Chi: Hello, and welcome to another episode of This is HCD.  I’m your host Chi Ryan and get ready for an exciting episode because today I’m speaking to Australian designer and nurse practitioner, Maitu Bush.  Maitu has a masters’ degree in public health and broad clinical and managerial nursing experience, including working in Tijuana, Mexico with Nobel Prize Laureate, Mother Terresa, in International Border Aid.  As well as experience as an emergency oncology intensive care nurse and as a sexual health nurse practitioner.  

Today, Maitu is a senior business innovation strategist at Bolton Clarke, where he drives innovation and creativity in the aged and community sector.  He founded One Good Street, a social networking platform to encourage neighbour imitated care for older residents at risk of social isolation and loneliness.  He also contributes to health system innovation through involvement of Better Care Victoria as a board member, and the Emerging Leaders Clinical Advisory Committee.  

Maitu is a Rotarian and a member of the Health Informatics Society of Australia and mentors the next generation of undergraduate and post-graduate science students through the University of Melbourne Science Industry Mentoring Program and through the Pinnacle Foundation.  Welcome to the show.  

Maitu: Thank you, great to be here.  

Chi: Firstly, it would be amazing if you could tell us a little bit about what you do?  

Maitu: I’m in a really privileged position.  I work in aged and community care.  I’m employed within a design team.  Our CEO, the board of the company I work for, which is Bolton Clarke, it’s a really large aged care provider, has embraced human-centred design.  We’re an internal human-centred design team.  Our job is to be incredibly creative and innovation within the space of aged care.  That aged care sector is so ripe for creative thinking.  

Chi: I think it would be really interesting for the listeners to understand your background.  

Maitu: Sure, so I’m a hybrid professional.  I’m a clinician.  I trained as a nurse practitioner and infectious diseases.  I’ve also worked in oncology, I’ve worked in HIV, in a range of surgeries.  I have a broad clinical background.  Then I’ve come into human-centred design.  I think I did design as a native, and people kept pointing that out along my career that, hey, this is design.  I’m thinking, “I’m just a nurse that can do a few extra things.” I then embraced that part of my professional self.  I consider myself a hybrid professional, someone who is a designer but also a clinician.  

I’ve got two lenses that I’ve been able to blend, almost like bifocals, when I look at a health system problem, or a health system dilemma.  I first started studying fashion design when I left high school.  Then moved into working in international aid, so how did that happen?  It was essentially going to fashion shows and then going home and watching the Somalian famine on the TV.  Realising that, hey, I’ve got to do something far more significant with my life than make garments.  I jumped in.  I actually wrote a letter to Mother Teresa.  She wrote back to me.  She was 19 years of age.  

This is the kind of thing you do when you’re 19.  She wrote back and off I went and worked with her for four and a half years.  Came back, and then finished my nursing studies and have been working in healthcare ever since.  That’s probably around 23 years ago.  

Chi: Not many people can say, well, I don’t know many people who can say that they worked with Mother Teresa.   I have to ask, what was that like?

Maitu: Interesting.  I was interviewed about it.  I said she’s like Margaret Thatcher in a Sari.  That was the headline: Mother Teresa in a Sari.  I learnt a lot, she was amazing.  Also, she was deeply flawed.  She had a rigid adherence to a model of care that scaled up across the world but failed to adjust to different contexts.  I’m highly critical of her because she had millions of dollars in bank accounts but she wasn’t paying for antibiotics for people that were in her care and could have had curative, preventable treatment for their health issues, because she stuck to this rigid model of care, which was take in the poor, feed them, provide them shelter, provide them water, that is it.  

I learnt a great deal about standing behind somebody who was a world leader.  To be ruthlessness and fearlessly look at their flaws.  Look beyond the houbaras and the pantomime of what it is to be a world leader and what it is to see people project a whole lot of emotion and their emotions on to you.  I was living in the reality of who she really was.  

Chi: Wow, that’s pretty intense.  

Maitu: Yes, look, it was an amazing experience.  I worked with about 40 volunteers from a range of different nationalities.  I think we had about 15 nationalities, all blending in.  One thing I would stress that was one of the most valuable lessons for me, is that we should not use disadvantaged populations as the raw material for our expression of charity of some kind of philosophy.  They’re not the raw material to demonstrate a particular framework, if you like, because that robs them of autonomy.  

