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Your Role in the Future of Healthcare

Originally presented at the 2017 Duke University Innovation by Design Symposium

Hello! My name is Brett Bishop and I’m here to talk with you about your roles in the future of healthcare. But first, let’s quickly level-set on the state of healthcare in the U.S.

The cost.

$10,345 per capita. That’s $10,345 for every man, woman, and child in the U.S. (Doesn’t matter if you used it or not, that’s the breakdown.) That amounts to 3.2 trillion dollars every year. And it’s going up. I spent way too much time looking into ways to bring that number into some kind of perspective, but A) all I could find were comparisons for 1 trillion dollars and multiplying it by 3 immediately diminishes the comparison and B) even the 1 trillion dollar comparisons seemed to lack the punch of exactly how much money that is. Every. Single. Year.

The poor outcomes.

 

Any guesses on where the U.S. sits in a comparison of global health outcomes? Top 10? 20? 30? Nope. The United States comes in at number 37, just behind Costa Rica. And that’s with spending 3.2 trillion dollars.

 

 

The mistakes.

Medical errors are estimated to be the 3rd most common cause of death in U.S. medicine. The reason I say estimated is that we don't actually count medical errors in official records. A professor at Johns Hopkins (who I'm sure is very popular in health circles these days) conducted a meta-analysis just last year and came to the conclusion that if we were able to count medical errors, that's where they'd sit. At the number 3 cause of death in U.S. cases.

 

And before you immediately put the image of a clumsy doctor slipping with a scalpel or a nurse not reading her instructional manual, this more often the kind of "medical error" that abounds. This is an EMR that's supposed to tie things together. This is considered an improvement.

 

In reality, those medical errors are more often caused by a confusing, disconnected web of information that leads to different clinicians seeing different things at different times and making disjointed decisions...all of which land at the feet of the person receiving care.

And do you know where conversations about solving these problems start?

 

 

Right here. Over a spreadsheet. Rows, columns, red and black, year-over-year trends. You can talk about it all day long. Look at it just about every different way.

 

 

And we find ourselves asking these questions atop those spreadsheets. These are great questions. The people asking these questions want to help. Yet these questions lack specificity. They lack the humanity that underlies improving an outcome, reducing a cost without impacting care, or reducing an error. What does it actually mean to accomplish any of these things? What's on the other end of a percentage drop or a bump up in any of these areas? We instead should be asking the question, "...how are we improving a person's life?"

And yet - these questions are often posted atop an excel spreadsheet. In a meeting room. Closed doors, good luck with some windows providing some semblance of a connection to the outside world.

All of this to say, "You cannot solve problems with the same thinking that created them." And of course, Einstein boiled this thought to a much better point. This is essentially what I want to share with you today - that we cannot solve the healthcare problems we are currently facing with the same thinking that's led us here. We will not build a better healthcare system in the generations to come by blindly following the procedures you'll likely run into as you join the healthcare industry. How important it is for each of you to solve problems differently and push for that different way of problem-solving in your future work. And how important it is for me, personally, to see this happen.

As I said previously - I'm with Philips Health - working as a Design Lead for the Connected Sensing Venture. Our vision is to improve peoples' lives by erasing the lines between the various silos in today's healthcare landscape and plugging the holes where people fall through the cracks as they move through their healthcare journey. We aim to accomplish this through a combination of software and hardware that allows both patients and clinicians to move seamlessly through the touch points in their care.

Like I said, this isn't just a job for me. I came here to share my perspective and why it's personally important for me to see us do things differently. These are my grandparents - seen with their favorite grandson here. Betty and Hank Zelias. Native New Yorkers who moved to Florida during the rapid growth of the 1960s to provide a better life for their 4 kids. I still marvel at the gall of my grandparents to pick up a family of 6 and move them from upstate New York, leaving everything and everyone they knew, and settling in southern Florida based on some conversations with members of their church.

And I lost them both in 2016.

