“I’m hungry, mom.What’s to eat?” askedfour-year-old Isaac. Beth mentallysearched the refrigerator and couldn‘tcome up with a thing.“Whaddaya say wego out for lunch today?” she offered.Instantaneously, the kids’ eyes lit up. Isaacand his younger sister and brother (twintwo-year-olds) were almost out the doorbefore Beth could pack up all their para-phernalia and grab the car keys. Fiveminutes later, we were all piled into theminivan and turning onto Route 434toward Oviedo.

It was Tuesday morning, summer2005, the second day in a five-day fieldresearch study conducted mostly withyoung families around the Orlando area.Our sponsor was a major fast-food com-pany. The assignment had three aspectsto it: first, to describe in some detail thedimensions and patterns of the quickservice restaurant (QSR) customer expe-rience; second, to diagnose possible gapsor discontinuities in the customer expe-rience; and third, to prescribe and devel-

op new concepts targeted to improvethe customer experience. Over thecourse of the assignment, we spent lotsof time with families and other key cus-tomer types, as well as with restaurantemployees—all of which yielded awealth of information to guide thedesign planning process. Though ourinitial project focus was the physicalQSR environment, the research databroadened our attention to incorporateservice and system issues. This, in hind-sight, is not particularly surprising,because many sophisticated businessofferings today are hybrids of product,service, and setting. Increasingly, every-thing is connected. Consider a recentNew York Times headline: “You’re NotBuying Gadgets, You Are Subscribing toThem.”1 We would only add: “You mayalso be sitting comfortably in one rightnow drinking coffee.”

P R O D U C T I O N

ithin an expansive view of options and possibilities, Michael Eckersleydemonstrates how in-depth market and strategic trends research is instru-

mental in pinpointing what should be developed and why. Projects in the fast-foodand healthcare industries suggest the subtleties of his methods and the opportuni-ties they can reveal for innovation and more effective competitive branding.

Michael D. Eckersley,HumanCentered

Designing Human-Centered Servicesby Michael D. Eckersley

W

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1. Saul Hansell, “You’re Not Buying Gadgets,You Are Subscribing to Them,”New York Times,January 18, 2008.

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60 Design Management Review Winter 2008

Design in the services ecosystemOur firm, HumanCentered, came to servicesthrough the side door of technology. Since 1997,we had been developing web-based reservationsand financial services applications for PremierResorts and for Sybase. We had no particularexpertise or formal training in services, but wesoon found that we had considerable influenceover the nature and expression of that aspect ofour clients’ businesses. With that influence camegreater responsibility and risks. Fortunately,some of our design process, problem-solving,and systems expertise was readily transferable.But because our assignments soon crossed overinto diverse industries, including healthcare,enterprise software, and consumer products, get-ting up to speed on new, domain-specificknowledge has been a constant.

Services can involve design on at least threedifferent levels: strategic design planning, designplanning, and design implementation (Figure 1).Over the years, we have gravitated to the level ofresearch-based design planning. As social scien-tists, our bridging expertise has long centered onhumans and human behavior, complemented bythe requisite market and strategic trendsresearch. As interaction designers working in adesign planning capacity, we are intent onanswering the question: Of all the things thatcan be developed, what should be developed,and why?2 Because design can grow to involvemany broader and narrower considerations, wehave chosen to specialize here.

Not all our design programs get implementedsubsequently, of course, at least as presented. Butthat is largely beside the point; they do tend tobe influential. Companies use us to show themwhich concepts and offerings are possible, andhow these might yield customer and businessvalue. Concept simulations and experience pro-totyping are critical to representing such value.As funded concepts move toward implementa-

tion, we are often staffed to advise in thatprocess.

Because services comprise most of all com-mercial activity in advanced economies today,there is bound to be growing market demandfor sophisticated and systematically designedservices. However, services tend to be under-optimized, generally. In fact, many services actu-ally contribute to a widening gap that separatespeople (consumers) from the latent value thatbrands could provide if only they could decodesalient customer needs and fill the gap withsmart, sustainable offerings. As socio-techno-economic systems, services are complex. How toinnovate them is not well understood. This isironic, in that better-designed services are gener-ally regarded as more useful, usable, and eco-nomically valuable.

