HXD Reflections: The Ecosystem of Bias and Systemic Change
This post is the first in a series reflecting on the recent Healthcare Experience Design (HXD) conference in Cambridge, MA. Powered by the team at Mad*Pow in Boston, HXD is focused on the future of health with a lens toward human-centered design.
When I attend big events I generally like taking my notes via Twitter, but my recent adventure to Cambridge for the annual Healthcare Experience Design (HXD) conference — the landmark conference for professionals at the intersect of human-centered design, behavioral psychology and healthcare — called for extra reflection. Below are my takeaways for those who missed it.
For systemic change, we need to rethink the role of the designer.
As systemic change was a core theme of the two-day conference, HXD got us in unfamiliar territory by introducing us to Cheryl Dahle, Founder & CEO of Flip Labs — and a leader in addressing the complex global overfishing problem. As designers, she advised using this menu of options when considering systemic change.
Walking us through complex challenges of inventory, regional sales reps, fishermen and middlemen, Cheryl’s keynote emphasized that true transition design must be community-led, and new partners we don’t think of working with must be brought into the conversation. She advised we let the “non-designers” do the ideating, while we serve as catalysts or coaches to lead them through the design process and recruit missing voices to fill in gaps where necessary.
She also recommended leveraging influence across silos. For example, if there is a financial issue with the supply chain that impacts the quality of the fish, and you’re target is making your fish healthier to eat, go to finance to gain leverage to intervene with the supply chain folks.
Start bringing others to the table in the system. Hmmm. Easier said than done. While many of the sessions at HXD showcased certain aspects of solutioning within the system, Becky Stamez (Product Innovation at Geisinger Health) energetically described her experiences tackling problems in the presence of silos, and how her innovation team reflects the ecosystem — not just consisting of designers but also doctors, nurses, informatics teams, full stack engineers and leadership. She referenced how in healthcare systems the idea of change is often viewed as risky. She described her approaches as going for “minimally destructive innovation” — or working within the complexities and risk-aversion of the ecosystem to move the needle. (Side note: Whoever is in leadership at Geisinger is doing it right for innovation. Becky reiterated innovation is structured, influenced and driven from the top down. Would love to pick her boss’ brain on their management philosophy.)
In the vein of bringing others to the table it was also refreshing to hear from Allison Sikorsky of At Your Service Psychiatry. As one of the only clinician speakers at the conference this year, Allison discussed health IT challenges demonstrating how clinician needs must be factored into workflow and UI designs. She also highlighted the weight bad UI (and plenty more) has on clinicians. One physician commits suicide every day (burnout epidemic?). Just staggering. I for one also didn’t know physicians are required to report their mental health history to licensing boards — something else she shared. Like many conference attendees I mainly think of HXD as patient-centric design, but to truly create systemic change we need to actively bring everyone in the community together to solve problems — and this should include clinicians, nurses and other staff impacted by altered workflows.
HXD and Public Health Still Needs to Permeate It’s Own Silo
For someone like me with a background in public health and digital behavior change initiatives for wellness, it is still (frustratingly) apparent that we need to get out of our own silos. The Robert Wood Johnson Foundation’s Stephen Downs smartly delivered a keynote emphasizing that we as a society need to embrace health as a core value in product design across the board — not just in designated health products and solutions. For example, what would happen if the maps on our phones Google defaulted to walking directions? Google Maps isn’t necessarily a health app, but what if the product was designed with health outcomes in mind?
This got me thinking. If the answer to successful HXD is integrating health into other, non-health products, how will we disperse the HXD mindset to designers NOT thinking about health implications or opportunities? Shouldn’t we be having this conversation at another table, taking Steve’s message to other “non-health”-focused designers and product managers?
Maybe this is our responsibility. Similar to how Read Holman explains how public health language is inherently bad for explaining the concept of prevention, and how Dr. Adaeze Enekwechi drives home how we need to make sure the social determinants of health aren’t just a passing fad, we as the public health experts and HXD “believers” need to be bolder. We need to be in conversations with other industries to share the bigger picture when it comes to the contexts that drive (and impede) health.
We need to accept and remember our biases and stay humble, v. playing big brother.
In Vanessa Mason’s (Onboard Health community member!) keynote examination of power dynamics (where power is defined as the ability to drive consequences), we were reminded of the agist, ableist, racial and other biases that remain in the design solution landscape. She warns in many cases — though perhaps not intentionally — we are widening the service disparity gaps even more.
For example, in the booming trend to design for expectant and new mothers — a population vulnerable to mental health challenges — are all of our new information products, apps, tracking tools, etc. dropping more responsibility and expectations on them? And as many designs are direct to consumer, are we continuing to only help people with money to thrive?
Similarly speaker and behavior change design expert Amy Bucher took issue with the phrase “patient engagement” that has taken hold. Though the phrase is all the rage these days in HIMSS and health IT circles, are we actually listening? The end goals we’re often working to satisfy are often about ROI, utilization rates, etc., and not what the patient actually wants. Further the phrase assumes patients want to be engaged and by default in ways that we choose.
Product managers and the design community needs to recognize we are in positions of power, and listen for story nuances and ask ourselves if we are asking the right questions. For us to successfully change healthcare, we need to come to terms with our bias and irrationality.
To this point and from my perspective as a behavioral psychology aficionado, I found these conversations reiterated the need to design on a local level, and if necessary, to fight pressures to scale. Though this is of course how everything gets funded, scaling inevitably leads us to a “one-size-fits-all” approach. The principles of behavior change/wellness design are that different populations within the same healthcare system, hospital region or member base may respond differently to different design solutions. As Mad*Pow host Amy Heymans reiterated, “if we want lasting change, we need to identify what people value and stimulate their intrinsic motivation.” And sustainability is what this is all about.
What were your takeaways from the HXD Conference? Agree to disagree on any of these points? Comment below.
