Full Ebook of Health Design Thinking Second Edition Bon Ku Online PDF All Chapter

Health Design Thinking second edition
Bon Ku
Visit to download the full and correct content document:
https://ebookmeta.com/product/health-design-thinking-second-edition-bon-ku/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...
Linkography Unfolding the Design Process Design

Thinking Design Theory 1st Edition Goldschmidt
https://ebookmeta.com/product/linkography-unfolding-the-design-
process-design-thinking-design-theory-1st-edition-goldschmidt/
Investigating second grade 1st Edition Thinking Kids

(Firm)
https://ebookmeta.com/product/investigating-second-grade-1st-
edition-thinking-kids-firm/
Visual Thinking for Information Design 2nd Edition Ware
https://ebookmeta.com/product/visual-thinking-for-information-
design-2nd-edition-ware/
Different Perspectives in Design Thinking 1st Edition

Yvonne Eriksson
https://ebookmeta.com/product/different-perspectives-in-design-
thinking-1st-edition-yvonne-eriksson/
Principles of Innovative Design Thinking Synergy of
Extenics with Axiomatic Design Theory Wenjuan Li
https://ebookmeta.com/product/principles-of-innovative-design-
thinking-synergy-of-extenics-with-axiomatic-design-theory-
wenjuan-li/
UX for XR: User Experience Design and Strategies for

Immersive Technologies (Design Thinking) Hillmann
https://ebookmeta.com/product/ux-for-xr-user-experience-design-
and-strategies-for-immersive-technologies-design-thinking-
hillmann/
Interfaceless: Conscious Design for Spatial Computing

with Generative AI (Design Thinking) 1st Edition Diana
Olynick
https://ebookmeta.com/product/interfaceless-conscious-design-for-
spatial-computing-with-generative-ai-design-thinking-1st-edition-
diana-olynick/
Scala Design Patterns Second Edition Ivan Nikolov
https://ebookmeta.com/product/scala-design-patterns-second-
edition-ivan-nikolov/
Thinking While Doing Explorations in Educational Design

Build Stephen Verderber (Editor)
https://ebookmeta.com/product/thinking-while-doing-explorations-
in-educational-design-build-stephen-verderber-editor/
DEDICATED TO LORNA BREEN (1970–2020), WHO CARED FOR SO MANY
Health
Design
Thinking
CREATING PRODUCTS
AND SERVICES FOR
BETTER HEALTH
edition
REVISED AND
EXPANDED
Bon Ku, MD
Ellen Lupton
Illustrations by Jennifer Tobias

Contents Methods
66 DESIGN WORKSHOP
Bon Ku, MD
6 FOREWORD 70 DESIGN SPRINT
Pamela Horn, Cooper-hewitt, Katie McCurdy
smithsonian design museum 72 COLLABORATIVE DESIGN SPRINT
7 PREFACE Sebastien Park and Shuya Gong, ideo
Ellen Lupton, Cooper-hewitt, 76 BRAINSTORMING
smithsonian design museum
Ellen Lupton
Bon Ku, MD, Thomas Jefferson
University 78 INTERVIEWING
8 DESIGN PROCESS MAP Serene Chen, MD

Ellen Lupton and Bon Ku, MD 82 LISTENING SESSION
MICA center for social design
84 PERSONA
Principles Matthew J. Trowbridge, MD, MPH,
UVA School of Medicine
12 HUMAN CENTERED
88 ROLE-PLAY
Ellen Lupton
Kristy Shine, MD, and Bon Ku, MD
20 EMPATHY
90 SIMULATION
Bon Ku, md, and Serene Chen, MD,
Highland Emergency Medicine, Andrew Petrosoniak, MD,
Alameda Health System st. michael’s hospital
24 CODESIGN 92 STORYBOARD
Ellen Lupton, Bon Ku, md, and Ellen Lupton

Serene Chen, md 104 JOURNEY MAP
30 SOCIAL DETERMINANTS Ellen Lupton
Ellen Lupton, Elizabeth Sanders, and 108 PROJECT BOARD
Julie Pastor, cooper-hewitt,
smithsonian design museum Andrea Landau and Bon Ku, MD,
Thomas Jefferson University
110 INFORMATION GRAPHICS
38 CREATIVE MINDSET
Ellen Lupton Bon Ku, MD, Ellen Lupton, and
Elizabeth Sanders
40 QUESTIONING
118 OCCUPANCY SURVEY

Ellen Lupton and Bon Ku, MD
KieranTimberlake and Bon Ku, MD
44 VISUALIZING
124 SPATIAL DATA MAPPING

Ellen Lupton and Bon Ku, MD
KieranTimberlake
52 PROTOTYPING
128 DEVICE DESIGN
Ellen Lupton , Bon Ku, MD, and
Kristy Shine, MD, Thomas Jefferson 10xBeta
University 130 SERVICE DESIGN
60 STORYTELLING Morgan Hutchinson, MD,

Ellen Lupton Thomas Jefferson University
Case Studies 186 INFORMED CONSENT
Alexander Langerman, MD SM FACS
136 PHARMACY REDESIGN and Caitlin Moon, JD MA, Vanderbilt
University Medical Center
PillPack
190 VISUAL HEALTH HISTORY
138 SURGICAL PROCEDURE TRAYS
Katie McCurdy, Pictal Health
Deborah Adler
194 SHARED DECISION-MAKING
140 FOLEY CATHETER KIT
Maggie Breslin, the patient revolution
Deborah Adler
198 PERSONALIZED ASTHMA CARE
142 HOSPITAL GARMENTS

mica center for social design
Chaitenya Razdan, care+wear
202 DEMAND FOR CHLORHEXIDINE
144 HOSPITAL HACKS
US Agency for International Development
Molly Bonnell (USAID) and Dalberg Design
146 RETHINKING PPE 206 TARGETING TRACHOMA
Ellen Lupton and Julie Pastor, cooper- ThinkPlace and SightSavers
hewitt, smithsonian design museum
208 EMERGENCY DEPARTMENT SIGNAGE
152 EVOLUTION OF ULTRASOUND
PearsonLloyd
Resa E. Lewiss, md, Thomas
Jefferson University 210 EXAM ROOM
154 MONITORING HEALTH REMOTELY Stacey H. Chang, MD, and Kate Payne,
Design Institute for Health,
Ellen Lupton and Julie Pastor University of Texas at Austin
158 TELEHEALTH SERVICE 212 LABOR AND DELIVERY UNIT
Aditi U. Joshi, MD, MSc, FACEP, Chair, Ariadne Labs and MASS Design Group
Telehealth Section at American College
of Emergency Physicians 216 CHOLERA TREATMENT CENTER
160 AUGMENTED REALITY TELEHEALTH PLATFORM MASS Design Group
Tran Tu Huhyn, do 220 FIELD HOSPITAL ICU PROTOTYPE
162 RETHINKING VENTILATORS CRA-Carlo Ratti Associati
Ellen Lupton and Julie Pastor 222 SENSORY ARTS GARDEN
168 IBREASTEXAM David Kamp, FASLA, LF, NA, DIRTWORKS, PC
Mihir Shah, Matthew Campisi, 226 FAMOUS LAST WORDS
and Bhaumik Sanghvi, ue lifesciences Natasha Margot Blum
172 NEWBORN PHOTOTHERAPY
Timothy Prestero, Design That Matters
174 SMS SERVICE FOR COVID-19 ASSISTANCE Learn More
Ijeoma Azodo, MD, Dr. Alistair Ewing, Blythe
Robertson, and Geoff Huggins, NES Digital Service 230 HEALTH DESIGN LAB
(nds), NHS Education for Scotland (nes)
234 MEDICAL FUTURES LAB
180 DIGITAL HEALTH RECORD
236 HEALTH DESIGN CURRICULUM
Greater Good Studio and The Ihangane Project
242 3D PRINTING
182 CLINICAL TRIAL DESIGN
246 RESOURCES
Urvi Gupta, Dominick Zheng, and Larry Chu, MD,
248 FURTHER READING
Stanford Medicine X Program
249 ACKNOWLEDGMENTS
250 INDEX
6 Foreword
Health Design Thinking, Second Edition is a unique publication

conceived and executed by Cooper Hewitt, Smithsonian Design
Museum. The book is coauthored by Ellen Lupton, curator of
contemporary design at Cooper Hewitt, and Bon Ku, MD, co-founder
of the Health Design Lab at Sidney Kimmel Medical College, Thomas
Jefferson University. Collaborations like this one drive Cooper Hewitt’s
ambitious publishing program. Our books, journals, and online
essays extend and deepen the knowledge produced by the museum’s
curators, educators, staff, and research and design partners.
The first edition of Health Design Thinking was released in Spring
2020, just as COVID-19 was exposing fatal flaws in the world’s health
care systems. Lupton and Ku immediately began doing research
for this new edition of their book, seeking to capture the creativity
and courage embodied by countless clinicians, designers, and
communities during this time of historic disruption.
Health Design Thinking, Second Edition is illustrated with stories
about real-world health design challenges. Projects range from open-
source plans for mobile ICUs to public health campaigns addressing
vaccine access. Health Design Thinking, Second Edition is part of
Cooper Hewitt’s sustained work in the area of design and well-being.
This practical, hands-on guide builds on decades of work dedicated
to accessibility, inclusion, and social justice.
In 2020 and 2021, Cooper Hewitt partnered with MASS Design
Group to create the exhibition Design and Healing: Creative
Responses to Epidemics and the book The Architecture of Health:
Hospital Design and the Construction of Dignity. Our collaborative
teams produced these projects while the pandemic was undoing
the daily practices of every institution on Earth. Cooper Hewitt,
Smithsonian Design Museum is proud to join forces with leading
voices in health design to create accessible design tools for anyone
engaged with health care as a human-centered practice.
Pamela Horn
Director of cross-platform publishing
and strategic partnerships
Cooper Hewitt, Smithsonian Design Museum
Preface 7
Health design thinking is an approach to generating creative ideas and

solutions that enhance human well-being. Health design thinking is an
open mindset rather than a rigid methodology. Anyone can participate
in this process. Listening, observing, storytelling, prototyping, and
role-play are tools for building empathy and thinking creatively.
The first edition of Health Design Thinking conveys ideas and
methods that have been applied to products, environments, and
services. This new edition builds on those fundamentals in light of
the changes in design and health care prompted by COVID-19. When
the pandemic hit, clinics, schools, and design offices were forced to
immediately provide services online. Policy failures, misinformation,
and political manipulations exploited frontline workers. Marginalized
communities demanded equitable care. Catastrophic gaps in the
global supply chain demanded the design and redesign of personal
protective equipment (PPE), mobile testing, remote care, and safe,
inclusive ways to use public and private space.
Health Design Thinking, Second Edition is a field guide for rapid-
response design. Our underlying methodology emerged from the
Health Design Lab at Thomas Jefferson University, co-founded by
Bon Ku. The Lab began as an experiment. Could medical students
with no engineering background create prototypes for new devices
and services? During the pandemic, the Lab switched gears to
confront such challenges as manufacturing nasopharyngeal swabs for
detecting SARS-CoV-2 and deploying mobile testing and vaccination
sites in underserved neighborhoods.
Cooper Hewitt, Smithsonian Design Museum joined forces with
the Health Design Lab to create and update this essential guide for
doctors, nurses, educators, students, patients, advocates, architects,
and designers. Design thinking will continue to grow, becoming a
crucial tool as hospitals, governments, caregivers, and communities
prepare for the future.
Bon Ku, MD Ellen Lupton

