Rebecca Mead’s New Yorker feature The Sense of an Ending describes some really dramatic (and successful) reframes in care for dementia patients. There’s a number of profound shifts in how the caregivers describe their role and in the kind of experience they seek to deliver for the patient (and their family). The whole article (linked above, but subscribers only) describes those shifts and the cultural and organizational efforts to get there. I’ve included just a portion here

One of the first things Alonzo did, in 1998, was to ask an aide who was born in Vietnam to talk to staff members in her native tongue. “It was the only language I could find that nobody else could speak,” Alonzo recalled. “So we had her tell us very sweetly, in Vietnamese, what she wanted us to do, and we couldn’t understand her.” The staff had to become attuned to the woman’s nonverbal cues.

On another occasion, Alzono underwent a public bed bath, in front of the entire staff, of twenty-seven. She didn’t allow herself to move her limbs, and behaved as if confused. Afterward, she was able to describe the nature of her discomfort, and staff members analyzed their own activity in light of it. “Let me tell you, it sucked – it was incredibly uncomfortable,” she told me. Staff members then spooned food into one another’s mouths and brushed one another’s teeth, in order to be on the receiving end of activities that they performed for their charges every day. “You can find how threatening it is to have something touch your mouth when you have not brought it to your own lips,” she said.

In the most radical experiment, the staff wore adult diapers. “That was kind of life-changing for everybody involved,” Alonzo told me. “We all recognized just how uncomfortable it was to sit in a wet brief. Some of our front-line staff, who really wanted to know how bad that felt, did not change them for a couple of hours.” Previous may residents had been dressed in diapers, as they tend to be in a majority of nursing homes. Not long afterward, aides decided to stop the practice with most residents, instead taking them to the bathroom fifteen or twenty minutes after mealtimes. This made residents happier while making the staff’s jobs easier, because they no longer had to change people who were agitated.

There’s a rich tradition of participating in the experience our customers are having (see this great war story about an adventure in an “old age simulation suit”) and what feels like an increasing mention of empathy. I really like how this story highlights not so much the ergonomic or functional task aspects that are revealed but how this drives to revisiting the fundamental ideas of how the institution conceives of the patient experience it provides. I also like the full-on simplicity of the approach, the people who do this stuff to others now try it themselves and talk about it.

See also Richard Anderson’s blog post from this week about reframes in general and in healthcare specifically.

Another year is speeding towards its conclusion and we wanted to share our highlights for 2011.

• We are joined by inveterate sing-talker, Tamara Christensen! Hooray!
• Steve is writing The Art and Craft of User Research Interviewing: Diving Deep for Insight to be published by Rosenfeld Media in 2012.
• Julie and Steve wrote several columns for interactions magazine: What To Expect When You’re Not Expecting It, Elevator Pitch, and Kilroy Was Here.
• We got our umbrage on about a Braun customer survey, Newegg’s gobbledygook customer communications, HP’s TouchPad advertising, Kimpton’s attempts at personalization, Facebook’s anti-empathetic approach to redesigns, Netflix’s user-blindness, web security questions, breast cancer memes, and irrelevant and badly executed cross branding.
• We kicked off the Omni project, examined how people completed everyday tasks in previous eras of technology, gained mucho insight from Nicolas Nova and Adrian Hon, and completed an extensive secondary research slash cultural audit.
• We drew inspiration from Haruki Murakami and Neil Peart.
• Steve was interviewed about the future of reading and digital books for Digital Book World and about interviewing users for the User Experience podcast.
• We reflected on consumption in general and information specifically, flow states in user research, muffin signifiers, hearing protection and customer service, nerds, recycling, gendered design and marketing, silliness at 76 stations, and MacWorld.
• Steve spoke about Discovering and Acting on New Insights at Lift11 (video and slides), Improv in Brainstorming at APDF, Successful Collaboration (slides) at Frontiers of Interaction, Best Practices For Interviewing Users at SXSW (slides and audio), Culture, User Research and Design at OCAD (slides and audio), We’ve done all this research, now what? at UCB and CHI2011 (slides), Uncovering Innovation From The Outside In at the UIE Web Apps Masters Tour, and User Research Analysis in a UIE Virtual Seminar (buy). He also taught full-day workshops including Spinning Data Into Gold (slides) with Rosenfeld Media, and Immersive Field Research Techniques (podcast) at UI16, and We’ve Done All This Research, Now What? at Unfinished Business (slides) and UX Hong Kong (slides).
• Julie presented Finding the Right People for the Center for Design Research at the University of Kansas (slides);
  Tamara co-presented Big Ideas, Focused Action, Problem Solved at the Oklahoma Creativity Forum (slides)
• We offered a design and experience critique about the One Day For Design experiment.
• Steve shared photographic observations from Geneva, Hong Kong, Toronto, and Florence and Lucca.
• Julie and Steve were out and about in New York (Julie, Steve), Boston, and Portland.
• Our blog (the place for debating/defending the design of really really nichey products, it would seem) turned 10 (yes, 10!)
• We redesigned our business cards around the theme of What’s Your Story and started a blog series to explain the stories behind the new designs (collect all six!)
• Steve began co-chairing the IxDA12 Student Challenge
• We doubled our office space, taking over an adjacent space that opened up in our complex. Kitchen! Couch! We’re living large!
• Not to mention like a bajillion quickies!

