A follow-up conversation on human-centered design in healthcare
I first spoke with Shaun Gummere in May. Our audience’s response to his call for more human-centered design in healthcare was overwhelmingly positive. So much so that we decided to follow-up with Shaun to ask him more about this often ignored topic.
Free: Please provide examples of the effectiveness of human-centered designed products/solutions in industries outside of healthcare.
Gummere: Putting people first is increasingly recognized as a competitive advantage. The hospitality industry has long understood that putting guests at ease, anticipating their needs, and responding well to issues when they may arise, increases loyalty and extends the reach of their brand.
With other choices a click away and information on the quality of a service, product, or experience easily in reach, organizations can no longer hide behind their place in the phone book or the influence they think arises from their brand. They need to deliver consistently good and meaningful experiences to the people who matter to them.
Now, more and more organizations are doing the necessary work to align how they’re organized, what they do, and what they measure with the real-life needs of the people they serve. Organizations such as Fidelity.com have pursued user-centered approaches that put the customer first, rather than marketing (after the fact) an existing product or feature.
In redesigning Fidelity.com, with over 2.5 million daily users, user research and user testing were integrated from the start. Steve Turbek, SVP of User Experience Design, described user research as “the heartbeat” of the project, which enabled them to successfully preconceive a massively huge online experience.
The Fidelity team first shifted their approach based on a project they undertook at Stanford’s d.school, where they asked the students to help them answer the questions: How do you get workers to save money for the future? How do you get younger people to do something that they know is good for them, yet for which the positive payback is many years away? Inspired by the experience, they brought a “design thinking” process back to Fidelity and made it core to their design process. Read more in Harvard Business Review.
More significantly, USAA embarked on a transformative mission to place the customer at the center of their organization. This led to staffing, assessment, organizational, as well as online, print, web, and phone experience redesigns. The compelling case study can be read in Outside In: The Power of Putting Customers at the Center of Your Business.
In our own work, we’ve seen how Customer Journey Maps and Service Blueprints can help organizations see themselves how their own customers see them: as one organization with a promise to keep, no matter when or where it’s delivered. This makes clear how and why (re)design activities – encompassing both product and service offerings – are necessary, valuable, and can make the whole more compelling than the parts.
Free: In your opinion, why do you think the healthcare IT vendor community has not organically gravitated toward human-centered design when creating their products/solutions?
Gummere: Most organizations group their functions into specialized areas: marketing, IT, sales, etc. On the one hand, this makes sense. Each unit is arranged to optimize their area of expertise.
We know, however, that people perceive each interaction with an organization as parts of a whole. If you have a great experience with one part, but a lousy experience with another, all you remember is that your experience with the organization as a whole was poor.
The typical organizational structure is ill suited, then, to understand how all the pieces are perceived and experienced by their customers. Most vendors are similar: they focus on one area of expertise, and hire, measure, and sell that service.
In particular, IT has historically asked people to bend around the technology they implement. By placing people first, process second, and technology third, this approach is turned on its head. This is a sea change for most IT organizations and the incentives (in the short term) simply aren’t there for them.
Human-centered design requires that organizations shift their perspective to see things from the customer’s point of view, which can run counter to assessing success on a unit by unit basis or passing the buck (“that’s not my job, that’s Marketing’s job”). This approach offers real, tangible, and long lasting benefits, but is a change from “business as usual.” It requires fresh, outside thinking.
Free: Studies show that many patient portals are actually pushing away certain populations rather than engaging them. How do you believe human-centered designs might encourage patients, especially those with low health literacy, to use patient portals to help manage their own care?
Gummere: Consider the patient portal not as a product, but as part of a larger service. It can’t be approached as a “bolt-on” information resource, but must be conceived and designed from the perspective of the people it serves to meet their service needs and expectations.
Our process includes deep research to understand and see the world from the perspective of the people for whom we’re designing. We also invite people to design with us in co-design sessions. Designing for people means including them as early as possible, which leads to approaches that make sense.
Such co-design activities ensure everything – look, organization, language, and context – is taken into consideration in the design process because we ask and include the people the design is intended to serve as early and as often in the process as possible. Design isn’t something done to people, but something done with them.
