Design-thinking has come to health/care, finally, and Amy Cueva has been beating this drum for a very long time.

I’m delighted to be in her collegial circle, speaking at the conference about the evolving healthcare consumer who’s financially strapped, stressed-out, and Amazon Primed for customer service.

I’m blogging live while attending HXD 2018 in Cambridge, MA, the health/care design conference convened by Mad*Pow, 26th and 27th June 2018.

Today was Day 1 and I want to recap my learnings and share with you.

Amy, Founder and Chief Experience Office of Mad*Pow, kicked off the conference with context-setting and inspiration. Design and empathy are now discussed in health conferences, where the healthcare industry may be ahead of other sectors in embracing the concept of social impact.

Her ultimate goal: to untangle the “wicked problems” in healthcare, engaging the many stakeholders across the health ecosystem and disciplines to reinvent the systems that serve us all, inclusively.

Wicked problems, indeed: “It is only when you are lost in the system that you become aware of how far we need to go to actually change it,” Amy observed.

Sara Holoubek, Luminary Labs’ CEO, followed up with a provocative discussion about ethical challenges in light of the growing roster of digital technologies that are being applied in healthcare at a dizzying rate: AI, blockchain, voice-enabled solutions, autonomous cars, and digital therapeutics, to name a few.

She said these solutions “are all still in hypothesis” mode: we are testing them all out in real life, in real time, without having an evidence base or protocols for incorporating them safely and efficaciously in healthcare.

How do we navigate this ethical turf in a go-go innovation paradigm?

Sara’s team at Luminary Labs has been working on thorny problems that matter, in her words: with Merck and Amazon on voice-enabled tech to help newly-diagnosed patients with Type 2 diabetes; with blockchain to analyze whether the technology could be useful to solve the tragedy of human trafficking; and with AR/VR simulations to prep students on jobs of the healthcare future.

We have a “responsibility to imagine unintended consequences,” Sara believes, and in 2018 we are not at a loss for examples — like autonomous cars as a risk factor for accidents and possibly mortality.

She explained how a technology can start with earnest health-goals and result in ethical dilemmas: consider the potential for wearables to change how we improve our health, a “wonderful thing,” Sara said, enabling passive data collection. Then add a social element and, hey, you have a buddy for fitness collaboration when running. Then open up the Strava app, run on your military base and — oops! — you reveal just where you’re running on that military base that some evil-doer may want to target.

OK, then…What happens when an algorithm cuts your health care? A recent Verge article asked that not-so-unthinkable scenario.

And then there’s that woman who discovered that Amazon Alexa sent recordings of private (!) conversations to a contact without her permission.

Sara wrote an important column in MM&M magazine called “the Rise of the Health-Tech Ethicist,” which I highly recommend you read.
Sara offered six prescriptions for us to consider as design-thinking, ethical humans in healthcare:

1. Read more science fiction
3. Get to know the tech ethicists (they’re already out there working on the thorny tech-ethical issues)
4. Take (or create) an oath (like the Designer’s Oath), a code of ethics for doing right by people
5. Spur your ethical imagination
6. Join the community to share best practices, dilemmas, and learnings.

Every design decision you make has the power to lift people up or push them down, Sara warned.

Deborah Brown, who is Chief Strategy and Innovation Officer for Health in the New York City Office of the Deputy Mayor, discussed her challenging role in helping drive design thinking in public health for all New Yorkers – especially the most vulnerable citizens.

Her audacious, crucial goal: to use human centered design to disrupt inter-generational cycles of poverty and disempowerment. Simply put: “We just want to dismantle structural racism by next Tuesday,” Deborah shared.

She’s focused on the inter-generational impact of homelessness, poverty, child welfare, and foster care: the multiple structural policies and processes that place children and families at risk for poor outcomes over a lifetime. from parent to child.

“These problems can be mitigated through the process of design, which is an intellectual approach that emphasizes empathy, abductive reasoning, and rapid prototyping,” Deborah quoted Jon Kulko from his seminal article, “Wicked Problems: Problems Worth Solving.”