Marta and Robert Adelson Professor Senior Curator, Contemporary Design
of Medicine and Design Cooper Hewitt, Smithsonian Design Museum
Sidney Kimmel Medical College at
Thomas Jefferson University
8 Design Process Map
PRINCIPLES Since the 1990s, thousands of groups and individuals

have explored the practice of design thinking. Notable pioneers
include the design consultancy IDEO and Stanford University’s
d.school. Design thinking has been mapped in a variety of ways—
as an open spiral, a twisted loop, a double diamond, and a row of
circles. Regardless of how we diagram the process, two core values
or principles recur in design thinking methodologies.
First, design thinking is human centered. It starts with the needs
and desires of people, rather than with a business proposition or
an artistic concept. Human-centered design involves observation,
conversation, research, and collaboration.
Second, design thinking adopts a creative mindset, favoring
open-ended exploration over a straight path headed toward a
given outcome. The creative process involves asking questions,
visualizing ideas, creating tangible prototypes, and telling stories
about people, ideas, and outcomes.
These core principles—being human centered and maintaining
a creative mindset—fuel the living, changing process of design
thinking. This book begins by exploring these principles in relation
to examples drawn from the unique context of health care.
Human Creative
Centered Mindset
Empathy Questioning
Codesign Visualizing
Social Prototyping
determinants Storytelling
Ellen Lupton and Bon Ku, MD 9
METHODS In theory, the design process breaks down into three

main phases, as shown in the diagram below. In practice, however,
you can start anywhere and make your own path.
The first step is to observe. This requires looking, listening,
asking questions, and gathering information. Observation requires
patience, care, and humility. User interviews build empathy
and reveal insights. Workshops facilitate codesign with diverse
stakeholders. Researching the life of a community yields deeper
knowledge. The values of human-centered design ground each of
these methods.
The next step is to imagine. This involves generating multiple
ideas, sorting them into groups, seeking relationships and
analogies, and deciding how to move forward. Here, human-
centered research mixes with creative thinking, opening our minds
to unexpected concepts.
The third step is to make. Creative action now surges into the
foreground. Making is hands-on and physical. Prototypes show how
a product could work. Storyboards explain how users might interact
with a device. Role-play embodies a service or process in a social
and physical way. Each creative method leads back to asking how a
design solution or insight could help real people. Each prototype or
narrative is a tool for communicating with users and stakeholders.
Observe Imagine Make
HUMAN CREATIVE
CENTERED MINDSET
Principles
Two core principles illuminate the
rich and varied practice of health
design thinking. First, by embracing
a human-centered perspective,
each person becomes a more caring
listener and a keener observer. This
work requires patience and attention.
Next, by actively applying a creative
mindset to design and health care,
we become inventors, makers, and
storytellers, equipped to help build
a culture of wellness. People don’t
think of health care as a creative
field. Clinicians feel inspired when
they discover that they can apply
creativity to medicine.
12 principle
Human Centered
Design is the practice of shaping materials to achieve goals and
express beliefs. Human beings and other creatures make tools and
build structures in order to survive, thrive, and harmonize with—or
dominate—each other and their surroundings.
Design seeks change and invention. Designers look at a given
situation—from the layout of a room to the shape of a door handle—
and consider how it could be altered, improved, or embellished.
Human-centered design is an approach to changing objects or the
environment that aims to improve people’s lives. Well-being is the
ultimate goal of any human-centered intervention.
You might be wondering, Isn’t all design human centered? In fact,
the design process doesn’t always focus on people’s needs or desires.
During the Industrial Revolution, familiar things—from tableware to
textiles—were produced with machines and sold for profit. Now as
then, many design solutions emphasize cheap production or planned
obsolescence over human value.
In the mid-twentieth century, designers began researching human
behavior and anatomy to simplify everything from telephones to
farm equipment. This field is called ergonomics. Lever-style door
handles—now standard in hospitals and public buildings—allow
hands-free operation. This design rejects the conventional pattern
of the round doorknob in favor of an accessible handle that can be
operated with limited dexterity. Contactless door openers took on
new value during the COVID-19 pandemic; this solution has long been
favored by people with limited mobility.
At its best, human-centered design is inclusive and collaborative.
Health care users—including patients, clinicians, families, and
communities—are active participants, not passive subjects to be
measured and manipulated. Design, like any profession, often falls
short of its ethical goals. Entrenched hierarchies reinforce bias and
prevent designers—as well as clinicians—from becoming as human
centered as they aspire to be. Good designers question everything,
including themselves.
ellen lupton 13
DESIGN FOR DOOR HARDWARE

This drawing shows how designer John
De Cesare applied decorative forms to
hardware for a door. Functionally, the
door follows the traditional form of a
round doorknob, which is difficult for
some people to grasp and twist. Drawing,
Study 141b (detail), 1957; John De Cesare
(American, b. Italy, 1890–1972); Color
pencil, graphite on cream wove paper;
61.1 × 48.5 cm (24 1/16 × 19 1/8 in.); Gift
of the Estate of John De Cesare, 1982-25-
70; Cooper Hewitt, Smithsonian Design
Museum; Photo: © Smithsonian Institution
Designed for beauty and originality
LEVERON DOOR HANDLE ATTACHMENT

This plastic attachment was designed
to be added to conventional round
doorknobs. The lever allows a person
to open the door without grasping and
twisting. Such movements are difficult
for people with limited hand use and
for anyone carrying a package or small
child. The bright color enhances visibility,
making the knob easier to locate.
Leveron Door Handle Attachment, 1983;
Manufactured by Lindustries; H x W x
D: 7.6 × 16.5 × 15.2 cm (3 × 6½ × 6 in.);
Gift of Lindustries; 2014-47-2; Collection
of Cooper Hewitt, Smithsonian Design
Museum; Photo: © Smithsonian Institution
Designed for a better fit with diverse human bodies

14 principle | human centered
Intubation Kit
1 Intravenous catheter
2 Bougie
3 Disposable laryngoscope
4 Endotracheal tube
5 Yankauer suction tip
6 Flexible stylet
7 10cc syringe
8 HEPA filter
9 Glidescope blade
10 End-tidal CO2 line
11 Orogastric tube
12 12 Lubricant jelly
8
11
7
6 10
5 9
4
3 2
AIRWAY CART Emergency medicine physicians designed intubate a patient. They shared their design on Twitter,
many creative solutions during the first wave of allowing it to be adopted by emergency departments
COVID-19, from creating walk-in testing sites to training (EDs) around the world. On-the-fly design solutions like
staff on how to safely don and doff PPE. Intubating this one don’t require any special tools or a complex
patients posed high danger to emergency physicians. approval process. Every day, working clinicians apply
Doctors at Jefferson University designed an airway cart, their know-how to solving challenges. Source: Dr.
a rolling cart stocked with rolls of equipment. Taped to Efrat Kean, Thomas Jefferson University Emergency
each roll were all the supplies and equipment needed to Department.
health design thinking, second edition 15
Like the design profession, the health care Health care systems in the US and many
field has sharpened its focus on human needs. other regions can perpetuate systemic racism.
Early hospitals in the West, which belonged to Marginalized communities struggle against the
churches, applied spiritual care to the ailing body. adverse social determinants of health. Rochelle
As medicine became more scientific, charitable P. Walensky, MD, MPH, who became director of
hospitals were established to tend to the poor. the US Centers for Disease Control and Prevention
The patients in these places had no power and no (CDC) in 2021, declared, “Racism is not just the
great chance of being healed. They were research discrimination against one group based on the
subjects in the drive to uncover the science of color of their skin or their race or ethnicity, but the
disease. (Wealthy people were cared for in their structural barriers that impact racial and ethnic
homes by doctors.) groups differently to influence where a person lives,
In the early twentieth century, modern hospitals where they work, where their children play, and
signaled the rising power of the doctor, who where they worship and gather in community.”
became one of society’s most esteemed members. Meanwhile, the medical establishment has
Nursing evolved from a marginal occupation to a ignored racism as a research topic. A 2021 study
respected profession. Attracting wealthy patients, reviewed medical literature that was published
private and semiprivate rooms replaced open 1990–2020 in four prestigious medical journals; the
wards. Designed for cleanliness and efficiency, study revealed indifference to the topic of racism
modern hospitals enabled people to recover from and health. The authors of the study, Nancy Krieger,
illness and injury in ways once unimaginable. Rhea W. Boyd, Fernando De Maio, and Aletha
Yet these monuments to progress could be Maybank, denounced the medical establishment’s
forbidding, unwelcoming, and exclusionary places. refusal to address racism as the “production of
Historically, hospitals have resembled everything scientific ignorance.” That ignorance is beginning
from monasteries and prisons to hotels and to lift. In November 2020, the American Medical
office towers. Today, vast health networks sprawl Association recognized racism as a public health
across cities and regions, serving as engines of threat and committed to undoing racist policies
employment and economic growth. Contemporary and practices within the field of health care.
hospitals are places of constant coming and going, A global reckoning with racism erupted
where outpatient treatments are more common alongside the pandemic, which disportionately
than extended stays. Hospital design must damaged low-income communities. The COVID-19
account for complex equipment, disaster-safe crisis highlighted dangerous flaws in the design
infrastructure, and the daily flow of thousands of and delivery of health care around the world,
patients, families, and workers. especially in the US, where profit motives and
Doctors dominated the first modern hospitals. political maneuvering continually muddle a patchy,
In the ideal hospital of today, patients occupy the opaque, and enormously complex health care
center. Individuals participate in their own care system. Hospitals overwhelmed with patients
and have control over their environments. Public were unable to easily transfer patients to facilities
areas and patient rooms include ample space for with available beds. The global supply chain broke
families, and these spaces use color, light, and down with surging demand for PPE and ventilators.
materials to foster comfort. Alas, many hospitals Public health communication broke down as well.
fail to meet these standards, and too many people Conflicting guidance about social distancing, mask-
lack access to care. Around the world, disparities wearing, testing, and vaccination sowed dangerous
in health outcomes reflect racial bias and egregious confusion. Conspiracy theories and willful denial
income inequality. flourished along with the virus.
PATIENT-DESIGNED DEVICES Patients

are pioneering the invention of new
devices and services. The Nightscout
Foundation, established by families of
children with diabetes, hacks existing
technology so that parents can monitor
glucose levels when their children are
away or at school. Illustrated here are
3D-printed covers that fit directly over an
insulin pump, providing a visual reminder
of when to change the injection site. Files
are available on Thingiverse.com.
South Korea’s relative success against COVID-19 Transformative change isn’t linear. Progress is
early in the pandemic resulted from policies, slow in hospitals, where mistakes are costly and
technology, and social cohesion. In place of a can endanger human lives. Many proposals fail to
nationwide lockdown, Korea implemented rigorous launch. Design alone cannot undo the entrenched
contact tracing, extensive testing, and strict institutions and harmful mindsets that perpetuate
isolation for anyone in contact with someone who health inequities. Although the COVID-19 crisis
was infected. Masking rules were unquestioned. emboldened many hospitals and communities to
Schools were partially online, partially in person. work quickly and try new approaches, progress was
The US never adopted a consistent national stymied by government inaction, misinformation
policy. Into this vacuum stepped many individuals, campaigns, and community distrust of the
companies, and institutions. Designers, engineers, medical establishment. Human-centered design
clinicians, entrepreneurs, and community is potentially a tool for making health care more
members produced PPE, invented new supply equitable, but design can also perpetuate the
chains, developed emergency medical equipment, status quo and feed the profit motive.
created local and mobile testing sites, and At its best, human-centered health care sees
educated each other about health inequity. patients as individuals traveling on the journey
Working with speed and ingenuity, teams of people of life. In the words of Victor Montori, author of
collaborated to address design challenges such as Why We Revolt, “Cruelty seems to require that we
the cost, function, sustainability, and accessibility as clinicians dehumanize patients and consider
of ventilators and PPE. Designs shared online them not like us, not like our own kin.” Industrial
generated a wealth of open-source knowledge. health care makes clinicians feel dehumanized as
COVID-19 accelerated changes that were well—burned out, used up, pushed too far. Human-
already underway in health care. Medical services centered design can help shift health care away
are moving into homes and neighborhoods. from a relentless process of extracting wealth from
Accessible design supports aging in place and suffering and embrace an ethos of investing care
caregiving at home. Wearable devices allow people and attention in human beings. Designers, patients,
to monitor their heart rates and oxygen levels. and clinicians can all contribute to this change.
read more –> “Media Statement from CDC Director Rochelle P. 2020, —> www.ama-assn.org/press-center/press-releases/new-ama-
Walensky, MD, MPH, on Racism and Health,” Apr 8, 2021, —> www.cdc. policy-recognizes-racism-public-health-threat; Matthew Campbell
gov/media/releases/2021/s0408-racism-health.html; Nancy Krieger, and Heesu Lee, “There’s Still Time to Beat Covid without Lockdowns,”
Rhea W. Boyd, Fernando De Maio, and Aletha Maybank, “Medicine’s Bloomberg Businessweek, Dec 10, 2020, —> www.bloomberg.com/
Privileged Gatekeepers: Producing Harmful Ignorance about Racism features/2020-south-korea-covid-strategy/, Victor Montori, Why We
and Health,” Health Affairs, Apr 20, 2021, —> www.healthaffairs.org/ Revolt: A Patient Revolution for Careful and Kind Care (The Patient
do/10.1377/hblog20210415.305480/full/; “New AMA Policy Recognizes Revolution, 2017).
Racism as a Health Threat,” American Medical Association, Nov 16,
LOCAL HEALTH CARE Pastor John Jenkins spearheaded

the creation of pop-up vaccination sites in Prince
George’s County, Maryland, a predominantly Black
area, including this site at the First Baptist Church of
Glenarden. In 2021, numerous churches, schools, and
community centers became partners in the largest
vaccination effort in history, serving people where they
live. Photo: Erin Schaff/New York Times, 2021
CITIZEN HEALTH CARE Ventizolve is a portable device

for treating opioid overdoses. It is designed for use by
everyday bystanders, not just medical professionals. The
kit contains two doses of naloxone, which can reverse
the effects of an overdose in less than a minute. While
this treatment is traditionally injected intravenously,
pharmacists at Norway’s NTNU University developed
a version of the drug that can enter through the nasal
passage as a small amount of fluid. When someone is
overdosing, a bystander carrying this unit can divide
it into two and insert one applicator up a nostril. (The
second dose provides a guarantee, in case there is
a problem with the first one.) Designed by ANTI, the
product’s packaging makes the device easy to identify in
a purse or backpack, comfortable to hold, and free of the
stigma associated with carrying a syringe. © ANTI
HEALTH CARE ON WHEELS Moving health care

into homes, parks, and public places is one tool
for building health equity and improving care for
vulnerable populations. Buses, bookmobiles, vans,
and trucks have been customized to deliver testing,
vaccines, and social services to individuals in their
own communities. The goal is to meet people where
they are to build trust and improve access.
MOBILE RESPONSE COVID-19 TESTING UNIT Mobile services offer alternatives to drive-in facilities,
In the early months of the COVID-19 pandemic, mass vaccination sites, hospital-based clinics, and
Perkins&Will Architects designed a system and a set services requiring travel by car. Perkins&Will Architects
of guidelines for converting a school bus into a mobile collaborated with NYC Relief, an organization that works
testing lab and future vaccine clinic. This open-source with unhoused populations, to create a portable booth
project addresses high-risk populations, including those to enable an accessible, COVID-safe, and equitable
who are homeless. School buses are nonthreatening, environment for personal conversations between clients
easy to modify, and available in every community. and outreach workers. © Perkins&Will Architects
ICE CREAM TRUCK This design for a

mobile vaccination site was a finalist
in Cooper Hewitt, Smithsonian Design
Museum’s National High School Design
Competition in 2021. Allison Casey is a
student at La Jolla Country Day School,
La Jolla, California. Her concept uses the
joyful sound of an ice cream truck to bring
vaccines to underserved communities.
Incentives include games, activities, and
free ice cream. The service is designed to
be appealing to children and families and
to anyone seeking health care in their own
neighborhood. © Allison Casey
MOBILE HEALTH UNIT The Jefferson