Free: Can you please cite instances of how human-centered design has improved patient care?
Gummere: The traditional clinician-patient relationship places distance between the clinician and the patient. The clinician is concerned, first and foremost, with understanding symptoms and treating disease. This generally leads the clinician to focus on tests and data and to subordinate the patient experience. Yet, patient experience is key to long-term health and well-being. If patients are not engaged, do not understand and embrace their care plan, or feel ownership of their own well-being, they are unlikely to change their behavior. Indeed, outside of acute care settings, the effectiveness of health care interventions are dependent on the patient’s adherence to self-care activities, including taking medications, refraining from specific activities or habits, etc.
In 2008, Princess Margaret Hospital in Toronto had the opportunity to rethink how it delivered chemotherapy. Their breakthrough was to begin by envisioning the complete patient journey both inside and outside the hospital as the starting point. This gave them a complete picture of patient needs, in a real-world day-to-day context.
This was also the starting point for envisioning how each of these steps could be improved. Everything from scheduling online, providing access to discussion boards and patient support groups, offering valet parking service, to the redesign of the chemotherapy pod to resemble business class airline seating (rather than a drab, clinical tool) placed the patient at the center. The complete case study can be read in Heather M. A. Fraser’s book Design Works: How to Tackle Your Toughest Innovation Challenges through Business Design.
Free: Can you please cite instances of how human-centered design has improved clinical workflows?
Gummere: Clinical workflows are influenced by a variety of factors. In recent years, the adoption of EMRs has caused workflows to change in response to the technology. We see this as exactly backwards. Technology should enable the right processes, and the processes that are right are those defined and required by real-life human need.
In a famous example, designers from IDEO working to design a new hospital had themselves wheeled into the emergency room on gurneys. As IDEO CEO Tim Brown put it: “You see 20 minutes of ceiling tiles and realize the most important thing is telling people what’s going on.” Human-centered design is all about deeply understanding what the patient experiences, and is backed by a methodology that’s like a combination of anthropology, journalism, and empathy. Through observation, interviews, and contextual analysis, opportunities arise to address the whole human experience, including workflow.
The key question is how to institutionalize the perspective of the patient in a way that positively influences the workflow of doctors, nurses, and administrators? The answer is to internalize human-centered practice. This is precisely what IDEO did at Kaiser Permanente, where their engagement resulted in the creation of an in-house “Innovation Consultancy.”
Kaiser-Permanente discovered that service innovation provided myriad opportunities to quickly and affordably make changes with far-reaching consequences. One project to reduce medical errors cost $470,000 to implement and in its first year saved close to $1,000,000. Similarly, the Consultancy improved how nurses exchange information during shift changes. These now occur at the patient bedside (rather than at the nurses’ station), where errors are less likely to be passed along without correction. The patient is encouraged to participate.
Free: Do you see any industry-standard processes or regulations that serve as barriers to new human-centered designed approaches in healthcare? If so, what are they and how might they be overcome in the near future?
Gummere: Yes, the Health Information Technology for Economic and Clinical Health (HITECH) Act drove investment in EMR adoption. Meaningful Use guidelines were articulated to drive adoption in the way the federal government thought would yield the greatest benefit, starting with Stage 1 covering technical implementation (e.g., data capture) and Stage 3 ending with patient experience (e.g, patient outcomes). We believe these incentives are backwards. Human-centered design suggests that any technical system or supporting workflow will only find lasting success if they are aligned with the needs and real-life contexts of people. To us, this means first and foremost the patient, but also the doctors, nurses, and administrators to deliver health care or manage the supporting systems that enable health care to be delivered. By beginning with technical implementation, many limitations have been “locked in” by the assumptions and requirements inherent in these systems. While this is a major obstacle, the fact that Stage 3 is starting to drive federal incentives offers hope that patient and clinician experience will start to drive the design of these systems.
Customer Journey Maps, Design Works: How to Tackle Your Toughest Innovation Challenges through Business Design, Fidelity.com, Health Information Technology for Economic and Clinical Health, HITECH, human-centered designed, IDEO, Kaiser Permanente, Service Blueprints, Story+Structure, User Experience Design