Nursing homes know they have a problem when one of their patients with dementia or Alzheimer’s suffers an episode of disorientation. Momentarily, that person does not know where they are or what they are doing there. The natural response is to try to leave the nursing home and recover their former life: going back to their old house, returning to their old job, returning to their parents or reappearing in their childhood school.

All the nursing homes have protocols for and experience with these types of situations. Thus, most cases in which the patient leaves the nursing home are prevented. But at times, patients manage to get out onto the streets in a disoriented state, and they escape. They walk around the city, lost and in a deep state of anxiety. It is not surprising that they go back to their old houses, where other people now live. It all ends as a traumatic experience for them.

Their caregivers and relatives also suffer greatly during the process of searching for the patient. On many occasions, the police have to participate in the distressing search. The heads of the “Benrath Senior Center” in Düsseldorf were concerned about these cases, but could not find a solution. The employees of the nursing home had no idea how to deal with these cases either—until one day, an elderly person brought forward the solution. His idea was so strange and different that they laughed at it and dismissed it. The solution for episodes of disorientation in people with dementia and Alzheimer’s was to build a bus stop at the entrance to the nursing home.

The argument for building this bus stop was as follows: A bus represents the first step on your way . . . back home, to school, to your job, back to your parents. The bus stop as such is a lie, a deception. There are no buses that stop at it. For patients suffering an episode of disorientation that manage to bypass security protocols, the first thing they will see when they leave the nursing home will be this stop. They will stop there to wait for a bus. When they are seen by a caregiver, the caregiver will take care of them.

Although it seemed ridiculous and far from any previous knowledge on geriatric matters, management thought it could work. Employees of the nursing home did not look favorably on the crazy idea. To them, it was cynical and inappropriate. They were sure it would not work. Despite the opposition, a bench was installed and next to it a yellow and green sign that was like the rest of the shelters in the city. The sensation of reality offered by the bus stop even affected locals; many of them thought there was a new bus stop in the neighborhood, and they stopped at it.

The first time that the bus stop proved itself to be useful was with an elderly woman who wanted to go straight home to her parents. The caregivers tried to console her and convince her, but they were not able to. As she sobbed, they escorted the woman to the new bus stop. The old woman, seated and waiting for a bus that would never arrive, seemed to console herself with the idea of returning. She waited patiently for the bus to appear. After some time, little by little, she regained her awareness of “now.” The whole process was traumatic and painful for the patient and the caregivers. This time, it progressed in a calmer and more natural way. The bus stop was built five years ago and has been working. Its introduction has shown its usefulness, both for preventing escapes and for reducing anxiety in patients.

The Experts and the Rules

I think this story points to something seemingly contradictory: having a lot of knowledge about a subject/industry only guarantees that you know the rules people play by in it. The acquisition of this knowledge in some way hinders working outside of those rules. Changing the rules in a subject/industry never comes from experts. It is the “outsiders” who break the rules and define a new framework for the game.

Knowing something in depth means knowing its limitations and adapting to them. Whoever changes the rules of the game does not have these limitations. The odds are they don’t even know they exist. Their view is completely new. That is why they can play at speculating about new and unexpected solutions.

Being a manager or a worker with extensive experience in a nursing home guarantees enough knowledge to maintain that organization, its rules and its operations. Not bearing in mind the limitations under which a nursing home works allows one to think of an imaginative, groundbreaking solution.

Small, incremental improvements always come from experts. Knowing the rules better allows you to excel within them, to push them to their limit. You will be stronger, faster and more effective, but this improvement will only be real if the rest of the players accept the same rules. When you play against someone who does not accept your rules of the game is when uncertainties and revolutions occur. The perspective of the new person, the “outsider,” is necessary when we want to change a market, a business, a mindset—whatever you want to change.

Now is when my doubts start. What role must the designer and the design play? Are we experts and do we ensure evolutionary improvements in our projects and clients? Should we be out-of-the-box thinkers and be demanded by companies that need to break a paradigm? Will we sometimes be some things and sometimes others? Will the very fact of aspiring to be design experts be destroying disruptive roles that should advance our discipline?

The seed of this post was sown by Daniel Suarez Sánchez, with his masterly class in La Nave Nodriza, I don’t know whether to thank him or to pinch him to death :/