Health Design Lab in Philadelphia worked
with Ford Motors to design a van for
servicing pop-up COVID-19 vaccination
events. A large decal reading “Don’t Wait/
Vaccinate” shows people that health
care providers are working in their local
church or school. This approach builds
trust. Inside, the van is equipped with
storage shelves, walk-in cabinets, and
electrical outlets. The van stores laptops
and hardware along with tables, chairs,
and vaccine supplies. A refrigerator
keeps vaccines cold. Design: Jefferson
Marketing. Read more about mobile
vaccination: Methods | Service Design.
Empathy
Empathy, the ability to share in the experience of another creature
and communicate that understanding, helps clinicians build stronger
relationships with patients, improving patient satisfaction and
clinical outcomes. The project-based learning approach of health
design thinking can help medical students develop empathy, a known
challenge in medical education.
When a health design team seeks to change the layout of a patient
room or devise a new glucose monitor, they first try to understand
the medical situation from diverse points of view. What’s it like to be
on the receiving end of a pelvic exam? Uncomfortable, embarrassing,
and disempowering. The situation is even worse in emergency
departments, where 6.3 million pelvic exams are performed
annually—and gynecological beds are rarely available. Clinicians
often improvise by pushing a bedpan under the person’s pelvis. This
workaround is demeaning to patients and can lead to suboptimal
exams. When a team from the Health Design Lab began searching for
a better way to perform pelvic exams in the ED, they knew they had to
experience the exam process firsthand. The team included two male
medical students, who put themselves on the exam table in order to
understand the patient’s perspective.
The design team also studied the problem of pelvic exams in
the ED from the point of view of hospital administrators, who are
concerned about cost and efficiency. It is expensive to transfer
patients to stirrup-equipped beds elsewhere in the hospital. Existing
wedge supports are bulky to store; even bulkier to store (and vastly
more expensive) are full-sized, folding stirrup beds. In the process of
making and testing prototypes and researching existing solutions, the
team invented Tilt, a collapsible, portable wedge that is moderately
priced, medically appropriate, and easy to store. Tilt also protects
individual dignity and eases the workflow for caregivers.
Displaying your pelvis on a bedpan is one way for designers to
cultivate empathy. They also use interviews, observation, and role-
play to get closer to people’s lives and learn from their expertise.
Bon Ku, MD, and Serene Chen, MD 21
TILT is a portable medical device designed for

performing pelvic exams in emergency departments.
The team who designed the product includes three
medical students, one occupational therapy student,
and an industrial design student from Thomas
Jefferson University. Understanding the experience
of patients, doctors, and nurses was crucial to their
design process. Historically, the medical field was
dominated by men; today, more diverse perspectives
are contributing to better products and protocols.
The team founded the company Gia in order to
develop their product for market.
Design team: Sean Haynie, Hannah Levy, Elliott

Perow, Kelly Sullivan, Sarah Weinblatt, Thomas
Jefferson University
read more Samantha A. Batt-Rawden, MBChB, et al.,

“Teaching Empathy to Medical Students: An Updated,
Systematic Review,” Academic Medicine 88, no. 8 (2013):
1171–77, –> doi:10.1097/ACM.0b013e318299f3e3
22 principle | human centered | empathy
BECOMING THE USER What challenges do with serious illnesses. Creative Director Thomas
individuals face in the realm of health care? Winkelmann explains, “All SYPartners provided was
Many new mothers must figure out how to pump a ‘Be a Journalist for a Day’ toolkit to guide them
breast milk at work and in public places. Many in going through their own contacts to get access
older adults must learn how to take numerous to a patient and have a heartfelt, exploratory
medications with varying frequencies. People with conversation. The executives had to find that
diabetes may require multiple finger pricks daily. person themselves. We weren’t there when they
Like many aspects of the health care experience, met. It was a very humbling act for these business
these activities are neither intuitive nor easily managers.” The experience helped Onyx develop
described to others. When designers or clinicians a deeper focus on patients—and to increase the
try out a task themselves, their understanding company’s funding of patient advocacy.
becomes more concrete and embodied. Many of the health care procedures one might
The process also can illuminate unmet needs seek to experience firsthand require access to the
and crystallize problems. Spend a few hours in a clinical care setting, which demands cooperation
hospital waiting room. You might notice that you from medical teams. Plan how you will capture the
need a charging station for devices, or access to insights learned from the exercise. Take care to
food for family members, or the ability to avoid document the experience and gather reflections
close proximity with other patients while you are that can be shared with others. Will someone
not feeling well. film the interaction or record the sounds that are
The act of becoming the user allows designers heard? Will you or someone else take photographs
and clinicians to identify challenges and experi of key elements? When will you write down your
ences that may not be explicitly mentioned or raw reaction to the experience?
even consciously known by the user. At Virginia Your teammates may empathize with you more
Mason Medical Center in Seattle, a team of staff than they would with a stranger. Thus, when you
and clinicians was instructed by a consultant share a video in which you are weary of tasting
from Toyota in Japan to unfurl a spool of blue bitter medications or pricking your fingers multiple
yarn over the map of the hospital along the path times a day, you become an advocate for your user,
that a cancer patient would take. The blue yarn infecting your team with empathy.
snaked across registration, laboratory, pharmacy, The process has limitations, however. You
oncology, surgery, administrative, and financial will perceive and evaluate the activity based on
offices. The knotty blue map that resulted showed your own values, biases, and experiences, as well
how the current system demands excessive time as your own state of health. People most often
and energy from some of the sickest patients. If the experience health care when feeling unwell and
team had directly asked the patients to describe unlike their normal selves—they may be anxious,
their experience of going to appointments, the scared, or harboring other feelings not fully
patients might not have been able to convey the present in your simulated experience. Seeking to
severity of the problem. Tracing the journey with understand a patient’s viewpoint does not replace
blue yarn revealed the problem in a visceral way. primary research, such as conducting interviews
Onyx, a pharmaceutical company, asked and surveys or codesigning with patients. Be
SYPartners, a management consulting firm, to help mindful of your users’ values and biases, and go
them understand and enrich their own point of through the experience knowing that you can never
view toward patient-centered care. SYPartners told really wear another person’s shoes.
Onyx executives to locate and interview people
read more Charles Kenney, “The Blue Yarn,” in

Transforming Health Care: Virginia Mason Medical
Center’s Pursuit of the Perfect Patient Experience
(CRC Press, 2011), 33–46.
Find out how it feels to . . .
Attempt to communicate with clinicians covered in PPE.
Spend a day isolated in a patient quarantine room.
Find your way through a hospital complex without asking for directions.
Sleep in the emergency department to simulate the experience of a patient waiting for
a hospital bed after being admitted.
Stay overnight in an inpatient bed and get your vital signs checked every four hours.
Concentrate on a difficult task in the doctor’s workspace in a busy outpatient clinic.
Get an intravenous line started on you (above).
Navigate the hospital with a wheelchair, walker, or cane, or with crutches.
Test your blood sugar three times a day.
Remember to bring an item such as an EpiPen with you—everywhere.
Take a complex set of placebos—some twice a day and some three times a day.
Taste the medications commonly prescribed to children. They are surprisingly bitter!
Codesign
Empathy is a crucial component of human-centered design. But
empathy alone is not enough. Focusing exclusively on empathy can
lead to separating “us” (designers and health care professionals) from
“them” (users and patients). Patients and other stakeholders should
be active participants in the design process, not just objects of empathic
feeling. Individuals who experience ailments, injuries, or disabilities are
experts on their own life condition. Codesign is a collaborative process
that actively seeks knowledge and ideas from end users.
Each member of a design team has deep knowledge about their
own life experience. Codesign directly injects this expertise into
the design process. Furthermore, team members have diverse and
overlapping areas of knowledge. A patient may also be a design
professional, a clinician, a health expert, or an advocate.
Codesign should be integral to the design, execution, and
interpretation of research. Currently, patient involvement is not yet
routine in biomedical and health services research. Dr. Kristin Rising,
a researcher and physician at Thomas Jefferson University, embeds
patients as active and equal participants on her research teams.
In one study that she led, patients on the research team enrolled study
participants, conducted interviews, led group brainstorming sessions,
and performed data analysis. The team developed a list of patient goals
related to seeking care for diabetes. Having real patients on the study
team enabled all researchers to understand their subject from a patient
perspective. Patient voices were present during the gathering, analysis,
and final interpretation of data. Involving patients and the public is
required for funding many research studies and clinical trials.
Tools for codesign include user interviews, photo journals, surveys,
and user testing in addition to inclusive brainstorming activities. Each
codesign process should be executed in a way that acknowledges the
expertise of all participants. Codesign takes effort. Patients must be
willing and able to contribute their time and expertise. Care must be
taken to avoid reverting to familiar power structures or exploiting the
experiences of people who are vulnerable or have survived trauma.
Ellen lupton, bon ku, md, and Serene Chen, MD 25
TEAM WORK Students in design, medicine, and read more Elizabeth B.-N. Sanders and Pieter Jan Stappers,
pharmacy at Thomas Jefferson University codesigned Convivial Toolbox: Generative Research for the Front End of Design
tools with Lariq Byrd, who breathes with a ventilator (Amsterdam: BIS Publishers, 2012); Deana McDonagh, “Design
and uses a wheel chair for mobility. Maximizing subtle Students Forseeing the Unforeseeable: Practice-Based Empathic
movements in his left hand and wrist is important to Research Methods,” International Journal of Education through Art
his quality of life. Byrd participated in each step of the 11, no. 3 (2015), —> doi:10.1386/eta.11.3.421_1; Dr. Kristin Rising, –> www.
design process, including defining the problem, teaching pcori.org/research-results/2015/concept-mapping-scalable-method-
the team about the issue, and testing and retesting identifying-patient-important-outcomes
prototypes. Together, the team created products
uniquely suited to Byrd’s abilities, including a remote
control that responds to micro movements and a glove
designed to optimize Byrd’s grip.
26 principle | human centered | codesign
DESIGN FOR ONE Codesign allows for the circumference. The design allows Kern to easily
generation of customized solutions for individuals bring the coat around the back of her shoulders
who have unique challenges. Open Style Lab and insert her arms into the sleeves. The garment
(OSL), led by Grace Jun, uses codesign to help is professional but not too formal. It provides
people living with disabilities perform to their full warmth, and—perhaps most important—it
capacities. OSL raises awareness of accessible embodies Kern’s spirit and positive energy.
style through public events and workshops. OSL addresses the gap in the current market
Clothing is an essential tool used by humans to for adaptive clothing and wearable technologies.
engage and integrate with their environments and In the US, one out of five people identify as having
communities. Lack of access to adaptive clothing a disability, but few companies offer products that
diminishes the dignity and independence of people adequately address accessibility. This population is
with disabilities. often lumped into one group without consideration
An OSL team member, Kieran Kern is a for the unique conditions and needs of individuals.
freelance writer, advocate, and mom who has To reduce inequality and foster inclusive design
cerebral palsy. Kieran desired stylish clothing that innovation, OSL offers programs where codesign
she could wear to client meetings and could put flourishes. Designers, engineers, and occupational
on and remove without the assistance of others. therapists work with a person with a disability to
The design team created an attractive, functional make functional clothing and accessories that are
red coat with a silk lining, batwing sleeves, a also fashionable.
rigid collar insert, and armholes with a large
OPEN STYLE LAB Designers: Kieran Kern,

