Steven Allder, Consultant Neurologist on designing for clinical change presentation at "Everything is design. Everything!" - Paul Rand event.

1. Everything is design. Everything
Dr Steven Allder
Consultant Neurologist

2. Introduction
My Background
• Doctor
• Clinical Researcher
• Consultant Neurologist
• Interest in ‘Hysteria”
• Management, leadership
and Improvement
• Harvard Executive
Development Programme
My view of title and talk
• Wow!
• Resonated
• Resonated but, BUT…
• Design is essential but on its own not
sufficient
• Design is a social process
• Embedded in a social system
• To fully exploit what design can offer
societies:
• we need to cultivate our understanding
of these social elements = MIND
• DESIGN of our MINDS

3. Phase 1
Phase 2
Phase 3
Phase 4
Back to start!
I will be 68!
Born
Qualified
Consultant

4. The Healthcare challenge
Stability of growth of current system

5. There is hope!

6. Redesigning health care is possible…

7. My results were bewildering…
CVA1 N1 4hr RTT CVA2 Medicology CVA3 Strateg
y JT
Taunt
on
Step 1: CT SA
own
service
SA CD 8/2006 AMD NSS AMD post
FT
CVA
performan
ce
FT Via
JDY
Step 2: ACT
1 - Analysis
SA LOS IP SA SA SA FT risk table Mine-
theirs
SL Good
Step 3: ACT
2 Deliver
change
SA Via
attendi
ng
Via OBS Via
Dept
Via
redesign
Medicology SW vs ESD Manda
te
Progra
m
Step 4:
Provoke SC
JDP AW PDR GV/PV loads CST Strategic
implicatio
ns
Await
AJ
In all
5!
Step 5:
Name and
see
TR TR IC after
crisis
PV
after
crisis
Ian yes Yes 1:1 Dec
Step 6:SMT
PLAY and
explore
Step 7:
Experimen
t 2
Step 8:
Roll-in
Won..
Lost..
Won..
Battle
Won..
Lost
Won..
Lost
Supporti
ve
Lost.. Lost Bury
me
Mana
ged
better
!
DESIGN
ALWAYS
APPLICABLE!
SMALL SCALE
SUCCESS!
LARGE SCALE
FAILURE!

8. A sudden insight…
These board meetings feel like my
consultations with my ‘hysterical’
patients! LEON FESTINGER
Cognitive
dissonance

9. Design of the Mind: Three Loops
Stimulus
1. Innate
Wisdom
2. Conditioned
Intuition
3a. Reasoned
Judgement
Delivered
Action
Outcome
3b. Action
Logics
Moments:
Embedded in
streams
activity 500-
700ms
Ever present:
Move Towards
or Away
Controversial
idea
Implicit learning
‘Good’ (Automatic)
‘Bad’ (Should)
Explicit
awareness:
Own view,
Choices and
decisions Action
Options:
Create
Deliver
Avoid
Outcome:
Who’s ‘Truth’
Extended choice
theory
Learning
Loop (s)

10. Design of the Mind: Temporal
development
Stimulus
1. Innate
Wisdom
2. Conditioned
Intuition
3a. Reasoned
Judgement
Delivered
Action
Outcome
3b. Action
Logic
Learning
Loops
0-5 yrs moments
(Reactive)
Learning to walk
Learning to talk
5-23 yrs moments
(Proactive)
Learning an instrument
Learning to drive
“Hysteria”
Loop 1
buried..

11. Design of the Mind: The developed
‘successful’ mind
Stimulus
1. Innate
Wisdom
2. Conditioned
Intuition
3a. Reasoned
Judgement
Delivered
Action
Outcome
3b. Action
Logic
Learning
Loops
With expertise
comes:
More Choice,
Opinions and
Decisions
CAPABILITY FOR
DESIGN!
Creativity
Influence
Leadership
As we mature, 23
and beyond…

12. The prevailing MIND paradox!
Why Important?
Why Happens?
Beyond the
Stable state:
VUCA
Designed to
exist in the
pack!

13. Design of the Mind: The dangerous
rational delusion
Stimulus
Innate
Wisdom
Conditioned
Intuition
Reasoned
Judgement
Delivered
Action
Outcome
Action
Logic
Learning
Loop
VITAL NEED FOR:
Different Options,
braver choices and
hard decisions
NEW ,NON
ROUTINE, DESIGN!
True Creativity
Real leadership
WHEN THE HEAT IS
ON…
Prof Chris Argyris:
99% of executive teams with critical moments act
defensively not creatively
Totally, unconscious..
Barry Oshry – Living Systems

14. Results
CVA1 N1 4hr RTT CVA2 Medicology CVA3 Strategy
JT
Taunton
Step 1: CT SA own
service
SA CD 8/2006 AMD NSS AMD post FT CVA
performan
ce
FT Via JDY
Step 2: ACT 1
- Analysis
SA LOS IP SA SA SA FT risk table Mine-
theirs
SL Good
Step 3: ACT 2
Deliver
change
SA Via
attending
Via OBS Via Dept Via
redesign
Medicology SW vs ESD Mandate Program
Step 4:
Provoke SC
JDP AW PDR GV/PV loads CST Strategic
implication
s
Await AJ In all 5!
Step 5:
Name and
see
TR TR IC after
crisis
PV after
crisis
Ian yes Yes 1:1 Dec
Step 6:SMT
PLAY and
explore
Step 7:
Experiment 2
Step 8:
Roll-in
Won..
Lost..
Won..
Battle
Won..
Lost
Won..
Lost
Supportive Lost.. Lost Bury me Managed
better!
The explanation: I was advocating a
non-routine design
99% of executive teams mess up critical
moments
Totally, unconscious..
Emotional repression….

15. It can be overcome…
Adult Cognitive Complexity
Small % of
individuals
reclaim
Their creativity
Via Destructive
process!

16. Reality of change currently..
Undeniable
need to
change…

17. It really is
No pain, No gain…
Doesn’t really
capture it…
HERD!
Courageous
individuals!

18. I mean, real pain:
Dante’s Inferno

19. A better way forward: Vertical Development
Stimulus
Meta-cognition (Mindset)
“Prism”
Innate
Wisdom
Conditioned
Intuition
Reasoned
Judgement
Delivered
Action
Outcome
Action
Logic
Learning
Loop
7
6
5
4
3
2
1

20. Design of the Mind: New Skills
Stimulus
Meta-cognition (Mindset)
“Prism”
Innate
Wisdom
Conditioned
Intuition
Reasoned
Judgement
Delivered
Action
Outcome
Action
Logic
Clear
Intent
Learning
Loop
Re-learn
to be
creative
Right
teams
Realistic
Theory
of
change
Honest
feedback:
Fail often, fail
safely, know
failed
Reclaim your
emotional
world via your
body
7
6
5
4
3
2
1
Identify context
specific critical
events and
moments
Real time
monitoring

21. IMPLICIT
Powerlessness
Poor Self worth
ACTING
REQUIRES:
Vulnerability
And Courage
Increasingly
Intangible…
Transpersonal
phenomena
Broadening the PRISM: Why so hard?

22. Bob’s Big idea:
The real reason we are getting older:
the need for WISDOM

23. The route forward, is a lesson from
ancient times – via our Hearts….
Brene Brown Barbara Friedrickson

24. Everything is design. Everything
Including the tool and environment
in which design can contribute…