Interview with Renato
Valdés Olmos — Head of Design at Honor
Healthcare + Design Episode #2
In this episode of Healthcare + Design, I interview Renato Valdés Olmos, head of design at Honor. Honor helps older adults continue to live at home through connecting them with loving care professionals in their area.
Renato discusses the healthcare startups he has been involved in and his journey to leading design at Honor, he explains Honors mission to change the home care industry, his personal motivation for being a designer in healthcare, the vision he sees for his design team at Honor as they continue to scale, and tips he has for younger designers and startup teams looking to help change healthcare in the US.
Can you explain your design career thus far and how your journey has led you to Honor?
My first job in design was when I was sixteen, it was not by luck it was privileged as hell. My dad, he’s retired now, but he was a doctor that was one of the pioneers in nuclear medicine. He was one of the leading doctors at the Dutch Cancer Institute, which is the leading cancer hospital in the Netherlands and one of the most important ones in Europe. They were looking for a UI and interaction designer so I joined that for a few years. That’s where I started working in healthcare as a designer for the first time. This is 15 years ago and back then design in healthcare and health tech was a complete afterthought. I mean just the fact that they hired a 16 year old designer to design EPRs and patient trial systems already shows how they thought about design. I continued my career after and spent most of my time teaching myself graphic design and visual design. Through that job I really got interested in service design, user interfaces, and very complex systems.
I applied to a design school back in the Netherlands and did my masters in interaction design. My graduation product became my first company. It was called Cardcloud. We built a mobile business card sharing app and it was quite successful back in Europe. The biggest competitor in the US was Bump which was a similar app. In the end, Cardcloud got acquired by a enterprise firm in the Netherlands. Right after that I started a company called Human. Human was much closer to health tech again. I started Human because I used to be very obese when I was younger. I lost a whole bunch of weight and I was like “alright I have this talent to build companies, assemble teams, and do spiffy designs”. Can I combine that to make an app that changes people’s lives in a much deeper and more meaningful way? So that became the premise of Human, like can we make people move more through a habit changing app. We built this super simple activity tracker with a very beautiful design and we started stressing on how to design for people who wanted to change their habits. It was really successful and we actually made people move significantly more through that app.
I decided to move full-time to San Francisco and that’s where I ran into Seth Sternberg, our CEO here. Honor wasn’t even called Honor yet. We didn’t have a name. I met with him very briefly and he pitched me this amazing idea and I thought I need to be a part of this it’s very important. He said he needed someone to lead product and brand. The challenge in this space is absolutely immense from an entrepreneurial perspective and as well as a design challenge. I joined and became head of design. The rest is history.
You won some awards for Human. Did Seth know your work from Human and what you did there? How did you find one another?
Partially yes, that obviously helped that I had a background in building health companies. The real connection was way weirder. Back when I was still building Cardcloud, I got in touch with the guy who ran Bump, our main competitor in the US, Dave Leib. We became friends and ultimately Cardcloud got acquired by a European company and Bump got acquired by Google. Dave, my friend and the CEO at Bump, started working at with Seth at Google. Once Seth exited Google to start Honor, Dave was one of the first investors. Dave told Seth, “I know who you are looking for” and he made the introduction and that’s how it happened.
What is Honor and why have you chosen to design in healthcare?
We connect families who have older adults that require in home care with the best caregivers in the industry. In home care (not medical in home care) is basically helping people with daily activities. At some point in your life, you are going to have trouble taking care of yourself. Things are going to happen to your body and your mind that will make everyday life a lot harder. By everyday life I mean getting up out of bed, washing the dishes, changing light bulbs, but even things like washing, grooming, and medication reminders. All of those things will require more help. In the current market, or the old market, there are over 40,000 local agencies delivering care in the United States alone. It’s a huge market and it’s extremely fragmented. Nobody really knows what home care is and nobody wants to get in. It’s a very stigmatized and ugly market. Partially because these home health aides are paid close to nothing. They are paid extremely low wages and with some of the companies taking the larger cuts of the payment. This leads to immense problems because if you have somebody going to your home that needs to work three jobs to make ends meet their mind is not going to be around providing the best care. We thought there’s this huge fragmented market that’s completely untouched by technology. There is huge problems on all ends of the spectrum. We want to reinvent this whole space and start from scratch. In order to do that, we assembled the best team possible to build this and the best investors possible. We basically said, “okay we are going to redesign home care from the ground up with a clean slate. The way we want to be treated and hopefully at some point ourselves as well”.