Among designers, the growing interest inservices is understandable—not necessarilybecause service design offers a forum for creativevalidation or for professional publicity (the prod-ucts of service-based design are usually anony-mous and the closely guarded intellectual prop-erty of the sponsoring organization). Rather,services pose inherently interesting design prob-lems and contexts for design thinking. This hasconsistently pushed our own firm beyond exist-ing capabilities and challenged us to take onassignments of the widest manageable scope.

Service and the quick service restaurant(QSR) modelSome telling deficiencies in the fast-food experi-ence were not hard to spot, beginning with agood deal of waste in the QSR model. No, not inthe hyper-efficient restaurant operation itself,but in the customer’s own expenditure of time,attention, and energy spent interacting with it.

SDP

DP

DI

STRATEGIC DESIGNPLANNING

What subjects and oppor-tunities should we pursue?

Model business, market, cultural and resourcecontexts. Articulate strategic goals and businessrationale

DESIGN PLANNING What should we develop?Develop, validate and prototype the conceptand related offerings in context

DESIGNIMPLEMENTATION

What form(s) should it take?Design, produce and test the actual products, services, systems, environments

RESEARCHDERIVEDINSIGHTS

Figure 1. Strata of design activity, from strategic to operational. From Charles L. Owen, “Design, Advanced Planning, and Product Development,”International Symposium: Nuevos Metodos & Tecnologias para el Diseno de Productos, Santiago, Chile: Nov. 12, 1998.

2. cf. Karen Christensen, “The Power of Design: Questionsfor Patrick Whitney.” In Rotman, the Magazine of theRotman School of Management, Spring/Summer, 2005.

Natural human patterns around food and eating(for example., sample tasting, personalization,watching the preparation, serving oneself, sec-ond helpings, after-meal sweets and desserts,hosting, socialization, and conviviality) are vir-tually ignored in the industry. That blind spotmeans that such variables go unrecognized,unmeasured, unmanaged, and unmined forinnovation opportunities. Sure, customers havegotten used to modern fast-food conventions,but the sacrifices—conscious or otherwise—ofimpersonalized dining are real.

Fast food is intended to be fast. But at peaklunch and dinner times, the customer experienceis all about waiting. Most QSRs still process cus-tomers on a serial, undifferentiated basis, withnewbies and “super-users” all together in thesame line. Burgeoning, hard-to-read menuboards place an additional cognitive load onthose unfamiliar with the various food options.Asking questions about the menu is treated asslowing down the process, so ordering is oftenrushed, and done without a clear idea of whatfood will show up. Unfortunately, various tech-nological options for customer self-service facestiff internal resistance. But the design opportu-nities for multiplying the number of orderingpoints throughout the QSR offer the potentialfor expedited order processing during peak peri-ods, not to mention shorter service queues,reduced customer stress, and increased order

volume. Operational challenges to this approachare not trivial, but the first QSR brand to designand implement such a reflexive system willprobably enjoy real competitive advantages byoffering customers better and more flexibleoptions for ordering.

Another behavioral pattern we observedamong QSR customers involved issues of germanxiety, restroom convenience, and hygiene. It’sa good bet that most fast-food customers eatwith dirty hands. Only a small percentage actu-ally wash up before eating. Moms with youngchildren tend to avoid the restrooms altogetherif possible, concerned that they or their kids willexit the restroom dirtier than when they went in.We saw a lot of user work-arounds in responseto this concern. These included changing diapersin the car rather than in the bathroom, usingnapkins or toilet tissue to open restroom doors,and sterile wipes for the kids packed along in abag of convenience snacks, books, and toys—just to manage the experience of going out forfast food with the kids. These findings inspiredsubsequent design of convenient hand-washingalternatives separate from restrooms and adja-cent to the QSR dining area.