Really nostalgic? Check out summaries from 2010, 2009 and 2008.

Yesterday I spoke at Lift 11, giving a 20-minute presentation. Here’s all the goodies

Video

Slides

Graphic recording (click to see larger)

More pictures

Warning, Portland, OR, December 2010

Last week I stopped at a Safeway store in Portland, OR. On my way to the bathroom, I passed through a backstage area with the various HR notices, schedules, and so on. And then, I see this sign, depicting a crazy-eyed dog, and the exhortation: Warning – A customer who wants a sample looks like this. Don’t Forget The Selling Suggestion.

I’m astounded that Safeway would put this sign where customers can see it. I would hope that companies wouldn’t be using anti-customer imagery as motivational posters, but if they are, I would expect that they wouldn’t put it where customers can see it.

Really, Safeway? You think so little of us that you don’t even care if we know how little you think of us?

2010 has been an amazing year for us. While we can’t talk about many of the incredible experiences we had doing fieldwork and working with clients, below are some of the highlights that we can share:

• New faces! Our team is ably enhanced by Julie Norvaisas and Wyatt Starosta (also see a conversation with Julie here)
• Steve shared observations of Austin/SXSW, SXSW again, Austin again, Munich, Rome, and gleaners at the Munich airport
• We noted symbols and meaning, branding in the details, the need for authenticity in marketing (and in jeans), and the need for something we’re calling anticipatory design,
• We took umbrage over ridiculous user experiences from United Airlines, airplanes and elevators, hotel elevators, conference badge design, a cupcake store, Lenovo, and a shaver out-of-the-box experience
• We mused about packaging and branding, conceptual collisions, neighborhood erosion, Harley branding dissonance, uncomsumption, localized stereotypes, super-immediate gratification, global norms for question asking, how research informs design, and this thing we call user “needs”
• We tracked provocative, charming and curious messaging, designs and user experiences from a cupcake store (by Steve; by Julie), a parking lot, toilets, Vodafone’s retail outline in Munich, building painters, JetBlue, what’s in the garage, foreign groceries, Devo, and the Savannah police
• We prototyped the ideal research study for Netflix (sadly, we never got the gig)
• We drew inspiration from Eminem, Will.i.am, Jack White, photographer Michael Schmidt, James Toback, fiction in the New Yorker, Douglas Coupland, and Neal Stephenson
• Steve assessed the human impact, micro and macro, of technology and design for interactions, extracted innovation principles from an discomfort-inducing ad for menstruation products for Core77, considered Homer Simpson and global culture for Core77, and interviewed Eric Ludlum (of Core77) for Ambidextrous
• Steve was interviewed for a book about innovation in design for emerging markets and in a podcast with Jared Spool about user interviewing best practices
• We interviewed ourselves for the premiere of Core77’s Wiretap feature
• Steve presented When Not To Follow User-Centered Design Techniques at HFES, Ethnography as a Cultural Practice at PARC, Skill Building for Design Innovators at CHIFOO, Culture, You’re Soaking In it at UPA 2010 in Munich, Integrating User Insight (with Aviva Rosenstein) at SXSW, and Deep-Dive Interviewing Secrets at a UIE Virtual Seminar
• Steve also lectured on improv and creativity for Seattle’s CHI group, Reading Ahead for Adobe and SCAD, innovation skills for Amazon, and synthesizing user research at the Austin Center for Design, Formation Design Group, CHI2010, University of Oregon, PDX IxDA, SF IxDA, and Interaction 10
• We attended November’s User Research Friday 10 and reflected on what we learned; we also led a Thursday workshop for User Research Friday and reflected on what we learned. We also attended last February’s User Research Friday 10 and reflected on what we learned
• Whew!