Now, working in aged care, I see the same thing, when they say older people, older residents, older citizens, we’re clumping the beautiful individuality of humanity together.  Then comes a charitable response that can rob people of agency and autonomy.  

Chi: It’s funny because I’m a real advocate of not calling users, users.  At its most basic, for most designers, when we call the people that we’re designing for users, you’re losing something where we are grouping people together in a way that makes them not valued.  I think that’s very important.  At the most basic of levels, I think that all designers could learn something from that, because when we look at people as this lump, we’re not really designing for them truly.

I think there’s something in that for everyone.  Well, it’s truly inspiring just to hear that, but I know that the listeners are going to want to hear what you’ve been doing recently, because that’s amazing in itself.  Tell us a bit about what you have going on at the moment?  

Maitu: A couple of things.  The most recent thing is, we’ve installed a digital wall in a dementia unit.  This is an enormous wall, about five meters long.  It is a fully interactive wall that is digital and patients with dementia can come and touch it and interact with it.  It changes colour.  It provides more expression of movement because they can trace their hands and move their hands.  It subtly changes throughout the course of the day, so they can sit there and watch it with soft fascination.  

It doesn’t demand anything from them.  We’ve been able to install it in a dementia unit with Bolton Clarke and remove all of the TVs.  We’ve been able to really shift the culture, to say that we have to have a very specific understanding and focus about what older people with dementia can hear, so the acoustic environment, the acoustic atmosphere.  Also, the visual atmosphere.  We’ve had a lot of success with it.  

Children who want to come and visit grandma more because it’s far more exciting to engage with.  It’s a real success of how technology can be a trojan horse for changing the thinking of what a dementia memory support unit can be like.  

Chi: It’s so cool because I shared the story about the wall with my team.  One of my designers, Adam, he said, “Oh my god, if we get to work on something that’s like that, can I work on it?  I’d love to work on something like that.” It’s inspiring for what it is, but I think for designers to see that there are projects out there that are really making a difference in people’s lives, particularly in marginalised groups, really making a difference.  It’s wonderful because it’s something that can make other designers think differently about the way that they’re doing things.  If that’s the power it has beyond its own use, what a great initiative it is.  I think that’s truly amazing.  

Maitu: Yes, I think we’ve been working with virtual reality in aged care, but virtual reality is so labour intensive one-to-one.  With these kinds of digital immersive experiences, you get far more return on investment because you can engage and entertain and provide a therapeutic intervention to much larger groups.  That was really exciting for aged care.  

Chi: I was in Rio a couple of weeks ago to judge the interaction design awards.  I won’t mention too much about what was happening in the awards, but there were some truly inspirational pieces of work.  What I came to realise when I walk away was that, there’s so much focus in design on complex technologies and using the latest fan-dangled things, whether it be AR or artificial intelligence.  Those things are fantastic and I’m sure they have plenty of possibility in the future.  

Interactions that are really smart don’t necessarily need to be as technical as people might think.  I think that particularly in this case, where you’re dealing with groups that are not necessarily going to need the latest craziest technology, but rather something that makes the interaction meaningful.  It’s really about thinking harder about the interactions that people are having with what they’re using, rather than it being about the technology that they’re using.  

Maitu: Absolutely.  Totally agree with that.  

Chi: You mention phenomenology, which is a term quite close to my heart.  Tell me a bit about what that means to you?  

Maitu: Brilliant.  For a long time, working in human-centred design and in wicked problems in healthcare, I have felt a frustration with some of their simplistic reductionistic ways we engage with those wicked problems.  One of those has been the lens of empathy and empathy mapping and walking in the shoes of the customer are very important, but it is only one story.  Almost like one thread that has to be combined with many other threads to get a real sense of what an entire phenomenon is.  

Phenomenology for me is the ability, like an astronaut, to look back at the planet and have what’s called the overview effect.  That overview effect is when you can see something in its entirety.  Then when you see it in its entirety, it doesn’t mean you know all of it intimately, but you see it working as a whole.  