In all, we spotted five latent opportunities forinnovating the QSR model. One was the idea of“brand channeling” the dining room (Figure 2).This insight derived not so much from some-thing we saw in the QSR environment, but from

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Design Management Review Winter 2008 61

Figure 2. Brand-channeling the QSR dining room

62 Design Management Review Winter 2008

Designing for the Service Industry

something we did not see: conscious humanengagement. Many fast-food customers undergothe fast food experience as if in a virtual stupor.We found many customers apparently unen-gaged, sensorially or cognitively, in the QSR din-ing area after ordering and during the meal. Thisgap of “attention space,” we determined, couldbe intelligently managed by the brand in thesame way airlines manage the in-flight experi-ence. It’s not hard to imagine 6,500 flat plasmascreens in existing restaurants across NorthAmerica feeding a regular stream or periodicallyupdated loop of music, entertainment, andoffers to a live customer audience. A live newscrawler and an updated list of order numberswould run below and to the side of the screen.Done imaginatively, the experiential and eco-nomic benefits of brand-channeling the QSRdining room could be significant.

Customer expectations of the fast-food expe-rience are generally low. Our design recommen-dations for expanding the versatility andambiance of the QSR keyed on variables ofinformation, time, and space, and deemphasizedissues of matter and energy (Figure 3). In otherwords, we identified ways of making the systemsmarter and more adroit in serving the cus-tomer, rather than simply adding more overheadcost in terms of material and energy. Most suc-cessful fast-food brands are highly engineered,efficient machines. But their models are subopti-mal, at best, when it comes to important humantouch-points. Having largely mastered themechanics of food delivery, innovative QSRbrands will have to win customers and marketshare more on the basis of customer experiencethan on cost.

Serving moms and newborns“But why did I have the contractions?” Viola askedthe nurse anxiously. (Viola worries if anything

seems unusual, or if she doesn’t understand some-thing.) The nurse said the tests were normal thistime. But Viola had had a couple of contractionsduring the procedure, and she was concerned. Thenurse took her blood pressure and mentioned thatit was a little high, but gave no explanation orreassurance that it was acceptable. When the doc-tor came in, he indicated his intention to inducelabor the following Monday. But when Violaexpressed surprise over the date, he checked hisrecords again and realized that he had gotten thedate wrong. She still had some weeks to go. Violaasked both the doctor and the nurse about theblood pressure and the contractions, but theyseemed distracted and offered no comment. Thenurse explained that the contractions were “proba-bly just Braxton Hicks.” The doctor and the nurseuse technical terms like this with little or no expla-nation of them, and they don’t ask her if sheunderstands....

Viola (not her real name) was a 25-year-oldHispanic female in the third trimester of preg-nancy, a special-needs patient in the maternalfetal medicine program of a large Americanhealthcare system. She was in acceptable condi-tion, considering that she had had a liver trans-plant and splenectomy just two years earlier.Viola’s pregnancy was unplanned, and she didnot become aware of it until she was a full 20weeks along. Viola and her husband had plentyof reason to be concerned.

Healthcare is a personal matter. But health-care is often served up in the most impersonalmanner. For those Americans fortunate enoughto be covered by some form of health insurance,dissatisfaction rates run high,3 having doubledsince 1998. Cost is the biggest reason; insurance

spaceinformationmatter

energy

low med hightime

Figure 3. The QSR low-energy, high-information program—making the system more efficient in serving the customer, rather than simply adding moreoverhead cost.

3. Ruth Helman, Mathew Greenwalk & Associates, andPaul Fronstin, “2006 Health Confidence Survey:Dissatisfaction with Health Care System Doubles Since1998,” EBRI Notes, vol. 27, no. 11 (November 2006).

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Designing Human-Centered Services

premiums have risen 87 percent since 2000—more than five times the rate of employee com-pensation. Despite these endemic problems, wefind working in the healthcare industry gratify-ing. The issues are complex, the people aresmart and well-intentioned, and—put simply—healthcare matters.