Magdalena Kraszpulska, Noah Litvin,
Xiaojie Yang, and Tong Zhang.
ON AND OFF Softable is a jacket designed to be donned

and doffed independently by a user with limited upper
body strength and range of motion. The OSL team
developed a unique garment fitted with 3D-printed
snaps and a pulley for cinching the waist. Robert, who
has limited mobility, prefers to pull the garment over
his head, but that can leave the garment too loose in
the stomach area. Thus, the team designed a waist belt
built into the garment. Robert is able to pull the belt
with his dexterity, reach, and strength. Designers: Alyssa
Brandofino, Bolor Amgalan, Herbert Ramirez, and Robert
Appelman, the Riverside Premier Rehabilitation and
Healing Center in New York City
HANDS FREE Patients living with amyotrophic lateral The OSL design team created Swipe, a 3D-printed
sclerosis (ALS), or Lou Gehrig’s disease, face daily portable device that allows Christina to push her
challenges in their routine lives—brushing their hair, Metrocard through the card reader at a subway turnstile.
typing on a computer, and eating meals. Christina Swipe hangs around the neck and attaches to the
Mallon, a woman working as an inclusive experience turnstile by tiny magnets. Without Swipe, Christina could
designer at Wunderman Thompson, has a rare form not ride the subway independently and would risk losing
of ALS that has left her arms and hands completely her job because of not being able to commute to work.
paralyzed. The progressive loss of function of her hands This solution is customized to her unique needs and
and arms over the years has made daily activities like lifestyle. Designers: OSL team (Christina Mallon, Julia
dressing and taking transportation extremely difficult. Liao), Estee Bruno, Claudia Poh, and Ultimaker.
28 principle | human centered | codesign
CODESIGN WITH PHYSICIANS In fall 2019, an The design team created low-fidelity sketches
interdisciplinary team at the Center for Social along with detailed designs to help the physician
Design at Maryland Institute College of Art team identify specific views and information they
(MICA) kicked off a collaboration with Johns would want to see in the final tool. They visualized
Hopkins School of Medicine, Center for Data a variety of possible features, which the doctors
Science in Emergency Medicine (CDEM) to reduce ranked according to preference. The design team
the disconnect between emergency medicine also used personas (fictional patients inspired by
clinicians and their patients. real-life encounters) to create ideal home pages for
Doctors in the ED care for acutely injured and various patient situations. Next, the team created
critically ill patients. These clinicians usually have working prototypes of LOOP measuring the number
limited knowledge of their patients before their of in-hospital mortalities as a metric.
encounter, and they lack access to any transparent Moving forward, the CDEM team plans to expand
process for following up on patients post ED. The the LOOP dashboard to include more data about
impact of COVID-19 heightened these dynamics different outcomes and to scale the dashboard
in patient follow-up. Designer Cameron Morgan across the Hopkins Medical System and nationally.
explains, “Right now, there’s no way for your The CDEM team is continuing to test the impact of
emergency physician to find out what happens LOOP on the quality of patient care and physician
to you after you leave the ED.” Most clinicians decision-making.
interviewed by Morgan’s team reported having had
little knowledge of either patients’ outcomes or team, Johns Hopkins University: Principal Investigators:
trends in outcomes. Jeremiah Hinson and Scott Levin; Data Science + Support:
Eili Klein, Matthew Toerper, Aria Smith, and Arnaud
During an eighteen-week course at MICA using
Debraine; Physician Support: Christopher El Khuri and
a human-centered design approach, a team of Alexandria Strauss. team, MICA Center for Social Design:
students, faculty, and staff worked with emergency Lee Davis, co-director; Becky Slogeris, associate director;
medicine physicians to learn what information and Cameron Morgan, designer; MICA student designers:
and feedback would help them in their practice. A Kadija Hart, Eesha Patne, Sasha Avrutina, Eunsoo Kim,
collaborative process of research, brainstorming, Ayangbe Mannen, Harley French, and Vidisha Agarwalla
and prototyping resulted in LOOP (Linking
Outcomes of Patients), a dashboard that enables
physicians to review post-ED patient outcomes.
SIMPLE PROTOTYPES Dr. Jeremiah
Hinson shares his concept for a
Netflix-inspired pop-up system that
will alert doctors about outcomes.
Did a patient return to the ED
within seventy-two hours? Was
a patient transferred to critical
care? Doctors Scott Levin, Diego
Martinez, Rich Rothman, and Ericka
Shelton created additional sketches,
including an “instant replay”
recounting a doctor’s previous shift.
The physicians who collaborated on
LOOP were so engaged with these
ideas they continued to use them as
touchpoints for talking about
the project. Photo and graphics:
© Cameron Morgan
PHYSICIAN-SPECIFIC TRANSPARENT DATA

Instead of showing department Details show when
trends, LOOP provides physician- information is pushed
specific information. to the dashboard.
EXPANDING EPIC
Physicians often review
patients through custom lists
from EPIC, the electronic
health records system. Some
lists show users only their last
ten patients, making it hard
for physicians who care for
many more patients on their
shift to follow up. This list
offers a quick look at patients
and a place to begin exploring
further.
KEEP IT SIMPLE
Large numerals and concise
language make information
easy to grasp. Graphs are
not included on the simple,
quick-view homepage.
CARE OVER TIME

Rates are the central
visualization for all outcomes.
The dashboard groups data
by week, enabling physicians
to see information related to
their shifts.
UNDERSTANDING ROLES
Patients often see multiple
physicians during their
journey. To attribute care,
the dashboard indicates
designated levels, helping the
physician see their own role.
PATIENTS ARE KEY Although trends in

outcomes are helpful, the best learning
occurs through cases. A list of patients
affected by the outcome includes details
about each journey.
Social Determinants
Modern societies place a tremendous burden on individuals to
safeguard their health. The behaviors connected with a “healthy
lifestyle” are praised as matters of personal virtue, yet people are
constantly confronted with cheap, addictive food options and
sedentary activities. Rich people live in areas with clean air, clean
water, and open green spaces, while people experiencing poverty
occupy dangerous neighborhoods that are devoid of opportunity.
Health, like wealth, is distributed unevenly. Social determinants
of health include food, housing, education, employment, and
transportation as well as medical care. Low-income communities,
like groups facing discrimination based on race, gender, sexuality,
or disability, often lack access to health-enhancing resources. The
persistent bias experienced by marginalized groups further degrades
health and leads to lower-quality care within health care systems that
perpetuate bias. Data maps help expose these inequities.
Dr. Jennifer D. Roberts is Director of the Public Health Outcomes
and Effects of the Built Environment (PHOEBE) Lab at the University
of Maryland. She studies the health impact of “recreation deserts”
and uses community-based participatory research to help encourage
physical activity in areas lacking access to parks, green space, gyms,
and active transportation. Such deserts are a product of segregation
and disinvestment. In the words of designer Antionette Carroll,
“Racism is a public health issue. . . Every seven minutes, a Black
person dies prematurely due the effects of racial discrimination.”
Many urban environments are designed to favor cars and elevators
over sidewalks and ramps. Inadequate public transit and segregated
housing trap people in poverty. Multilane roadways cut through poor
communities, causing pedestrian injuries and fatalites from cars.
Rural areas lack hospitals and clinics. Cigarettes and processed foods
contribute to global problems of obesity, diabetes, and lung and heart
disease. Design thinking is one tool among many for enhancing health
across communities and diminishing health inequities.
ellen lupton, julie pastor, and elizabeth sanders 31
RACIAL DISPARITIES AND COVID-19

During the first wave of COVID-19
infections in the US, data research
showed how the pandemic amplified
existing health disparities. PolicyMap,
founded in 2007, combines mapping,
data, and analytics to make geographic
data accessible to journalists,
researchers, health care institutions,
and government policymakers. The
map at right, created in April 2020,
shows the racial geography of Chicago.
Populations indicated in green are
predominantly Black.
This map shows that areas whose

populations had lower life expectancies
(shown in light purple) before COVID-19
correspond with neighborhoods whose
residents are predominantly Black
(shown in green on the top map). The
health disparities that already adversely
affected these neighborhoods were
exacerbated by the onslaught of the
pandemic. Maps can help explain why.
Illnesses common in neighborhoods

with lower life expectancies, such as
hypertension (shown in dark purple), are
associated with higher mortality from
COVID-19. These neighborhoods also
have large populations of older people,
who are at greater risk for COVID-19.
In addition, many neighborhood
residents are health care workers, which
increases individual and community
exposure. See Eliza Wallace, “Racial
Disparities Magnified by COVID-19 Cases
and Deaths,” PolicyMap Mapchats
Blog, April 8, 2020, —> policymap.
com/2020/04/racial-disparities-covid19/
© 2021 PolicyMap. All rights reserved. read more Laura K. Brennan Ramirez, PhD, MPH, Elizabeth A. Baker, PhD, MPH, and
Marilyn Metzler, RN, Promoting Health Equity: A Resource to Help Communities Address
Social Determinants of Health (Centers for Disease Control and Prevention, 2008);
Antionette Carroll, “Designing for Justice,” Design Lab with Bon Ku, —>cms.megaphone.
fm/channel/bonku; Shadi O. Tehrani et al., “The Color of Health: Residential
Segregation, Light Rail Transit Developments, and Gentrification in the United States,”
International Journal of Environmental Research and Public Health 16, no. 19 (2019):
3683, —> doi:10.3390/ijerph16193683
32 principle | human centered | social determinants
CONNECTING COMMUNITIES WITH RESOURCES of color living in low-income communities. VotER

In many communities, there is a profound gap began with kiosks in the ED and touchless posters.
between available health care resources and the VotER went national with the Health Democracy
people who could benefit from them. Services Kit, a lanyard that had a card imprinted with a QR
may exist that are not used to full capacity. An code. Individual health care professionals who
older adult needing home care may not know requested a kit could now help patients complete
how to register for visiting nursing services. A the registration process on their phones. VotER
young adult derailed by depression, anxiety, or thus mobilized health care workers to become
substance abuse may struggle to find treatment. grassroots advocates for civic engagement.
A person experiencing unstable housing may lack A health intervention must be viable in its local
access to medications for a chronic condition. context. In the US, many rural communities lack
An undocumented immigrant may avoid applying easy access to the Internet. In some developing
for health care services. Various organizations regions around the world, cell phones are widely
have used design thinking to help bridge the gap used for banking and business, whereas desktop
between health care resources and individuals in computers are rare. In other regions, Facebook is
need. Processes that combine digital tools with the primary means of interacting online. Literacy,
active, person-to-person outreach can help people education, and attitudes toward sexuality and
address obstacles to better health. reproduction are important factors in designing
A hospital or clinic can serve many needs. successful tools for health care. Health design
Dr. Alister Martin is an emergency physician interventions fail when they are imposed from
and former Chief Resident at the Massachusetts the top down without regard for a community’s
General Hospital. During the 2020 presidential own expertise, priorities, values, and resources.
election, he started VotER, a program to register Sending patients to an app or a website or handing
voters as they waited for services in the ED at them a brochure is useless in the absence of a full
Mass General. The majority of eligible citizens in process of engagement that yields mutual respect
the US who are not registered to vote are people and understanding.
GET OUT THE VOTE According to Dr. Alister Martin, MD, MPP,
patients come to the ED with “problems that have their
roots in upstream public policy issues like homelessness,
addiction, food insecurity and lack of access to mental
health care in this country.” In 2020, Martin launched VotER,
a program that helps people register to vote while visiting
the hospital. The program also encourages staff to register.
BUILDING UNDERSTANDING Misinformation or planning in Baltimore and develop prototypes for

distrust can lead individuals and communities educational materials. The design process was
to underutilize an available health resource. The informed by surveys and interviews collected
Baltimore City Health Department (BCHD) sought from various stakeholders, including Baltimore
to increase access to long-acting reversible City women, family planning medical providers,
contraceptives (LARCs). The goal was to achieve and leaders and staff from a community outreach
“contraceptive equity”—meaning that all people organization (B’more for Healthy Babies).
should be able to choose, obtain, and use any FDA- The design team prototyped a Family Planning
approved contraceptive for family planning and the Toolkit for use in counseling sessions. Designed
prevention of sexually transmitted infections. to support lively, hands-on discussions, the
Over a several-year period, the LARC Access Toolkit aims to guide women’s perceptions of
Project expanded availability of LARCs in publicly contraceptives and encourage them to choose
funded family planning clinics, trained over more effective birth control methods. Bright,
five hundred clinical staff and providers, and playful, and accessible, the Toolkit uses gamelike
contributed to the increase in LARC utilization from activities and informative graphics to prompt
10 percent to 20 percent throughout Baltimore reflection on family planning decision-making
City. Despite these advances, the BCHD needed to and address common barriers, such as myths
address client demand. Creating better access to and misconceptions, challenges with access to
a health care resource isn’t useful if people don’t services, provider mistrust, and male partner
know about it or don’t want to use it. As clinics engagement. The Toolkit also addresses overall
improve LARC access, they must also address goal setting and pregnancy planning.
the prevalence of provider mistrust, birth control Projects like this view health care as more than
myths, and lack of health education. a technical service. Effective medical interventions
In 2018, the Center for Social Design at MICA must meet the needs of a community and be
(Maryland Institute College of Art) began working created through an active and respectful process
with BCHD to understand the barriers to family of listening and learning.
FAMILY PLANNING TOOLKIT Project leads, MICA’s Center for Rachel Serra, Amber Summers, Jade Shih, Cecilia Yang.
Social Design: Charlotte Hager and Becky Slogeris. Project Advisors: Denise Shanté Brown, Alexandra Eisler, Vanessa
team, MICA’s Center for Social Design: Hayelin Choi, Sarah Geffrard, Dr. Olnfunke Pickering, and Dr. Nishant Shah.
Dunn, Elishabha Eaton, Aylin Onur, Vic Liu, Claudia Norena, Partner: Baltimore City Department of Health.
CANCER ALLEY Environmental racism results and be built on burial grounds of enslaved people.
from the collision of redlining (the denial of home Activists have proposed reclaiming the land for
mortgage loans in minority neighborhoods) use as a memorial ground or historic museum
and the placement of factories in these areas. testifying to the history of systemic racism.
Factories devalue property and expose residents to
pollutants that cause chronic health conditions. SAN FRANCISCO From March to May 2020,
Colloquially known as Cancer Alley, St. John people who had recently emigrated from Asia to
Parish is an eighty-five-mile stretch of land along downtown San Francisco were disproportionately
the Mississippi River. It houses over two hundred affected by COVID-19. Intergenerational
chemical plants and oil refineries. Proximity to the households are common in the community. Many
river has made it easy for factories to dispose of impoverished residents live in poorly ventilated
harmful waste. The surrounding neighborhoods single-room apartments, where a virus brought
are predominantly Black and contain the highest into a household by a younger member of the
rates of poverty. The air has tested positive for family could quickly spread to elders. Illness and
ammonia, chlorine, hydrogen, cyanide sulfuric fatalities from COVID-19 were spurred by pre-
acid, and other toxins. Pollution has caused high existing conditions, language barriers, and lack of
rates of cancer, lung disease, diabetes, kidney access to health care and social services.
disease, and other conditions, leading to the Various strategies emerged to alleviate health
nation’s highest rate of chronic illness. care inequities in San Francisco, including a
For decades, citizens have fought against Cantonese-language option for citywide COVID-19
chemical plants in Cancer Alley. In 2021, information. The Chinese Cultural Center of San
activists called on President Biden to revoke the Francisco supported various relief efforts, such as
permit given to Formosa, a Taiwanese plastics food security programs and a COVID-19 emergency
manufacturer, to build fourteen plants in St. James fund to aid low-income families. The Chinese
Parish. The proposed plants would exacerbate Cultural Center also commissioned public art
existing health crises, evidenced by high rates of murals, installations, and artist talks exploring how
respiratory illness and fatalities from COVID-19. art and design might help communities recover
Furthermore, the plants would destroy wetlands from crisis.
HEALTH INEQUITY In spring 2020, the

case-fatality rate among Asians was
nearly triple that of all other groups in
San Francisco County. As of October 3,
2020, Asian Americans had 1,413 positive
COVID-19 cases and forty-three deaths—a
rate of three deaths for every hundred
cases, as compared to one death per
hundred white patients. © USA TODAY
NETWORK
source Marco della Cava, “Asian Americans in