You can also see previous summaries from 2009 and 2008.

• [from steve_portigal] Does Language Influence Culture? [WSJ.com] – [Stanford psychology prof Lera Boroditsky examines how it does, and why it does] Just because people talk differently doesn't necessarily mean they think differently. In the past decade, cognitive scientists have begun to measure not just how people talk, but also how they think, asking whether our understanding of even such fundamental domains of experience as space, time and causality could be constructed by language…All this new research shows us that the languages we speak not only reflect or express our thoughts, but also shape the very thoughts we wish to express. The structures that exist in our languages profoundly shape how we construct reality, and help make us as smart and sophisticated as we are…As we uncover how languages and their speakers differ from one another, we discover that human natures too can differ dramatically, depending on the languages we speak. [Thanks @ebuie]
• [from steve_portigal] Facebook Is to the Power Company as … [NYTimes.com] – [The gap between being a customer and being a happy customer. Will Facebook be like Microsoft in a few decades, *still* whining about not being beloved – let alone actively disliked?] It was a typically vexing week for Facebook. On the one hand, the social-networking service signed up its 500 millionth active user. On the other hand, it was found to be one of the least popular private-sector companies in the United States by the American Customer Satisfaction Index. Apparently, Americans were more satisfied filing their taxes online than they were posting updates on their Facebook page. It is a continuing contradiction: Facebook is widely criticized for shifting its terms of service and for disclosing private information — and yet millions of people start accounts each month.
• [from steve_portigal] Digital Domain – Even With All Its Profits, Microsoft Has a Popularity Problem [NYTimes.com] – [We want your money and your love!] Microsoft’s enterprise software business alone is approaching the size of Oracle. But despite that astounding growth, Microsoft must accept that, fair or not, victories on the enterprise side draw about as much attention as being the No. 1 wholesale seller of plumbing supplies. Microsoft won’t receive the adoring attention that its chief rival draws with products like the iPad. In a conversation earlier this month, Mr. Shaw explained what prompted him to write his post. “I noticed some pretty critical conversations going on in the technosphere among the technorati,” he said. “There’s a gap between that conversation ­ ‘the company is not doing well, period’ ­ and what the company is actually doing.” In the blog, he writes, “With Windows 7, Office 2010, Bing, Xbox 360, Kinect, Windows Phone 7, in our cloud platform, and many other products, services and happy customers, 2010 is shaping up as a huge year for us.”

I was walking to dinner with a client in Chicago and saw this choice piece of graffiti. I immediately imagined using the image for an end slide in a presentation – “Problem Solved.” Very nice.

It wasn’t until after I had posted the shot on Facebook and seen it uploaded that I realized what it actually said. Which means that I saw the graffiti, composed the shot, took several alternate shots, and processed it in Photoshop, all the while seeing what my mind had interpolated rather than what was actually written there.