If you happen to have spent substantial timeat a typical clinic or hospital recently, the seamsin the healthcare customer experience are appar-ent: labyrinthine policies and payment systems,duplicative documentation, inconsistent careformularies, and to-the-bone cost-cutting. Forperfectly healthy pregnant women and theirfamilies, a healthcare system that is essentiallyengineered to treat the sick does not always sup-port their special needs.

Between 1994 and 1995, we researched theexperiences of mothers and families as theyengaged with a complex healthcare system dur-ing pregnancy and childbirth. Our assignmentwas to develop design recommendations toimprove the quality and value of healthcareenvironments and services. Sponsoring theresearch was a large and highly respected inte-grated healthcare system based in the westernUnited States. Our work would inform the plan-ning and design of a new hospital for womenand newborns. Our client’s motivation for usinga firm such as ours was simply stated: “We getmarket research reports all the time, but they’re

not relevant to us in our planning and design.The information is mostly generalized and hasno texture. It never deals with exceptions.”4

We conducted in-depth contextual researchwith expectant mothers and families in theirhomes and in healthcare environments, begin-ning from their second trimester visits andonward through labor, delivery, and postpartum.Our team was small—just two skilled colleagues,Judy Rice and Hillary Leonard, and myself. Butwe learned a great deal, identifying four generalpatterns or themes driven by the research data.These, in turn, inspired a design program com-prising seven key concepts.

One theme from the research involved therole of expectant mothers. We wanted them tohave greater control in co-managing the experi-ence with care providers. Pregnant women andcouples enter the healthcare system seeking thesafest, most humane, and most affordable prena-tal, delivery, and postnatal infant care. The sys-tem can treat these women and their families asfaceless, temporary occupants of waiting rooms,beds, and wards. Expectant mothers and theirpartners are often anxious and not clearlyinformed about the experience they are under-going. Nevertheless, they do not check theirminds or autonomy at the door when they vir-

Figure 4. Program of mother/family control.

4. John Rich, vice president, facilities planning and devel-opment, Intermountain Health Care (personal commu-nication with the author).

tually move their families to the hospital for twoto five days. Disappointments and affronts hap-pen at this emotionally charged time, even in thebest of systems. Empathy can be in short supply.This kind of naturalistic data informed the sub-sequent design of a program for the family, aswell as the mother (Figure 4), geared to provideinformation, choices, and a better sense of con-trol over such things as food, snacks, privacy,telephony, lighting, entertainment, and sleepingoptions. The program extended to facility plansfor a family day-room area adjacent to thematernity ward for immediate family and gueststo gather. Plans also included dedicated life-management facilities for special-needs familieswith infants receiving intensive or long-term,monitored care. Other design requirementsinvolved ways of “smoothing the corners” in careinteractions and transitions, facility affordances,amenities, and send-offs.

Another theme that emerged from ourresearch involved what we later called transfor-mation and rite of passage. We learned thatwomen, couples, and families undergo variousobvious, and subtle, kinds of transformation as aresult of the experience of pregnancy and child-birth. Some mothers and families today do nothave the same kinds of cultural support that wasavailable to past generations processing thisexperience. In fact, this experience has physical,emotional, cultural, and even spiritual implica-

tions that should not be ignored, but could con-ceivably be honored, by design. To this end, wedeveloped a program to assist families in makingmeaning from the experience. An element of thisprogram, called Recording and Remembering,involved a branded remembrance book withideas and examples for assembling thoughts,photos, ultrasound recordings, digital files, birthannouncements, and other artifacts. Anotherelement of the program engaged with architectsin phases of site and facilities planning to createthemed environments and interactive exhibitsfor children and families to use and enjoy duringthe long hours and days of semi-residence at thehospital (Figure 5). A capstone of our designprogram, Legacy Affiliation, was meant to enrichand extend the mother’s relationship with thehospital long after her stay. It included a mem-bership affiliation program with opportunitiesfor volunteer service, topical discussion groups,educational offerings, and news. The programwould introduce expectant mothers to the pro-gram and facilities months before the scheduledbirth and would be gently reinforced with taste-ful welcome and goodbye gifts at the hospital.