My grandmother to COPD. or Chronic Obstructive Pulmonary Disease. A lung disease that essentially renders you perpetually short of breath. And, with each year, shorter breath. Doctors estimated her lungs were operating at roughly 20% capacity when she passed away. After living with the disease for roughly 15 years, she passed peacefully in her sleep, surrounded by family.

My grandfather to complications from sepsis. Essentially, a blood infection. It likely languished for months while he was at home - slowly worsening yet not enough to raise concern. He took a fall at home ("he must've tripped, old people are clumsy, right?"), was admitted to the hospital, stabilized, and went to a skilled nursing facility for rehabilitation, and went into septic shock over night. The nurses didn't find him until the following morning.

It's not they died that bothers me, though that's never pleasant. There's always going to be a period at the end of the proverbial sentence. It's how we're sort of trained to expect things to go. Our grandparents, our parents, that's the natural order.

It's how their lives were lived in the decades preceding their deaths that get to me. The confusing doctor's appointments, the referral from one specialist to the next, the constantly changing medications, the confusion and stress on their- and their family's - shoulders. And that's only mentioning the times they were being "cared for".

 

No amount of poring over a spreadsheet is going to improve those years of life.

And the thing is, their situations are not unique. As painful as it is to me, and my family, my grandparents' experiences are an epidemic in the U.S.

An estimated 258,000 people die every year from sepsis. In the span of this talk, 15 people will have died.

There are currently 16.8 million people in the U.S. living with COPD. And there is no cure for COPD - that's the whole "chronic" aspect. These are 16.8 million people who have been told it's a matter of time before the disease catches up with them.

But we lose the gravity of the situation when we flip it to faceless numbers. And we lose the level of detail necessary to truly understand what an individual's life is like and develop solutions that fit into their lives in order to improve their care, their quality of life, and ultimately - impact the massive systemic inadequacies we're facing within the U.S. healthcare landscape. (As an aside, has anyone seen a Stalin quote used in a positive manner before?)

We, and I use "we" in this instance to corral the multitude of skills we have here - tech, engineering, business, design, etc. - must considering it our own responsibility to remember the individual tragedies, not only the statistics, as we set out to solve these problems. It's what keeps us grounded, digging it out, and continually orients us in the right direction.

Too often I see the responsibility for "understanding your end users" fall to designers. As if designers will single-handedly force that perspective into the brains of every team member that's critical to brining something new to the market. Additionally, simply "understanding" what happens isn't enough. My ability to recount, factually, what occurs in a given environment is table stakes. We have to passionately feel what it's like in the situations we're tackling. It keeps us hungry and allows us to see the solutions that may not seem obvious or "logical".

In fact, there's no guarantee that a designer will even be there to shoulder that load - particularly in medtech companies just getting off the ground.

It is every single person's responsibility to demand that perspective, be guided by that perspective, seek it out and work with others to ensure it's driving the decisions you're making.

And it's not just everyone having that impassioned perspective for those at the center of care. It's those delivering care. They systems they're using. And how all of these pieces interacting with each other to ultimately deliver better care and a new lease on life for those we love.

So why am I telling you this? Because I'm at Duke University. I've grown with a favorable impression of Duke. But I did some digging into exactly the kind of pedigree Duke can claim. I found a laundry list of c-suite executives, politicians, board members, founders, and more.

(This animation was 3x longer but I think you get the point.)

I'm standing in front of a group of people that have pretty good odds at making some big decisions in the future. This isn't ass-kissing. It's a simple fact. You'll start something, decide something, change something that has some significant weight in the grand scheme of things. And I ask of you - when you find yourself in those situations...

 

 

 

Don't just think of this.

 

 

 

Screen Shot 2017-03-14 at 4.41.24 PM.png

 

Think of this.

Or more accurately, your own grandparents, parents, and loved ones. Remember their individual, personal journeys.

 

Thank you.