You get a cognitive shift and it helps you build the vision for the future.  Astronauts often talk about this overview effect, how seeing the world from afar provides them with such a profound cognitive shift that they no longer think the same way that they used to.  Phenomenology and the application of that methodology helps me do that.  For example, I mapped the journey of a woman who is 84 and was diagnosed with stage 4 breast cancer.  

Now, my human-centred design peers would do the process map and do potentially even swim lanes.  I needed to do far more than that to capture the rich complexity of what the experience was, and empathy is just one component of that.  I needed to look at politically what was going on in the breast cancer funding scene, because that means you’ve got multiple NGOs and not for profits that are trying to help, which can actually make things a lot more confusing, so there’s a political aspect.  

There’s the economic, how much is she spending at each set of the journey?  We tracked how many kilometres she was traveling, how many places, she visits, how many people she saw.  We counted the number of materials that she had to read.  We got a real sense of what breast cancer does, not just to the life of that individual, but to the ecosystem of that person’s life, that 84-year-old person’s life.  Phenomenology helps me do that.  Wicked problems are actually completely immune to our single solutions.

Often, the methodology that we currently use and that my peers use are often creating a lot of noise and potentially artificially trying to hone people into solutions that are just too simplistic and reductionistic.  I see myself as a phenomenologist is looking at the breadth of the experience I’m exploring and looking at all of the layers.  The political, the economic, the personal, all of the flow on effects, the things that are unexpected.  I get a rich sense, a rich overview of what we’re trying to design for.  Within that comes the wisdom of not designing, as well.  

Chi: Phenomenology is a term of endearment for me because it’s something that my favourite architect, Peter Zumthor has written a lot of books about.  He bases his architectural practice on phenomenology.  From an architectural standpoint, not just an architectural standpoint, to me it means the thingness of things.  Peter Zumthor, he thinks about the way that he designs in this way, which is really interesting when you think about the things that he’s designed.  He hasn’t designed that many things, in terms of buildings.  

By the way, Pritzker Prize Winner, so he’s the business when it comes to architecture.  There are stories of him designing a church in Switzerland, he’s Swiss, and the church is designed around the thingness of the churches that he remembers as a child.  The floorboards were designed to creak.  It’s the level of detail of the thingness of things.  I think that there’s something really interesting in thinking about experience from the perspective of phenomenology because it’s all good to map the empathetic journey for someone, you can do that at a very superficial level.  

When you’re really trying to understand the way that people genuinely experience the world, that takes on a whole new dimension.  A lot of the time, I wonder, if we get empathy confused with sympathy, a lot of the time, designers are sympathising with the people that they’re designing for, but they’re not necessarily empathising.  There’s a real difference between those two terms.  I think phenomenology can allow you to genuinely get into not just the shoes but embody the way that something feels.  

Maitu: Absolutely.  The designers I spoke to yesterday were designing a wearable for an older person that would send alerts to loved ones if they was a change in condition.  It was like a monitoring wearable.  I encouraged them to understand the journey of someone’s cognition during a week.  If a family member is going to be happy to receive an alert, how many other alerts exist?  What happens if they want to take time off and don’t want to be monitoring their parents?

What’s it like to change your role and suddenly, purchase products that allow you to rob the anonymity and the autonomy from your elder parents because you’re aware if they use the kettle, the fridge, how much time they’re watching the TV because you’ve got passive sensors in there?  This is the approach that’s so important.  It’s so lacking in conversations around smart homes.  What’s that feeling like?  What is the thingness of changing the way you live and beginning to have monitoring and increased data on the people you love?  

How does that change your role with them, and the paternalism and the other stuff, which really ties in the ethics of what we’re doing, which we have to grapple with.  This is a blood sport.  If you’re designing well, it should be a blood sport.  You should be bruised by the time you design something because you’re grappling with all of those layers and elements and the ethics of putting in tech in an 83-year-old’s home and then you are getting all of that data, how it fundamentally changes your relationship with them.  

There’s a grief component to things like that, which we don’t design for, which our collateral for products don’t talk about.  We actually disappoint our customers in the end when we don’t address those particular experiences.  

Chi: It’s really interesting.  I saw a talk, I think it was in October here in New York, there was a wonderful speaker, she was a deaf designer, and she was talking about what it’s like to be deaf herself and to be a designer.  She showed this video of these gloves that two non-deaf people had made.  They were a fantastical technology, that you put the gloves on, and you do sign language and they magically interpret the sign language and tell a non-deaf person what you’re saying.  Everybody in the room watched the video and the video ended and everyone cheered.  She says, “You guys all think this is good?” Everyone is like, “Yes, this is great.” She says, “This is shit.”  

