Whether it's healthcare, energy, tech, or even governmental, services are the way people experience, consume, and pay the output of most organizations. This diverse panel of experts will divulge the basics of new approaches to managing and improving services, plus share ideas that you can take home and make immediately applicable:

1. Seeing Tomorrowʼs Services:
A Panel on Service Design
Sponsored by CMU Bay Area Alumni and Adaptive Path
Hosted at Adaptive Path on 19 March 2009

2. What is service design? Why
does it matter? What's critical?
Shelley Evenson is Associate Professor and Director
of Graduate Studies at Carnegie Mellon University
where she has been writing, speaking, and teaching
the practice of service design focusing on tapping into
the needs of users of the service.

3. designing for service
Seeing Tomorrow's Services: A Panel on Service Design
Shelley Evenson
School of Design | Carnegie Mellon University
19 March 2009

4. A luxury hotel
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services:

5. A luxury hotel
+
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services:

6. A luxury hotel
When delivery falls short of expectations…
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services:

7. Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services:

8. JʼsUnitedStarbucksWestinWolfgangPuckPeetsHertzOnStarBlackberryAT&TZoneTagFlickrQuicken
Our service
experiences
are multifaceted and
co-produced
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services:

9. TwitterFacebookTwitterCuteOverloadGizmodoBoingBoingTwitterPerezHiltonTwitterDiggTwitterFlick
rTwitterEtsyTwitterLivejournalOMGKittyFacebookMyspaceImInLikewithYouTwitterCore77Weather
TwitterTreehuggerStarbucksTwitterAmazonAppleInsiderSomethingAwfulTwitterCuteAddictDeviant
ArtPennyArcadeFacebookEbayTwitterYouTubeTwitterCriticalMassTwitterPotLuckDinnerHalo
Many new service
experiences
are multifaceted,
co-produced,
and shared Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services:

10. TwitterFacebookTwitterCuteOverloadGizmodoBoingBoingTwitterPerezHiltonTwitterDiggTwitterFlick
rTwitterEtsyTwitterLivejournalOMGKittyFacebookMyspaceImInLikewithYouTwitterCore77Weather
TwitterTreehuggerStarbucksTwitterAmazonAppleInsiderSomethingAwfulTwitterCuteAddictDeviant
ArtPennyArcadeFacebookEbayTwitterYouTubeTwitterCriticalMassTwitterPotLuckDinnerHalo
Many new service
experiences
are multifaceted,
co-produced,
and shared NOW Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services:

11. people are
changing…
seeking fulfillment and meaning
•
but there is too much information to cope with
•
more actively and more consciously participating
•
in design—
they want to co-produce their products and
services
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 9

12. So is the work they are doing...
Total US Employment New jobs in the U.S. 1998-2004
Number of employees in millions % 100% = 5.4 million
Source: Johnson, Mayika, and Lee, Next revolution in interactions, McKinsey Quarterly 2005 number 4
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 10

13. technology is
changing…
Web-based services have had a huge
impact
More will change as the world becomes
filled with swarms of sensors with local
embedded computation
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 11

14. business is
changing…
The kinds of experiences a company
offers contributes to the performance
metrics and valuation of the company
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 12

15. traditional 4ps of marketing
Product—things you sell to people
Price—determining what the value exchange will be
Placement—how the product gets to its audiences
Promotion—how people find out the product is available
Neil Borden 1964
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 13

16. people
product
place
process
performance (after Lovelock and Wright) Photo Christopher Alexander
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University
© Evenson
Seeing Tomorrow's Services: 14

17. Important concepts
journeys and touchpoints
back stage and front stage
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 15

18. system interactions
p2p p2m m2m
person to person person to machine machine to machine
Me & my doc Me & the mri My sensors/agents
to systemʼs agent
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services:

19. The impression
(the sum of the experiences)
is the brand
for both providers and
customers.
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 17

20. brand customer
service
relationship
provider (user)
meta design design
service
medium
A ʻservice as designʼ triangle (After Gadrey 1996a)
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 18

21. form the
framework
and strategy
create | express
discover socialize
implement
refine
After Robinson and Dubberly
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services:

22. We combine interdisciplinary
teams, conceptual model-making,
and design-centered methods
over three research stages
exploratory generative evaluative
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services:

23. we use lots of methods to address
the issues...
stakeholder modeling | competitive analysis | technology trends | extremes |
era analysis | analogies | social trends | economic forces | ethnographic |
directed storytelling | blueprinting | prototyping | enactments | service relabeling
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 21

24. designing for service
is hard
You are iteratively planning and constructing a service
system or architecture to deliver resources that choreograph
a design experience.
but when a company provides the optimal mix—
they will have produced a resonating service system that
will deliver a clear experience advantage.