Design infiltrates organizations (and is trans-formed in the process)In a 1993 interview, Peter Coughlin describedthe work of IDEO’s Transformation by Designgroup this way:

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64 Design Management Review Winter 2008

Figure 5. Transformation and rites of passage—themed environments.

Designing Human-Centered Services

Design Management Review Winter 2008 65

We took IDEO’s core process, and addednew tools and methods to help instigate orga-nizational change. Our high-level operatingtheory is to engage with the client, do adesign project together. Use what you’velearned from that to learn about the organi-zation. Then redesign the organization tomeet this offering you’ve created. So—designthe offering first, then design the organiza-tion to successfully deliver that offering.

Most consulting says, here’s the newoffering, delivered in a tome that lays out thestrategy. If the new offering fails, it’s becauseyou haven’t spent the time to change the cul-ture that’s supposed to deliver it. Our prom-ise is that we can help transform organiza-tions by giving them the capability to designexperience from a human perspective.4

That is a radical point of view of design, espe-cially for a generation of designers trained in aformalist tradition and used to performing in asubordinate, work-for-hire, project culture.Nevertheless, everything we have learned inde-pendently about advanced design and service-based offerings over the past 10 years ratifiesCoughlan’s assertion. Services are treated differ-ently than product-based offerings. But servicesare central to what a company is, not just what itmakes. By this logic, flawed services reveal seamsin the organization itself.

Designing innovative services cannot be doneat arm’s length. We were inspired by embeddingourselves firsthand in the operations of organi-zations and in the lives of their customers.Success improved vastly when organizationalteams got involved with us as collaborators.Because their detailed process and systemknowledge always exceeds our own, their buy-inhas been critical in making change stick.

Looking back, the popularity of Joseph Pine’sand James Gilmore’s The Experience Economy,in 1999, signaled a big turning point. The bookgave tacit approval and a rationale for prepareddesigners to touch virtually any kind of offeringthat would derive value from thoughtful analysisand imaginative design thinking—servicesincluded. The only permission we needed wasfrom organizations willing to give us a shot.

Increasingly, designers have the means, themotive, and the opportunity to engage activelyin services at various levels and in various front-end and back-end capacities. We can bring auniquely integrative point of view to servicesand service innovation. Parochial or narrow def-initions of interests are no longer called for.Leadership is. Which prompts the question:What are the boundaries of design today, if notextraordinarily wide? We know that designscales. We suspect that the future will favordesigners and teams who can scale with it.

Suggested ReadingsChristensen, Karen. “The Power of Design:Questions for Patrick Whitney.” In Rotman: TheMagazine of the Rotman School of Management,Spring/Summer, 2005.

Owensby, J., Maglio, P., Spohrer, J., Murphy, W.,“Services Sciences, Management, andEngineering (SSME),” Frontiers of Knowledge inScience and Technology for Africa, UniversityLeader’s Forum. Almaden Services Research,IBM Corp., November 20, 2006

Owen, Charles L., “Design, Advanced Planning,and Product Development,” InternationalSymposium: Nuevos Metodos & Tecnologiaspara el Diseno de Productos, Santiago, Chile:Nov. 12, 1998.

Pine, B. Joseph, and Gilmore, James H. TheExperience Economy: Work Is Theatre and EveryBusiness a Stage (Harvard Business School Press,1999).

Tergas, Leslie, and Karyn McLean, “InlandRevenue New Zealand: Service Design in aRegulatory Context,”Design ManagementReview, Winter 2008.

Verma, R., Fitzsimmons, J., Heineke, J., andDavis, M. “New Issues and Opportunities inService Design Research.” Journal of OperationsManagement 20 (2002) 117–120. �

Reprint #07191ECK59

4. Mark Hurst, “Interview: Peter Coughlan, IDEO,” good-experience.com, September 2003.