San Francisco are dying at alarming rates from
COVID-19: Racism is to blame,” USA TODAY,
October 18, 2020. Data source: San Francisco
Department of Public Health, Census Bureau.
—> www.usatoday.com/in-depth/news/
nation/2020/10/18/coronavirus-asian-americans-
racism-death-rates-san-francisco/5799617002/
TOXIC WASTE IN CANCER ALLEY

In seven Louisiana parishes, more than
200 plants have toxic emissions that
are so high, they must be reported to
the government.
COVID-19 FATALITIES During the first

months of the pandemic, Cancer Alley
had more fatalities from COVID-19 than
other parts of Louisiana. Respiratory
diseases, which are pervasive in these
areas, make it difficult for the body to
combat the virus. Poverty, environmental
racism, and preexisting health conditions
enabled COVID-19 to devastate these
communities.
sources Lylla Younes, Al Shaw, and Claire Perlman

of ProPublica, “In a Notoriously Polluted Area
of the Country, Massive New Chemical Plants
Are Still Moving In,” ProPublica, The Advocate,
and The Times-Picayune, October 30, 2019, –>
projects.propublica.org/louisiana-toxic-air/;
Clayton Aldern, The Grist, data sources: K. Terrell/
US Census/Louisiana Department of Health/
van Donkelaar et al.; data as of April 26, 2020.
Particulate matter concentrations represent
seventeen-year averages.
MUTUAL AID Most health care is intimate and of the health care industry to difficulty getting
personal: parents care for their children, children appointments and traveling to a clinic. Creating
care for their parents, and neighbors bring each vaccine sites for, by, and in the community helped
other food and look after one another’s gardens address these concerns. The First Baptist Church
and pets in times of need. Mutual aid is the of Glenarden is located in Prince George’s County
voluntary sharing of services and resources among in Maryland, a majority-Black area hit hard by
members of a community. Building and using the pandemic. Pastor John Jenkins mobilized
mutual aid networks is a strong tradition among volunteers from his congregation to create
marginalized groups. vaccination sites in collaboration with University
Around the world, mutual aid expanded rapidly of Maryland Capital Region Health. Together, they
and embraced new structures in response to established a mass vaccination site in the church’s
the COVID-19 pandemic. Neighbors ran errands recreation center in addition to pop-up clinics.
for housebound people, sewed PPE for friends Designer Rachel Smith founded Design
and family, distributed food and clothing, and to Combat COVID-19, a network of volunteer
mobilized 3D printers to manufacture face shields. designers. Smith, a Latina Mexican American,
Loosely organized groups used social media created a Slack channel to connect volunteer
and tools like Slack and Google Docs to connect designers with community organizations and small
volunteers. Local organizations created ways to businesses that needed help with app design,
bring people together and help children learn web design, infographics, signage, mentorship,
and play during the shutdown. Going to outdoor and more. Smith also founded Masks for Docs, a
movies became a popular summer activity. network of engineers, designers, and 3D-printing
In many communities, churches became a enthusiasts who helped produce and distribute
trusted place for COVID-19 vaccination clinics. over one hundred thousand pieces of medical
Vaccine hesitancy arose among communities of equipment. Smith says, “We ended up building our
color for various reasons, from historic distrust own grassroots supply chain network to provide
PPE from local communities to hospitals.”
FREE ART Over 1,500 posters about
hope, care, and solidarity were pasted
to shuttered storefronts and city
walls in Philadelphia in the spring
and summer of 2020. This grassroots
project, called #FillTheWallsWithHope,
brought together submissions from
dozens of artists. Many of these
poster walls were installed at food
distribution sites, providing a vibrant
backdrop and a gentle guide for social
distancing to people lining up for food
during a difficult period of quarantine
and economic distress. Photo: Mark
Strandquist
FREE FOOD Greenpoint Fridge is a project of North FREE MASKS Mobile Mask Machine was founded by
Brooklyn Mutual Aid, a group formed during the Janique L. Robillard, Katja Flükiger, and Matthew
COVID-19 pandemic to connect neighbors and support Ingram in New York City in 2020. They connected with
donations of food, hygiene kits, and other necessities. community members in various neighborhoods to host
Thousands of similar organizations have formed around a plywood cupboard stocked with masks hand-sewn
the world. Greenpoint Fridge offers a place to donate and by Robillard and volunteers. © Mobile Mask Machine,
pick up food. Photo: © Madison Gardner Janique L Robillard, Katja Flükiger, and Matty Ingram
read more Jennifer Steinhauer

and Abby Goodnough, “As
Nation Speeds to Vaccinate
All, Maryland’s Path Shows
Challenges Ahead,” New York
Times, April 1, 2021, —> nytimes.
com/2021/04/01/health/
FREE MOVIES In fall 2020, Black Space Oklahoma covid-vaccine-eligibility-
organized Deep Deuce Drive-In, a series of socially maryland.html; “Q&A: Rachel
Smith, Design to Combat
distanced events located in Deep Deuce, a neighborhood COVID-19,” Design Vanguard,
in Tulsa, Oklahoma, with a rich heritage as an African —> designvanguard.org/
American jazz district. perspectives/rachelsmith/
38 principle
Creative Mindset
Creativity is not a rare talent. It is a fundamental human capacity that
anyone can cultivate. Specific techniques and exercises can wake up
our thought processes and help us generate ideas more easily. Most
ideas disappear unless we write them down or make a sketch. An
idea that lives only inside our own heads rarely lasts long or travels
far. As we love and care for an idea—adding details and exploring its
consequences—a fleeting thought becomes a concrete concept that
can be discussed, tested, or even built. A few basic principles guide
the process of generating ideas and making them concrete:
QUESTIONING is the act of looking at any problem from a new angle. It

is the process of asking questions and reframing assumptions. A good
question helps us look at a situation and ask, “How could this be different?”
VISUALIZING draws on our innate ability to perceive objects and spaces,

patterns and structures. Designers use line, shape, color, and form to make
connections, reveal insights, and communicate concepts.
PROTOTYPING is the act of making ideas concrete in a provisional,

speculative way. Although some prototypes resemble real products or
include a working mechanism, many prototypes are rough sketches or
quickly assembled artifacts that explore one aspect of a design solution.
STORYTELLING is the universal art of recounting a signficant action that

takes place over time. Designers gather stories from users and other
stakeholders, and they create stories about how a product, space, or
service will be used and experienced.
A well-prepared mind is equipped to unleash creativity and come

up with new ideas. When (according to legend) Archimedes shouted
“Eureka” in his bathtub, he was able to do so because he had been
thinking long and hard about the problem of how to measure volume.
In the process of health design thinking, a period of careful, attentive
research prepares our minds for active making and discovery.
Ellen Lupton and bon ku, md 39
ESSENTIAL MASK BRACE The N95 respirator, introduced with nonwoven fabric, which offers excellent filtration.
in 1972, is standard-issue safety equipment in hospitals The Essential Mask Brace presses the surgical mask
and factories. The COVID-19 crisis forced clinicians snugly against the face. Early prototypes made with
to wear these uncomfortable devices for long hours; rubber bands proved that the concept could work. The
furthermore, high demand drove up cost and made team used intensive product testing to ensure the safety,
N95s inaccessible to many workers who needed them. fit, and affordability of their new product, which is made
Sabrina Paseman, a former mechanical engineer at from soft, springy silicone rubber. Photos: Top left, Karen
Apple, wondered if a low-cost surgical mask could be Santos Photography © FTM Corporation; Top right and
adapted to form a tight seal. Surgical masks are made bottom: FTM Corporation © FTM Corporation
40 principle | creative mindset
Questioning
Questioning is the act of viewing any problem or situation from a
new angle. This process helps us reframe assumptions. Looking at
problems from different perspectives is a crucial tool in the process
of both design and medicine. The questions in health care are
complex. The answers are rarely black-and-white, yet physicians are
trained to make a definitive diagnosis and treat the illness. However,
problems in health care systems—ranging from how to expand
access to primary care to how to reduce medical errors—are difficult
to fix using medicine’s traditional mindsets. Although the evidence-
based approach to disease has been successful in biomedical
research, it fails to address many of the challenges in health care.
The hypothesis-driven scientific method assumes that you know
exactly which questions to ask. But more often than not, we ask the
wrong questions. Design thinking starts with exploring the problem
in an open-ended way that doesn’t predetermine the answer. It also
requires listening and having authentic conversations.
Health design thinking can provide a framework for understanding
chronic diseases such as diabetes. A patient who struggles
with controlling their blood sugar requires more than a doctor’s
instructions on the optimal insulin regimen and low-carbohydrate
diet. Asking “Why?” invites people to share their stories. The
social determinants of health can play an overwhelming role in the
experience of chronic conditions. A patient may no longer be able to
afford insulin because of a new insurance plan. Social isolation may
reduce their motivation to monitor their glucose levels.
Instead of labeling patients as noncompliant when they don’t carry
out their prescribed treatment plans, clinicians can help patients
design treatments that have a higher probability of succeeding. For
example, if a person with diabetes presents with elevated blood
glucose levels arising from unhealthy eating behaviors, asking open-
ended questions can illuminate the challenge from a patient’s point of
view: “What kind of problems are you having with your diet?” “What’s
the worst part of eating unhealthy?” “What do you hope for?”
ellen lupton and bon ku, md 41
Asking and listening

Deeper insight into the human condition can transform
patient narratives.
Medical documentation in the electronic health record

(EHR) describes patients like this: Susan is a thirty-
three-year-old insulin-dependent diabetic female
who has noncompliant behavior, including difficulty
adhering to dietary recommendations.
Try to learn more about the person: Susan, a busy,

single, working mother of two toddlers living with type
2 diabetes, eats fast food because she’s too exhausted
to cook a meal and lacks access to local healthy food
options. Medications are too expensive for her budget.
42 principle | creative mindset | questioning
DEFERRING JUDGMENT A “how-might-we” QUESTIONING EVERYTHING Reframing problems

question, or HMW, is a pattern for writing better is not enough. Every design challenge is linked to
problem statements. HMWs were popularized by social, economic, and environmental systems that
IDEO and the Stanford d.school. These questions are distorted by the unequal distribution of power
avoid preordained solutions. Instead of asking and resources. The entire health care apparatus in
“How can we design a better water bottle?” an the US and globally has been shaped by centuries
HMW might ask “How can we carry drinking water of bias and imbalance. Design thinking and other
without wasting resources?” An HMW focuses creative problem-solving frameworks also are
on a desired outcome rather than one path for shaped by these power structures.
achieving it. Critics point out that design thinking privileges the
The idea of using open-ended questions to expertise of designers and protects the status quo.
generate multiple ideas comes from the work of Ingrained practices and financial motives—
Sid Parnes and other pioneers of creative problem- not the desires of individuals and communities—
solving. In the example below, a chemical company often dictate the choice of a solution. Natasha
sought to weigh heavy barrels of gunpowder to Iksander warns that design thinking can provide
determine shipping costs. Rather than ask how cover for entrenched interests by making “a process
to hoist the awkward barrels onto the scale, they that is deeply informed by social and economic
asked how else they might calculate the weight. structures seem merely technical or aesthetic.” The
Solution: fill the barrels with premeasured powder tools outlined in this book must be used with care
to eliminate weighing each barrel. and a critical eye. Question everything.
read more Sidney J. Parnes, Creative Behavior

Guidebook (New York: Charles Scribner’s Sons,
1967). On the origins of How-might-we questions,
see “ReAppreciating Sid Parnes,” Humantific,
March 28, 2021, —> humantific.com/post/who-
owns-how-might-we; Natasha Iksander, “Design
Thinking Is Fundamentally Conservative and
Preserves the Status Quo,” Harvard Business
Review, September 5, 2018 –> hbr.org/2018/09/
design-thinking-is-fundamentally-conservative-
and-preserves-the-status-quo
How might we?
How might we...
so that....
Fruitful questions focus on a specific aspect of a problem.

