04.28.22
Sara Hendren + Lee Moreau | Audio

The Futures Archive S2E4: The Defibrillator


Do you notice the defibrillator on the wall or behind the cash register in the places you visit daily? Have you ever been called on to use one? On this episode of The Futures Archive Lee Moreau and Sara Hendren discuss the defibrillator, designing life-saving machines for everyday users, and the power of the power button.

With additional insights from Christine Ball, Rachel Plotnick, and Lucienne Roberts.

Sara told Lee about how odd it is to encounter the defibrillator on a daily basis:
You encounter the defibrillator over and over in a public space when you are precisely doing some of the most banal tasks of your life. You're standing there at the cash register and thinking: "Wow, the blueberries cost that much?" and there's a defibrillator—you're just blinking past it. And occasionally you do ask yourself: "That's a real piece of medical equipment. I wonder if I could...," and then you tend to short circuit because you think: "Goodness, I'm sort of hoping not to be the person called upon to act when it really counts." But it is right next to the grocery bags—this emergency care on which minute by minute depends somebody's life. I mean, it's really something.
Lee Moreau is President of Other Tomorrows, a design and innovation consultancy based in Boston, and a Professor of Practice in Design at Northeastern University.

Sara Hendren Sara Hendren is an artist, design researcher, writer, and professor at Olin College of Engineering. She is the author of What Can A Body Do? How We Meet the Built World.

Christine Ball is an anesthetist at the Alfred Hospital in Melbourne, adjunct associate professor at Monash University, and an author of many books including The Chloroformist.

Rachel Plotnick is an assistant professor of cinema and media studies in the media school at Indiana University, Bloomington and the author of The Power Button A History of Pleasure, Panic and the Politics of Pushing.

Lucienne Roberts is the founder of design studio, LucienneRoberts+, co-founder of the advocacy initiative GraphicDesign&, curator of Can Graphic Design Save Your Life?, and author of GOOD: an Introduction to Ethics in Graphic Design.

The Philips FRx Automatic External Defibrillator (AED) usage video referenced in the episode can be seen here.


Subscribe to The Futures Archive on Apple Podcasts or your favorite podcast app. And you can browse the show archive.

Kathleen Fu created the illustrations for each episode.

A big thanks to this season’s sponsor, Automattic.



Transcript

Lee Moreau
Welcome to The Futures Archive, a show about human centered design, where this season, we'll take an object, look for the human at the center and keep asking questions. I'm Lee Moreau...

Sara Hendren
...and I'm Sara Hendren.

Lee Moreau
On each episode, we're going to start with an object with power. Today, that object is the defibrillator.

Philips FRx Automatic External Defibrillator (AED)
Analyzing heart rhythm.

Lee Moreau
We'll look at the history of that object from our perspective as designers who've done work in human centered design, not just how it looks and feels, but also the relationship between that object and the people it was designed for.

Sara Hendren
And with other humans, too. I mean, the defibrillator is in public space. It invites strangers to use it with people under duress in an emergency. So it's an electrical object. It's electrifying to sort of think about taking it up and using it.

Lee Moreau
And it has a button.

Philips FRx Automatic External Defibrillator (AED)
(Beeping.) Shock advised press the flashing orange button now.

Lee Moreau
The Futures Archive is brought to you by the design team at Automattic. Later on, we'll hear from product designer Dani Oliver.

Lee Moreau
Hi, Sara. How are you?

Sara Hendren
I'm good Lee, how are you?

Lee Moreau
I'm doing great. Thank you for being here. It's great to have you on the show. This is the first episode that you're going to be co-hosting this season. The kind of track that we have you kind of helping to shepherd forward is on health and safety. And I'm wondering if you can kind of talk to our listeners about what health and safety have to do with human centered design.

Sara Hendren
Yeah, I mean, health and safety is both a kind of individual matter and a collective matter, right, necessarily. So sometimes we're the subjects of clinical care in hospitals, in clinical settings, and you do need human centered design in those places too. I mean, just think about White Coat Syndrome that we know elevates people's blood pressure. What that tells you is that everything about the room, even the naming of the white coat, the appearance of a designed object, actually has an effect on the actual health data that are coming out of that room. You know, so what that means is if you want to think about the best delivery of care and you want to think about outcomes, and you also need to think about environmental factors that have to do with design. So sometimes that would be at the product scale. At the interaction scale, there's just a huge number of human centered considerations that is broadly called bedside manner in a clinical setting that may or may not be, you know, skillfully applied in the moments where it counts. But that's just in the doctor's office. So then you think about, again, situations where health and safety comes up in public space or in private space, but nonetheless in shared space. So we don't have the kind of security of the clinic or the hospital, but we have bodies that have frailties and needs. We depend on other people. Sometimes those are experts and sometimes they're just our fellow humans walking around. But we depend on each other, you know, first responders, but also just human to human. So that includes design.

Lee Moreau
As you were framing that, you use the word care and outcomes and almost as if they're different things. But I think the ambition should be can we pull those things together?

