HXR 2017: Amy Cueva, Mad*Pow: Purpose Driven Design

Editor's Notes

1. Hi everyone! It’s great to see you all again! Today, I want to kick things off by taking a step back. By talking a bit about… … How we think about design … How design serves as a channel for motivation … And how if we approach design and technology in health with not just empathy and compassion but also purpose we can bring people together to solve some very big problems. First, I’d like to share a little story that helps illustrate why design is so important.
2. In the book The Design of Everyday Things, author Don Norman tells a story about a friend getting trapped in a doorway. You might ask, “How do you get trapped in a doorway?” It just opens and shuts, right?
3. Well, this entrance was actually a row of six glass swinging doors, followed immediately by a second, identical row. It was designed to reduce airflow and maintain the indoor temperature of the building. But before his friend could get to the second row of doors, he got distracted and moved slightly to the side. When he came to the next door and pushed, nothing happened. So he tried to go back outside. Nothing happened there either. He tried the inside doors again. Nothing. And before long he panicked. It wasn’t until some friends came along that he was able to actually get through the door. Norman uses this story to help us look beyond the aesthetic beauty of the everyday things we interact with and consider what can happen when even simple things are not designed to be intuitive.  But I think the story also tells us something else: that design isn’t just about a single object – but how many different objects work together as part of a system and how that system impacts people’s lives. And I think the story also shows how design can either open doorways for people … or close them. I became a designer because I want to open doorways for people – and believe design can change the world. Not just the design of everyday objects … or a collection of objects … but the design of whole organizations and networks. Because when design is driven by a sense of purpose, I believe it can help us: Find our direction as individuals… Drive innovation in the health industry … And deliver positive change to society as a whole.
4. It’s our experiences that give us a sense of purpose. My father was a civil engineer – he loved solving problems. He designed bridges while in the army, and then buildings for Gillette that would provide line workers with an environment that was both comforting and productive. And my mother was a nurse – she was committed to caring for people and helping them. They taught me that through ordinary actions, we can make a positive impact on people’s lives. So for me, it’s biology… I am kind of “hardwired” to empathize with people and to create solutions for them. And when I focused on design in college, I quickly learned that design is about helping people find new ways of looking at things – helping them to envision solutions to the problems they face …
5. But not long after my design career took off, my personal life developed problems of its own. I had to face the addiction of a loved one. My marriage fell apart. And one of my three children was diagnosed with an autoimmune disease. – all before I turned 35. So I was left to face my own anxiety, and the joys and challenges that come with parenting three children alone … all while running my business. But these things didn’t wear me down. If anything, they gave me an even greater capacity for understanding the pain, confusion, fear, and loneliness of others … They gave me: A sense of direction. Of determination. Of urgency. And definitely, a sense of purpose. 
6. All of my experiences became increasingly useful in my work as a designer! As technology has become more central to our lives, businesses look to designers and technologists like us to help create their websites, software, and mobile applications. At first it was about making these things look beautiful … but then it became more importantly about making sure things would work well for the people using them. At the same time, we started to see people make decisions around who to do business with based not just on a single interaction with a website … but on the service the organization provides and the overall experience they have with that organization. With this, the ”Experience Economy” was born and the concept of “Human-Centered Design” took off. Human-centered design is based on the idea that if we understand people’s behavior and what drives them then we’ll become more effective in serving them. It puts people at the center and and invites the end-user, the patient, the person, into the design process itself. And in health, that’s where we are - trying to humanize the system such that we recognize and understand the emotions and challenges patients face. And when you think about how confusing the health system can be, it makes a lot of sense.
7. But as important as understanding and empathizing with patients is, I’ve come to the conclusion that human-centered design isn’t enough to solve the problems we face. This became crystal clear a couple of months ago when I got a call from my dad. I was in a meeting at work and when I picked up the phone my dad was beside himself with worry. He told me that my mom had been diagnosed with a Glioblastoma – an aggressive form of brain cancer. And that he wasn’t sure how much longer she would be with us.  My mom Claire, is here with us today, by the way. Here’s the thing my mom helped me realize about empathy in health: It’s only when you’ve faced the health system first hand, day to day … that you begin to really understand how far we need to go to improve the situation. When you’ve experienced the difference between a doctor who is desensitized and jaded … and one who takes the time to truly understand the whole patient … you begin to really understand. When you’ve fought with your sister—your sister who is like a best friend that you never fight with!—about treatment options that could extend your mom’s life … you begin to really understand. When you’ve had to tell your mom “I know it is scary, but maybe you should just try the chemo and radiation, they say the side effects are better now,” … you begin to really understand. And mom, I’m glad you did it and there were no side effects! And when you’ve combed the Internet for research on a disease you can barely pronounce to save a loved one’s life … while at the same time trying to come to terms with losing her and appreciating the beauty of each moment you get with her … you begin to really understand. Because it’s hard to really understand what it’s like to be lost in the system until you are the one who is lost – the one who is on the receiving end of big, hairy systemic problems that no one organization and piece of technology in isolation can fix. So many of us have been THERE, and that is why we are HERE.