25. What is service design? Why
does it matter? What's critical?
Robert Glushko is an Adjunct Full Professor at the
University of California at Berkeley School of
Information where he teaches and writes on service
design focusing on the contribution of the service's
quot;back stagequot; where materials or information needed by
the front stage are processed.

26. Designing “Service Systems”
Robert J. Glushko
UC Berkeley School of Information
Information & Service Design Program
19 March 2009

27. Is “Service” a Homonym?
Web Service
Personal Service Self-Service
If these are all “services,” are there any design concepts
and methods apply to all of them?

28. Service Design Patterns
• Adjusting the absolute and relative amount
of interpersonal, physical, and
informational interaction
• Adjusting the line of visibility
• Choosing a point of view
• Scoping the service system and the size of
the “touchpoint windows”

29. Service Design Contexts
• Front stage – the continuum from
“Personal service” to “Self-service”
• Back-stage intensive
• Multiple devices
• Multiple channels
• Location-based
Each design context emphasizes different goals
and constraints and has characteristic design
methods

30. Deconstructing Front Stage “Service”
(Apte & Mason)
Service encounters can include:
• Interpersonal interaction
• Physical interactions
• Information processing and interchange

31. … Technology changes these proportions
• Person-to-person, technology-enhanced P2P, and self-
service form a continuum
• Information can augment interpersonal and
physical interactions
• And can also replace them

32. Telepresence & Telerobotics

33. Front Stage and Back Stage
Front Stage: where interactions with
service customer / consumer happen
Back Stage: produces information and
“stuff” needed by front stage
Placement of “line of visibility”
is a design parameter

34. The McDonalds Experience
Front Stage Back Stage

35. Gourmet Restaurant Experience
Front Stage Back Stage

36. Benihana Experience
Front Stage Back Stage

37. Amazon.Com
Front Stage Back Stage
Credit Authority
Retailer
Warehouse / Distribution
Delivery Service
Customer

38. Point of View
Designate some actor or service as the
focal / primary consumer or customer
Typically the end of value chain or
information flow, or where “users” are
Often arbitrary, and other actors or
services could be alternative POVs

39. Who is the Service Customer?
In a teaching hospital
I am.
No, I am.

40. In a Cooking School?
Back Stage Front Stage

41. Multichannel Service System
Physical Store Virtual Store

42. Multidevice Service Systems

43. Location-Based /
Context-Aware Services
Location-based Service Context-aware Service

44. Service System Scope
• Design techniques for person-to-person services typically
describe the service from the perspective of the customer
and emphasize the “touch points”
• But the scope extends before and after these touch points
• The scope is more complex with multiple channels,
multiple devices, or location-based services
• Complex service experiences are paths that traverse
through multiple service systems
– Yahoo…Googlemaps…511…BART…Muni…511…
OpenTable…Yelp… OpenTable…Twitter…511

45. Service System Scope
Time is a primary dimension of scope
but not the only one
Front Back
- Time + Time
Stage Stage
Touch Point
“Window”

46. The Restaurant Experience
Touchpoints
Service Scope
Primary Producer Supply Chain Delivery The Stage

47. The Massage Experience
Touchpoint
Service Scope

48. The Amazon Experience
Touchpoint Touchpoint
Service Scope
The Stage Warehouse Wrapping / Distribution Stage Again

49. Service System Scopes
Back Front
- Time + Time
Stage Stage
Amazon
Massage
Restaurant

50. A Methodology?
• “Service system” is too broad for a
prescriptive design methodology
• Iterative scoping (and defining the POV in)
the service system determines relative
importance of each context
• Choose a portfolio of appropriate design
methods for the combination of contexts

51. Portfolio of Methods
Front stage emphasis
Back stage emphasis
Sequence Diagrams
Ethnography Stakeholder
Survey Blueprinting Model-based Integration
Persona
Use Case
Usability Testing
Data Modeling
Prototyping
Story / Scenario
Document Analysis
Iteration

52. How does an organization
practice service design?
Christi Zuber leads an internal Innovation
Consultancy at Kaiser Permanente where her and her
team have co-designed numerous new services with
patients and clinicians that have not only lead to
measurable impacts on patient safety and satisfaction,
they have been spread across Kaiser's 32 hospitals
and beyond.

