Annex 3: elements of a systems approach
A design perspective — explore, create and evaluate
A design perspective ensures that systems are delivered using a range of perspectives, creative approaches and evaluation strategies in order to meet stakeholder needs.
It has been argued that many problems addressed by designers are ‘wicked problems’, defined as a class of problems that are ill-formulated, where the information is contradictory, where there are many stakeholders with conflicting values, and where the behaviours in the system are confusing. In response, the Design Council’s ‘double diamond’  comprises an initial analytical phase, which determines all of the elements of the problem and specifies the requirements for a successful solution, and a synthesis phase, which generates a range of possible conceptual solutions and an implementation plan (Figure 16).
In practice, design is iterative in nature, comprising multiple explore, create and evaluate cycles that enable a team to progress from understanding the need through to developing the solution. Design can be seen as a risk reduction exercise, set to maximise the chances of delivering the right solution to the right problem reflecting the right need.
The design process is typical of those used to address wicked problems,  where it is not only highly creative, but also very likely to be highly iterative in order to deal with the intrinsic uncertainty in understanding the real needs and finding an appropriate solution.
This is evidenced by the Institute for Healthcare Improvement’s iterative model for improvement (Aim, Feedback, Changes, Plan, Do, Study, Act) often encountered in health and care, where the planning stage is particularly influential in ensuring the delivery of safe systems into practice.
The design perspective can be thought of as the iterative sum of the explore, create and evaluate phases.
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Figure 16: The ‘double diamond’ — defining the problem before the solution
Good design focuses on discovering the real need before defining the problem and delivering the solution. Good design also explores a range of problems and solutions before selecting the most likely to fulfil the need.
The explore phase asks the question ‘What are the needs?’ and leads to a common and accepted understanding of the likely needs for a system, taking account of the full range of stakeholders. It is likely to include a variety of activities that can help to build this understanding and draw the findings together, for example:
- observe users to reveal what they really need
- generate personas to represent key users
- describe typical user journeys through the system
- specify performance requirements.
The create phase asks the question ‘How can the needs be met?’ and leads to a range of possible system solutions that would help meet the needs and criteria identified by the explore phase. It is likely to include many of the activities commonly thought of as conceptual design, for example:
- generate a wide range of solution ideas
- develop solutions that could satisfy the needs
- make prototypes to demonstrate the solutions
- select the best solution(s) for development.
The evaluate phase asks the question ‘How well are the needs met?’ and leads to an evaluation, both virtually and in practice, of possible system concepts that could meet the needs and criteria identified by the explore phase. It is likely to include activities to provide evidence that the needs are actually met, for example:
test system with experts
test system with users
evaluate how well the needs are met
present evidence from the evaluation.
Explore the other perspectives
 Eleven lessons managing design in eleven global companies. Design Council, London, UK, 2007. www.designcouncil.org.uk/resources/report/11-lessons-managing-design-global-brands
 Dilemmas in a general theory of planning. Rittel and Webber. Policy Sciences, 4(2):155-169, 1973. www.researchgate.net/publication/225230512_ Dilemmas_In_a_General_Theory_of_Planning