 

 

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Boston's Dearth of Design Talent

Over the past few weeks, I’ve asked people in a number of U.S. cities a simple question: “What’s the first thing that comes to mind when I say Boston?” A few things I heard? “Harvard.” “Patriots.” “Amazing summers.” “Terrible winters.” “Healthcare.” “MIT.” As one might expect, we’re viewed as a city steeped in history, academic prowess, and scientific acumen. Our reputation precedes us. I repeated this exercise with a number of other major U.S. cities and, again, collected a variety of answers – but this time, each city had at least one reference to a variable that Boston’s descriptions had lacked. Boston’s missing variable? A culture of creativity. Be it New York’s anything goes, never sleeping lifestyle, San Francisco’s dime a dozen startups, or Austin’s music mecca – many of the country’s other cities are seen as being fueled, at least in part, by uniquely creative pursuits.

Prime talent across design fields is drawn to that kind of creative culture. Any designer worth the money knows that their best work comes from being surrounded by others whose work inspires them and challenges them to look at the world from a number of different lenses. They land in places like New York or San Francisco based on the cultures of cities and companies that offer such a surrounding.

I’m willing to bet that more than a few of you are ready to disagree with me, armed with references and examples proving that Boston is, in fact, quite the creative place. I don’t disagree. The Design Management Institute is located here. Continuum is headquartered here. Art schools abound. To those of us already living here, experiencing Boston day in and day out, we know that we have the culture that design thrives within. Yet, as the old adage goes, perception is reality. And the perception, inelegantly played out through my little experiment, is that DMI, Continuum, or art schools are not what Boston is known for. Even I, working in the design industry for nearly 10 years, wasn’t aware of Boston’s more creative side until moving here for other, completely unrelated, reasons. Boston is known for many great things – but the kind of freewheeling, exploratory, avant-garde culture designers need to thrive isn’t one of them. 

The reality is that companies born in Boston are more often feats of engineering than design. Major companies come to Boston to address their technical needs, not their creative ones. Boston’s world-renowned universities are known for their technoscientific pursuits rather than their artistic ones.

Looking to the future, firms and individuals must recognize that many of the things that put Boston on the map actively work against creating the cultural perception necessary to draw in premier design talent. The question then becomes are we willing to modify the city’s formula that has worked so well, in some regards, to date. Are we willing to prioritize the organizations, activities, and actions, and perceptions that create the cultural perception we need and change the reputation that precedes us?

Originally written for Massachusetts Innovation and Technology Exchange, posted 11.23.2015

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What My Grandmother Taught Me About Usability

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My 82-year-old grandmother once asked me if my laptop was a Facebook. Three years later, we decided to buy her an iPad for Christmas.

 Now, don’t get me wrong, my grandmother is quite the techie. She checks her email every night after dinner, watches how-to sewing videos, and even Skypes with her children, grandchildren, and great grandchildren from time to time.

 Knowing this, when we sat down to turn on her shiny piece of piece of tech for the first time on Christmas morning, I launched into what excites me about using an iPad – watching videos, reading books, playing games, sketching ideas. You can do anything with an iPad! How exciting! Right, Grandma Z?!

 My grandmother was completely lost and intimidated. She decided it was too complicated for her.  Instead, we played a couple of games of double solitaire, with actual cards, and called it a night.

What went wrong? Some would argue that buying my grandmother an iPad was simply a waste of money. Why spend that much on something if she isn’t savvy enough to use it to its fullest potential? Here’s why:

 It’s not about what the device can do; it’s about what the user wants the device to do.

 With this idea in mind, I tried a different approach the next morning. I sat down at the breakfast table and asked my grandmother what she was reading about in the paper. With a few taps of her finger, I showed her how she could get to that exact same story, in that exact same paper. I showed her how she could read other, related articles simply by tapping the blue underlined text included in the article. There was even a video included with the online article that added more detail. I also showed her how to find and download a double solitaire app so she could have new double solitaire partners at her beck and call after I’d returned to DC. She mentioned she needed to remind my aunt to pick up something at the grocery store, so I opened iMessage and sent a quick text – receiving a response in less than a minute.