53. How we fit
HOW DOES THE INNOVATION CONSULTANCY FIT WITHIN KAISER
PERMANENTE?
Innovation Consultancy
Innovations in Frontline
Care
IAT
Innovations in KPConnect
INNOVATION
Advanced EHR Innovation
AT KAISER PERMANENTE
Technology
Innovation Learning
Garfield Innovation
Network (ILN)
Center
Knowledge Sharing
Innovative space for
Innovation
collaboration and
simulation
+
Many, many more
1

54. How we do it
We are driving innovation at the frontlines of healthcare by
bringing together best of class methods in innovation, design and
implementation.
There are 3 key parts to this.
Frontline Collaboration Prototyping & Development Implement & Assess
Synthesize Brainstorm
Prototype
Storytell
Field test and
Observe &
implement
Inquire
We collaborate and work with our We use a proven methodology We use IHI best practices to
frontline care providers and created by IDEO, a world renown implement and evaluate the
patients. They are a critical part design firm to develop and impact of our innovations
of our team throughout the prototype ideas based on human
process. needs.
3

55. Roles: Innovation Consultancy, Nice to Meet You!
+ 7 brand-new team members
Christi Zuber Scott Heisler Chris McCarthy
ABOUT the Consultancy
Our Kaiser Innovation Consultancy (IC) is a group of creative people who help
challenge conventional thinking to develop human-centered designs and solutions.
Our ultimate goal is to positively impact the work experience of our employees
and the health of our KP members. We test out the usability of new products, workflows and
space designs, and conduct simulations in real and mock patient environments. We work
together with our KP employees, physicians, and members to better understand challenges
and develop and prototype human-centered ideas using proven methodologies from
both IDEO and IHI
2
Email: Innovation.Consultancy@kp.org

56. What we do
Innovation and Design Thinking on the Frontlines of Healthcare
We leverage design-thinking to develop human-centered solutions to
impact patient care and the work experience of our care providers.
How you might know our work...
tools
Medication Administration: Interruptions dropped
by 50%, Process reliability increased, Medication
errors reduced; spread across KP and abroad
Design
NKE
spaces processes
Thinking
.
Nurse Shift Changes: Nurses got to see patients
at the start of their shift 3x faster under NKE pilot.
Patient satisfaction measuring “I understood my plan
roles of care” increased. Sought out by outside institutions
as best practice in nurse shift changes.
4

57. KP MedRite
Making hospital medication
administration safer - together
Christi Zuber christi.zuber@kp.org
5
Director, Kaiser Permanente Innovation
Consultancy
Adaptive Path-Service Design Panel 3.19.09

58. Creating a Case for Change
In the United States alone…
………7,000 deaths each year are caused by medication errors*
………1.5 million people each year are “harmed” by medication errors
………1 medication error per day per hospital patient
………$3.5 billion is spent each year treating medication injuries
*1999 report “To Err is Human: Building a Safer Health System”
In 2007…
A cross-regional effort began which focused on Medication Administration.
Kaiser’s Innovation Consultancy, supported by Quality and Safety, Patient Care
Services and KP HealthConnect, was commissioned to frame the problem, and
generate and try out ideas with front-line staff from three Kaiser Hospitals.
• Hayward
Patient Care
• West Los Angeles
Services
Innovation
Consultancy
• South Sacramento
Quality and KP
Safety HealthConnect
6

59. Observations and Storytelling
Nurses were asked to draw the first thing that came to
their mind when they thought of “Medication
Administration”
These drawings by nurses in Hayward and WLA
summarized the voice of the nurses across the pilot
sites.
-Chaotic
-Interruptions
-Unclear Process
Ask 12 nurses how they “Administer Medications” and you
will get 12 di!erent answers…
“I open my medications in the med room so I can get them
ready to go for the patient. It makes it easier.”
“I wait and open each medication in the room. That way the
patient can see that it is clean, if they don’t take it, it’s not
wasted. If they do take it we can double check the medication
together.”
7

60. Brainstorm, Prototype and Enact
• For two-days in April 2007, over 70 people (nurses, doctors, pharmacists,
experts and leaders) gathered at the Garfield Center to hear the stories,
stretch thinking and then brainstorm ideas.
• They came up with hundreds of ideas, some of them inspired by the
analogous observations
– Pharma TV
– MedBed
– Self-Administration
– Sacred Zones
– Sterile Cockpit
8