Are there any personal reasons or stories behind why you want to design for the elderly and home care industry?
It’s definitely a combination of both. Everybody has a story like this. The problem with that from a bit of a made up perspective is we don’t like to think about our own mortality. We don’t like to think about death. We don’t like to think about how we are actually going to exit this world. That’s why we have all these sad stories of our family members passing away in horrible ways. I remember this with my own grandparents. Two of them passed away from cancer, the other one suffered through alzheimer’s, and my parents are at an age right now where me and my brothers are starting to think about what happens when they can’t take care of themselves anymore. It’s definitely something that is at the back of my mind continuously. From a professional perspective, it’s an insanely huge market. It’s significantly larger than the taxi market, to give you an example. It’s still untouched by technology and specifically high quality design. When you think about home care there isn’t a single brand that pops into your mind. You don’t really know where to start as a consumer either. Once you know that you or your parent needs home care where do you start? You probably are going to start at the hospital or with a doctor or through some other occurrence that is somewhat related to disease. That just leaves this massive challenge from a design perspective as well. When you look at the current companies and products operating in the market it’s all very bleak to be honest. Talking in designer terms, every single company is using these condescending stock photos of “poor little old people” with nurses and hands on the shoulders and everyone is smiling and it’s oversaturated and just really horrible. What I really want to do is create the first national healthcare brand. The aging industry is the perfect platform to do that.
What are some of the challenges you’ve encountered during your time working at Honor?
The challenges have been absolutely insane. From a product design perspective, when I started building the product with the engineers, as the first designer, it was the most complex system I’ve ever built. We have several different relationships. To give you an example, a lot of people compare us with Uber. They say “Honor is Uber for home care”, but the way we operate is completely different. The needs of the customers are completely different. It’s not as simple as needing a car right now to take you from point A to point B. That on-demand matching is actually quite simple compared to what we need to do. We have these super intricate schedules of older adults that could range from a couple of hour of care per week, to 24/7 care shifts. We need to match those ups with our care professionals who also need to have constructive lives. Most of our care professionals are mothers themselves. They have their kids to pick up from school and we want to treat them in a very respectful way with high wages and everything else. Balancing that out and making sure that we have a match so that scheduling and distribution systems works well was one of the biggest challenges I’ve ever faced. However, we figured it out. We piloted properly and iterated really quickly on product. Now we have an algorithmic based system that automatically matches customers with care pros in the best way. That was, from a system architecture perspective, a huge challenge.
When you look at our users, for example, we have a three way user system which is already super weird. We have our care professionals, our older adults that need the care, but we also have adult children who want to stay in the loop of their parents care process. The account owner is not necessarily the care recipient but they can be. Designing a system for all of these players was another huge challenge. Then, of course you have a whole group of blue-collar workers who have never used a smartphone in their profession at all. Caregivers have never used a smartphone to do a better job so designing an app that they are able to use really quickly, understand quickly, and that will allow them to do a better job was a huge challenge as well. The way we did that was to make sure that everybody on the product team became a caregiver volunteer. They spent, at least, half a day volunteer caregiving with older adults in San Francisco. That really shows you how those interactions take place and what you can and what you can’t do. This kind of empathetic design is really crucial to design and ship products for very specific people. Designing that app was a huge challenge and then of course you have product design on the side of the older adults and the side of the adult children. All in all, we have over 7 products right now that are taking care of this caregiving journey.
You also have the brand side which is a huge part of my work at Honor. How do we turn an industry that is negative and guilt driven and turn it into something that is more uplifting and empowering. So focusing on what our elders can do instead of what they can’t do. We need to make sure this already negative experience of somebody not being able to take care of themselves anymore, a little bit more uplifting. Those are all massive challenges.
What ways were you able to really understand the home care space and the users you were designing for? Any more examples like making the product team volunteer as care volunteers?
