狭義のデザイン [編集]

狭義には、設計を行う際の形態、特に図案や模様を計画、レイアウトすることで、芸術、美術的な意味を含んでいる。美術を実用品に応用するため、応用美術とも言う。また、商業的なデザインを商業美術とも言う。産業革命の影響により、デザインの意識が高まり、アール・ヌーヴォーなどの流行、バウハウスの機能主義など、常に時代の象徴を創造し続けている。その対象は、非常に多岐にわたり、さらに細分化される流れにある。 デザイン界ではアーツ・アンド・クラフツ運動によって生活と芸術の統一が課題になり、それを受け継いだドイツ工作連盟によって芸術と産業の統一が意図され、その重要性が認識されるようになる。 広義のデザイン [編集] デザインとは、日本語では「設計」にあたり、「形態」や「意匠」と訳されてきたが、それだけに限らず、人間の行為（その多くは目的を持つ）をより良いかたちで適えるための「計画」である。人間が作り出すものは特定の目的を持ち、それに適うようデザイナー（設計者）の手によって計画されるのである。デザインの対象は、衣服、印刷物、工業製品、建築などにとどまらず、都市や人生計画にもおよぶ。物や環境を人が自然な動きや状態で使えるように設計する工学、あるいは、人の物理的な形状や動作、生理的な反応や変化、心理的な感情の変化などを研究して、実際のデザインに活かす学問という意味において、人間工学と共通している。。考慮すべき要因には、機能性、実現性、経済性、社会情勢など、目的を実現することに関わる全てが含まれる。なお、特定の事業は誰が計画そしてデザインしたのかという質問などに対して、事業は複数の事業主体と計画者、設計者が委員会等などチームとして実施されているなどで、通常、明確な答えが返ってくることは期待できない。このことは、デザイン等の悪い事例行為について、その責任の所在をわかりにくくしているとの指摘もあり、優れたデザイン行為が個人の業務実績として評価できないことがある。

建築家は建築のデザイン（意匠）を行っているものは、デザイナーと呼ばれる。建築家はデザイナーをも兼業し、デザイナーが建築家を兼務することもある。例として近代ではペーター・ベーレンス、ヘリット・リートフェルトらが挙げられる。しかし、建築家は計画、意匠、監理までに関わるものであり、デザイナーという言葉では非常に狭い意味、狭義のデザインをするものに留まる。日本でも近年、組織によっては（欧米式にならい）その人の経験によって「ジュニア・デザイナー、シニア・デザイナー、 プロジェクト・チーフ」あるいは 「意匠設計者」「アーキテクチュラル・デザイナー」などと称している例がある。また、特に個人住宅や小規模店舗の建築を行う建築家やインテリアデザインやリフォームなどの内装を重視するケースについては「建築デザイナー」などと呼ぶ例も出てきている。 デザインの語源 [編集] デザインの語源はデッサン(dessin)と同じく、“計画を記号に表す”という意味のラテン語designareである。つまりデザインとは、ある問題を解決するために思考・概念の組み立てを行い、それを様々な媒体に応じて表現することと解される。日本では図案・意匠などと訳されて、単に表面を飾り立てることによって美しくみせる行為と解されるような社会的風潮もあったが、最近では語源の意味が広く理解・認識されつつある。 Prior to Sitra, Steinberg served (1999-2009) as a Professor at the Harvard Design School where his work focused on developing strategic design processes. This work included leading the Stroke Pathways project: a strategic redesign of the stroke care delivery system, aimed at identifying strategic improvements in care (www.strokepathways.org).



About the Project APPLYING DESIGN TO OUR SYSTEMS OF CARE Stroke Pathways is an ongoing, two-phased research project to improve stroke outcomes by taking a system design approach to health care delivery. Our recently completed Strategic Design phase (phase 1) produced three distinct bodies of knowledge: 1. A methodology for looking at complex systems 2. A comprehensive & strategic roadmap to better outcomes at lower costs 3. Identify and defining the "top 10" opportunities for improvement

In the process we've developed: a "zero footprint" organizational model to collaborate across institutions and specialties a "strategic design" framework to create change opportunities a "system change" innovation model (outlined in our activity map below) Activity map- our system innovation model Activity map- our system innovation model A Design perspective to "big picture" problems A NEED FOR SYSTEM DESIGN Our society has been served well by deep and narrow specialties, but the nature of today’s “big picture” challenges fall at the intersection of what we know. Not unlike cooking, the solution today is not in any one ingredient, but in the mix. Because key decision makers cannot always see a complete synthetic whole, they are often blind-sided by the unintended consequences of their action. As an integrative discipline, design is uniquely position to fill this strategic need.

