2.1 Design vs implementation science for systems change


Question: should design be integrated with other disciplines and methods to enhance validity and impact, or does that fundamentally disrupt what design has to offer?


Design is by no means a silver bullet for all problems and contexts.  There are a plethora of approaches out there that can help us make desired changes in our services, systems and communities. By employing design in combination with other approaches, we can strengthen our impact . . .but this doesn`t happen without tensions and trip wires.

Take my experience at the Center for Addiction and Mental Health in Toronto where I tried to integrate design into our systems change work that was primarily driven by an approach called implementation science. Implementation science (IS) is built from evidence on what influences the full and effective use of new practices. Connecting design and IS is particularly valuable because implementation is one of the great struggles for design.

First let`s, start by comparing the basics of these two approaches. Design involves practical methods and tools to imagine and create, whereas IS offers guiding frameworks for how to realize and sustain change. So in many ways, these two approaches are complementary. However, the tricky part is that some of underlying principles are conflicting. Design is based on intuitive and creative reasoning whereas IS is much more rational and analytical. Design is aimed at created preferred futures and IS is focused more on fit with present systems. This differences can create some pretty hefty (but mostly healthy) conflicts.


There are also some key process differences between the design and IS. Design invests a lot of time up front in framing a problem or opportunity and generating creative ideas to catalyze the desired change. IS focuses more on identify problems that are already defined and finding existing evidence-informed practices that might be able to meet the defined needs. When determining potential solutions design encourages people to converge valuable ideas and IS encourages selection between options. Next, design works to build an early prototype of an idea (or multiple ideas!) and test it in context right away and then pivot when something doesn´t work. IS on the other hand has detailed templates for how to plan components of the intervention and implementation and then focuses on improvement through ongoing feedback loops. Design tends to create a platform for people and embrace the emergence of how things transpire whereas IS emphasizes fidelity and doing a practice as intended. When thinking about scaling design explores creative ways of spreading the impact, but not necessarily the existing solution, whereas IS discussed how to scale existing interventions up and out.


While there are some pretty major processes differences, there is room for the strengths of both processes to inform each other. For example, problem framing, convergence and prototyping are huge strengths of design and planning, improvement and fidelity are amazing assets from IS. Practitioners need not only have one set of tools.

Overall, I would say that many strengths of design are in the fuzzy front end of the processes, whereas IS excels as clarity forms throughout the project. Perhaps it is about knowing where to place the emphasis when.


Upon reflection, I can say that it did feel like parts of design`s transformative potential were being stifled by the more rational approach of IS, but overall, I think a thoughtful integration of the two created much more impact than either one of the two approaches alone. Drawing from multiple disciplines, worldviews and methods, requires constant reflection and negotiation, but doesn`t anything worth doing?


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