Everyone gasped and she said, “Because it wasn’t designed with deaf people I mind.  It’s all and good that you can understand what I said to you, but you can’t communicate with me.” It defies the reason of doing it in the first place.  I always come back to this quote for Jurassic Park that says: Just because you can doesn’t mean you should.  

That’s something we really need to think about, especially when we’re using technology to design, but in all aspects of design, whether or not we’re doing things for the right reasons and actually for the benefit of the person that we’re designing for.  

Maitu: True.  That’s a real quandary for a lot of us working as internal consultants in organisations, how to produce for our organisations the products, the collateral, do the R&D for them, but also inform as we do.  That’s the duality of being a human-centred designer within any industry, especially within our healthcare, because it’s a very new methodology to the health care setting.  

I work exclusively within healthcare.  As I’m designing, I’m also educating, I’m also proving that this concept, that this methodology can add something to the picture, add something to the conversation in healthcare.  Also, having to prove its worth because it’s so fragile within healthcare.  

Chi: Well, that’s a great segue into my next question because every day I hear from designers, they want to save the world, they want to make a difference, they want to work on amazing projects, especially in the health space.  What is it like to be a designer working in that world?  

Maitu: It is a blood sport.  You have to watch House of Cards and Game of Thrones as professional development because many of your ideas will be ripped to shreds.  It’s an area that is bereft of creativity.  Creativity within healthcare is treated with a great amount of suspicion because of the evidence-based framework of which healthcare exists.  Much of the work within healthcare across any particular area, whether it’s outpatients, it’s emergency departments, to be creative and innovative requires a different framework to allow these ideas to grow.  It’s in its infancy within healthcare.  

Whenever I talk, many designers, like what you’ve experienced, want to do work with meaning, the want work with greater value, greater meaning.  The flipside is, the hard yards you’ve got to do in the back to sit with clinicians, doctors, nurses, allied health, and run them through a design session and then do some rapid prototyping with them.  Then try and scale that up in a very resource-constrained environment, and very risk-averse absolutely is appropriate within healthcare.  

The lens, changing people’s lenses, so they can actually pan out a bit and think beyond what they currently do and beyond the cognitive frameworks that they currently use, which is around risk, adhering to standards, etc., helping people to jump those standards.  

For a hospital, a major hospital, or a health organisation, if they pass accreditation and meet all of the standards of infection control and consumer-centred care, then tools down, they put the tools down because they’ve met what the minimum requirement is.  It’s helping people jump further.  Using spectacular technology, like the digital wall, helps propel them further.  It is difficult.  Often, you need a CEO of an executive that champions it.  Also, I certainly tailor all of the workshops to clinicians.

I don’t ever use a post-it note.   I do not ever collect enormous amounts of people’s ideas.  We’ve changed the methodology.  I do a lot of one-on-one work, so that I don’t waste anyone’s time.  When I’ve pulled busy clinicians, who are seeing patients off the floor, most of the work has been done and I’m presenting the accumulation of all of their thoughts, so that they don’t re-prosecute the case.  If you pull a whole lot of clinicians off the floor, then they’re going to re-prosecute the question and they’re going to re-prosecute some of your assumptions.

I’m able to work in the background, so when they do come together, it is organic, but it has to be compressed organic because they are incredibly time poor.  There are a lot of things that need to change from our perspective in order to help them.  Often, designers come into health and go, “Right, we’ve got to have a mind shift, we’ve got to have the right mindsets.” That’s a wrong assumption.  

A clinician has no time to learn a literacy in regard to human-centred design to suddenly involve themselves in our process.  We dump the jargon, we speak their language.  We’ve shaved it right back.  We do a lot of work in the background, so that we do not put such a burden on them to learn our way of doing things.  

Chi: That’s one of the best pieces of advice I’ve heard in a long time.  I think that there are so many designers out there who will just be amazed by what you just said.  I think that’s something that every person that I know that’s working in design can learn from, 100 percent.  It’s something that happens time and time again, that designers go in.  It’s not just health, there are many areas that that applies to.  I think in this space, it’s incredibly important, yes.  Awesome.  Tell us a little bit about your amazing initiative One Good Street?