Sara Hendren
Yes, indeed. I mean, it's just that outcomes tend to be associated with what is measurable, quantifiable and, you know, numerical. And those, of course, are important pieces of data. But, you know, bedside manner is inherently qualitative. I mean, you can link it to better outcomes that are probably measurable, but some of that stuff is ineffable. Why do you trust your doctor and not the one you know down the hall? So caregiving is an art form too, you know, in addition to the things that are empirical and measurable. And I do think design can do that kind of mediating work can be both reassuring, friendly and approachable and at the same time precise and clinical in the ways that you want. But you need both.

Lee Moreau
And at its best, I think design is both art and science.

Sara Hendren
Yes. No question. Material language that's broadcasting to you in a dozen ways, some of which are legible and some of which are kind of precognitive. And we can talk about some of that today with the objects we'll talk about. But this is what's so fun about design is like making that invisible stuff more visible, you know, kind of raising our own literacy of like what is design doing in between that qualitative space of the art form, the material language, the symbolic register of something. And then it's yes, like very pragmatic functionality.

Lee Moreau
Well, I think the precognitive space of events is definitely the one we will be inhabiting with the defibrillator. (beep) How are you with emergencies? Like what, what is your go to emergency response vibe?

Sara Hendren
Yeah, I remember comparing notes about this among other people who have become parents when something minor kind of a minor emergency happens, you know, with your child, you might have an outsized response because it feels very distressing. But when something really acute happens, I get that kind of radical calm, you know, like slow motion. What is the next step to take? Is that really true? I mean, one of my kids choked pretty, pretty dramatically one time and I was freaking out, but my husband was also there. So that's a whole thing, too. If you have like a partner and somebody takes the kind of like doer role. But I feel like that's the key thing. I've been thinking about this a lot in anticipation of this conversation. That is to say there's design, and then there's also this question for all of us, which is, do you have the agency to act even when you're uncertain? You know, and I think of myself, I'm not afraid of blood or gore, you know, that kind of thing. But I've had a mixed response sometimes of the freak out kind sometimes have to step in and act right away. What about you?

Lee Moreau
I have very weird responses. So I think as a parent, I'm very similar to you, which is like at first with something minor, I might be a little bit overwhelming, but then with something serious, I can get into focused mode and deliver treatment, care, and the appropriate response. I do have a condition called the vasovagal reaction, which is basically a surge of adrenaline to your brain under extreme circumstances, and I just pass out. And I remember doing-doing research for the American Red Cross on blood donorship, of all things, when I was IDEO and we were in a facility in Chicago and we were watching people use the apheresis machine, which basically takes out your blood and removes the platelets. And I saw somebody having a really bad reaction on the machine. And I, that person was fine medically, but I passed out.

Sara Hendren
Wow.

Lee Moreau
But I have encountered this many times, and it was finally diagnosed. So it's a weird thing. And if I could control it, it'd be fine. But I can't. So which is why this particular topic is exciting to me. Because when you think about the kind of context in which someone is using a defibrillator, there are all kinds of scenarios that you can imagine, none of which we can predict. And yet that device has to work no matter what.

Sara Hendren
Yeah.

Lee Moreau
Or hopefully it does as a lifesaving tool.

Sara Hendren
That's right. Talk about the precognitive. I mean, you encounter the defibrillator over and over in public space when you are precisely doing some of the most banal tasks of your life, right. You're standing there at the cash register and thinking: Wow, the blueberries cost that much, there's a defibrillator— you know, you're just blinking past it. And occasionally you do ask yourself, she's like, if that really that's a real piece of medical equipment. I wonder if I could, you know, and then you tend to short circuit because you think like: Goodness, I'm sort of hoping not to be the person called upon, you know, to act when it really counts. But it is this, you know, right next to the grocery bags and, you know, doing your daily things, this emergency care on which minute by minute depends somebody's life. I mean, it's really something.

Lee Moreau
So we'll spend the next 30 minutes talking about these types of conditions and these sort of situations. First, we're going to hear from a few sort of experts and historians on the topic of the defibrillator.

Christine Ball
Okay. So I think the first thing to understand is that all this history goes back to the middle of the 18th century as scientists are beginning to understand, firstly, electricity and secondly, the resuscitation of human beings.

Lee Moreau
Christine Ball is an anesthetist at the Alfred Hospital in Melbourne and Adjunct Associate Professor at Monash University, and she's written a lot about the history of defibrillator technologies.

Christine Ball
There were a lot of quacks in the field making all sorts of bizarre pieces of equipment to try and restore life to-to dead bodies.

Lee Moreau
And so as the 19th century progressed and our understanding of the human body matured, as well as our sense of the general use of electricity, we start to see the sort of dual development of these two tracks of knowledge where electricity is starting to be used in medicine. Sara, have you ever used? You talked about being at the cash register and seeing it it sounds like you've never actually used a defibrillator yourself.