61. Field Testing – “No Interruption Wear” evolution
Hayward Hayward West LA
Deep Dive SoSAC
6/07 6/07 9/07
4/07 5/07
9

62. Pilot Solutions
Process
No
Interruption
Wear
Sacred
Zone
10

63. Pilot Outcomes and Spread
Pilot Results: 2 hospitals, 4 units
–50% reduction in the number of sta! interruptions to the medication administration
process
–15% faster per med pass from approximately 10:00 to 8:30 (minutes:seconds)
–18% increase in On-Time Med Passes from 61% to 79%
–Significant increase in process reliability from 33% to 78%
Financial Value of Innovation Consultancy’s KP MedRite Project
–If we avoided 3 medication errors, the project has paid for itself.
Because of the increased nurse and patient satisfaction and the results above, KP
MedRite is spreading to all 32 Kaiser Permanente hospitals
Pe rce nt of Me d Pas s e s w he re all five bas ic s te ps w e re com ple te d (n!68)
100%
90%
84%
81%
80% 79%
74% 74%
70% 68%
66%
WLA - 2A
60%
WLA - 3W
50%
HAY - 3CW
40%
37% HAY - 3E
33%
32%
30% 28%
20%
10%
11
0%
Baseline OneMonth Tw oMonth

64. Creativity in the
Implementation
A slide made by an
Assistant Nurse
Manager to show
how she adds in
some fun
12

65. 13
Slide from Alma Domingo – Asst Nurse Manager in Kaiser Hayward Hospital

66. My final thought…
If Service Design is HARD (and it is…) then
implementing and spreading these designs must truly
be ROCKET SCIENCE.
14

67. Howʼd You Solve It?

68. William Watt Electricians is a Bay Area company providing basic repairs,
installations, and troubleshooting for residential and small business customers.
Photo by I See Modern Britain, http://www.flickr.com/photos/27128437@N07/2534505446/

69. Out of two offices they dispatch their team of two dozen electricians to service
emergency calls, perform commissioned projects, and provide quotes. Given
broader economic trends, William Watt is interested in moving into…
Photo by Editor B, http://www.flickr.com/photos/editor/320670284/

70. …the growing green market to help homes become more energy efficient. Their
potential new offerings might include efficiency assessments, instillations of more
efficient equipment, and suggestions for improvements.
Photo by mjmonty, http://www.flickr.com/photos/36295747@N00/1519998876/

71. Youʼve been brought in to advise William Watt Electricians on how
they should approach the development of this new service.
➜ How would you approach the problem?
➜ And why is it the right approach?

72. William Watt Electricians
moving towards
greener homes

73. Service Goal: Make homes
more energy-efficient
GOOD NEWS:
huge number of
service
opportunities
BAD NEWS: huge
number of service
opportunities

74. Overall Strategy
• Use the 7 contexts to organize your design
thoughts
– Assess competencies wrt each context
• People, consulting (front stage) skills?
• Troubleshooting, repair (back stage) skills?
• Integration (multichannel) skills?
• Technology user or technology driver?
– Identify stakeholders wrt each context
– Brainstorm potential services wrt each context

75. Service Approaches
Person-to-Person
• Consultancy
• Qualitative Assessments
• Energy Consumption Diary Technology-Enabled
• Assessments based on installed
sensors, usage statistics
•Connect to home network?
• Proposals would show ROI
Collaboration with
• Home builders
• Utility companies (for referrals)
• Local governments

76. Service Approaches
Self-service technology
• For consumers who want the
experience of “being greener”, install
Back stage technology devices that they control or that keep
track of their energy usage
•Install devices that reduce
energy use, but aren’t visible to
consumers (tankless water
heaters, insulation…)
Remote Monitoring
• Can these devices be accessed
remotely?
• Can they be controlled remotely?
• Integrate into Internet service?

77. Watt?

78. How I would approach the problem
form the
framework
and strategy
create | express
discover socialize
implement
refine
After Robinson and Dubberly
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services:

79. our charge was
…help homes become more energy
efficient...
but there may be a bit
of a problem with
Wattʼs assumptions...
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 25

80. People see the world through their
own lenses...
Service group Equipment group Armament group
Wing group Electrical group Aerodynamics group
Empennage group Powerplant group Stress group
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 26

81. home and energy
electric
water
gas
...
composed of a variety of systems
people (families)
heating
cooling
cooking
wasting
...
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 27

82. redefine the charge to something like
…help people live their lives in a more
environmentally sensitive and energy
efficient way?
customers
service providers (Watt & Co)
utilities
government agencies
...
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 28

83. and Iʼd look at how other
transformations have happened in
the past…
gas -> electric lights (related)
outdoor -> indoor plumbing (sewer systems-big shift)
...
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 29

84. Ok—but what services for Watt?
perhaps Watt becomes the integrator
for all green related service provision?
or they install sensors and provide
ways to visualize behavior?
or sponsor community competitions
for clean energy generation?
Shelley Evenson | Interaction & Service | School of Design | Carnegie Mellon University © Evenson
Seeing Tomorrow's Services: 30