Better Health Through Design – More Usable, Understandable, and Profitable (with new ending)

The interplay of health and design isn’t new. In 1857, Nurse (and Data Scientist) Florence Nightingale used design principles to illustrate the casualties of soldiers in the Crimean War and changed national policy. Nightingale showed that soldiers weren’t dying mainly on the battlefield, but instead they were dying in the hospitals due to the poor sanitary conditions there. Nightingale used this now famous diagram to influence hygiene practices in military hospitals, which resulted in lower mortality rates. The kind of design that Nightingale used can be thought of as, “Design to improve understandability.”

The eponymous design firm IDEO is another organization for which the intersection of health and design isn’t new. Back when I was at MIT, I first came to know IDEO in the late 90s through their Cambridge studio, whose heritage is in medical device design. If you look at IDEO’s long list and history of design for the medical space -- ranging from a kidney transporter to a heart monitor -- you can see that IDEO’s vaunted “design thinking” has long been grounded in a lot of “design doing.” The kind of design that IDEO has brought to bear in this space is, “Design to improve usability.”

Today, designers in the technology industry are working hard to speak of design in these terms of Nightingale and IDEO’s intentions to use design for understandability and usability. And with the publication of the 2015 Design in Tech Report, I showed the intersection of design and profitability by highlighting designer co-founded startups like Airbnb and Pinterest that have collectively raised billions of dollars in the last decade.

However, it’s difficult to distinguish the word “design” from another common use in the consumer world – which is to seduce consumers with perfectly polished surfaces and comforting aesthetics. As someone who studied traditional electrical engineering and computer science at MIT, I don’t find it surprising at all – because a traditional technical education, or business education for that matter, doesn’t go deep into the history of art and design. The role of design in doing the job of making something more attractive -- “Design for getting noticed” – is an ancient craft that goes back to the symbol of the cross all the way to the brightly lit apple logos on the lids of many laptops today.

Design for Understandability and Usability

Back to the present, we had a full room at a recent KPCB event – my partner Lynne Chou led a fantastic panel with Michelle Kim, Patrick Morrow, and Megs Fulton. They all addressed design as framed within the aforementioned spaces of understandability and usability.

Michelle Kim, lead designer at Mango Health, thinks designers should be gamifying healthcare apps so they are fun to play. Kim posits that the same person who enjoys playing Candy Crush Saga, should also have as much ease managing their chronic illness. The difficult design problem sits within the fact that each user is different depending on the patient’s diagnostic history – so one size can’t fit all, as would be the case of a videogame design. Kim enhances understandability by leveraging a patient’s familiarity with something they already know. Designers tend to have a broad vocabulary of objects and experiences in the world that they use to help a user “rhyme” something new with what is already old to them. In doing so, they create a context for a new user to be more apt to feel they can understand something new.

Practice Fusion, the cloud-based electronic medical system, mirrors the real-life workflow of a doctor’s office. Patrick Morrow, principal visual designer at Practice Fusion, explained that the front desk person spends a lot of time in the calendar system, while a nurse requires charting workflows for one-on-one meetings with patients. Morrow’s example illustrates how usability cannot be designed for without understanding the social and physical mechanics of the context for a real-life user. In the past, many health technology IT services that were primarily designed by engineers lacked this empathy for the user because it was simply impossible for engineers to sit within a hospital waiting room or in a doctor’s office. That is now changing as designers are being brought early into the process of designing digital health services to ask the question, “How many of our potential users have we talked to, or visited?”

Design for Profitability and Performance

After Lynne’s panel, I hosted one with Sonny Vu and Jason Mayden.

When Misfit founder and CEO Sonny Vu dropped out of a Ph.D. program at MIT, he became an accidental entrepreneur. While at MIT, there was a $50K competition to start a company, which lead Vu to start his first one called FireSpout. During that time, Vu learned that a great idea and a great technology doesn’t always lead to riches. Vu saw that design needed to play a role in the user’s experience in order for the technology to have the most relevance to their every day lives.

Vu described the making of Misfit and revealed how they didn’t originally plan on making activity fitness trackers. After realizing other companies were doing well by selling step counters, Vu wanted to revisit the wearable opportunity. So Vu researched other products online by looking at thousands of Amazon reviews of Fitbit, Jawbone, and Nike. After researching fitness devices, Vu found obvious white spaces and had his team build a MVP (a fitness and sleep tracker without a screen).

Launching the Misfit Indiegogo campaign validated the consumer demand for the wearable product Shine, and eventually the outcome of an impressive acquisition. Recently, Fossil announced that it acquired wearable technology Misfit for $260 million.

And from Jason, came what I think is a key aspect of design that is implicit and important in business today: Design for performance. Mayden’s design mentor at Nike, Tinker Hatfield, taught him that great design comes from working within extreme constraints. Mayden learned from Hatfield how the material choices in a shoe design could cost an athlete the gold medal if the extra weight slowed the athlete down. As Mayden said that evening, “Great design is great restraint – every ounce, every stitch, matters.”

Megs Fulton’s Open Letter

The highlight of the evening, for me, was to hear Megs Fulton’s call-to-action for designers in health tech today that she shared at the event:

It’s the year 2015 and such an exciting time to for those of us working in technology. We’ve watched software transform entire industries. I can use this tiny pocket computer to get a ride across town, instantly share a photo with a friend in another country, or have food delivered to my doorstep in less than 15 minutes.

It’s easy, it’s frictionless and delightful. It’s also the year 2015 in the land of healthcare and medicine, where there’s still a lot of friction and not much delight.