8. We know that solving the problems in front of us requires the understanding of people’s behavior, and that understanding can be informed by research, observation, and co-creation… With patients and families … With doctors and nurses … With technicians and administrators … But we can’t really change those behaviors or the system until we address how it all fits together. Designing for change requires being driven by a sense of purpose and an openness to collaboration. And it just so happens that purpose is where it’s at. Millennials today are wired for purpose. In their relationships, in their jobs, and in their choices as consumers. They aren’t lining up to buy their ticket to the rat race. They often get a bad rap as the “selfie” generation, but many want to focus their life’s work on something that is meaningful and helps people. And millennials aren’t alone. More and more people want purpose in their lives … at home and at work. As a result, businesses are responding, and not just in the health industry. Mission-oriented organizations from USAA to Humana are designing their businesses to create places where customers, employees, and stakeholders can all take part in their mission. This movement is leading people to ask more and more: “Does this product or service make a positive difference in the world?” “Does my employer?” And “Could my work focus give my own life meaning?” 
9. I believe purpose-driven organizations will win in the marketplace. And Purpose-Driven Design will help them to do it. Their ideas will get more traction. Their technologies will get more investors. Here’s why: Purpose-Driven Design focuses on the ecosystem – the relationships and networks that can drive change and deliver social impact. After all, our health isn’t only about our interactions with our doctor … or our diet … or our relationships, stress levels, and socio-economic status. It’s about all those things… and how healthy we are is determined by how everything works together. Also, because purpose is profitable. In a 10-year study of more than 50,000 businesses, Jim Stengel of Proctor and Gamble found that businesses centered on the purpose of improving people's lives resonated more strongly with consumers. Not only that, but an investment a decade ago in the top 50 businesses in his study would have been 400% more profitable than an investment in the S&P 500 over that same time.
10. So, purpose is profitable. Purpose is trending. But can it really help us to transform our health system? After all, haven’t people been trying to do that for years? At Mad*Pow, the organization I co-founded 15 years ago, we’re focused on working with clients who have done the hard work of clarifying their purpose. We help them design for change – and deliver social impact and financial return as a result. Our approach is twofold: First, we design with an understanding of behavior … And then, we design to actually change the behaviors that matter. You can’t do one without the other. You have to do both.
11. That requires great people – with diverse experiences and talents who are capable of bringing brilliant ideas and research to the table. Being a bad-ass designer nowadays means more than visual expertise. It also means having a knowledge of human behavior, psychology, research, and strategy. At Mad*Pow, we employ psychologists and behavior change experts, architects, dentists, teachers and people with advanced degrees in public health, physics, library science and information systems. Some of our most innovative ideas come from this talent pool. For example, right now we are working on a project that introduces virtual reality into pediatric burn units – designing headsets to calm kids while they’re getting treatment.  Where’d we get this idea? One of our team members saw studies that soldiers with PTSD reported that their pain went down with VR usage. And our participation in the community of health innovation through our Center for Health Experience Design lead us to the right health system to explore this with. Pretty cool. But even cooler is that we also have the ability to deliver on those ideas, because we have great developers. Any designer worth her salt loves to work with developers … because they’re the ones who know that if you’re not thinking about how something gets built, it’s really just an idea. That’s why we hire developers who are also designers and experience experts – people who can iterate on the designs and make decisions that will help to deliver the best experience possible.
12. So people are important, as is how you bring them together. Designing for change also requires collaboration. I believe collaboration is the new innovation. Because modern innovation isn't just about creating shiny new technologies – but more often it springs from brilliant and even surprising connections. Through Purpose-Driven Design, we make those connections by tracing people’s pathways through the ecosystem of interaction – looking to identify unmet needs, obstacles, and opportunities. We’ve all heard of “journey maps” and many have been using them to visualize improved experiences over time, across channels, and including other organizations that people interact with along their journey. Well, for one client, we actually did a 54-foot journey map – that’s 17-feet taller than the Green Monster at Fenway Park. Was it overkill? Maybe! But the point is, if you want to actually understand and change behavior, you have to go deep. Many are also coming to the realization that we need to design with people as opposed to for people – inviting them to the table of innovation. With many clients, we utilize “participatory design methods” - partnering designers with stakeholders to facilitate the collaborative creation of solutions. This makes us facilitators rather than sole creators of solutions. More importantly, it makes those facing the problems not just subjects … but instead subject matter experts.
13. Designing for change requires fostering connections – both within an organization across it’s various departments and silos and outside of the organization, working with others who share the same vision. After all, we are not just designing services and technologies but also relationships. We are the design. How we work together, how we partner, how we integrate, will affect our ability to transform the system.