Maitu: Absolutely.  As a designer and as somebody who’s interested in social issues and almost an activist in our community, my design doesn’t stop when I finish at five o’clock or six o’clock at night, it continues.  That design mind continues.  I have an 83-year-old gentleman that lives on my street.  When he falls out of bed, he will call me, or his daughter will call me, and I go and pick him up.  Sometimes that’s four in the morning.  I put him back into bed.  Now, I know that I’ve saved him a hospital trip, I also know he’s saved an ambulance fair.  We’ve probably saved the public health system probably about $3,000 just by that neighbour-initiated care.  I knew something was in it.  

Then the more I spoke about the neighbour-initiated care, the more I found other people were doing incredible things for their elderly neighbours.  I decided to setup One Good Street, and we were lucky enough to win a senior’s innovation challenge, to kick off some funding, to get started.  What One Good Street is, is creating a participation culture, creating Facebook neighbourhood groups, to look after and provide support for and with older people in the community.  We reward streets for doing it by changing the colour of the street on a Google Map on our webpage.  

What that does is, allow the streets to see themselves glow with care from a visual point of view.  We take that to councils and to government and say, “Hey, look, these are the best streets to aging and these are the best suburbs to aging”, because of the participation of the community to support older people.  That rewarding the streets was a really important component.  In my neighbourhood, there’s a really thick market of social activity on Facebook neighbourhood groups.  

You hear the auctioneers when they auction a house talk about the social capital with the suburb and why you want to live there and why it’s valuable to live in suburbs like this.  I knew there was a way of rewarding the street for doing better in regard to caring for older people, and that this was a perfect way to do it through a visualisation on a Google Map.  We focus on running a range of activities for older people, from bike-riding with older people, to casserole clubs.  Today, in Melbourne, believe it or not, it’s going to be 38 degrees.  We run air-con clubs.  

Anybody working from home, you simply open up your house to your older neighbours, invite them in for a drink and to enjoy your air-conditioning.  Older people who are vulnerable often will not put on their air conditioning or their heating because they’re trying to save money because they’re on a very limited budget.  They will not heat or cool their houses during the day.  They suffer from heat stress.  This is a really simple way for neighbours to ensure that their elderly neighbours are well hydrated and nice and cool during really extreme weather conditions.  

This results in less old people attending local doctors or emergency departments with heat stress.  We know we save the health system, the ecosystem money when we do these things.  Also, it’s free of charge.  We don’t require police checks, we don’t send people on three-day training or incompetency frameworks for them to have an air-con club.  We just revel in the risk of opening up your home to people who live in your street and keep them cool during really hot days.  

Chi: So brilliant.  You hear about people not just getting ill from heat but dying.  Anybody who has been in Melbourne on one of those scorching hot days will know just how terrible it can be.  If you’ve got your air-con blasting, why not?  

Maitu: Absolutely.  The whole principle is based on some brilliant work done on the UK, where they looked at the neighbourhoods and how to activate them for a range of things.  In Lambert and Boon, they rolled out almost like a super structure across the neighbourhood that was aimed at developing a participation culture.  They used all the local heroes and all the local initiatives and combined them all into one big offering with a pool of volunteers, so that volunteers have variety and frequency.  

That volunteer experience and providing a platform for volunteers meant more people get involved.  We know that isolation and loneliness increases risk of death by 40 percent.  Loneliness and isolation in older people is a real issue.  People do absolutely die during these extreme weather events.  

Chi: I have two questions for you, the first one is, do you have any advice for designers out there?  I get asked all the time about how to startup my own side project, or how can I get involved in doing something, or how can I start an initiative?  Do you have any advice for people who are listening around how they can kickstart their own initiatives that they’ve got on their mind?  Maybe it’s within the health space, maybe it’s not.  If someone wants to go out there and do something like this for themselves, what would you suggest that they do?  

