Let’s talk healthcare design: Amy Bucher
Whilst Amy Bucher works at a design agency, you probably won’t find her playing around in Sketch. After an academic background and completing her PhD in Organizational Psychology, she’s now Mad*Pow’s Behavior Change Design Director in Boston.
We caught up with Amy to hear about her current role, and how healthcare designers can introduce behavior change techniques into their work.
What’s your current role and how did you get there?
I’m currently the Behavior Change Design Director at Mad*Pow, a design agency in New England that focuses on healthcare, financial well-being, education, and social good. Most of my career has focused on healthcare design, somewhat by accident. After finishing my PhD in psychology, I knew I wanted to apply behavior science to make immediate impact in the world. I landed a job with an agency that did training and research for pharmaceutical agencies, and was hooked on the health angle. My whole reason for moving away from academia was to have more direct effect on the world, and I found that health was the fast-paced, meaningful area where I could do that.
From there, I went on to work for HealthMedia, a startup out of the University of Michigan, that was ultimately acquired by Johnson & Johnson. After seven years there, I did a short stint at CVS Health on their digital specialty pharmacy team doing strategy. I was lucky to be exposed to a wide variety of health design through these jobs, from consumer products to connected health to pharmaceutical products and specialty medication adherence.
You’ve spent a lot of your career working with in-house teams at companies like CVS and Johnson & Johnson. Now you’re at Mad*Pow, what’s it like being agency side?
I love it! I find that I thrive on a fast pace and having a variety of challenges. I like that I can have some longer-term projects but also some briefer, more focused engagements.
I was able to experience a lot of that in the J&J part of my career. At the startup I was part of, HealthMedia, I worked for our Specialty Solutions team developing custom health interventions. J&J was actually a customer of ours and decided to acquire us and bring the digital technology in house. Part of their approach was to make us an internal capability that worked across J&J businesses. So while we did have our own SaaS product line that I worked on, I also had the chance to consult with many other J&J companies about their challenges. It was one of my favorite parts of that job and what made working with Mad*Pow so appealing.
I’d say a drawback to agency life is not necessarily seeing a project through to launch. We do projects sometimes where we do formative research, or some aspect of testing or development, but don’t necessarily stay on board through execution. That said, it is really exciting to see something you’ve worked on out in the wild, like when my airline tray table had an ad for a sleeplessness coaching program I worked on at J&J!.
What projects are you working on at the moment?
One major project on my plate right now is preparing for a full day behavior change design workshop we’re offering through our Center for Healthcare Experience Design. I’ve been putting together the curriculum and activities with a focus on making the workshop really usable for participants. My goal is that attendees can go back to their jobs and immediately use one or more new tactics they’ve learned on their projects.
I’ve also been involved in a project interviewing people in hazardous work environments about their safety behaviors. We’re trying to understand that gap between what people know (how to follow proper safety procedure) and what actually happens in the workplace (momentary lapses that can turn into serious injuries). Our research will ultimately help our client develop a new approach to training. A challenge there, which is common with any interview project, is that people don’t always have insight into their own behaviors (or they may not want to give voice to “bad” behaviors). Coupling the conversations with observations can help alleviate this.
You’ve written about the similarities between designing for behaviour change in healthcare, compared to other industries. Have you come across any specific challenges which were unique to healthcare, when designing interventions?
I would say one thing unique to healthcare is understanding the health condition or medical need someone’s dealing with, because it may change the types of behaviors you’d consider appropriate for that person. An example I encountered was building condition management tools for congestive heart failure. Normally you’d recommend people keep themselves well-hydrated, but with CHF, doctors often ask you to limit fluids. You’ve also got health conditions that present particular behavior change challenges. Anything where people need to self-inject, for example, means you have to think about training and coping with phobias and fears.
The physical environment can also be especially critical in healthcare. I don’t think we often advise people in finance or education to do much that is really physical, but exercise is one of the most frequently recommended behaviors for a host of health conditions. But in addition to people’s physical limitations, you also have to think of practical and environmental concerns. What if someone doesn’t live in an area with sidewalks, so taking a walk is unsafe? What if someone’s work and family responsibilities give them very little time to work out? And of course, what if someone does use an assistive device that means gentle low-risk exercises like walking aren’t appropriate? You really need to be aware of the physical person and environment with health in a way you don’t for other areas of design.
What advice you could give to a designer starting their first healthcare project?
The best advice I’d give to anyone starting their first healthcare design project is to get involved with the primary research, even if you don’t consider yourself a researcher. Ask to observe any interviews or focus groups that are being done as part of the project. Read through survey results and especially any comments on those surveys. Whatever your team is doing, ask to be part of it. (Since you’re new, you can always say you need it for training and orientation!)