Sara Hendren
I've never used it. You know, I've imagine myself there a bunch of times. I should tell you that. Like one of the famous stories in my family is that my father, who's a doctor, not a cardiologist or a specialist like a family doctor in Arkansas, you know, once or twice in his career has been that person— is there a doctor on the plane, like threw the guy out of the aisle, you know, who was in cardiac arrest and did the kind of manual defibrillator kind of thing, brought that guy back, you know, and so, like, I live with this kind of, like, heroic story of like the expert on the scene, but I've never had to be that person, you know, stepping in for the defibrillator. And-so the defibrillator is kind of intimidating, I think, in part because of the electricity piece. And if you think about it, what's the corollary product in your life that's product scale and electric? Well, think about your hairdryer and think about the big like skull and crossbones tag that's on that court. And you think about with young children always saying never, never, never, right. Never put this near water. Okay, what is a body? It is a big watery bag of organs. So something in you is going like that thing cannot touch this thing. The idea, right, even that the body has electricity in it I still find quite counterintuitive because it feels like, you know, these two things don't mix electricity and water.

Lee Moreau
And we'll hear a little bit more about the combination of the bag of water and electricity right now.

Christine Ball
So the ventricles are the big pumps in your heart that pump the blood around the body and they pump rhythmically, you know, sort of 70 times a minute. But when they fibrillate they just sort of quiver like jelly. So most cardiac arrests, the heart will not just stop. It will go into what we call ventricular fibrillation, where it it just quivers and it doesn't contract. So ventricular fibrillation was finally shown to happen in humans in 1899. We get to the defibrillator about 50 years later, which is a machine specifically designed to counteract ventricular fibrillation and make the ventricles into pumps again.

Lee Moreau
So I have to say, when we were kind of thinking about topics for this season, I was really excited about the defibrillator because it's sort of like you take the power of Zeus and you put it into the hands of a normal human being, right. It's a magical, awe inspiring kind of power. And I'm trying to imagine mentally like going back a century to imagine this kind of moment where you're trying to explain to someone that in every grocery store and supermarket, we're going to have these machines that give you the power of Zeus and you can bring someone back to life. It's sort of like, I don't know, is this what Mary Shelley's Frankenstein actually brought to the world? Is this what we've conjured? I think this is an incredible, incredible thing that we've achieved.

Sara Hendren
It's really true. I mean, the idea of the the body as a machine itself, right. That has this kind of these predictable motor qualities. And the idea that you could take another machine and, you know, greet that interface and and change something. And in the 19th century, it seems like there were so many theories about the body, competing theories about what makes the body go and how how strange it would be. As I said before, it's still strange to me to imagine electricity in this very organic, porous thing, you know, called it human flesh. So how strange, you know, I'm sure at every point it would have been to the average citizen.

Lee Moreau
So we see this kind of relatively new way of thinking about the human body. And that's just one way that health kind of appears in the public sphere or in the kind of notions that we have about ourselves as people in society. But in your experience, how do you deal with health showing up in the public sphere? What are some other ways that those two things are aligned?

Sara Hendren
Yeah, I mean, there are lots of, you know, negotiations that we're all thinking about. For example, in my space of disability and design, what happens when you're at a crosswalk with someone who's using a cane-a navigational cane? I think a lot of people, I have a lot of friends who are blind. So I've been coached on this, you know, not to offer help necessarily unless someone is there asking you for it. And sometimes people do ask me: Which bus is this? And so on. But everybody, people who are sighted are always making sort of those kind of fellow human health and safety decisions in the public sphere about when is assistance called for and how would I know and what kind of assistance is called for. And usually, you know, it's much better to just offer without, you know, jumping in to help. But that's a whole subtle matter, isn't it? And also, of course, we're looking out for other people's children before they run into the street and, you know, all those kinds of —and what's interesting, I think, about the defibrillator is that, you know, the reason why is in the grocery store is because you can call an ambulance and they'll get there pretty fast, but not fast enough. So the heart fibrillation, ventricular fibrillation is happening and and death is coming, right? I mean, there's there's a real acute temporal kind of need. So you have to rely on non-expert humans in the minutes and seconds that it counts.

Lee Moreau
Let's hear some more from Christine.

Philips FRx Automatic External Defibrillator (AED)
Remove clothes from patient's chest.

Christine Ball
There had to be a lot of complex mechanical input electrical circuits built so that the machine itself could interpret the rhythm that was being presented to it. And that didn't happen until about 2004. So now the defibrillators that you see on the walls of supermarkets and swimming pools and even in hospitals now are automated.

Philips FRx Automatic External Defibrillator (AED)
Peel white pads from gray plastic case. Attach pads to bare skin exactly as shown.

Christine Ball
You put the paddles on the chest, the machine reads the EKG and determines that the patients in ventricular fibrillation.

Philips FRx Automatic External Defibrillator (AED)
Stay clear of patient. Analyzing heart rhythm.

