Inclusive by Design
When I was seven, I moved to a place where nobody looked like me. I didn’t have any friends, I didn’t know English, and I had a really weird name. Yes, my name is legally Xin Xin. In Chinese it translates to “spicy happy” and I love that my parents named me that. It was painful when other kids made fun of it and I was so embarrassed that I used an American nickname for more than a decade.
In software, my name also causes me trouble and I like to collect examples of poorly considered name validators. They exclude me from common services like booking flights, signing up for bank accounts, and posting on social media.
The products we work on significantly affect the world around us and there are serious consequences when we don’t design inclusively:
- Because early airbags were designed and tested for the male body, women and children were more likely to get injured and killed.
- Because predictive policing focuses on arrest data, feedback loops are created for low-income and diverse neighborhoods.
- Because face recognition was trained on Caucasians, the success rates are much lower for people of color
Inclusivity is worth fighting for and I’d like to share 5 principles of inclusive design along with practical case studies to help you build considerate products.
1. Think beyond buckets
Personas are used in product development as a way to succinctly capture common user characteristics and behaviors. They’re useful, but they can also spread bias, especially when they are made without research or with a narrow band of people. There are other methods:
- Bell Curve: getting perspectives from extremes. At IDEO, designers talked with children and professional cooks, and built kitchen tools that were both high quality and easy to use.
- Venn Diagram: talking to someone who is part of 2 or more groups. Someone who is African American and gay might have an unique perspective on healthcare.
- Analogous: looking beyond your industry for inspiration. At One Medical, we love financial software for inspiration on data visualization and behavior change.
- Spectrum: finding what lies in-between. Healthiness isn’t binary. Different kinds of health conditions (mental, physical, chronic, etc) completely change user values and needs.
On the future of voting project at IDEO, our team’s goal was to design an accessible voting experience for every type of voter in Los Angeles County. I worked on the interaction design of the ballot machine. One thing I thought about: how does it work for someone who can’t see?
My biggest takeaway was that blindness isn’t binary. There are people who can’t see at all, and people who couldn’t see certain colors or contrasts. They might have another condition like deafness and limited mobility. Another learning was that many people with vision impairments have more powerful hearing. They were were able to listen to narration at twice the speed. Adaptive audio speed became a key part of our audio UI.
In thinking beyond blindness as a bucket, we learned that it’s a spectrum and a superpower. I was so excited when one of my superheroes, Stevie Wonder, who is blind, used the prototype we worked on. Our client emailed us saying “Stevie Wonder is here casting his ballot… he loves it!”
2. Be wary of defaults
One temptation is to only design for the “normal” user who falls right in the middle, but this can be dangerous because it excludes so many people. One example is registration forms listing male or female as the default options, which doesn’t account for folks who are non-binary.
Getting sex and gender right is especially important in healthcare and the One Medical team worked with doctors and users to improve the way we collect this information. We realized that this default had 3 parts:
- Legal sex and name: who someone is legally. We need this info for legal and insurance purposes
- Birth and biological sex: information that a doctor needs to treat a person. For example, the exact details of someone transitioning from one sex to another.
- Preferred pronoun and name: someone’s preference for identity. Good service is about building trust. If a doctor doesn’t call you by the right name, what does that say about the relationship?
In our new registration flow, we now have fields for people to add additional information on gender and preferred name. Then on the care team side, doctors can easily view that same information. Being aware of the way defaults broke down allowed us to provide higher quality service to our LGBTQ members.
3. Seek different viewpoints
As human beings, we are hard-wired to be biased. From psychology, we know about things like confirmation bias — the tendency to search for, favor, and remember information that confirms our existing beliefs. There’s also the irrational primacy effect, the tendency to hold onto initial evidence more strongly that information gathered later on.
At One Medical, the first project I worked on was Labs. These are tests that your doctor orders. You might get your blood drawn or pee into a cup, and receive results at a later time. I drew sketches of what a report might look like: numbers, charts, and alerts that said if a result was “abnormal.” This meant that it fell out of a pre-defined “healthy” range. I showed these to users and I’ll never forget the reaction of one woman. She had a chronic kidney disease.
