Our work builds on changes that are taking place in the way that we learn (and therefore in the way we design). We build on the work of a health scientist and policy maker Don Berwick who describes three eras:

  • In era 1, knowledge and its application were governed by the professions. There was progress, but also paternalism, and an unevenness in the beneficiaries of new knowledge.
  • Era 2 was dominated by what some call new public management in which providers of services and sometime individual practitioners were held to account for outcomes. There was more progress, but gaming of the system became endemic and learning suffered.
  • Berwick calls for a third ‘moral’ era, one that leads to continual improvement and a recovery of learning. Ratio thinks more in terms of an emerging relational era.

In reality, nobody can be sure what will come next. Ratio has employed the following ways of thinking, design and learning principles, ethics and practices to guide to its learning partnerships.

(3) Ethics for Design and Learning

  • Justice and equality
  • First do no harm
  • Beneficence (Do what is right)
  • Autonomy and agency

(4) Standard Design Good Practice

  • Innovation as copying: let us build on good ideas
  • Christmas Tree: we can be expansive in our thought (go out) and then bring it back to the practical (come back in), be expansive again (go out), and then again back to the practical.
  • Trust the person who is going to use the design (and don’t design something that wouldn’t be good enough for us).


(5) More Hacking

  • Let’s benefit from diverse, large groups of ‘experts’ who will challenge
  • Let’s move fast
  • But end with a clear design prototype
  • That we can test, and
  • Learn from.