Look for questions that are open-ended rather than ones that
suggest a particular solution in advance. The Health Design
Lab at Thomas Jefferson University led a workshop with staff
at IMRE, a marketing agency with a focus on health care.
Workshop participants were asked to imagine new products
or services for patients who had just received a diagnosis of
diabetes. Role-play exercises helped participants imagine Photo: David Campbell
receiving this diagnosis themselves. Participants also
discussed the illness with one of the workshop leaders—a
clinical pharmacist who himself had diabetes. To build
empathy, they experienced the challenge of using a blood
glucose monitor for the first time.
HMWs for the future of health care

This list of questions was initiated in 2019 by the Kyu patients, and clinicians free to imagine future practices
Collective, a group of creative companies committed very different from those of today. Each question
to addressing significant challenges facing business suggests many other questions, opening up rich areas for
and society. These visionary questions do not presume creative thinking. The authors of this book expanded the
a particular type of solution, which leaves designers, questions in 2021.
How might we enable rapid innovation in health care? Who owns you?
How might we dismantle racism in health care? How might we create fulfilling, sustainable, restorative
roles for providers (and beyond)?
How might we create equitable tools for remote care?
How might we create health communities that are joyful,
How might we manufacture medical supplies locally? inclusive, and seamless, and that people truly want?
How might we connect our personal health to the How might we engage a team of diverse health care
health of the planet? “supporters” around delivering lifelong, holistic care?
How might we think of health as a social contract? How might we enable a scalable symphony of high-touch
and high-tech care across the journey of lifelong health?
How might new currencies become health incentives?
What happens when bioelectronics and bionic
augmentation replace drugs?
Another random document with
no related content on Scribd:
on earth could have made him do a thing like that. Why he did it,
Heaven only knows. Complete mystery to me. Can’t fathom it. Thank
God he did, though!”
“You don’t think he might have been—murdered?” Roger
suggested tentatively.
“Murdered? How could he have been? Out of the question under
the circumstances. Besides, he took jolly good care of that. I’d have
murdered him myself before this—hundreds of times!—if I hadn’t
known it would make things worse than before all round.”
“Yes, I’ve heard about that. Kept the evidence addressed to the
interested parties, didn’t he? I suppose everyone knew that?”
“You bet they did. He rubbed it in. No, Stanworth never meant to
be murdered. But my God, I had a fright when I saw him lying there
dead and the safe locked.”
“You were going to try and open it when I interrupted you
yesterday morning, of course?”
“Yes, properly caught out then,” Jefferson smiled ruefully. “But
even if I’d found the keys, I didn’t know the combination. Lord, what
a relief that note of his was. You know about that, I suppose?”
“You got a note by the post before lunch, did you?”
“That’s right. Saying he was going to kill himself. Rum business.
Can’t explain it. Almost too good to be true. I feel another man.”
“And so are a good many other people, I imagine,” Roger said
softly. “And women, too. His activities were fairly widespread, weren’t
they?”
“Very, I believe. Never knew much about it, though. He kept all
that sort of thing to himself.”
“That butler now,” Roger hazarded. “He looks a pretty tough
customer. I suppose Stanworth employed him as a sort of
bodyguard?”
“Yes, something like that. But I don’t know about ‘employed.’ ”
“What do you mean?”
“He was no more employed than I was. That is to say, we got a
salary and we did our work, but it wasn’t a sort of employment either
of us could leave.”
Roger whistled softly. “Oho! So friend Graves was another victim,
was he? What’s his story?”
“Don’t know all the details, but Stanworth could have had that
man hanged, I believe,” Jefferson said coolly. “Instead he preferred
to use him as a sort of bodyguard, as you say.”
“I see. Then Graves hadn’t much cause to love him either, I take
it?”
“If he hadn’t known what would happen afterwards, I wouldn’t
have given Stanworth ten minutes of life in Graves’s presence.”
Roger whistled again.
“Well, thanks very much, Jefferson. I think that’s all I wanted to
know.”
“If you’re trying to look for someone who induced Stanworth to
shoot himself, you’re wasting your time,” Jefferson remarked.
“Couldn’t be done.”
“Oh, there’s a little more in my quest than that,” Roger smiled, as
he let himself out of the room.
He hurried upstairs, glancing at his watch as he did so. The time
was nearly five minutes to four. He scurried down the passage to
Alec’s room.
“Finished packing?” he asked, putting his head round the door.
“Good, well come along to my room while I do mine.”
“Well?” Alec asked sarcastically, when they were once more
ensconced in Roger’s bedroom. “Has Jefferson written out his
confession?”
Roger paused in the act of laying his suitcase on a chair.
“Alec,” he said solemnly, “I owe friend Jefferson an apology,
though I can’t very well tender it. I was hopelessly wrong about him,
and you were hopelessly right. He didn’t kill Stanworth at all. It’s
extremely annoying of him considering how neatly I solved this little
problem of ours; but there’s the fact.”
“Humph!” Alec observed. “I won’t say, ‘I told you so,’ because I
know how annoying it would be for you. But I don’t mind telling you
that I’m thinking it hard.”
“Yes, and the most irritating part is that you’re fully entitled to do
so,” Roger said, throwing his pyjamas into the case. “That’s what I
find so irksome.”
“But I suppose you’ve found somebody else to take his place all
right?”
“No, I haven’t. Isn’t it maddening? But I’ll tell you one significant
fact I’ve unearthed. That butler had as much cause as anyone, if not
more, to regret the fact that Stanworth was still polluting the earth.”
“Had he? Oh! But look here, how do you know that Jefferson
didn’t do it?”
Roger explained.
“Not much so far as actual hard-and-fast-evidence goes, I’m
afraid,” he concluded, “but we greater detectives are above
evidence. It’s psychology that we study, and I feel in every single
bone in my body that Jefferson was telling the truth.”
“Lady Stanworth!” Alec commented. “Good Lord!”
“Some men are brave, aren’t they? Still, I daresay she’ll make an
excellent wife; I believe that’s the right thing to say on this sort of
occasion. But seriously, Alec, I’m absolutely baffled again. I think I
shall have to turn the case over to you.”
“Well, do,” Alec retorted with unexpected energy, “and I’ll tell you
who killed Stanworth.”
Roger desisted from his efforts to close the lid of his bulging case
in order to look up in surprise.
“You will, eh? Well, who did?”
“Some unknown victim of Stanworth’s blackmail, of course. The
whole thing stands to reason. We were looking for a mysterious
stranger at first, weren’t we? And we thought he might be a burglar.
Translate the burglar into the blackmailer’s victim and there you are.
And as he burnt the evidence himself, and we haven’t the least idea
who was on Stanworth’s blackmailing list, we shall never find out
who he was. The whole thing seems as clear as daylight to me.”
Roger turned to his refractory case again. “But why did we give
up the burglar idea?” he asked. “Aren’t you rather overlooking that?
Chiefly because of the disappearance of those footprints. That must
mean either that the murderer came from inside the house or that he
had an accomplice there.”
“I don’t agree with you. We don’t know how or why the footprints
disappeared. It might have been pure chance. William might have
raked the bed over, somebody might have noticed it and smoothed it
out; there are plenty of possible explanations for that.”
With a heave Roger succeeded in clicking the lock with which he
was struggling. He straightened his bent back and drew his pipe out
of his pocket.
“I’ve talked enough for a bit,” he announced.
“Oh, rot!” Alec exclaimed incredulously.
“And it’s about time I put in a little thinking,” Roger went on,
disregarding the interruption. “You run along down to tea, Alexander;
you’re ten minutes late as it is.”
“And what are you going to do?”
“I’m going to spend my last twenty minutes here doing some
high-speed cogitating in the back garden. Then I shall be ready to
chat with you in the train.”
“Yes, I have a kind of idea that you’ll be quite ready to do that,”
said Alec rudely, as they went out into the passage.
CHAPTER XXVII.
Mr. Sheringham Hits the Mark
Roger did not reappear until the car was at the front door and the
other members of the party already making their farewells on the
steps. His leave-taking was necessarily a little hurried; but perhaps
this was not altogether without design. Roger did not feel at all
inclined to linger in the society of Lady Jefferson.
He shook hands warmly enough with her husband, however, and
the manner of their parting was sufficient to assure the latter, without
the necessity of any words being spoken on the subject, that his
confidences would be regarded as inviolate. The taciturn Jefferson
became almost effusive in return.
Arrived at the station, Roger personally superintended the
purchase of the tickets and deftly shepherded Mrs. Plant into a non-
smoking carriage explaining that the cigars which he and Alec
proposed to smoke would spell disaster to the subtleties of Parfum
Jasmine. A short but interesting conversation with the guard,
followed by the exchange of certain pieces of silver, ensured the
locking of the door of their own first-class smoker.
“And so ends an extremely interesting little visit,” Roger observed
as soon as the train started, leaning back luxuriously in his corner
and putting his feet on the seat. “Well, I shan’t be sorry to get back to
London, on the whole, I must say, though the country is all very well
in its way. I always think you ought to take the country in small doses
to appreciate it properly, don’t you?”
“No,” said Alec.
“Or look at it in comfort from the windows of a train,” Roger went
on, waving an appreciative hand towards the countryside through
which they were passing. “Fields, woods, streams, barley——”
“That isn’t barley. It’s wheat.”
“—barley, trees—delightful, my dear Alexander! But how much
more delightful seen like this in one charming flash, that leaves a
picture printed on the brain only to give way the next instant to
another equally charming one, than stuck down in the middle, for
instance, of one of those fields of barley——”
“Wheat.”
“—of barley, with the prospect of a ten-mile walk in this blazing
sunshine between you and the next long drink. Don’t you agree?”
“No.”
“I thought you wouldn’t. But reflect. Sunshine, considered from
the purely æsthetic point of view, is, I am quite willing to grant you, a
thing of——”
“What are you talking about?” Alec asked despairingly.
“Sunshine, Alexander,” returned Roger blandly.
“Well, for goodness’ sake stop talking about sunshine. What I
want to know is, have you got any farther?”
Roger was evidently in one of his maddening moods.
“What with?” he asked blankly.
“The Stanworth affair of course, you idiot!” shouted the
exasperated Alec.
“Ah, yes, of course. The Stanworth affair,” Roger replied
innocently. “Did I do that bit well, Alec?” he asked with a sudden
change of tone.
“What bit?”
“When I said, ‘What with?’ Did I say it with an air of bland
innocence? The best detectives always do, you know. When they
reach this stage of the proceedings they always pretend to have
forgotten all about the case in hand. Why they do so, I’ve never been
able to imagine; but it’s evidently the correct etiquette for the job. By
the way, Alec,” he added kindly, “you did your part very well. The
idiot friend always shouts in an irritated and peevish way like that. I
really think we make quite a model pair, don’t you?”
“Will you stop yapping and tell me whether you’ve got any farther
with Stanworth’s murder?” Alec demanded doggedly.
“Oh, that?” said Roger with studied carelessness. “I solved that
exactly forty-three minutes ago.”
“What?”
“I said that I solved the mystery exactly forty-three minutes ago.
And a few odd seconds, of course. It was an interesting little problem
in its way, my dear Alexander Watson, but absurdly simple once one
had grasped the really vital factor in the case. For some
extraordinary reason I appeared to have overlooked it before; hence
the delay. But don’t put that bit in when you come to write up the
case, or I shall never land the next vacancy for a stolen-crown-jewels
recoverer to an influential emperor.”
“You’ve solved it, have you?” Alec growled sceptically. “I seem to
have heard something like that before.”
“Meaning Jefferson? Yes, I admit I backed the wrong horse there.
But this is a very different matter. I’ve really solved it this time.”
“Oh? Well, let’s hear it.”
“With the greatest pleasure,” Roger responded heartily. “Let me
see now. Where shall I begin? Well, I think I’ve told you all the really
important things that I managed to elicit from Mrs. Plant and
Jefferson, haven’t I? Except one.” Roger dropped his bantering
manner with startling suddenness. “Alec,” he said seriously, “that
man Stanworth was as choice a scoundrel as I’ve ever heard of.
What I didn’t tell you is that he gave Mrs. Plant three months in
which to find two hundred and fifty pounds for him; and hinted that if
she hadn’t got it already, a pretty woman like her would have no
difficulty in laying her hands on it.”
“Good God!” Alec breathed.
“He even went farther than that and offered to introduce her to a
rich man out of whom she would be able to wheedle it, if she played
her cards properly. Oh, I tell you, shooting was much too easy a
death for friend Stanworth. And the person who did it ought to be
acclaimed as a public benefactor, instead of being hanged by a
grateful country; as he certainly would be, if all this had got into the
hands of the police.”
“You can hardly expect the law to recognise the principle of
poetic justice for all that,” Alec objected.
“I don’t see why not,” Roger retorted. “However, we won’t go into
that at present. Well, to my mind there were two chief difficulties in
this Stanworth business. The first one was that at the beginning
there didn’t seem to be any definite motive for killing him; and
afterwards, when we’d found out about him, there were far too many.
All those people in the house, Mrs. Plant, Jefferson, Lady Stanworth,
the butler (who, by the way, appears to be a murderer in a small way
already, as I gather from Jefferson; that was the hold which
Stanworth had over him)—all of them had every reason to kill him;
and the case began to take on the aspect not so much of proving
who did it, but, by a process of elimination, of finding out who didn’t.
In that way I managed eventually to dismiss Mrs. Plant, Jefferson,
and Lady Stanworth. But besides the people actually under our
noses in the house, there were all the others—goodness only knows
how many of them!—of whose very existence we knew nothing; all
his other victims.”
“Were there many of them, then?”
“I understand that Stanworth’s practice was a fairly extensive
one,” Roger replied ironically. “Anyhow, I was able to narrow down
the field to a certain extent. Then I began to go over once more the
evidence we had collected. The question I kept asking myself was—
is there a single item that gives a definite pointer towards any certain
person, male or female?”
“Female?” Roger repeated surprisedly.
“Certainly. In spite of everything—the footprint in the flower bed,
for example—I was still keeping before me the possibility of a
woman being mixed up in it. It didn’t seem altogether probable, but I
couldn’t afford to lose sight of the bare possibility. And it’s lucky I did,
for it was just that which finally put me on the right track.”
“Good Lord!”
“Yes; I admit I was slow in the up-take, for the fact had been
staring me in the face the whole time, and I never spotted it. You
see, the key to the whole mystery was that there was a second
woman in the library that night.”
“How on earth do you know that?” Alec asked in consternation.
“By the hair we found on the settee. I put it away in the envelope,
you remember, and promptly forgot all about it, assuming it to have
been one of Mrs. Plant’s. It struck me suddenly in the garden just
now that it wasn’t anything of the sort; Mrs. Plant’s hair is very much
darker. Of course that opened up an entirely new field for
speculation.”
“Good Lord!”
“Yes, it is rather surprising, isn’t it?” Roger continued equably.
“That set my brain galloping away like wildfire, I need hardly tell you;
and five minutes later the whole thing became absolutely plain to
me. I’m a little hazy about some of the details, of course, but the
broad lines are clear enough.”
“You mean you guessed who the second woman was?”
“Hardly guessed. I knew at once who she must be.”
“Who?” Alec asked, with unconcealed eagerness.
“Wait a bit. I’m coming to that. Well, then I began to put two and
two together. I’d got a pretty shrewd idea already of the personal
appearance of the man himself.”
“Oh, it was a man then?”
“Yes, it was a man right enough. There was never any doubt that
a man must have done the actual killing. No woman would have
been strong enough for the struggle that must have taken place.
Stanworth was no weakling, so that gives us the fact that the man
must have been a strong, burly sort of person. From the footprint and
the length of those strides across the bed he was evidently both tall
and largely built; from the clever way in which everything was left he
must have been possessed of a fund of cunning; from the manner in
which he left that window fastened behind him it was clear that he
was thoroughly accustomed to handling lattice windows. Well, what
does all that give us? It looked obvious to me.”
Alec was staring intently at the speaker, following every word with
eager attention. “I think I see what you’re getting at,” he said slowly.
“I thought you would,” said Roger cheerfully. “Of course there
were other things that clinched it. The disappearance of that
footprint, for instance. That must have been done by somebody who
knew what he was doing. And somebody who heard me say that I
was going to fit every male boot in the house into the mark, you
remember. Of course it was that which made me so sure at first
about Jefferson, because I jumped to the conclusion that it must
have been Jefferson whom we saw edging out of the library door.
After that I more or less had Jefferson on the brain.”
“I did my best to put you off that track,” said Alec with a slight
smile.
“Oh, you did. It wasn’t your fault that I clung to him so
persistently.”
“I tried hard to stop you putting your foot in it, if you remember.”
“I know. And I daresay it’s lucky you did. I might have put things a
good deal more plainly to him, with extremely awkward results, if you
hadn’t dinned it into me so hard.”
“Well,” Alec said slowly, “what are you going to do about it, now
you’ve presumably got at the truth at last?”
“Do about it? Forget it, of course. I told you my views just now,
when I said the man who killed Stanworth ought to be acclaimed as
a public benefactor. As that is unfortunately out of the question, the
next best thing is to forget as diligently as possible that Stanworth
did not after all shoot himself, as everybody else believes.”
“Humph!” said Alec, gazing out of the window. “I wonder! You’re
really sure of that?”
“Absolutely,” said Roger with decision. “Anything else would be
ludicrous under the circumstances. We won’t discuss that side of it
again.”
There was a little pause.
“The—the second woman,” Alec said tentatively. “How were you
able to identify her so positively?”
Roger drew the envelope out of his breast pocket, opened it, and
carefully extracted the hair. He laid it across his knee for the moment
and contemplated it in silence. Then with a sudden movement he
picked it up and threw it through the open window.
“There goes a vital piece of evidence,” he said with a smile.
“Well, for one thing, there was nobody else in the house with just that
particular shade of hair, was there?”
“I suppose not,” Alec replied.
There was another silence, rather longer this time.
Then Roger, glancing curiously across at his companion,
remarked very airily:
“Just to satisfy my natural curiosity, Alec, why exactly did you kill
Stanworth?”
CHAPTER XXVIII.
What Really Did Happen
Alec contemplated the tips of his shoes for a moment. Then he
looked up suddenly. “It wasn’t exactly murder, you know,” he said
abruptly.
“Certainly not,” Roger agreed. “It was a well-merited execution.”
“No, I don’t mean that. I mean, if I hadn’t killed Stanworth, he
would probably have killed me. It was partly self-defence. I’ll tell you
the whole story in a minute.”
“Yes, I should like to hear what really happened. That is, if you
feel yourself at liberty to tell me, of course. I don’t want to force