I think it’s common sense. The caregiving part makes total sense and we uncovered details that you just don’t get when you design behind a screen from a silo. The other part that is really crucial is to make sure you higher an extremely diverse team. By that I mean, diverse in terms of what their professional background is. The way we operate here is very fluidly. We don’t have a team devoted to iOS or a team dedicated to web or anything else. We have specific problems that we need to solve and we assemble a task force with a team that is perfect for that particular job. Through that process we build particular features and ship new things. Part of that is we had to hire the best people from the caregiving industry to fill positions here. People who have managed care in the old industry that tell us exactly customer interaction takes place, how specific assessments take place are really helpful. This helps provide different perspectives away from the siloed perspective of a designer or developer. It’s a combination of becoming your user but also working with people who have a lot of experience outside of your field. I started out with, pretty much, close to no knowledge at all about home care and no we are all home care experts here which is quite a big deal.
How big is your design team at Honor? How do you manage that team? How do you interact with the developers?
The design team is five people large on a total of 50 people in total at headquarters. It’s pretty significant for a startup at this stage. As a founding team, Seth wanted to put design as an executive role rather than something that comes later. I really love how we implemented that because as a design team we get to influence everything that is happening at the company. This is really that multidisciplinary approach where the recruitment teams benefit from the design team, the care operations team benefits from the design team. This is how we operate. I have two dedicated product designers, two dedicated marketing/communication designers right now. They all work together very collaboratively. I manage part of the product team as well. It’s quite embedded so our designers are embedded with the engineers and we treat is as one product team. We all sit together. The designers code, for example. We embed people with whatever is necessary right now. We try to keep it as silo free as possible and keep the organization flat and fluid so people don’t get stuck in their roles and responsibilities. We hope this allows their minds to think beyond their regular responsibilities.
Many head designers managing design teams don’t get to design themselves anymore. Do you still get your hands dirty and help design or are you mostly managing the designers designing the products?
Absolutely. I still get my hands dirty because I don’t think you can lead product design or brand teams without knowing what the fuck is up today. When I started working on Honor, I designed everything on my own and once we started processing those things I started finding the right people to work on those things and that allows you to do stuff quicker. What you need to do as a design leader is start designing through others. Identify the things that these other people are really good at and then design through them. The most important thing for me is I gather intelligence from all the other executives within the company. We have our business objectives and by knowing really deeply what’s going on with the pulse of the company and being able to relay this data to my designers and engineers really allows for a better design process and product. Of course we are still a startup so sometimes you are very low on bandwidth so when I need to open up Sketch or code a website I will gladly help with that stuff. As we progress, it’s gone more and more hands on to more top level stuff.
What does the design process look like at Honor? How do take something from an idea to a fully implemented feature?
It’s a mix of common design practices that I have been applying throughout my career. The processes definitely look different not from when we started. We started out with a whole bunch of really good product assumptions because we have a very seasoned team. We didn’t make any startup rookie mistakes on that front. Right now we have a solid system of scheduling and delivering this care. It’s a combination of problems that need to be solved because we are scaling and growing extremely fast and that brings a plethora of problems that we need to solve as designers. We are basically the fire squad. Then we have these objectives of features that we want to roll out, perhaps optimizations or redesigns of things that we have already shipped but tend to work slightly different when they are in market. We try to spread our time 50/50 between those things but in some months it’s like 80/20 and some months it’s the other way around. It’s like when you’re designing and operating in a company that grows this fast, you need to be very self aware because it’s like organized chaos. You need to be ready to step outside your regular responsibilities. If you see something is going wrong, I expect my designers to step up and fix that. That doesn’t necessarily need to be a design problem immediately but that is kind of the dynamic in which we work right now.
In terms of how we ship features, like I said before, we assemble a task force of the people that are required to solve that problem. For example, one of the things we did in the beginning was quickly build a branded UI kit. This is something that allows us to prototype super fast and engineers can pick and match UI components very quickly to build stuff. We go from concept, which is usually just a bunch of sketches, to a full fledged high quality designs really quickly and then the design team prototypes these things really quickly. We test that with care pros and customers as fast as possible. Then we bring it into engineering, refine, and ship. This process usually doesn’t last longer than two weeks. We move extremely fast because the designers I have in house right now have their dedicated tasks and specialities but I really encourage everybody to be generalists as well. They learn new skills continuously and I think it’s really important to invest in personal growth of the team as well. Whichever things they want to learn, I make sure that they get a stipend for that. If they want to become better at prototyping or motion graphics, for example. Continuously investing in the development of your team members is really important for continuous quality of work.