For the past few years there’s been debate about healthcare reform. But for all the talk about the affordable care act, regulations, rising insurance premiums, there’s a lot less talk about the people who are the center of the industry patients and physicians. And today we’ve somehow ended up in a place where the people who matter most are equally unhappy with the status quo.

It’s easy to empathize with patients. We’re all customers of the healthcare industry at one time or another. We could probably swap negative stories for hours about being endlessly put on hold by the front desk, waiting too long for an appointment that you need, sitting in the waiting room for your appointment that was 30 minutes ago, or being told that you need to book another appointment to address an issue because you’re out of time.

There’s an obvious opportunity to design better patient experiences. But there’s just as much, if not more, opportunity to design better experiences for physicians too. Doctors train for years to develop their medical expertise and hone their skills to provide their patients with great care only to enter a field where they have become a commodity.

Many physicians find themselves in a position where they’re trying to see as many patients in a day as possible in order to maintain their overhead. Resulting in appointments being booked in 10-15 minute increments, unable to give their patients more time. On top of and unrealistic schedule doctors are also spending more and more time on paperwork and administrative duties each week.

At a time when physician satisfaction job satisfaction and morale is low and trending lower, we have a responsibility as designers, engineers, PMs, to build experiences for doctors that are just as good as the experiences we design for patients.

And it’s not just about applying technology as a layer on top. But that’s what been done with many electronic medical records systems. And as a result EMRs are frequently cited as a source of job dissatisfaction with physicians. Their primary frustrations being that they’re hard to use, require time-consuming data entry and interfere with face to face interaction with patients. In one study following the time of emergency medicine practitioners found that 44% of their time was spent on data entry with only 28% of their time spent providing direct patient care. This could partially be because the process to enter data is so cumbersome. While doing some initial research for spruce one physician describe the seemingly simple task of processing a prescription refill for a patient as “death by a thousand clicks.” For some physicians the data entry has become so cumbersome they’ve hired medical scribes who shadow them typing in the details of an encounter so the physician can focus on their patient.

Software shouldn’t be making things worse for physicians or require physicians to increase their practice staff and overhead. And we shouldn’t be asking them to adapt to these new digital workflows. Instead there’s an opportunity to look at doctor’s existing workflows and design ways to enhance their processes, make them more efficient and let the software get out of their way. Even though the bar is low we shouldn’t be stopping at designing software for physicians that’s just “usable”. We should be designing tools for physicians that are intuitive, beautiful, and a joy to use.

If we can design systems to partner with doctors we will help them be best doctors they can be. And they can put their focus back on part of their job that brings them the most satisfaction, providing their patient excellent care by listening to their patient’s concerns, explaining their diagnosis and thoroughly discuss treatment options.

By designing better experiences for doctors we’ll also be designing better experiences for patients.

Megs’ elegant words, and all the designer panelists’ thoughts that evening, underline the fact that design in the healthcare space is increasing in importance right now. And for its potential of improving the quality of life for millions, I think it’s a great time to design for healthcare.

Wait. You’re Still Here?

Shortly after this post went live on TechCrunch at 4AM on December 6, 2015, I went out for a jog in Palo Alto on El Camino Real. It was like every early morning run for me -- not too cold, not too hot. Dry. Safe. A route that I knew well. And then I tripped.

It hurt. I landed on the sidewalk with my face, arm, and knee. It was quite a shock. It was still dark. I felt my face with my left hand, and could tell I was bleeding. My right hand wouldn't move, and I soon realized that something had happened to my elbow. It felt a bit like lego pieces over there. I was scared. 

But I was fully conscious, and sitting up on the sidewalk there in the darkness. A few cars would pass by hastily. No phone with me. And no ID. I had my Apple Watch to measure my steps ... but of course it couldn’t help me to communicate to get help. I started to shiver in shock. And I could walk, but barely. I needed to get back to the Airbnb I was staying at -- which was roughly six blocks away. Each time I got up, I started to pass out. I realized I should not pass out, as I had no idea what would happen when someone found me.

There was nobody else on the streets. I also thought that nobody was likely to help me as I was dressed in a dark hoodie, bleeding from my face, and really ... what commuter-in-rush would want to stop to help such a questionable looking person that looked fresh out of a zombie movie?

So I would walk a few steps. And then lie on the sidewalk. I'd lie on a few people’s lawns. And fortunately I got back to the airbnb, to my phone, located the nearest hospital with the help of my EA, got a little cleaned up, and called an Uber. When I got to the ER around 6am, I was handed a clipboard and pencil. My good arm was broken and I am a righty; but I adapted as a lefty to my best abilities. Eventually I entered the healthcare system fully, and I was in surgery the next day. 

I am a fan of discovery through new, serendipitous experiences. Whoever thought I would make a post on healthcare x design, and only two hours later would spend days, weeks, and now months getting patched up? I love the irony.

My key conclusion is that there are incredibly talented people who work in the healthcare system, who have access to woefully inadequate technologies to support them. In short, everything that I learned at the KPCB #DesignInHealth event that could happen to me, actually happened to me. But I have never felt down or depressed about it all because of the people. Because I know that folks like Megs Fulton are out there. Because Megs wrote that lovely open letter above to designers-in-health who seek a new reality for all of us, who are working hard to make the system work better for the amazing women and men working in health.

I still have more than a month to go before I feel normal again, but I absolutely relish the experience to get smarter about this health-tech space first hand. Well, with my left hand at least, for now. -JM