Charles Eames was once asked to define the boundaries of design. “What are the boundaries of problems?” he replied. That was more than 50 years ago. The impact of design has only grown. As the boundaries of problems have expanded, so has design. We believe it must expand even more in the years to come.
The problems facing business and, indeed, humanity are becoming even more intractable, intertwined, and complex. The global population will be nearly 10 billion by midcentury. Cities will house some 2.5 billion people by 2050, making them more crowded and clogged. Meanwhile, the global demand for everyday goods, housing, and transportation is rising — requiring material resources that we do not have and squeezing our planet’s ecosystems. Mass migrations, booming income inequality, raging pandemics, and the impact of AI and automation add dramatically to the challenges we face.
The world is screaming out for new solutions to tackle the myriad problems and mitigate their consequences. These calls for innovation — bold, new approaches that can be adopted by people, businesses, public organizations, NGOs, and even international bodies.
If we’re serious about tackling the world’s thorniest problems, we won’t just need good design. Rather, we need to expand the very way we think as we seek to create solutions to our biggest challenges. In so many ways, however, the way we innovate today no longer reflects reality. We believe we can use a more ambitious set of design principles to better respond to the transformations that are occurring.
Thinking expansively about time
Founded in 1379, around the time the outlaw Robin Hood first appeared in myth, the New College is one of Oxford University’s oldest colleges. Inevitably, it boasts legends of its own — including the story of the oak beams that span the ceiling of the college’s ancient dining hall. The tale begins about a hundred years ago, when an entomologist discovered that the beams were riddled with beetles and needed replacing. The fellows of New College were stumped. How on earth would they afford the timber required to make comparable beams?
When one of the fellows proposed using the oak trees growing on the college’s land, the college forester said he’d been wondering when they’d ask. The 14th-century fellows of New College had known the beams in the dining hall would one day need to be replaced — and so they’d planted a grove of oak trees precisely for that purpose. The fellows’ plan required expansive thinking about time — planting seeds for a result more than 500 years in the future.
Thinking expansively about time means resisting short-term thinking and instead reconsidering the time frame for which we plan for the future and make decisions.
In recent years, the analytical rigor of mapping trends and uncertainties — which is at the core of foresight work — has increasingly been supplemented with other approaches, not least from the design field. Bringing design — which is to say the ability to visualize and shape plausible futures in ways we can see and engage with — together with foresight methodology bolsters the so-called “scenario methodology” in long-term strategic planning. By using collaborative design approaches, a wider group of people with more diverse backgrounds and experience can be included in the scenario-building process, stimulating a divergence of ideas and challenging conventional thinking.
Designing with flexibility
In 2011, the Ole Kirk Foundation — which was established in memory of Lego founder Ole Kirk Kristiansen — agreed to help fund a new hospital for children. Built in the 1970s, Denmark’s national hospital was getting increasingly crowded. Its children’s wards were scattered across six buildings — leading one exasperated parent to complain that “when they move you from one ward to another, it’s like arriving in another country.”
“The physical layout was terrible,” Anne-Mette Termansen, a management consultant with years of experience in the healthcare sector, told us. In 2014, she was tasked with finding out whether it would be possible to build the world’s best hospital for children, adolescents, and families — and what it would entail. Or, as she puts it, she set out to explore “how to design the future for sick children.”
In particular, Termansen was responsible for designing “the future user experience, the physical design, and the overall transformation of the organization.” Along with Bent Ottesen, a professor of obstetrics and gynecology, she started running a series of workshops to explore what the future children’s hospital might look like — and invited patients, families, and hospital staff, including doctors and nurses.
At the first workshop, held in January 2015, the participants used colorful Duplo blocks to build prototypes of the new hospital. A workshop in October 2016 saw the involvement of representatives from the entertainment industry, including Lego and Tivoli Gardens, as the focus shifted to user experience and user design, and getting “the first 10 minutes” at the hospital right.
These workshops often led to eye-opening and counterintuitive revelations. When one group proposed making hospital suites “just like home,” with an open-plan kitchen and dining room for the patient’s family, there was widespread approval — until a 12-year-old boy with cancer quietly pointed out that it would mean he couldn’t be around his family because the slightest smell of food made him sick. “All these doctors and nurses working with children for 20 years or more had not thought about it,” Termansen recalls.
Embracing an unknown future
Underlying all of these workshops were several truths. The first was that while they were attempting to design the future, by definition, the future is unknowable. To put it another way, one of the only things they knew about it was that they did not know much about it. What the new children’s hospital and its patients would need when it opens in 2024 is likely to be very different to what we might predict they’ll need today, let alone in 2044.
Of course, several forecasts could be fed into the scenario. Demographic projections indicated that the new children’s hospital would need to treat 17% more patients in 2025 than it did in 2014. Moreover, in 2016, Denmark raised the pediatric age limit from 15 to 18, meaning that a larger group of patients would be classified. as children and be moved from adult wards to
the children’s hospital.
The workshop participants also considered the likelihood that it would become increasingly easier to treat patients at home. They were mindful, too, that the new hospital should be built with the greatest possible flexibility so that it could be adapted to unknown future needs. That meant future-proofing the hospital so that it could implement the highest technological standards. Among the options included in the blueprints: coordinated patient and medicine scanning, electronic medical records, electronic wayfinding, and continual monitoring of individual bed locations.
Denmark’s hospital of the future will seek to inspire the private sector in several ways: An entire floor will house an innovation lab where medical students, researchers, and employees of medical or technology firms can cooperate on designing new products, devices, or services. “The medical industry is characterized by very deep specialization,” Termansen says. “We want to build an operating theater that incorporates all of the specialisms.”
For example, one company currently produces everything related to eye surgery, while another produces the entire suite for heart surgery. The new hospital hopes to change that. Likewise, it would prefer to have one microscope that can be used for surgery on, say, eyes and ears, as well as plastic surgery.
“That isn’t yet on the market,” Termansen explains, “but it’s something we would love private companies to help develop.” Denmark’s future children’s hospital will be physically flexible too. “We do not know how many operating theaters we will need in 20 years, or how many beds, outpatient rooms, so we can change among these capacities,” says Termansen. The new rooms will all be the same size, allowing future administrators to switch between recovery rooms, outpatient rooms, or offices, as and when necessary. “We wanted it to be flexible so you could tear down walls or build them up, so mistakes can be corrected,” adds Termansen.
Coming back to the legend of the New College oaks, it turns out it wasn’t exactly true. While the beams in its dining hall were indeed replaced in the mid-19th century, using oaks growing in forests that New College owned, those trees hadn’t been planted for the express purpose of replacing the beams. For one thing, New College had only owned the forests since 1441—60 years after the hall was built. But whether the oaks were intended to be used to replace the beams is beside the point. They were planted in the expectation that eventually, hundreds of years in the future, they would be used for major construction work. And none of the people who planted the trees believed they would live long enough to enjoy their benefit.
Taking the long view is thus about collapsing the distance between now and then, today and tomorrow, this century and the next — no matter whether you’re planting trees or building a hospital.
Excerpted from Expand: Stretching the Future by Design copyright © 2022 by Jens Martin Skibsted and Christian Bason. Reprinted with permission from Matt Holt Books, an imprint of BenBella Books, Inc. All rights reserved.