confidences about—well, about the second lady in the case.”
“About Barbara? Oh, there’s nothing that reflects on her, and I
think you ought to hear the truth. I always meant to tell you the whole
thing if you found out that I did it, and of course, if you were intending
to take any drastic step, such as telling the police or trying to get
Jefferson arrested. That’s why I made you promise to tell me before
you did anything like that.”
“Quite so,” Roger nodded understandingly. “A good many things
are plain to me now. Why you hung back so much and were so
unenthusiastic and threw cold water on everything and pretended to
be so dull and refused to believe that a murder had been committed
at all, although I’d proved it to you beyond any shadow of doubt.”
“I was trying to keep you off the right track all the time. I really
never thought you’d find out.”
“Perhaps I shouldn’t have done if the significance of that hair
hadn’t dawned on me at last. After that everything seemed to come
in a series of flashes. Even then I might not have hit on the truth with
such certainty if two particular photographs hadn’t suddenly
developed themselves in my mind.”
“Tell me all your side of it, then I’ll tell you mine.”
“Very well. As I said, that hair was the clue to the whole thing. I’d
taken it quite idly out of my pocket out there in the garden and was
having a look at it, when it suddenly struck me that whosoever it
might be it was certainly not one of Mrs. Plant’s. I stared at it hard
enough then, I can tell you, and the second realization occurred to
me that, from the colour at any rate, it looked uncommonly like one
of Barbara’s. Then the first of the pictures flashed across my mind. It
was of Graves sorting the post just before lunch yesterday. He had
only three letters, and they were all of exactly the same appearance;
same shaped envelopes and typewritten addresses. One was for
Mrs. Plant, one for Jefferson—and one for Barbara. The first two I’d
already accounted for, now I seemed to be accounting for the third.
Add to all that Barbara’s ill-concealed agitation the next morning and
the fact that, for no apparent cause whatever, she broke off her
engagement to you at the same time, and the thing was as plain as
daylight—Barbara was also in the library that night and for some
reason or other the poor kid had got into Stanworth’s clutches.”
“She hadn’t,” Alec put in. “It was——”
“All right, Alec; you can tell me all that in the proper place. Let me
finish my story first. Well, having got so far, of course I asked myself
—What light does this throw on Stanworth’s death? Does it give a
definite pointer to any person? The answer was obvious. Mr.
Alexander Grierson! I gasped at first, I can assure you, but when I
got rather more used to the idea, daylight simply flooded in. First of
all, there was your hanging back all the time; that began to take on a
very significant aspect. Then there was your height and your
strength, which fitted in very nicely, and I knew that your place in
Worcestershire, where you must have spent most of your boyhood,
is liberally supplied with lattice windows, so that you might be
expected to be up to all the tricks of the trade regarding them. So far,
in fact, so good.”
“But what about that footprint? I thought I’d managed that rather
neatly. By Jove, I remember the shock you gave me when you
discovered that and the way I got out of the library that night. I’d
thought that was absolutely untraceable.”
“Yes, that did give me an awkward couple of minutes, until I
remembered that you’d run back to get your pipe while I was talking
to the chauffeur! And that’s where the second of my little pictures
comes in. The scene flashed across my mind on that flower bed just
after you had stepped on to the path when we were trying to find out
who had been in the library and before you smoothed out the fresh
footprints you’d made. The old and the new prints were absolutely
identical, you see. I suppose I must have noted it subconsciously at
the time without realizing its significance.”
“I noticed it all right,” Alec said grimly. “It gave me a bad turn for
the moment.”
“After that all sorts of little things occurred to me,” Roger
continued. “I began to test each of the facts I’d collected, and in each
case the explanation was now obvious. Those letters, for instance. I
knew they must have been posted between five and eight-thirty that
morning; and at eight o’clock behold you coming back from the
village and actually saying you’d been down there to post a letter!”
“Couldn’t think of any other explanation on the spur of the
moment,” Alec grinned ruefully.
“Yes, and curiously enough I questioned the bookmaker motif at
the time, didn’t I? Then there was your quite genuine anxiety to stop
me from assuming complicity on the part of Mrs. Plant. I suppose
you knew all the time about her and Stanworth, didn’t you?”
Alec nodded. “I was present at the interview between them,” he
said briefly.
“The devil you were!” Roger exclaimed in surprise. “I never
gathered that. She didn’t say anything about it.”
“She didn’t know. I’ll tell you all about that. Anything else on your
side?”
Roger considered. “No, I don’t think so. I gathered that you had
somehow got to know that Stanworth was blackmailing Barbara, and
had simply waded in and shot him, as any other decent chap would
have done in your place. That’s the gist of it.”
“Well,” Alec said slowly, “there’s a little more in it than that. I’d
better begin right at the beginning, I think. As you know, Barbara and
I had got engaged that afternoon. Well, I suppose you can imagine
that a thing like that rather unsettles a chap. Anyhow, the upshot was
that when I got to bed that night I found I couldn’t sleep. I tried for
some time, and then I gave it up as hopeless and looked round the
room for a book. There was nothing I particularly wanted to read
there, so I thought I’d slip down to the library and get one. Of course
I had no idea that everyone wouldn’t be in bed, so I didn’t trouble to
put on a dressing-gown but just went down as I was, in pyjamas.
There were no lights on the landing or in the hall, but to my surprise
when I got there I found all the lights in the library full on. However,
there wasn’t anyone inside and the door was open, so I went in and
began to look round the shelves. Then I heard unmistakably
feminine footsteps approaching and, hardly wishing to be caught like
that, I nipped behind those thick curtains in front of the sash window
and sat down on the seat to wait till the person, whoever it might be,
had gone. I thought it was someone come down like me for a book,
and probably also more or less in a state of undress. Not that I really
thought much about it at all. I just didn’t want to be mixed up in a
rather embarrassing situation.”
“Quite natural,” Roger murmured. “Yes?”
“Through the chink in the curtains I could see that it was Mrs.
Plant. She was still in evening dress, and I saw at once that she
looked rather worried. Very worried, in fact. She began to wander
aimlessly about the room, twisting her handkerchief about in her
hands and it looked rather as if she’d been crying. Then Stanworth
came in.”
“Ah!”
Alec hesitated. “I don’t want to exaggerate or turn on the pathetic
tap too much,” he resumed a little awkwardly, “but I hope to God I
never have to see anything again like the scene that followed. Roger,
it was almost unbearable! I don’t know how I sat it out without
dashing through the curtains and getting my hands into Stanworth’s
throat; but I had the sense to see that anything like that would only
make matters very much worse. Have you ever seen a woman in
agony? My God, it was absolutely heart-rending. I could never have
imagined that a man could be such an indescribable brute.”
He paused, shivering slightly, and Roger watched him
sympathetically. He was beginning to realise just how terrible that
scene must have been, if it could move the stoical Alec to such a
display of emotion.
“You know the main lines of what happened, don’t you?” Alec
went on, rather more calmly. “So I needn’t go into details. The
wretched woman begged and wept, but it had no more effect upon
Stanworth than if he had been a stone image. He just went on
smiling that infernal, cynical smile and told her not to make such an
unnecessary fuss. Then he made that suggestion to her that you told
me about, and for the moment I very nearly saw red. As for her, it
finished her off completely. She just crumpled up on the chesterfield
and didn’t say another word. A few minutes later she got up and
tottered out of the room. Then I came out of my hiding place.”
“Good man,” Roger murmured.
“Well, of course I knew by this time just how the land lay. I knew
what Stanworth was, and I knew where he kept his evidence against
these people. I didn’t quite know what I was going to do, but it was
pretty clear that something had got to be done. Well, he was a bit
startled at first, but recovered himself wonderfully and began to be
infernally sarcastic and cynical. I told him that I wasn’t going to stand
the sort of thing I’d just seen; and unless he stopped the whole thing
and let me burn all the evidence he’d been talking about, I’d go
straight to the police and tell them all about it. That seemed to
amuse him quite a lot; and he pointed out that if I did that, everything
would come to light which all these people had been paying money
to keep concealed, and they’d all be very much worse off than
before. That had never occurred to me, and I was rather taken aback
for the minute; then I told him that if that was the case I’d unlock the
safe myself, even if I had to lay him out to get the key. He simply
laughed and tossed his keys on the table. ‘That’s the one for the
safe,’ he said. ‘I don’t quite know how you’re going to open it as you
happen to be ignorant of the combination, but doubtless you have
provided for that contingency.’ Of course that took me in the wind
again, but before I could answer him I heard somebody coming
down the stairs.
“ ‘Ah!’ he said. ‘I was quite forgetting. I’ve got another visitor
coming to see me to-night. As you seem to have mixed yourself up in
my affairs, the least I can do is to invite you to be present at this
interview also. Get behind that curtain again, and I think I can
promise you an interesting quarter of an hour.’
“Well, I hesitated, while the footsteps began to cross the hall, till
he caught me by the arm and sort of snarled, ‘Get out of sight, you
fool. Can’t you see you’ll make it ten times worse for her by letting
her see you?’
“Even then I didn’t realise what he meant, but I saw that there
was something in what he said, and just managed to get behind the
curtain in time. You can imagine what I felt like when the door
opened and I saw Barbara come into the room.”
“Ghastly!” Roger exclaimed with feeling.
“Ghastly! That’s putting it mildly. Well, I’m not going to tell you the
details of what happened then, because there’s really no need to
and it’s only giving people away unnecessarily. All I need say is that
Stanworth had got hold of some information about—well, about Mrs.
Shannon. I don’t even know what it was. He ostentatiously pulled a
revolver out of his desk, opened the safe, and showed her two or
three pieces of paper, holding them so that she could read them
without taking them into her hands. Then he told her to sit down on
the settee to talk things over, keeping the revolver in front of him on
the desk all the time. Well, Barbara sat down, looking very white and
frightened, poor kid, but still not knowing in the least what Stanworth
was getting at. He didn’t keep her in ignorance long. He just leaned
back in his chair, informed her calmly that if she didn’t fall in with his
wishes he’d make the information he’s just shown her public property
and calmly proceeded to state his terms.
“Lord, Roger, old man, I had some difficulty in holding myself in.
What do you think he wanted? He told her absolutely plainly that
what he was after was money, and went on to say that he knew quite
well that she herself hadn’t got enough to satisfy him. Therefore
she’d got to marry me within a month, so that she would be able to
pay the very moderate sums which he would from time to time
require. She could either tell me or not, as she saw fit; it didn’t matter
to him in the least. If she refused, he was very much afraid she and
her mother would have to take the consequences.
“Of course you see what he was getting at. Me! He was
practically saying to me that if I didn’t marry her and pay his
blackmail, he would disgrace and ruin the mother of the girl I loved.
Very neat sort of trap, wasn’t it? Incidentally, he went on to point out,
also for my benefit, that it wasn’t the least use trying to do him any
sort of bodily harm, because that would only bring things to a head in
the way you know, and he never opened the safe without a loaded
revolver in his hand, which he wouldn’t hesitate for a second to use if
it became necessary.
“Well, Barbara behaved like an absolute thoroughbred. In fact,
she told him, in so many words, to go to the devil; she wouldn’t
dream of involving me in the affair, and as for her and her mother,
they’d have to take what was coming to them if he chose to behave
in such a damnable way, but they’d take it alone. Great Scott, she
was wonderful! She practically defied him to do his worst, and said
that she was going to break off her engagement to me the very next
morning. Then she sailed out of the room with her head in the air,
leaving him sitting there. No tears, no entreaties; simply the most
overwhelming contempt. Roger, she was just marvellous!”
“I can believe you,” Roger said simply. “What happened then?”
“I came out again. I think I meant to kill Stanworth then if I got a
chance to do so without making a worse mess of things. Remember,
I knew already to what lengths he was ready to push the wretched
women that he had in his clutches, and though Barbara would
certainly never give way to him an inch, I wasn’t so sure about Mrs.
Shannon. Well, there was the safe still open, and there was
Stanworth sitting in his chair with the revolver in his hand. He looked
at me with a grin as I appeared, and said he hoped I hadn’t been too
bored. I walked straight up to him without a word (I was beyond
talking by then), and I suppose he could see from my face what I had
in mind. Anyhow, when I was only a few feet away he whipped up
the revolver and fired. Luckily he missed, and I heard the vase
shatter behind me. I lunged forward, grabbed his wrist and used all
my strength to twist it round till the muzzle was pointing straight at
his own forehead. Then I simply tightened my finger over his on the
trigger and shot him.
“I didn’t stop to think what I was doing, or anything like that; I
hardly imagine I was capable of thought at the moment. I just knew
that Stanworth had got to be killed, in the same way that one knows
that a mad dog or a rat or any other vermin has got to be killed. In
fact, once he was dead, I hardly paid any more attention to him at all.
He was a filthy thing wiped out, and that’s all there was about it. I
never felt, nor have felt since, a single moment’s compunction. I
suppose it’s curious in a way.”
“You’d have been a sentimental fool if you had,” Roger said with
decision.
“Well, I suppose I’m not a sentimental fool then,” Alec replied with
a slight smile; “for I most certainly haven’t. Well, as soon as the man
was dead I became as cool as ice. I knew exactly, almost without
thinking about it, what had got to be done. First of all, and in case I
was interrupted, the evidence in the safe had got to be destroyed,
and then I had to make my escape. It didn’t take long to burn the
documents in the safe. There was one shelf full of them, all done up
in envelopes inscribed with various addresses; about sixteen or
seventeen altogether, I suppose. I burnt them in the hearth without
opening them, and just ran through the contents of the other shelves
to make sure that I hadn’t missed anything.
“Up till then, mind, it had never occurred to me that the case
would ever appear to be anything but murder; and if it was traced
back to me, I should simply say that I had shot him in self-defence,
after he had first shot at me. I would have gone to the police straight
away and told them the whole thing, if it wasn’t that that would have
given away the facts of blackmail, which it was of course essential to
hush up. Then I glanced at the chair in which he was lying, and it
struck me that he looked exactly as if he had shot himself, so I
began to wonder if I couldn’t make the whole thing look like suicide.
“I knew you weren’t such a blithering fool as you’ve been trying to
make yourself out to be for the last forty-eight hours——”
Roger interjected, “Yes?”
“Well, the whole finished effect didn’t occur to me at once. I
started off by shutting the safe and putting the keys back in his
waistcoat pocket; the wrong pocket, as it turned out afterwards. Then
I cleared up the bits of vase and shoved them into my pocket for the
time being, and examined the revolver in Stanworth’s hand. To my
joy, I found that I could get at the chamber and extract the first shell
without loosening his grip, which I proceeded to do. You were right
about my knowledge of lattice windows. I knew that trick with the
handle when I was a boy, and patted myself on the back when I
realised how I could get out of the room and leave everything locked
behind me. Lord, I never thought anyone would spot that!”
“You weren’t reckoning for me to be on the trail, my boy,” Roger
said with modest pride.
“Well, you certainly made me jump when you discovered it. Let’s
see now, what did I do next? Oh, yes, the letters. I knew that all
these people would be scared to death at the idea of Stanworth
having shot himself with the safe still locked, as even if they had the
keys nobody could open it without the combination; and I thought
that in the agitation of the moment Mrs. Plant or somebody might
give some vital point away. So I sat down and hammered out letters
to the three of them on the typewriter, for I knew by what I’d seen in
the safe that both Jefferson and Lady Stanworth were involved in it
also. You know what I said in the letters, of course. Well, then, I had
a final look round and just by chance thought I’d better glance into
the waste-paper basket. The very first thing I saw there was a sheet
of paper, only very slightly crumpled, that bore Stanworth’s
signature. Instantly I thought to myself—why not rig up a statement
of suicide just to clinch things? And I typed one out above the
signature.
“Of course all this took a devil of a time. In fact, it was about four
o’clock by now. I’d been as cool as a cucumber for two hours, but I
was getting so tired that I made one or two mistakes after that. I
never searched the waste-paper basket, for instance, and so left that
other piece of paper with the signature there for you to find; and I
forgot to smooth over that footprint on the bed. I did curse myself for
that when you found it! Also I ought not to have thrown those bits of
vase into the shrubbery between the library and the dining room, I
suppose.”
“But how did you get back into the house?” Roger asked.
“Oh, before I locked up the library I went through and opened the
dining-room windows. Then I just walked round from the lattice
window and in through the dining room, locked the dining-room door,
and went up to bed. And that’s all.”
“And very nicely timed,” Roger remarked, glancing out of the
window. “We shall be at Victoria in five minutes. Well, thanks very
much for telling me like that, Alec. And now let us proceed madly to
forget all about it, shall we?”
“There’s one thing that’s been worrying me rather,” Alec said
slowly. “Do you think I ought to tell Barbara?”
“Good heavens above, no!” Roger shouted, staring at his
companion in dismay. “What on earth would you want to tell her for?
She’d only be overcome with shame that you knew anything about
her mother’s shortcomings; and the fact that you’d killed a man more
or less on account of her would simply make her wretchedly
miserable. Of course you mustn’t dream of telling her, you goop!”
“I think you’re probably right,” Alec said, gazing out of the
window.
The train began to slacken speed, and the long, snaky Victoria
platforms appeared in sight. Roger stood up and began to lift his
suitcase off the rack.
“I think we might stay up in town this evening and do a dinner and
a show, don’t you?” he said cheerfully. “I feel as if I want a little
relaxation after my strenuous mental efforts of the last two days.”
Something seemed to be troubling Alec.
“You know,” he said awkwardly, “somehow I can’t help wondering.
Are you really sure, Roger, that it wouldn’t be best for me to go and
tell the police? I mean, it isn’t as if they’d have me up for a murder or
anything like that; nothing worse than manslaughter, I should
imagine. And I daresay I should get off altogether on the self-
defence idea. But are you sure it isn’t really the right thing to do?”
Roger gazed down at his companion with disfavour.
“For heaven’s sake, Alec, do try sometimes not to be so
disgustingly conventional!” he said scornfully.
The End