14. But let’s get this out of the abstract. Through our Center for Health Experience Design we worked with Behavioral Health Innovators – a nonprofit helping teenagers who are facing addiction. We created a series of participatory design workshops with students in recovery from addiction. For a problem like addiction with so much stigma and complexity, developing a creative, free and empowering space for students in recovery was particularly important – because it gave them an opportunity to share their voice. So, after curating a large body of evidence-based research, we helped students identify what needs were missing in their lives that substances replaced – and together, we worked to shape and design what an app to support their recovery journey would be like. How would it help them stay on track? How would the app react if they had a relapse? The process not only empowered the students by helping them illustrate their experience with addiction and recovery … It also created tangible artifacts … directing the client toward potential solutions … solutions that never would have come to light without those students’ stories.
15. And it isn’t just nonprofits. Purpose-Driven Design also can help major for-profit health organizations develop solutions with the potential to impact many. Dartmouth-Hitchcock Medical Center focuses on delivering health as opposed to just treating sickness. As their CEO puts it: they want to create a world where “healthcare takes place outside hospital walls, in the places where people live.” This is an organization that understands its purpose: and wanted to create a new service offering and business model that keeps people healthy at home – and out of the ER. But how? The solution involved a smartphone app and high tech things like Bluetooth biometric sensing devices, and algorithms to support evidence based care pathways. But our focus wasn’t on just the technology … rather on the experience that would seamlessly connect patients with their care team and provide them what they need to feel empowered to care for themselves at home. And of course, we really had to nail the fundamentals – from the ins and outs of secure data transfer, to understanding HIPAA, and all of the other regulatory hurdles that come with a project of this scope. But it worked! ImagineCare worked so well in helping people become healthier and saving money that this spring, Dartmouth-Hitchcock sold the technology and assets to a Swedish health startup, that has now taken on the ImagineCare name. The company will adapt the solution for the European market before commercializing it in markets around the globe. It’s a really exciting new chapter for ImagineCare … reminding us that when we design with purpose, ideas and technologies are more likely to take on a life of their own.
16. Purpose-Driven Design can unite organizations who have never before collaborated to pursue promising opportunities together… Cigna recently partnered with Samsung to create a digital health coach pre-loaded on Samsung Galaxy devices that helps people set health goals, collects data from device sensors, and provides feedback and encouragement – similar to a human coach, but available ‪24/7. Instead of an insurance company and telecommunications giant focused solely on their individual business goals, Cigna and Samsung are driving toward a shared goal: Bringing increased health awareness and behavior change to 500 million people worldwide. They are partners in purpose – part of a growing network of businesses advocating for wellness … and understanding their role in making it all possible. Now through our Center for Health Experience Design, Cigna is collaborating with Mass Health Quality Partners around opioid addiction, which takes the whole idea of partners in purpose to the next level. In the Center, we’re doing research and co-creation sessions with patients and doctors focused on redesigning how conversations about pain take place – and how those conversations can lead to better outcomes, including a potential reduction in opioid prescribing. Because, when you reorient companies toward purpose things change. New opportunities come to light. New partners come to the table.
17. As we speak, our health system may be turned on its head once again … or maybe not. But whatever happens in Washington, the issues we are discussing these next two days are important. And countries around the world single payer or not, all face similar problems. People will still be struggling to have their voices heard in the system.Families, doctors and nurses, will still need help finding solutions and making decisions. Health organizations will continue to try to find new ways to disrupt and transform themselves. Our system was “designed by default”. Our task ahead is to design a system with intention that serves people’s needs in the real world, as opposed to one which demands people to serve it with obedience. It’s up to us as individuals and organizations – to make change - to deliver health and vibrancy - to help people heal and flourish. Through Purpose-Driven Design, we have an invitation to do just that – by solving problems big and small in our health system, and asking questions like: What if the health industry collaborated with the food industry to deliver food with good nutritional value and help to change the Standard American Diet, otherwise known as “SAD”? How do we help people live healthier lives as the top chronic conditions that ale us are are also lifestyle related? How do we help people to reverse their diabetes as opposed to just helping them manage it? What if we engaged patients in the waiting room to better prepare them for the conversation with their doctor … instead of leaving them to fill out paperwork while their children run around the office? And could doctors someday soon begin prescribing apps in addition to drugs … or perhaps in place of them … that help us develop healthier behaviors? These are all ideas and projects we at Mad*Pow are working on in various capacities. And I know so many at this conference are working on them as well.
18. Because at the end of the day, we are all designers – opening doors for our loved ones in the hospital, for ourselves at work … and for the people and causes we care about. We are all designing a better future … and all of us can make an impact. So over these next two days, as you hear from speakers, ask yourself: “What is my purpose? What impact will I make? Where will I focus my life’s work?” I can’t wait to see you open that door, and walk through it.
19. Thank you! You are about to meet my source of inspiration! Our next speaker, a very special guest, will be sharing her perspective that we all have a role to play. I am so privileged to present to you, my mom, Claire... Stage notes: Clap and leave stage. Play video. Come back out clapping for mom – ask her to wave. Go down to hug her and then leave.