Christine Ball
And until it's worked that out, it won't let you do a shock. But once it's done that, it will then advise a shock. It will charge up the machine. It will tell you to stand back from the patient so you don't electrocute yourself. And then it will tell you press the button and defibrilate the patient.

Philips FRx Automatic External Defibrillator (AED)
Shock advised. Stay clear of patient. Press the flashing orange button now.

Christine Ball
And then it will actually decide if it's worked.

Philips FRx Automatic External Defibrillator (AED)
Shock delivered. Be sure emergency medical services have been called. It is safe to touch the patient.

Christine Ball
So they're really clever machines.

Lee Moreau
It's supposed to be incredibly standardized so that anybody can do it under really acute and extreme circumstances. Have you ever kind of made something like this — the equivalent of this, which is something that's very, very standardized? I know this is not your primary domain. In fact, a lot of what you do is designing for an individual or design for one.

Sara Hendren
Yeah, no, I've never worked on something quite like this. I certainly try to raise the literacy of design students to think about what are all the material languages of a thing that you're going to use. You know, it's a moment where a lot of software applications want to load up with functionality. And this is one of those situations where complexity is probably your enemy. So, you know, all of that requires designers to be thinking all the time, not just about how the material would mix, in this case — solidity, reassurance, and also approachability by an amateur. But also how few moves can you make and how how just, you know, brute force clear? Could it be about what you have to do first, what you have to do next?

Lee Moreau
I know that from doing research on this very object and design work, when I was at Continuum, the team was kind of doing some testing on it and they they knew that the biggest challenge was that people would get everything set up and then they wouldn't push the button. They're like, one, two, three. And they're like, ahhh I can't do it.

Sara Hendren
Yes.

Lee Moreau
So what do you do to, like create queues and that kind of rhythm and establish a sense of almost purpose in in the moment that I've got to push this button, it's like pushing the button saves a life.

Sara Hendren
Yes. I wonder if that's the button to make green for go instead of safety orange. I wonder if that if that button were twice as big, if it did a staccato beep that was a little less like a sort of vise grip in your ears. It has to ride the line between approachability. Hey, you can do this, you know, I'm telling you exactly where to press, but it needs to do that without a bunch of verbiage. This is sort of that what happens when a clinical expertize bit of product shows up in the amateur public sphere, when every second counts and you need it to be reliable and you need it to be trustworthy and you need people to feel okay to do it. I mean, tell me more about what happened in your situation. Where did you go from there?

Lee Moreau
I mean, basically, in the context of designing the AED, from what I understand, and I wasn't on this design team, was that there was a lot of things that were fairly process driven and that you could basically encourage people to do something in a procedural way as instructions for use often do on medical devices. But then there's this hyper emotional moment that is super counterintuitive, where fear comes into the into the context and the sense of, like, I may do something terribly wrong. And the cognitive load at that moment is so severe that, you know, people would just kind of hesitate and hesitation is dangerous in this case.

Sara Hendren
Yeah. And I just wonder if there's some way to put an X variable on our shared theme of power, which is to say the literal power that is involved in the heart's electricity and therefore the deployment of electricity to help it, but also the power that you have been charged with in that situation. I mean, this is why our theme is so resonant.

Lee Moreau
The Futures Archive is brought to you by the design team at Automattic, which is building a new web and a new workplace all around the world.

Dani Oliver
My name is Dani Oliver and I'm a product designer and I'm originally from Barcelona, but now living in Mexico City.

Lee Moreau
For Dani, Automattic's unique distributed approach allows him to focus on his design practice.

Dani Oliver
Design at Automattic is about having time to ask the best questions. I'm a designer that likes to design. Like I really like to spend time thinking about my projects and designing and sketching and collaborating with others on the project itself. And in other companies, I don't have time for that like and especially remotely in the previous company I worked on, it was maybe 6 hours a day of meetings, just meetings, and it wasdraining and exhausting. And when I discovered how Automattic works and how they approach remotely, that would seem like a big plus. It just like made it like a dream job for me, really. Most of our processes and decisions are kind of like articulated in written form, so that kind of like takes off all the pressure of just like attending meetings. So that freed up my time to just design and do what I really like doing.

Lee Moreau
Designing a better web. Join us at Automattic dot com slash design. That's auto m a double t i c dot com slash design.

Lee Moreau
And all of this comes down to the moment building up to pushing that button, right. And it's where human interaction comes down to a single moment.

Rachel Plotnick
We think about, you know, this phrase human machine interaction as being so complex, like having to do with artificial intelligence or robots or algorithms or something really fancy. But the button sort of crystallizes all these issues that we have around what it means to be human and what it means to use technology.

Lee Moreau
Rachel Plotnick is an assistant professor of cinema and media studies in the media school at Indiana University, Bloomington. She's the author of The Power Button A History of Pleasure, Panic and the Politics of Pushing.

Rachel Plotnick
Buttons are always operating in this gray area, I think between delivering us that magic surprise, but also kind of in this gray, I don't really know what the outcome of this is going to be, which can make people feel, you know, pretty uncomfortable as well.