If there aren’t formal research activities as part of the project, fake it as best you can. Go read through message boards and condition-based social networks. Ask for and study any research your client or company has related to the users of your project. Talk informally to people you know who have experience with that area of health. There is no faster way to grasp the complexity and importance of healthcare design than seeing the people who will use it. I find it really motivating, and it helps me learn about the problem space way more effectively than reading or talking to subject matter experts.
What roadblocks should they look out for and how can they overcome them?
A challenge I continue to struggle with in healthcare design is balancing what we know people should do for their health against what they want or are willing to do. As a psychologist, I know how important autonomy support is. If we want people to change their behavior and keep up that behavior change over time, then they’ve got to be doing it for their own reasons. And that means we can’t just deliver the list of ideal action items and call it a day.
It can be frustrating to be in the “expert” position and know what someone should do and watch them not do it. I have two tactics I use to cope with it. The first is focusing on ways to make whatever I’m designing really engaging, because if people want to interact with it, it makes it more likely they’ll start to adopt some of the recommended behavior changes. The second is looking for opportunities to develop a conversation with the user, whether that’s a real personal interaction or if it’s something we can mimic in an app or experience. The key is to see if you can help people unpack their own reasons for wanting to be healthier, which then would put them in a better psychological position to make changes.
What’s a good starting point for healthcare designers wishing to start integrating behaviour change methods in their work?
This is a great question. I think as a true starting point to bring behavior change into your work, the best thing is to talk to people who’ve got experience in the space. I believe in the apprentice model of learning in general, and if you want to ramp up quickly and get things done well, the fastest way is to get an expert in and then learn everything you can from them. And that’s not just advice for beginners; several times in my career, I’ve been lucky to work alongside someone a lot smarter than me who’s taught me how to do my craft better.
A mistake I see newbies committing is not knowing what they don’t know — a weird sort of unconscious incompetence. Because everyone lives the human experience, a lot of psychology feels intuitive when you hear the theory for the first time. It’s like, “Oh, that explains everything I do and think!” And it’s natural to assume that because that surface description resonates with you, that you really understand the whole theory. Often the devil is in the details, and not realizing that leads a lot of people to make sloppy decisions around the behavior change science.
Here’s a simple example — behavioral economics and “nudging” are really popular right now, and it includes this idea of anchors. If you provide people with a value, an anchor, then their decisions are skewed by it. So someone might say, I’m going to recommend that you work out 200 minutes a week, with the idea being that the anchor of “200” will get people to work out more minutes than a lower anchor of “100.” Well, that’s all good, but it doesn’t account for other psychological dynamics where if people feel a comparison standard or anchor is really out of reach, they’ll mentally discount it and just do nothing. That 200 minutes anchor might work just like you planned it for someone moderately active, but it’s going to demotivate the heck out of a couch potato.
So it all gets back to my first piece of advice — talk to the experts whenever you can.
What are some of your favourite design (or healthcare design) resources?
This may be unexpected from someone who has a PhD in psychology and is equipped to read primary source research papers, but I love well-done pop psychology books. They are the quickest and most engaging way for me to keep up on the field and often include lots of real-world examples that bridge psychology and design. I was also recently struck by Yu-Kai Chou’s Actionable Gamification: Beyond Points, Badges, and Leaderboards, which is not a psychology book but was an utterly unique take on layering games, psychology, and design into a framework.
In terms of conferences, there are a bunch I really like. I have to mention HxRefactored (http://hxrefactored.com/), which Mad*Pow co-sponsors, but not because I work here! I attended the very first HxR years ago and have gone nearly every year since. It’s one of my favorite conferences because of how it explicitly ties together design and health, and it’s also how I came to know about Mad*Pow. I’m also a fan of UXPA Boston, which I find very well-curated and important to help me build out other parts of my skill set. Even though it seems a bit overdone, I also like the TEDx conferences. I presented at one when I worked at J&J and found it a really positive experience, and I like that they craft the talks to be short and compelling.
And finally, what’s coming up for you that you’re excited about
On the personal side, I’m planning a bucket list trip to Argentina that I’m thrilled about. I love to travel but I’ve never been to South America. We finally decided to stop talking about it and just go.
Professionally, we have a few new projects on the horizon that I’m excited for. I can’t get into a ton of detail, but one of them is a large behavior change program to tackle a health issue I’ve done a lot of work on in the past. I’m excited because it’s a chance to mix things up a bit, to preserve the best of the work I’ve done before but also update my knowledge and experiment with different ways of getting to good outcomes. I’m also co-facilitating a behavior change design workshop at HxRefactored in June with Dustin DiTommaso that I’m excited about. We’re going to apply behavior change design to the challenges of healthy aging, which is such a critical issue. I think we should get some really intriguing insights from the workshop, and hopefully ultimately find a way to apply them to helping people.
Questions from James Turner and answers by Amy Bucher who’s Behavior Change Design Director at Mad*Pow.
DesigningHealth.care tells stories from designers working on the front lines of healthcare transformation. Want to take part? Drop us an email at hello@jamesturner.co.uk.