“This doesn’t work for me… because I will never be normal. I take these tests every month and I know they will never change.”
I realized that I was biased. Because I never had a serious health condition, I didn’t know how stressful and scary labs were. A day later, this amazing woman sent back her own sketch for a lab report. What she cared about was control and dialogue: understanding what the terms and numbers meant so she felt in control of her disease, and being able to have a meaningful conversation with her doctor about it.
Sharing my design with someone different helped me recognize the limits of my own perspective. It was uncomfortable and difficult, but completely worth it.
4. Pick the right moments
One misconception people have for inclusive design is that you have to include everyone, all the time, and that it’s too time and resource intensive. But what are the specific moments when it does make sense to bring in different viewpoints? It could be in research as you’re discovering opportunities, in scoping as you’re prioritizing which features have the highest value, or in evaluation as you’re figuring out next steps.
On a project for billing at One Medical, the team felt overwhelmed and confused by the complexity of medical billing and differing perspectives of our stakeholders. So we held a workshop for the product team, stakeholders and care teams. Here’s a selection of exercises we did in 3 days:
- Map out the current state to fill information gaps
- Set up a “Day in the Future” prototype to find potential issues
- Brainstorm ideas for product and service issues
- Prioritize features to set a minimum launchable product
- Write a launch plan together
- Share team hopes and fears
It was incredible to witness the sense of togetherness this event fostered and how quickly we were able to align. For our team, this was the right moment to be inclusive and bring our team together on a complex product journey. Here’s what people said afterwards:
“This was the piece it felt like we have been missing for the last year and a half.”
“It was a chance to dream big and then channel that into the product and process.”
“I felt that my voice as an admin [someone who works at the front desk] was heard.”
5. Embrace differences
This is about inviting people who are different to have a seat at the table. Our users are diverse and there’s always something about them that is different from the “average” person. When thinking about differences, there are many dimensions like gender, race, ethnicity, sexual orientation, disability, religion, age, individuality, and experiences.
An amazing woman called Barbara Beskind helped me realize why this is so important. She started as a product designer at the age of 89 and I was lucky to work with her at IDEO. She believed in designing with, not for people.
I love Barbara’s redesign for the walker, which she thought was unattractive and promoted poor posture. She bought ski poles from Costco and wrapped the handles with tape and cloth. This prevented blisters and gave her a better grip. Because she couldn’t see very well, she differentiated the tops so she could tell left and right poles by touch.
“Good designs are meant for everybody…I think the elderly are an untapped resource, whose input should be sought.”
When you build out your team and stakeholder groups, think about who is missing a seat at the table. Make sure you find your Barbara and include her.
Conclusion
To sum up the 5 principles of inclusive design:
- Think beyond buckets: Labels and personas are shortcuts. Consider alternate frameworks to expand your thinking.
- Be wary of defaults: What may work for most can be dangerous for some. Question norms and standards.
- Seek different viewpoints: Everyone has bias. Account for your own by exploring multiple versions of the truth.
- Pick the right moments: It’s not all or nothing. Good use of inclusive design makes the process more efficient, not less.
- Embrace differences: The minority is the majority. It’s good design and good business to design inclusively.
The last point is especially powerful because it’s so easy and comfortable to seek sameness. Embracing our differences makes our work and culture stronger, and great product are built by the inclusive processes of diverse teams.
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This a version of a talk I gave at the 2018 Grace Hopper Conference. Many thanks to One Medical, especially the design team plus the Grace Hopper attendees. Kimber encouraged me to apply, David cheered me on every step of the way, and Rachel + Sneha listened to my talk 3 times! Preethi and Kyle helped edit this article. Also thanks to folks who provided helpful feedback like Afshin Mehin and Mane Chakarian. I’m so grateful for your time!
The One Medical team is growing, and if you’re curious what it’s like working here, feel free to visit our website.