Lee Moreau
Sara, talk to us about button pushing.

Sara Hendren
Yeah. I mean, buttons are-give us this kind of haptic and mechanical feedback so that it's an immediate resistance back to your finger, often, in which you both know that you've sort of accomplish a task but your body also feels that kind of satisfaction of I've now got an input that I'm deploying through my body and I got an output that is telling me, yes, you know, that button has been pushed. So we think about elevators, think about how your keyboard on your computer owes itself to the typewriter, and all that deep mechanical feedback and how it's been sort of diminished over time. But nothing about the button is predetermined, I think. And, you know, it's been really interesting to see drag and drop and swiping interactions, for example, on iPads. And again, in my space of disability and access, you know, it's been quite revolutionary to see the replacement of that old what is a legacy of the typewriter, which doesn't actually share that much with it with the computer and what it's supposed to do, but it borrows that logic of the keyboard, and for a lot of people that I know who have atypical hands and arms, people who have low muscle tone, people who have limited or absent mobility entirely in their arms and hands and fingers— it's more people than you would think— the replacement of swiping, dragging and dropping on the iPad, which I think was underestimated, to be honest, when it came out, people said: Oh, it's just a big iPhone, but they've forgotten. I mean, if you spend time with people with A.L.S., for example, you'll find people who don't have the motor capacity to push buttons in that mechanical depress and release way. But who, with a mouth stick, for example, with a soft end to it, can swipe on a tablet when their hands are not involved at all. Now, that's a portal to the world that doesn't rely on buttons, you know, and and that in the past, even a mouse, right, has that depress and release. And there's been all kinds of innovation between not just swiping, dragging and dropping— I mean, there's voice, dictation, software and so on, but I've seen the button replaced by other kinds of ergonomic moves that we should really pay attention to, because as my friend Rosemary Garland Thompson, who doesn't type herself but has written multiple books and all this with voice dictation software, she's just like the keyboard is essentially arbitrary to her. She sees it as this kind of enemy typewriter and thinks in an era of hardware and software that does so much, why should the button be so standard still?

Rachel Plotnick
Okay. Why buttons and why buttons in a particular situation? I think a lot of it comes down to the binaryness of buttons in that what most buttons do is they either act like a trigger or they give us two conditions to choose between on off, start, stop. And because of that, they really kind of limit our field of choices. And I think for human beings, that often becomes a desirable set of conditions in that you don't have to think that much about it. It's either this or that. I push it. Something happens instantaneously, which again, I think is a very gratifying kind of formula for people. That being said, we can see all of the problems that poses as well.

Lee Moreau
And that's exactly what you were just talking about, Sara. That sort of multiplicity of ways of-of interacting. You know, this binary button pushing is so limiting and reduces everything into a this or that.

Sara Hendren
That's right. I mean, I think you could still make a strong case for it in the defibrillator, precisely because of the reasons that Rachel just named, just that you you're actively trying to reduce cognitive load. It is a kind of quick is this thing off is it on —now is the time, on is beckoning you you know like press the button. But I think it's interesting that we rely on it in lots of situations that aren't so temporally, you know, acute that we could think about what are all the ways in which a body, you know, can interact. And it's just interesting to think about what's that moment of contact and then what is all— what are all the ways that the body has its many varieties of interacting? And let's just get really specific and disciplined, right, about which kind of interaction we're hoping to create and where can we lessen either cognitive load in that emergency situation or ergonomic load if we're talking about the daily interactions of our lives.

Lee Moreau
So this is the the realm in which we're trying to design for fewer choices. But there are also these other contexts where you're trying to increase the number of choices or number of entry points into the space of play or the space of engagement.

Sara Hendren
You know, and that reminds me actually of one of my favorite kind of access designs at city scale has to do with the button, what's usually a button on the crosswalk call box, you know, so the pedestrian call box the most interesting variation on this that I've seen to the button is a sensor augmented call box that's all over Singapore, like 500 intersections. And if you are a senior citizen in Singapore or a person with a disability, you can have a little metro card that's outfitted with a special chip and your card, when hovered over the call box for the pedestrian crosswalk, knows that you need a little bit of extra time in the crosswalk. So it will extend the length of the crosswalk for you for 12 or 13 seconds, after which the intersection will revert to its normative seconds of time. So think about that. Now you're intervening, and it's not just a one size fits all press the button and you get what we've established as 42 seconds for, right. The average walking gait of a you know, an unencumbered able bodied person. But it's a city flexing its structures, changing a button to a sensor that knows if you're someone who needs extra time. So here's the opposite of the emergency time in which quickness is our chief value. Here's where slowness can actually be made part of our world. There are all kinds of ways you could intervene and make a city which is hard and concrete in every way a little bit more flexible.

Lee Moreau
The button is no longer binary, the button is sort of responsive at that point.

