Design as science fiction

I write science fiction, and science fiction isn’t about the future. I don’t know any more about the future than you do, and very likely less.

— Ursula K. Le Guin, introduction to The Left Hand of Darkness, 1976

A few weeks ago, somewhere in the midst of explaining why a thing annoyed me so much, I started to understand a gap in how we work, and by “we” I mean NHS England or possibly just “The NHS”, full stop. It became clear that it was no one’s job to imagine the future.

Most of my work is practical. The focus is on things we can accomplish, ideally within the current financial year, that do not require first addressing dependencies that are outside of our control. Almost all of the topics in that category exist within the interface layer of the app. The work is meaningful and important, but it has limited reach. Most of the problems that would make a serious difference to health outcomes live outside of the app, in the wider system. Despite my official title being Lead Service Designer, the work is not service design. The work is bricolage. The work is making do and getting by. Fixating on anything else would be insane.

My day-to-day posture toward the work is, generally, defensive. I try to stop bad things from happening, to hold the shape of the larger endeavour together while an ever-growing number of teams tack things on. The goals are coherence and raising the floor for quality standards. It’s honourable and necessary, sure, but hardly exciting. It involves no projection. It posits no grand theories for what might be. We reflect the system rather than direct it.

It is thus more than a little surprising that I now find myself a few days into a piece of design strategy work that will, hopefully, help to establish permission and backing to go after the really hard, systemic challenges that constrain our ability to create a truly digital health system. Through some combination of being a nuisance with a list of complaints, writing the odd declaration or two, and good ol’ lucky timing, I’ve managed to insert myself into an ambitious effort to describe the big picture of where we should all be headed. It has been, shall we say, a gear shift.

To get started, I’ve embarked on a round of interviews with my peers. These are fairly informal and relatively short; just enough research to get a feel for the shape and dimensions of their domains. In those conversations, I am trying to both extract their view of the problems to solve and make a case for my work, advocating for what I am doing as worthwhile. I’ve had a few different reactions, but I’ve been using an analogy to describe my orientation: design as science fiction.

Here, I’m thinking about what Isaac Asimov called “social science fiction”, which he poses against gadget and adventure stories (think: Ursula K. Le Guin’s The Dispossessed or Octavia Butler’s Parable of the Sower). In my formulation, design is a way of describing a world that does not yet exist but should, a world that involves meaningful change to socio-technical systems. The designer’s goal is to draw that imagined world closer to present-day reality. As in all of the science fiction that I’m interested in, technology is but a foil for telling a story about what could be different for people, social groups, politics, and institutions.

The failure mode of this work is a beautiful video or set of slides that describe the impossible. We might be painting a picture of a different world, but it does need to be achievable, if also a stretch. New technology or altered social situations become a lens through which you can examine the consequences of change. What was different about being sick in that world? Who had power in it? What became cheap that used to be expensive? What did people stop having to do?

Frederik Pohl (or maybe Isaac Asimov) put it very well:

A good science fiction story should be able to predict not the automobile but the traffic jam.

Science fiction is, in essence, a game of constraints. So is design. Both work with, establish, attempt to change, and ultimately obey rules. You change a rule and follow the consequences, wherever they go. You trace a consequence and then work out how to change the rule that produced it. Imagination is easy; the hard bit is consistency and follow-through. Working out what some change of technology does to clinical practice, hospital referrals, or people waiting for care is half the work. The other half is figuring out how to make it happen. The first half is systems analysis while the second is actual service design.

Eventually this project will end and I will scooch on back to my normal role. Knowing that, I can’t help but think about how this way of conceptualising design practice might scale to the individual product teams who are working in the trenches to solve practical problems in the here and now. How do I embed a pragmatic dreamer’s sensibility into teams that need to ship working software? I don’t know yet. This place is a constraint machine and it is very easy to end up blinkered, without the ability to look beyond formulaic solutions. The question I wrestle with is how to help teams make constraints generative rather than purely limiting. Science fiction uses constraints to create new worlds. Often it feels like our constraints result in nothing but limits and frustration.

The difference is that novelists get to choose their constraints while we inherit ours. They are nearly infinite and no one really knows what they all are. Unnamed constraints stop feeling like a material to work with and start feeling like nature. This suggests that a decent output might not be a picture of the future, but rather a picture of today if things were just a little different. Something that might have already been if we had done the work to alter the plumbing years ago.