 I now hear from my grandmother at least once a week – be it a random text asking how my dog is doing or sharing the latest local news from Southern Florida. Before her iPad, we’d talk every month or so via the obligatory grandson phone call.

 All in all, regardless of whether you’re developing a new product or teaching your grandmother how to use her new iPad, keep your end user at the center of your considerations. It’ll make everyone happier.

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Observations are Easy. Insights are Hard.

Humor me for a second and write down your definition of the word ‘insight’. If you don’t have a pen and paper handy, take a second to think of your definition. ‘Insight’ is one of those words that is so common, especially in business circles, that most would feel the need to delete their search history after looking it up. We’re all smart people, so we all have a clear (and correct) understanding of what an insight is, right?

I’d be willing to bet on the contrary. Think back to the last research report you read or the last “insight share-out” meeting you attended. The word ‘insight’ was probably thrown about like confetti. But how many of those ‘insights’ actually met the following definition:

“The understanding of a specific cause and effect in a specific context.”

Put another way, “understanding why.”

In my own experience, quantitative and qualitative data points, without the underlying why, are mistakenly labeled as insights everyday. For example, the three data points below are often passed around with the ‘insight’ tag:

·      “48% of consumers have used mobile banking in the past year”

·      “Many people are not using mobile banking because their banking needs are being met without mobile.”

·      “50% of consumers are concerned about the security of mobile banking”

What do we do with that? Our strategy going forward is to…get more people to use mobile banking? …Increase mobile banking security? (I wish I was kidding, but I’m sure this literal translation has happened more than once.) This kind of information is only the tip of the iceberg. I’m certainly not disparaging the need to collect these data points. Insights are built from a collection of data, observations, perspectives, and experiences, all interpreted and synthesized together into succinct statements. But most people stop at data and observation. They fail to use their perspective, experience, and personal reflection to tie the data points together.

Unfortunately, there’s no magic formula or input/output box for discovering insights. But that doesn’t mean there aren’t clear best practices. My team’s been successful in uncovering insights, and subsequently building compelling experiences, by asking people to tell us their stories in their own words, digging into the stories that hold the most emotion, and spending a healthy portion of time reflecting on everything we’ve heard.

I can also look back on the insights we’ve uncovered and tell you that every single one has been unexpected and surprising. In fact, most insights, when shared with our senior leaders, are initially met with raised eyebrows and a healthy dose of skepticism. That’s okay – and in my opinion, preferable. An insight that fails to change how you look at a challenge or spark a new approach to the challenge isn’t much of an insight at all.

 With all of that in mind, let’s look at our mobile banking data from before and envision what a compelling mobile banking insight might look like:

“People who’ve have grown comfortable with a banking routine (for example, paying monthly bills online and depositing checks at a branch) do not currently feel the need to conduct these banking activities on a mobile device. While they understand that banking via a mobile device is technically possible, they categorize banking as a focused activity you do ‘sitting down at home’ vs. something done in fits and starts throughout the day. Mobile banking, relative to traditional online banking, doesn’t fit within a user’s frame of how 'banking' is done. On the other hand, younger folks, who have not yet developed a banking routine are more accustomed to multi-tasking, both on and off devices, and are  more likely to switch fluidly between online and mobile banking.”

The above does away with the percentages and surface-level details, instead focusing on the underlying drivers of the same behavior highlighted in the earlier bullet points. Now, we can make more interesting recommendations, moving beyond “get more people to use mobile banking” or “increase mobile banking security”. We can use human-centered language to consider “how might we bring the ‘sitting down at home’ experience to mobile banking” or “how might we break the banking experience into singular pieces that are better suited for the ‘stop and go’ style of a person’s day.” These new recommendations lead to fresh and creative thinking around our problem space, suggesting a number of interesting solutions.

Insights, the underlying "why" driving attitudes and behaviors are the foundation for successful products, services, and experiences. Push yourself to move beyond simply recording data and observations. Take the time to listen to your users - truly listen - and dedicate time to making sense of their stories. Bring in your perspective, experience, and personal reflection to discover the unexpected and the surprising.

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