You said your designers code. Are you taking your sketches straight to a coded high quality prototype every time on your design team?
Hayden: In an interview I watched, people were comparing Honor to Uber and Seth was very purposeful in saying, “Honor is a relationship business, not a transactional business”. Really hitting on service design and it being all about the care professionals.
From a service design perspective, how do you find the best care professionals and what does the onboarding process look like?
When we started designing the service, the first thing that I did was map out literally every single human to human interaction scenario that we had. Anytime humans would interact with each other we had a scene for that and we mapped all out that to the product road map and part of that of course is care pro onboarding. We have the best people in the world as well who run our supply chain. They onboard the care pros. It’s very easy to design for something like this when the mission is so good. The mission really was: we need to pay our caregivers a respectful wage and we need to design products that will allow to them to do their work better. Part of that is becoming a caregiver, so that you know what you are actually doing throughout the day, and part of that is making sure we spend a lot of attention to the details. In the old industry, caregivers are not treated well at all. This is from onboarding to the way they are distributed to clients. We make sure everything is handled respectfully. We call them care pros because they are actual professionals. We are educating them as well. We made the decision to make all our care pros employees earlier this year. This allows us to train them and make sure they become better at their jobs through apps and training programs. The ability to provide really high quality materials and a fantastic recruitment website helps. The design team is also responsible for all our videos, for example. Shooting actual care pros talking about the Honor product are already things that a lot of companies just can’t do. These are things on how we actually improve that but it’s also the way we have designed the application process/funnel and designing tools that allow us to onboard users more quickly. Of course you are always dependant on external factors, like background checks and legal verification, that contribute to the speed of things and it not being instantly. Part of it is just keeping your eyes open as a designer continuously. Where do you see bottlenecks happening? This is so important in a hyper growth company. Once you see things slowing down, as you scale up, make sure you pay extra attention to that so you can so that you can come up with a solution. The same things happens on the care pro end.
Speaking of bottlenecks, there are a lot of regulations in healthcare. Are you running into that with the home health service Honor is providing?
In healthcare companies you need to become best friends with your legal counsel and lawyer. That is exactly the case here. That goes back to what I talked about in terms of multidisciplinary teams and cross collaboration within the company. We have a lot of regulations to comply to and California is even more strict than any other state in the US. The way to go about that is to include your counsel super early in the progress and get back to that person with prototypes and include them in the design process as well so you can find the optimal balance between what are we allowed to do and what is the optimal experience for the user. Once you let one or the other overpower the other, you can get in trouble legally or the user experience becomes horrible because there is too much legal intervention. Finding that balance is extremely important and the only way to do that is to include the counsel in the design process and that is exactly what we do.
You have a lot of users to care for with the elderly user, the family of the elderly person, and the care pros. I’m sure you have a lot of data coming in all over the place. How do you design with all that data and use it to make informed design decisions to empower users?
Data right now is extremely powerful. It’s really our special power. When we started out we had nothing but average and generalized industry data and you just have to make good assumptions based off that. Because we were all seasoned founders we were are able to do that. The cool part of building Honor in this day and age because they are so many amazing tools out there that allow you to get insights super quickly, even if it’s just a small group of users. We started implementing Google Analytics, Mixpanel, and Looker, for example. We are very enamored with Looker app right now which gives us super ingrained details with insights on how our customers are using the app. It allows us to uncover things that we didnt even think of. Day to day data and usage directly influences all of our product decisions without doubt. There is, of course, the vision and common sense of where we think we should be heading but in terms of day to day operations, data tells the truth. When we ship something, we know whether it’s effective or not pretty much immediately. Having the tools today that allows you to get that data in real time without having to do to many calculation after the fact is super helpful. The bottom line is it allows you to move 10 times as fast.
Where do you see yourself and Honor going in the next 5 years?
I think it’s pretty obvious that we have high ambitions for Honor. I don’t want to get into too many strategic details but in terms of how I personally see that, I think it’s important to create an environment for people to really develop themselves. I want to create room for personal growth rather than just focusing continuously on that growth curve, which is obviously still really important. You can only keep that up if people in your company continue to grow professionally in the same way. I hope that we will be able to scale up the processes that we have and scale up the already really great mission driven culture that we have here. Everybody who has joined the company, so far, wants to solve this problem. It’s extremely difficult it’s mega unsexy. The fact that we have something really helps but it’s still mega complex and hard. Sometimes it’s not as low key as building the next photo sharing app but the impact you have on people is extremely huge. Making sure that we scale up the processes and the organization that we have right now to be able to operate once we are really huge is going to be my biggest challenge. Personally, I really hope to be doing what I’m doing but just at a larger scale in the future. Still designing through others and making sure others can do the best job while enjoying themselves is my personal mission.