Sara Hendren
Yes, that's right. That's right. It is interesting to think generationally, right about especially I guess in the case of the defibrillator, who's likely to be using that and how much are they reliant on that kind of old mechanical feedback of the button? What would make it more like if you're in that research moment that you were talking about, how slow does that change your expectation that a button is primarily mechanical and it's primarily useful in this situation when it gives you that easy on off binary? Yes, you did it. No, it's not done yet.

Lee Moreau
So we have to get over this barrier, right, that we've been talking about, that kind of threshold. How do you design something that makes people feel like it's okay to use it?

Sara Hendren
Yeah.

Lee Moreau
And-and Sara, this takes us into the realm of communication design, which you've also did a lot of work in.

Sara Hendren
Yeah, I mean, I think here's where health and safety, you know, takes another kind of turn that isn't just about life saving products, and they're not just about safely crossing streets, but also just the kind of health and safety of looking out for one another in public space as a form of kind of courtesy. And I think something like the defibrillator and other kinds of medical gear, you know, have to they have to think about if it's designed in that clinical language of that the gray silicone, the wires, the red with a cross on it, the kind of language of emergency, the high pitched beep— that will be legible and useful to medical professionals. It will be reassuringly clinical to the amateur. But will they also feel like they can actually use it? I mean, you think about the way that lots of consumer hardware tools are in that yellow and black vernacular, which is meant to suggest a kind of construction site, which is a strong, high contrast safety reassurance site. Most of us are not, you know, doing that kind of heavy gear. We're doing fix- its around the house, but we can purchase those materials in part because we think we should trust them, that they're safe. And all of that is achieved in some of that yellow and black, you know, kind of, you know, is like, again, precognitive. And I wonder, you know, what's another situation in which communication design is called upon to do, you know, a little bit more than the graphic isotope, but is meant to ride that line of both clarity and approachability. What do you think?

Lee Moreau
Well, I think in the case of the defibrillator, you're trying to communicate with a very small population of people. It's that one person who's about to use this device to do something really important. Whereas I think in some of the context you're talking about, there's a social dimension. What is the role of the person within this broader population of people, and how do you communicate the interrelationship between what you do and what you should contribute to the rest of the society? There's a long history of designers kind of working in this realm and asking these kind of questions. And I think it's much of it is about what we're talking about here.

Lucienne Roberts
Our idea was really to foreground the relationship of graphic design and every other subject, so we had to do something about graphic design and health.

Lee Moreau
Lucienne Roberts is the founder of design studio, LucienneRoberts+ and co-founder of the advocacy initiative GraphicDesign&. In 2017, she curated an exhibit at the Wellcome Collection called "Can Graphic Design Saved Your Life?" about the history and the intersection of graphic design and health initiatives. The exhibit included things like Renaissance plague posters and comic books from Planned Parenthood,

Lucienne Roberts
To campaigns like Kill Jill, which was a campaign run in Scotland, which was about organ donation. And it was very provocative because it was it looked like a game. You had a picture of a woman and it said, you want to kill Jill or not. And it was like, no or yes, it was. It was to try and prompt people to donate organs, you know. So that was quite hard hitting, you know, but-but effective.

Lee Moreau
And she's the word prompt there. But really she means like provoke, I think.

Sara Hendren
Do you want to kill Jill or not? Talk about the binary of the button, right. You know, it is an artifice deployed specifically to be confrontational and in fact, to irritate you a little bit. Oh, how dare you suggest that in fact, this is my fault. But what they're betting on there, the designers, is to say you have to kind of really rush into people's faces if you're going to plant a seed that has an afterlife, right. That what you encounter this thing, it it annoys you. It makes you mad, but it tries to be as and ignorable as possible. And and that's a very particular design choice, right? Like you can do this kind of I'm going to be this thorn in your flesh about organ donation, or you can plead in the bleeding heart sense and you can cajole, you know, with the kind of awareness campaign, all of this stuff designers are turning the little, you know, knobs of the the register of of the communication design at every choice.

Lee Moreau
So on the spectrum between sort of an affront or a provocation to on the other end, more of an invitation to dialog. Where does your accessible icons project live in that? And maybe you can share a little bit about that project.

Sara Hendren
Yeah, that's a really interesting case because it shifted in its kind of modus operandi over time. The Accessible Icon Project has a public domain image, a kind of an isotype for anyone to use for free in the built environment that is a kind of an alternate sort of functional equivalent, as the law would say, to the blue and white wheelchair icon that you see all over in public space. And I worked with a graffiti artist initially on a kind of street art campaign that had a clear backed sticker and a new image, a new isotype of a wheelchair user in which the person is really foregrounded. You can think of it as the old image in italics, it's sort of leaning forward and the person is the protagonist in that image, the clear backed choice there, shows the old image with a new one superimposed on top of it. One has the energy of of the body adapting to the world in it and the other. Lots of times you see that blue and white image. All of the limbs, the arms, the two arms and the feet are represented in hard geometrical edges that have none of the organic roundedness of the body.

