Tag: quality improvement

Making change or being changed?

Photo by Parker Coffman on Unsplash

If you’re reading this, you’re probably trying to make a change in the world, even if you don’t call yourself a change agent or an activist. Maybe you’ve spoken up or shared a link on social media around an issue in your community. At work, you might be leading your organization through a big transformation or simply trying to improve how things get done. Perhaps you’re trying to right a bigger wrong and have joined a protest, signed a petition or are running for office.

Large or small, the actions we take to enable people to thrive, communities to flourish, society to become more just and the world to become more beautiful are steps worth taking.

Peace activist A.J. Muste reminds us that even when our efforts don’t succeed, we take them to honor our soul and live in integrity. A reporter once asked him, “Do you really think you are going to change the policies of this country by standing out here alone at night in front of the White House with a candle?” He replied, “Oh, I don’t do this to change the country. I do this so the country won’t change me.” Even when we don’t succeed, taking some action has value.

Lately I’ve been noticing how this work has the potential to make me feel less aligned with my wholeness than I’d like it to. I’m starting to wonder: Do I create a false duality of “us and them”? Do I use this as an excuse to treat people in a way I don’t want to be treated? Am I so attached to a particular outcome that I feel despair and outrage when it doesn’t come about? Do I talk about what isn’t working in ways that cause me to see myself and others as victims? Have I internalized the stories I tell to move others so that I forget that I am more than those moments? Have I pushed myself so hard that I’ve burned myself out or neglected other roles in my life that are equally important to me? Have I pushed others so hard that they burn out too? Have I pursued continuous improvement so deeply that I’ve forgotten that I am enough just as I am?

I have to admit I can answer yes to all of those questions from time to time. So I’m questioning my theories about change.

One way I’m doing this is through an on-line course called Unlearning: For Change Agents with Charles Eisenstein. Throughout the class, we are encouraged to explore and rethink:

  • How we frame issues and problems. What assumptions and beliefs do we have that cause us to define issues and sides in conflicts?
  • How we relate to others. What stories are we making up about others, and how can we relate them in a way that invites them to live into their gifts?
  • How we make change. Must we force open the door to change, or do we have alternatives to struggle? Is change even something that needs to be “made”?

Eisenstein is more metaphysical than the mainstream, so this course may be a bit out there for some. But if like me, you’re feeling a cognitive dissonance about how you relate to others and change, you might find something here.

If you decide to check it out or if you have ideas and sources for a new way of creating change, I’d love to hear from you.

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After spending years coordinating healthcare and other services for my son, I now lead and support initiatives in which patients and their families, clinicians and policy makers collaborate to create better health and care. I welcome you to join in an on-going conversation about healing health care by subscribing to this blog, in which I write regularly about the experience of living in a complex special needs family and working to create and support change, or by connecting on Twitter or LinkedIn.

The tyranny of Norman doors

As a person who considers herself often on the threshold — though of what I’m not always sure — doors and doorways catch my attention. They create a boundary between here and there, allowing us to be in one place while looking into another

One particular style of door fascinates me. It’s best summed up in this photo of a door at my office with its many pieces of flair. It has a button with a key on it to show us where to unlock it, and a sign and arrow telling us to do so. There is another lever that releases the lock but should only be used in an emergency, hence the running guy icon. There is also a button to open the door and hold it open, for example if one is wheeling through a cart or wheelchair; this button needs to be held open for a longer-than-obvious period of time, so it too has a note on it telling us how long to hold it. And because we frequently trigger the alarm by standing with the door open too long, there are not one but two signs in English and in Swedish telling us to get a move on. It’s a wonder we ever get out.

Yesterday I learned that this type of door has a name — the Norman door.

A Norman door is a poorly designed door that confuses or even tells you to do exactly the opposite of what you’re supposed to do. It was named after Don Norman, the researcher, professor and author of The Design of Everyday Things, the bible for the field of human-centered design. This video, It’s not you. Bad doors are everywhere. tells the story of Norman doors and the principles behind good design.

It turns out that through their design, objects subtly communicate instructions to people on how they should be used. Certain handles just feel like they should be pushed, and others pulled. Bad design sends us signals that are confusing.

And when things go wrong, it’s usually the user who is blamed, not the designer. Sometimes we even shame the user, as in this Far Side classic. I remember a coffee shop in my old neighborhood that had this panel taped to the door because so many people opened the door incorrectly. But it wasn’t the door’s fault, it was ours.

In the film, Don Norman reflects that “if you continually get it wrong and if other people get it wrong, that’s a sign that it’s a really bad door.”

Swedish designer Sara Tunheden shared the video this week and challenged those of us working in health care to think about the services we deliver and design. Are they really as great as they think we are, or are they Norman doors?

As a person who works within the health care system to improve it, I know I want patients and families to experience health care as a place of partnership, agency, responsibility, power and health. As a patient and family member, sometimes I can get there. Though often the door is surrounded by confusing and unintuitive mechanisms that keep me scratching my head, struggling needlessly, or even worse, locked out.

Good design, according to Norman, offers discoverability (the ability to discover what operations one can do) and feedback (a signal of what happened). For those of us in a position to be offering a health care service, we can ask ourselves some questions:

Are the doors people need to pass through to reach us easy to open, or are they overloaded with gatekeepers and signs in the forms of wait lists, complicated referral or intake processes and inefficient booking systems?

Does the entrance feel truly welcoming for everyone, regardless of race, gender, sexuality, language, intellectual ability and culture? Are people treated with dignity and respect, or as if they should be grateful to have been let in at all? Does the door actually open when the person does all the things they are asked to do? And if it doesn’t, do we blame — or even shame — them for not getting in?

In my experience, we spend a lot of time thinking about what we want patients and families to do, how we want them to behave and act. This isn’t just about access, but even about following our instructions, being engaged, and taking responsibility. When they don’t do that, maybe it’s worth considering that it there may be a Norman door in their way.

Please subscribe, share or comment. I’d love to hear what you think.