We’ve had numerous experiences of clients joining us in the field and saying – after we’ve interviewed someone who was either using or enthusiastic about their products – “She’s not our customer,” because the person didn’t fit their organization’s idea of who their customers are. We’ve also heard, “We already fixed that problem,” even after seeing clearly that the solution was unknown to the end user and the problem was still a problem.

It can be very hard to see something as it is if you come to it with a strongly ingrained idea of what you think it is.

But there is a reality – customers, environments, markets – whether you are seeing it or not. If you’re developing and selling products and services, you’re far better off working from an understanding of what’s actually there, rather than what you think is there.

• Gathering insights by having people hand write their stories [DMI News & Views] – Asking people to tell us stories has repeatedly proven to be a rich and productive avenue for important insights. We ask people to tell us a story about a relevant event or experience. For instance, tell me about the last time you baked something from scratch. Or tell me about the last time you purchased a car. We try not to set too many rules or give too much guidance. We let them determine where the story will begin. This, after all, is what we are looking for. We ask for the story to be in writing—and ideally the story will be handwritten, if the logistics permit. We ask for the story to be as descriptive as possible—and we ask that the story be illustrated with pictures (hand drawn stick people or cuttings from magazines or from the Internet).
• 100 Records: Project turns on fictional jackets [SFgate.com] – Exhibiting as "100 Records", Sonny Smith, a San Francisco musician, artist and writer, commissioned nearly 100 artists from around the world to create the artwork for 100 45 rpm record jackets that represent more than 60 fictional bands and singers.

• Dan Formosa on Why Marketing Research Makes Us Cringe [interactions magazine] – In a bigger picture, design research needs to expand its techniques to more fully understand the potential of design. It’s bad enough that some of these marketing-based methods continue to be practiced in a rote manner in the field of marketing. (Delving into technical discussions involving both logics and statistics can bring many people, in marketing and design, far from their comfort level.) But blindly applying marketing methods to design creates a double whammy that should be avoided at all costs.

• Forrester’s 2010 Customer Experience Rankings [Customer Experience Matters] – # Retailers take 12 out of the top 20 spots. Most of the top rated companies on the list are retailers. Hotels also grabbed three of the top 20 spots. Interestingly, three financial services firms also cracked the top 20: credit unions, SunTrust Bank, and Vanguard.
  # Healthcare, Internet and TV services dominate the bottom. The bottom 11 companies on the list came from only four industries: five health insurance plans (United Healthcare, Medicaid, Anthem, and CIGNA), three ISPs (Charter Communications, Comcast, and Qwest), two TV service providers (Charter Communications and Comcast), and one credit card provider (HSBC).
• Can Design Change Behavior? [Stanford School of Engineering] – Because behavior can be influenced—not just observed—it provides an important opportunity for tackling complex challenges such as sustainability. That opportunity is perhaps best addressed with design…With this outlook, Banerjee says he is excited to be one of the principal investigators in a new project funded by the U.S. Department of Energy in which he is working with other Stanford professors who have expertise in behavioral sciences, communications, human-computer interaction, and behavioral economics. The team aims to create interventions that influence behavior to bring about significant reductions in energy use. But what designers understand well is that people are “predictably irrational” and influenced by emotional as well as rational criteria, Banerjee says.
• The Art of Asking the Question [UIE Brain Sparks] – Steve Portigal will show your team the art of asking the question. You might visit the user in their office or home, have them come to you for a usability test, or even have a chance encounter at a trade show or while waiting for an airplane. Do you know what to ask? Do you know what to listen for, to extract the critical detail of what they can tell you about your design?

  Steve will help you prepare your team for any opportunity, be it formal user research or less structured, ad-hoc research. He’ll also give you tips on how to work with your stakeholders and executives, who may also be meeting potential customers and users, so they know what to ask and how to listen—integrating their efforts into the research team. (Wouldn’t it be great if they understood why you’re doing what you’re doing?)

  Update: Use promotion code CHITTAHCHATTAH to get lifetime free access to the recording after the fact (normally a separate cost)