ‘get out’. But I also felt helpless. These escapes are stressful not only to the patient, and their family, but also to the staff.

One of the characteristics of the disease is that while short-term memory is shot, long-term memory remains – people remember where home is (or was). So there came a suggestion at the Benrath Senior Center, that if the patients want to get home, why not provide them with a bus stop to do just that. Only no bus would ever come.

Initially the response from the nursing staff was cynical, dismissive and derisive. Until one patient in a panic was calmed by the simple act of leading her to the bus stop and sitting with her.

As the patients wait at the bus stop, their mood shifts from sadness and panic. They soon forget their urgency and simply sit and enjoy the outdoors. Sometimes with a nurse and cup of tea at their side. It’s been nearly three and a half years since the bus stop began. It is well frequented. Sometimes nurses will even direct people there. Sometimes, they don’t see escape occur, they just see the person waiting at the bus stop.

The intuitive existence and placement of the bus stop treats the patients with respect. Sure, the bus stop is a lie, but what’s the alternative? If the patient doesn’t accept rational arguments or the truth why not allow the world of their mind to be true, and when their urgency passes coax them back. The bus stop takes the feelings of the patients seriously – knowing that these feelings are short-term and will pass. As Lulu Miller puts it “the forgetting is the problem and the solution.”

So why is it my favourite piece of service design? There were conscious choices made based on evidence, this wasn’t a process re-engineering. Dementia has contributing factors that, quite frankly were leveraged. The solution took into account the dignity of human experience –the patient, medical staff and patient’s families.

It needed to understand a host of touchpoints and experiential elements (what people do, what they think about, what they use) and craft the experience in a realm of two dimensions – the reality of a mind with dementia and the reality of the ‘real’ world.

Maybe what I like about it most is that it doesn’t treat people like their components of a system. The experience of ‘going home,’ the levels of human interaction required, the dignity of allowing people to make and act on their decisions, these are the intangible yet oh-so-human elements of service; people seeking goals over a range of interactions over time. Just happens that time is distorted and the goals are unachievable. But this service supports those goals and interactions as very real, and very meaningful. It makes a difference to people’s lives in a unobtrusive and simple way – and that is why it is my favourite example of service design.


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