Maitu: I suggest being micro ambitious.  Stay absolutely micro.  Just work one street at a time, one letterbox at a time.  One composting bin at a time.  Use your methodology that you know so well.  Prototype it.  Prototype it on your street, in your local community, in your school/college/hospital.  Start incredibly small and be consistent.  Over time, you’ll end up with your battery recycling project winning an award in three years’ time.  Stay incredibly micro.  Stay incredibly open.  I encourage you to be highly promiscuous for partnerships.  

Often, designers love to have their own little exclusive thing that’s beautifully branded, the story is beautifully told with your beautiful little logo.  You’ve got to be far more collaborative to get shit done in the community, which means you’ve got to work well with a range of people.  So, anyone that puts up their hand to say, “Hey, I’m doing something, you should join me.” Say, “Yes, absolutely.” Go along for the ride.  That ability to partnership with others is the key to getting structural and organisational change.  

In examples from overseas, the working together, the collaboration between all of these local heroes under a super structure meant that 17 percent of older people ended up in emergency departments less because all of the cooking groups, the garden groups, the walking groups, the tai-chi group, the old person’s dancing group started to work cohesively together.  You had a net benefit.  Working with others in a really collaborative way to join up your initiative will get great impact for the community.  

That’s the key.  If you focus, your finish line has to be big population health improvement, improvements in wellbeing.  That’s the finish line.  Not snatching a trophy for your initiative or telling a beautiful story on Instagram.  The finish line has to be big picture stuff.  Stuff that changes communities.  The stuff that you want to do that you probably can’t do in your organisation because you’re designing service catalogues or whatever.  That has to be the finish line.  

With that in mind, you start to design better because you’re designing for the long-haul, it becomes a marathon.  As you do it, you learn tremendous amounts about engagement, about community, about what’s organic, and allowing this organic process to happen, so that you can transform your local neighbourhood.  

Chi: I think that’s brilliant advice and it’s so funny because I’ve got a friend who’s thinking about kicking off a little initiative.  It’s quite a cute one, but it definitely gives me some ideas to tell him about what he might be able to do.  My final question is, if people out there are interested in getting into design in health, what is the best way to do it?

Maitu: There are two ways, try and do an internship or get a job as a project manager in healthcare.  If you’re looking for a job as a designer in healthcare, we’re an endangered species and those positions are very rare.  Most hospitals now are working towards, and healthcare services, are working towards a chief experience officer.  There are projects to be done.  Get in the door first of all.  Often, I meet people who want to disrupt aging.  I encourage them to think about the terminology of disrupting, number one.  

Also, to actually become care workers.  To actually care for someone, care for an 80-year-old, and then start to renovate.  Be an entrepreneur and entrepreneurship is something that is so new to healthcare, but we’re starting to see accelerator networks and incubators happening in hospitals.  Innovation is spoken about on a daily basis within healthcare.  

There are opportunities, but you may have to enter through a project management and you may have to work in different parts of the hospital to build that credibility, but once you’re in and you start to get familiar with the world of a major hospital, of the stresses of clinicians, of the different flavours of all the tribes, doctors, nurses, allied health, pharmacists, physios, researchers, and the political context and funding stresses that they all experience.  

That allows you to provide valuable insight to them when you’re invited at the table to talk.  That’s how I would say get into health.  Look at the types of jobs that are available, make yourself fit them, go and start working.  Then like lemon through an entire bowl of flour, your job is to disseminate human-centred design thinking as you go.  If you’re good at it, they will notice you and they’ll want to hear what you’ve got to say because you’re giving them a perspective, a new lens on something that they haven’t had before.  

Chi: On that note, I’d like to say thank you very much for a very, very insightful conversation.  It’s been an absolute pleasure to have you on the show.  I can’t wait to get to hear you talk again because the last time that I heard you talk at a conference, it was amazing.  Thank you.  I’m sure all of our listeners are going to love this chat.  

Maitu: Absolutely pleasure, Chi.  You guys have a great day.  

Chi: What an inspiration.  If Maitu doesn’t inspire you to get out there and do something good for the world, nothing will.  If there were no obstacles and you could do anything to make the world a better place, what would you do?  We’d love to get your feedback and thoughts on this topic.  To join in on the conversation, go to thisishcd.com and register to join our Slack channel, where you can get in touch.  We use our Slack channel to shape future episodes of the podcast, as well as sharing interesting design-related content every day.  Thanks for listening to this episode of This is HCD.  See you next time.