Lee Moreau
It's very stick figure like.

Sara Hendren
That's right. So I just thought, you know, what would it look like not to just say: Oh, here's a new, you know, sort of a new image, but to say, what does it mean that we carry around in that precognitive way an image of a disability that's everywhere in public space. That, by the way, is a profound provision, right. Just that you would cordon off doors and parking spaces and to make sure that people with disabilities can get into the public space and therefore into the public sphere. It's remarkable. But you always need to wake up histories like that to sort of point to what is an accessible world, what is the unfinished work of that. So the register, those material choices in the early days to do the clear back as a street art informal campaign was strategic on our part to be-to have that kind of confrontational quality. What's interesting is that people came to us in the years after the street art phase and said: Well, I want a new image wholesale. I want it for my you know, if the signs need to be replaced at my Temple or my school or whatever, and can you provide that? So we worked then in a team and with a formal graphic designer to bring it in line with the requirements of isotypes. And now you can download it for free in a bunch of different forms at accessible icon dot org. So it became, in other words, that bureaucratic, friendly, approachable, scalable, replicable image. And now we see it everywhere and it's far exited our authorship. It's just all over the place now. So that's the most scaled thing I've ever done. But it went from being a street art campaign to being a product in a really interesting way.

Lee Moreau
I love this notion were, you know, you talked about provocation of this project in the early days and this notion of waking up history. I think it's a beautiful, a beautiful idea and so essential that we had these things that kind of trigger us into revisiting the things that we just take for granted in the past. Let's hear a little bit more from Lucienne.

Lucienne Roberts
Graphic design manipulates, after all. It persuades, it informs, but it manipulates too.

Lee Moreau
So graphic design manipulates, and all of design manipulates, right. And persuades and this is absolutely true. You talked about what it does and the decisions that you make in taking a particular design direction here, either prevent or preclude other decisions being made later on. And so the sort of anticipation of what that manipulation might create and predict, I mean, you have to start to read the future or predict the future when you're doing design today because you're you're you're creating paths that that are going to be, whether we like it or not, somewhat inevitable.

Sara Hendren
That's true. And I want to just name, though, what I think is a real interesting tension in graphic design in particular. And that is it does manipulate, but I don't think that means it is representational in the forms that other kinds of culture and especially art making are representational, right. Because graphic design gets part of its strength and its usefulness precisely from streamlining, standardization, scalability, and replicability, and therefore it's not a 1 to 1 representation of the world. And I think that's really important to remember, because people came to us in the wake of the Accessible Icon Project and said: Well, if you're trying to represent disability, not everyone is a wheelchair user, you know. And so then there were these kind of people would run these contests for sort of like what would an open ended full plurality representation of disability look like? And I think, I think what you're talking about is art making, right, which is to say doing a more local and granular in particular representation of the body. Whereas the beauty of the wheelchair icon is that I can get on a plane today and go somewhere in the world where I don't speak the language and I'll still know where the ramp is and where the, you know, accessible stall is. Its virtue, after all, is simplification and standardization. But then I'm sure, you know, I wonder what Lucienne would say about the Keep Calm and Carry On, you know, like that that was graphic design meant to set a tone in a quite top down way at a very particular moment in history to be both reassuring, but also to direct. And that that really came back kind of in the twenty-teens as this like widespread meme, keep calm and do all kinds of things. It's just interesting right there. There certainly is a kind of with hindsight, manipulative quality to it. But I want to hold on to, you know, in the spirit of graphic design, what it does when it simplifies and standardizes.

Lee Moreau
So I want to go back to the defibrillator as the topic here. So the graphic implication is that we want someone to go and push the button. At least that was the intention. That is very reductive and binary, but in that moment we need that right?

Sara Hendren
That's right. In this case, it's a strength, I think.

Lee Moreau
But what I was gonna say. But then there's the design for the gray area where maybe the thing that we want people to do is not so much to kind of push that button, but to think a little bit or to question the context, what have you. So we also use designed for that as well.

Sara Hendren
It's true. And I do think that the defibrillator has to have the binaryness of the button. It has to have very clear, probably less verbiage overall and a really close attention to scale and color and sound cues to get you to follow a very strict sequence and script of events. And it's highly unusual in that way, but we can learn a lot from it. But as you say, Lee, and I think this is just so true in terms of thinking about public space as the public sphere. What it counts on is the agency of people to act, you know, and to not look, you know, right and left and think not it, you know, but to think this is a time step and be brave. Trust that you can be enfranchised, you know, with with these tasks. It's interesting to think about what are the habits and dispositions in a life that would make that moment a little easier.

Lee Moreau
You know, this takes me to the kind of responsibility of being the designer.

Sara Hendren
I mean, I think one thing we've not talked about is the way that design does also implicate policymakers. And I think designers should be thinking, too, about public private partnerships and policies that go along with a designed object so that it can be deployed effectively. And sometimes I think designers and the engineers I work with fail to see just how-how much communication and how much persuasion and how much systems thinking goes into any one just product, industrial design product.