Adam Connor, Head of the Design Transformation practice at Mad*Pow, shared practical lessons on innovation beyond the lab.

I was especially struck by Adam’s discussion of frameworks, like LEAN, Agile, and Six Sigma, et al. “None of them is the answer,” Adam has learned. Why? “There is no framework that wil make you more human centered,” he asserted.

See Conway’s Law, Adam implored: that is that, “organizations which design systems are constrained to produce designs which are copies of the communication structures of these organizations.” That form of groupthink is anathema to person-centered design.

Performances by students from the Berklee Musical Artists for Social Impact project moved the hundreds of attendees in the room. Amy introduced the young musicians noting that social movements start with artists, and that Millennials, specifically, are integrating economic and social fabric into their solutions for the wicked problems in the world, leveraging their creativity.

I was so touched by one performer’s part-rap part-song, “We were never safe here,” with the lyrics, “Livin’ in the ghetto is a girl in stilettos…There’s always dime bags in the sand, I’m always holding her hand (speaking of her mother)…”I’m so shook I’m overlooked the cop’s are crooks.”

In a long session on Navigating the Finances and Logistics of Health, several experts shared lessons on the health/wealth paradigm: Christi Wise of Fidelity’s Health Group; Julie Rish of the Cleveland Clinic; and, Melissa Gopnik from Commonwealth. Each of these women is working to marry design thinking into financial wellness for mainstream people/patients.

Christi laid out the profile of the financially struggling American, a frequent theme of mine here on Health Populi: 8 in 10 people are financially unwell, struggling to manage money; high deductible out-of-pocket maximums are over $6,000; and, 30% of people withdrawing early from 401(k) plans are doing so for spending on medical costs “today.” Christi shared several projects Fidelity has been working on to address financial wellness: an app to help patients identify lower cost healthcare services (like MRI imaging centers); an HSA education and empowerment portal; and, improving retirement healthcare cost literacy and investments. [I regularly cover Fidelity’s annual study on retirement healthcare cost sticker shock; here is my latest take on this important report].

Julie discussed the Cleveland Clinic’s project on designing a better medical bill, detailing the organization’s design thinking on the inpatient journey and commitment to patient-centered care. The Clinic is, “Not just a conglomeration of individuals or hospitals but rather a living idea….[we will] differentiate ourselves based on our individual merit, not our titles or the offices that we occupy that we all stand for what’s right for our patient…even when the right thing may not be population.” This quote is from the Clinic’s CEO, Dr. Tom Mihaljevic.

Engage the most under-utilized and most valuable resource, the patient, Julie recommended. Ensure that you design stuff for patients, not for ourselves; and, remember that, “Designing together will get us to a better place.”

Finally, Melissa from Commonwealth shared her perspectives shaped through working with lower-wage workers who tend, due to healthcare costs and high deductibles, to delay medical care, sustain out-of-pocket healthcare costs that can overwhelm take-home pay, worry disproportionately about finances, and bring financial stress to the workplace.

The outcomes for business are formidable: “39% of employees worry about money at work,” Melissa reported, eating up three hours a week of productivity at the workplace. Furthermore, “Financial concerns depress the cognitive capacity that workers are able to devote toward work tasks,” Melissa has learned.

Where design can help these workers is to deliver personalized data, provide knowledge about the employee’s chance of getting hit with a high medical expense, and have employers “seed” health savings accounts.

Here are some of the provocative questions that emerged for me through careful listening today:

  • Are we providing the care that people really want and need?
  • How can we inspire people to want to save money for future health care needs? (Note that Americans’ savings rate ranks very low versus health citizens’ saving levels living in other developed countries)
  • How can design reach un-reachable people: the homeless, the socially disenfranchised, the lonely?
  • In a similar vein, how can design help close the chasm between have’s and have-not’s in America?
  • How can we all, working in health/care, adopt ethical guidelines akin to the Designer’s Code, to be mindful and do right by patients, health consumers, and caregivers?

Other perspectives on the day can be gleaned by searching #HXD2018 on Twitter to reconstruct the flow of the meeting’s conversations.