Hayden: When you start talking about that vision and mission it gets me excited because that is exactly why I am interested in healthcare and design. I’m a senior, so I’m seeing a lot of my friends, specifically in Computer Science and Informatics, going to work for higher paying jobs in the next sexy consumer photo sharing app, sexting app, or whatever. However, there’s a whole other side of it over here like healthcare and all these regulated and crappily designed products that are affecting millions of people.
Yeah exactly it really needs to happen. When you look at the healthcare industry right now, especially the products in the healthcare industry, they are designed on super small budgets. They are user unfriendly. This is not the future that I have in mind for my parents nor myself. We need to solve all of these problems in order to advance as a human race as well. I am happy that you say that because we need a lot more people like you. I remember very well when we got a text from a care professional who was able to move out of a shelter and into her own apartment because of Honor. These things are deep deep effects you can have on people’s lives. Also, the letters we get from families are the best. We have a lot of unfortunately, customers that do receive end of life care and building the relationship between the caregiver and the family reaches to such an extent that we get these letters from families after a family member has passed away praising the care pros saying they stayed there until the last moment. This is something that we tie back to the whole onboarding process and also care pro support. These are people that are building up quite intimate relationships with our customers. They are their everyday and they see them until the end of their lives which also has a huge mental impact on the care pros as well. It’s not just a person after a few weeks of care. These are all things that we keep thinking about and these are huge problems that need to be solved in order to support this aging wave that we are going through.
You talked about how Human got you personally healthy. How do you yourself remain healthy today?
It’s really necessary because things here are absolutely crazy. We move so fast and Monday to Friday usually feels like one day squished together and to keep up that pace you need to stay healthy. I have my gym routine every morning but we just kickstarted an Honor running crew so on Tuesdays after work we have a small crew who will do a lap around the mission in San Francisco. It’s really important. I try to cook at home as much as possible. The trap of Silicon Valley is everything is on demand and instant gratification, however it’s not always the healthiest options although there are a lot of healthy options available. Cooking and being in touch with ingredients really helps mental health as well. It’s like mediation.
As a designer, where do you get your inspiration from? Are there any companies inside and out of the healthcare space that you are inspired by?
Within the healthcare space there is very little inspiration to find expert from other startups like Omada and Amino are doing amazing jobs. They are really great companies with amazing design. For me personally, I always look for inspiration outside of the field because I think that healthcare needs inspiration from other fields in order to get fixed. I personally get my inspiration from the fashion industry and science fiction is really important to me. For example, I take the design team on a monthly excursion to see a museum. Those are also things that provide different perspectives and insights. The creative mind needs nourishment continuously in order to stay creative. It’s very hard to get into the creative vibe like that it doesn’t happen like that. It takes awhile to get in there and then you’re stuck in there and then you emerge from there and it’s like “ahh”. You need to keep feeding that in order to stay productive. Science fiction movies and literature, comic books, fashion shows, I do all that stuff to stay inspired.
What’s some advice you can give to young designers or younger startups struggling to design inside the mess that is healthcare in the United States?
I think stepping outside your comfort zone to solve a problem is really important. Designers are a very specific type of person. It’s always stereotyped and cliche about the things we like and dislike. It’s causes a lot of positivity yet limits you as well. If you want to solve a problem, specifically in healthcare, apply founder mentality and own a specific problem. This means diving as deep as you can to understand what exactly is going on. Become the user. Don’t be afraid to talk to people and befriend people in order to get to know more about the specific problem you are solving. Specifically in healthcare, if you want to get noticed, apply a radical approach to a specific problem. Try to solve it in a way that is completely differentiated from anything else that’s out there. It might not always lead to the best result but it will get you noticed for sure. Healthcare is so broken that it’s almost impossible to pick where to start, it’s almost better to start with something super small and expanding on that then try to tackle something that really requires a large team for. When you are an individual designer, it can be something as simple as giving a redesign to an age old system.
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