Lee Moreau
There's a sort of implication that we're scaling up a little bit right into into the world of policy, into the world of the entire world. But I want to think about the future world. And when I think of my childhood sci-fi world, it seems to be that there's a lot of button pushing. I remember, you know, films like Star Wars and things like that where everybody pushing lots of buttons, almost like they were coding in real time. And I'm wondering if actually automation and where the future's taking this is going to go in the other direction, which is to eliminate potentially the need for pushing buttons at all. Like, does the AED even need us to push that button? And I there's a kind of question at the root of all of this, which is, is that really Important that we push a button on the AED to give someone that life saving charge.

Sara Hendren
I mean, I, I think it is Lee. In other words, I think it is a matter of human judgment. And this is where I think the automation conversation gets a little too- talk about binary, a little too breathless and sweeping and it's idea of machines that replace human judgment. There's no question that general artificial intelligence and so on, we'll be able to do a lot of rote tasks and we want a smart ish defibrillator, right. That can sense when it's being effective. Nonetheless, you need to be able to distinguish. For one thing, if there's a real emergency, if this person is actually waking up, maybe they just passed out. Are you really sure? Right, you want to be the person using the qualitative human judgment in real time to say, yes, this machine is a go or not. But I also think too Lee, you know, about the future. You know, I'm reading news stories right now and stuff about people by choice going back to wired ethernet in their houses as opposed to wi fi because the world of ubiquitous sensing and digital tools is not necessarily a desirable future, right? And ethernet is a choice to engage with the machine at a specific time and place rather than the machines logic being ambient and predictive and all encompassing. Which sounds to me like a dystopian future in some more than a few situations, even though I can see the sort of safety measures I know for older folks with smart doorbells and, you know, all those kinds of things, I get it. But I also think there are real tradeoffs to be made. And so the button, while it may be a legacy of the typewriter in its mechanics, I want to say in a sharply sculpted, desirable future, there's some stuff that I still want an on off button for, a start stop, a pause. Yes. You're allowed into my life or not, you know.

Lee Moreau
Wow, that's a call for control. And I embrace it, too.

Sara Hendren
Yeah.

Lee Moreau
You know, in this season, we're basically- our assignments are a little bit more organic and more related to the episode topic. And I'm wondering if there is potentially an assignment or a kind of thought exercise that we could give to our listeners for them to think about the power of the button. Is there something in their daily lives that they could probe on or question.

Sara Hendren
Yeah. Well, I do think of I've been thinking this whole time about that easy button that Staples put out, you know, and it's clearly like meant to be this- I've seen it used in like classroom settings for kids and stuff where, you know, it's cartoonish by choice. It has a lot of mechanical feedback and it's meant to do almost like this, like low grade cognitive behavioral therapy of like, see, that was easy, you know, like.

Lee Moreau
Yeah, like no problem.

Sara Hendren
And I've also seen sort of peel and stick panic buttons that people hang up as decor, right. So it'd be interesting to think about what's a speculative design for a button that doesn't actually function, but that tells you something about your choice to interact with it or not. And I think the easy button, which is big and red and shiny and funny, and the panic button, which is, you know, vaguely troubling and a little haunting and also resonant— what's a third? What's a fourth? What's a fifth kind of button that you would have around the house that invites you to push it, but it's not primarily functional. It's meant to do something-something else, something behavioral, something psychological, something expressive.

Lee Moreau
That's beautiful. I mean, so many times we find ourselves pushing buttons all day long without thinking about it because we know intuitively what the outcome will be. But what about those moments when the outcome might be uncertain? We don't know what's going to happen on the other side of the button push. That's a beautiful assignment. Perfect. Sara, thank you so much for being with us today. This was fantastic and I can't wait for the next couple of episodes.

Sara Hendren
You bet.

Lee Moreau
The Futures Archive is a podcast from Design Observer. To keep up with the show, go to TFA dot design observer dot com or subscribe on Apple Podcasts, Spotify, or wherever you listen to podcasts. And if you like what you heard today, make sure to rate and review us and share this with your friends.

Sara Hendren
You can read more about my research in disability and design and that rich, creative tradition of making and remaking the world in my book, which is called What Can a Body Do: How We Meet the Built World. It's out from Riverhead. I also have a newsletter about material culture, art, design and engineering it's on Substack and it's called Undefended slash Undefeated.

Lee Moreau
The Futures Archive is brought to you this season by Automattic. Thanks again to Christine Ball, Rachel Plotnick and Lucienne Roberts for talking to The Futures Archive. You can find more about them in our show notes at TFA dot Design Observer dot com, along with a full transcription of our show. Our producer is Adina Karp. Owen Agnew edits the show. Thanks as always to Design Observer founder Jessica Helfand and to Design Observer executive producer Betsy Vardell.


Posted in: Health + Safety, Product Design, The Futures Archive



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