Our work leveraged our unique skill-set to: Ask questions at different scales, because different scales provide unique insights; Examine problems in different contexts and from different perspectives, to understand their relative value; Involve stake holders and make our project their project; Create frameworks to integrate complex, and frequently contradictory, problems; Visually represent complex, multidimensional issues to enable a productive problem-framing; Bring to bear our ability to work with indeterminacy and relative precision. Rather than provide good solutions to the wrong problems, our strength lies in asking the right questions. Monday, May 26, 2008

Stroke and Strategic Design When we looked at the current system for stroke care, we identified two fundamental problems: It is set up to deliver a standard range of care for individual needs and it does so within a fragmented delivery system that varies by region, city, hospital and physician. All of these fragmented activities occur in separate realms driven by their own internal logics. Strategic design is a critical new perspective for stroke care. Current care improvement efforts focus on policy or on process improvement. Without a strategic component, even excellent tactical approaches may simply make poorly conceived care principles more efficient. Approach

* A full care cycle approach to care-innovations (prevention, acute therapy, long-term needs) * A systems approach to care delivery, focused on strategic improvements * A design-centric approach to problem solving Objectives Improved patient outcomes (mortality, morbidity, quality of life) at lower costs Products Our work delivered the following 1. A methodology for looking at complex systems 2. A strategic roadmap to improving outcomes at lower costs 3. Defining the “top 10” areas of opportunity for improvement

and we are currently developing 4. Pilots to demonstrate effective improvement 5. A methodology defining the science of implementation

Our "TOP 10" System improvement opportunities Our system design approach looked at stroke from a full care cycle perspective. We defined this into three distinct but interrelated phases:

1. Before a stroke (includes prevention) 2. Acute 3. After a stroke (includes rehabilitation and long term needs) The diagram shows our framework overlaid with the opportunities. Click on image for closer look North Carolina Pilot We are currently working to implement a unique care delivery system in the heart of America’s Stroke Belt that would improve stroke outcomes, reduce costs, and extend the reach of care to underserved communities in North Carolina while building a replicable model nationwide.

A NEW STROKE DELIVERY MODEL North Carolina has the 4th highest stroke mortality rate in the nation (twice the national average) and while improvements have been made in stroke care, the overall system of care is far from where it can be. The idea is to extend the reach of care to underserved communities in Robeson County through Lumberton’s Southeastern Regional Medical Center (SRMC). This is made possible by an integrated knowledge, team, and service model between SRMC and the North Carolina Neurosciences Hospital at UNC (NSH-UNC):

1. Partner with the existing stroke services at the North Carolina Neurosciences Hospital at the University of North Carolina (NSH-UNC). 2. Implement a new stroke patient segmentation system to better match care needs with therapy options 3. Extend the reach of care to underserved communities in Robeson County through Lumberton’s Southeastern Regional Medical Center (SRMC). 4. Apply our System Design know-how to redesign and integrate a new comprehensive delivery system to better serve patient outcomes at lower costs. Our approach is unique in that it is based on: 1. Triaging stroke patients along an integrated, full care cycle 2. Segmenting patients by imaging-based acuity to match them with most effective care 3. A hub and spoke delivery model to extend care to rural, underserved communities

We believe we have the right strategic insights, stakeholder buy-in, decision making support, and team partnership to implement a successful and robust system.

If you are interested in learning more, please contact us at:

Scientific Keys- our peer reviewed articles * Stroke segmentation scale (BASIS) * Stroke patient hospitalization COSTS (NEW!) * Time defined hospital catchment area for stroke- a GIS based approach (to be submitted soon) ARTICLES on DESIGN: complex problem solving * "Change!" The challenge of change-leadership (in Finnish): Dec, 2008 * D'A magazine interview extracts (in French): Oct, 2008 * "Changing the Change" Newsletter article: June 1, 2008 Project Team Principal Investigator

Primary Collaborators Collaborative Initiatives at MIT (link coming soon) Dr. Gil Gonzalez, Director of Neuroradiology, Massachusetts General Hospital Elizabeth Teisberg, Associate Professor, Darden Business School, UVA Dan Schodek, Professor, Harvard Design School Institute for Technology Assessment SITRA, Finnish Innovation Fund PHASE II COLLABORATORS

Stroke Care Pilot Dr. Sen Souvik, Director of UNC Stroke Team, University of North Carolina, Neuroscience Hospital, Chapel Hill, NC Dr. Michael Lee, Professor and Chairman, Department of Physical Medicine and Rehabilitation at UNC Dr. Bruce Whitman, Medical Director, Emergency Services, Southeastern Regional Medical Center, Lumberton, NC Diagnostic Tool Andrew J. M. Kiruluta, Assistant Professor of Radiology, Physics Department, Harvard University Research Assistant Adam Yock (Harvard College ’08) Advisory Group Esko Aho President, Finnish Innovation Fund; Former Prime Minister of Finland Emilio Bizzi Institute Professor, Brain Sciences, MIT David Cutler Professor, Economics, Harvard Univeristy Joe Hogan CEO, GE Healthcare Michael Porter Institute Professor, Harvard University Darrel Rhea CEO, Cheskin Charles Sanders Director, Genentech; Former CEO of Glaxo Donna Shalala President, University of Miami; Former Secretary of Health and Human Services

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