As I’ve continued to develop material for the Design for Care project, I’m struck by the difference between design for practice and design for individual health-seeking. In designing for practice, ethnographic research and work domain analysis enable us to understand the range of activities and scope of work performed in professional work. A rigorous analysis of an activity system enables us to design services and information products that fit the work practice and cultures of use.
Professional work is highly consistent, at least within institutions. As with other high-hazard, complex skilled work, healthcare practice is regulated by law and professional societies.
While we can study medical and patient care practices in situ and on paper analysis, we will usually never design in the first person. We, design researchers, are not health professionals. And when we are, as many physicians by training are professional informatics specialists, we must separate our personal interaction needs from those of the designated practice being designed for.
Designers must always maintain a cognitive on-guard system to ensure we don’t “go native” and believe we have the perfect solution. Or, we may start to fixate on a given solution or pathway based on early concept successes or insufficient research. This is a well-known occupational hazard, and I have created different routines to ensure design and research are kept at a safe distance from each other. If I am leading research, I might have an associate perform the majority of design, giving us a dynamic collaboration. The client might allocate their designers to rendering new concepts, which research can critique. Or we exchange design leads between research cycles, work in parallel concepts, and so on.
But now consider designing for the health consumer. Assume that is you, and from time to time, all of us have compelling health seeking need situations. So what do we do when we are essentially designing for situations we are ourselves subject to? How do we maintain designerly distance when we are at health risk ourselves? Should we take action and build a new disease or condition-oriented community? Can we design experiences and services in the first person context?
Industrial designers are often the quintessential first-person designers. It may be one of the defining differences between complex systems design and the design of things. In ID we are drawn to design things we already love (cars, bicycles, kitchen tools) and we are taught to design for ourselves as primary users. We know what we want. In the world of things, there may be plenty of other choices for consumer. Often the selection between one car and another, with all common features considered, is style and grace. Online services may have fewer competitors, and to get the interaction wrong may cost the business model. And in health services, adopters can get harmed if the product incurs error situations or is puzzling to use in times of stressful use.
Consider people that live with diabetes. Many product designers are clearly first-person, or are close enough to the daily care requirements of diabetes to be a first-person designer in the situation. How do first person innovations come to market in the huge, regulated insurance or government payer healthcare system?
One way is that designers and health seekers take action. The market for diabetes innovations could be much better indeed. The recent Diabetes Mine innovation contest (for which I was a judge) just ended, with $21K in 3 first prizes given to three deserving contestants. IDEO will be helping them with formulating stronger design proposals and making their concepts market-ready. These winners were:
- Finn the Glucose Fish, a practical, ready-to-go design for a portable kid’s glucose monitoring kit. This one suggested the start for a simple system around which a platform or other products could be built (since not every kid will want a fish kit, forever!)
- Test Drive, a glucose reading-dependent vehicle interlock that requires the input of a good glucose measure to enable a diabetic driver to start the car (in this case, designed for parents with teenage diabetic). While this idea may not have a large market, may have some readiness issues (and I have concerns for its level of control) we believed this to have true social merit. The application could extend to commercial drivers, commuters, professional uses of vehicles and could lead to better insurance coverages for these drivers (or pilots).
- Zero, named perhaps for its perfect ring-like shape, the most innovative concept and perhaps the least ready for prime time as well. It was well conceived and envisioned, and sets a high bar for the vision that future products might aspire to.
Most of the finalists in the Diabetes Mine contest were clearly first-person design concepts. If I studied the diabetes health situation, and perhaps if I simulated the everyday experience, I might be better prepared to propose a meaningful design concept. It is not a matter of user-centered design. An experiential gap exists between authentic health seekers (patients) and non-patients. The non-patient will not have the awareness, the sensemaking of situations, and the motivation to design the breakthrough in a domain of personal healthcare. We do not have the authentic need to create “health hacks” that help us get through the day and live with our pain, regimes, schedules, discomforts and supports, care communities. The distance from health hacker to health designer is closer than we think.