Full Ebook of Health Design Thinking Second Edition Bon Ku Online PDF All Chapter

Uploaded by

Copyright:

Available Formats

Full Ebook of Health Design Thinking Second Edition Bon Ku Online PDF All Chapter

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Full Ebook of Health Design Thinking Second Edition Bon Ku Online PDF All Chapter

Uploaded by

Copyright:

Available Formats

Health Design Thinking second edition

Linkography Unfolding the Design Process Design

Investigating second grade 1st Edition Thinking Kids

Visual Thinking for Information Design 2nd Edition Ware

Different Perspectives in Design Thinking 1st Edition

UX for XR: User Experience Design and Strategies for

Interfaceless: Conscious Design for Spatial Computing

Scala Design Patterns Second Edition Ivan Nikolov

Thinking While Doing Explorations in Educational Design

Illustrations by Jennifer Tobias

Ellen Lupton, Bon Ku, md, and Ellen Lupton

Health Design Thinking, Second Edition is a unique publication

Health design thinking is an approach to generating creative ideas and

Bon Ku, MD Ellen Lupton

PRINCIPLES Since the 1990s, thousands of groups and individuals

METHODS In theory, the design process breaks down into three

Observe Imagine Make

DESIGN FOR DOOR HARDWARE

Designed for beauty and originality

LEVERON DOOR HANDLE ATTACHMENT

Designed for a better fit with diverse human bodies

5 Yankauer suction tip

10 End-tidal CO2 line

PATIENT-DESIGNED DEVICES Patients

LOCAL HEALTH CARE Pastor John Jenkins spearheaded

CITIZEN HEALTH CARE Ventizolve is a portable device

HEALTH CARE ON WHEELS Moving health care

ICE CREAM TRUCK This design for a

MOBILE HEALTH UNIT The Jefferson

TILT is a portable medical device designed for

Design team: Sean Haynie, Hannah Levy, Elliott

read more Samantha A. Batt-Rawden, MBChB, et al.,

read more Charles Kenney, “The Blue Yarn,” in

Find out how it feels to . . .

Attempt to communicate with clinicians covered in PPE.

Spend a day isolated in a patient quarantine room.

Concentrate on a difficult task in the doctor’s workspace in a busy outpatient clinic.

Get an intravenous line started on you (above).

Navigate the hospital with a wheelchair, walker, or cane, or with crutches.

Test your blood sugar three times a day.

Remember to bring an item such as an EpiPen with you—everywhere.

OPEN STYLE LAB Designers: Kieran Kern,

ON AND OFF Softable is a jacket designed to be donned

PHYSICIAN-SPECIFIC TRANSPARENT DATA

CARE OVER TIME

PATIENTS ARE KEY Although trends in

RACIAL DISPARITIES AND COVID-19

This map shows that areas whose

Illnesses common in neighborhoods

CONNECTING COMMUNITIES WITH RESOURCES of color living in low-income communities. VotER

BUILDING UNDERSTANDING Misinformation or planning in Baltimore and develop prototypes for

HEALTH INEQUITY In spring 2020, the

source Marco della Cava, “Asian Americans in

TOXIC WASTE IN CANCER ALLEY

COVID-19 FATALITIES During the first

sources Lylla Younes, Al Shaw, and Claire Perlman

read more Jennifer Steinhauer

QUESTIONING is the act of looking at any problem from a new angle. It

VISUALIZING draws on our innate ability to perceive objects and spaces,