HealthChangers Podcast: Making Health Care Human Centered

December 11, 2018

“Personalization is always an expectation that people have…if I log onto your website, you know who I am. Going to the doctor's office…I don't have to tell them everything all over again because it should be there. My information travels with me.”

There's a shift happening in many industries with a greater focus on the consumer, but what if you're not sure who those consumers are and what they want or expect? That's where human-centered design comes in. It's an approach where businesses research consumer habits, expectations and experiences, and then use what they learned to improve their services and improve the way they interact with those consumers.

In this edition of HealthChangers, we'll be taking a look at one example of how human-centered design is playing out in health care. My guest is Nancy Vuckovic from Cambia. She's going to be sharing consumer research and human-centered design principles and how they can change the way people experience health care by putting the person first.

Nancy Vuckovic: Human-centered design is a method of problem solving that always makes sure we keep the human at the center of what we're doing. We engage the humans in the solutions that we create. We do that in two particular ways within human-centered design. One is at the very beginning of the problem, where we're trying to understand what are the needs, what are the motivations? Where are people coming from? So that we can use that information to design better solutions.

We try to take what we hear from people and not just at face value but look at the underlying reasons why they might say that and use that as the impetus for design. One example of that is say we can understand that people really don't understand what doctors are telling them when they go to the doctor's office for a visit. They might not really understand what they're supposed to be doing with the medication prescribed, let's say.

And you could say, "Well, it's because they don't understand it. We need to provide more education, so let's make a bunch of brochures and other kinds of tools that people can use." But in human-centered design, we look for the insights underneath that and say, "Well, why can't people understand it? Is it because they're too anxious at that moment? Is it because they're so preoccupied with the health concern that they have, that they really can't take that information in?"

When we go to that level of insight, we can begin to think of 100 different ways that we can solve that problem. Can we do something with the lighting or the mood in the room? Can we provide someone who can take notes for that person so they can have that information later? There's a lot of different avenues that you can use to address that situation, and that's part of the beauty of human-centered design.

But we don't stop there, because we still may not be getting it right. The important part is, as we prototype or begin to design these solutions, we take them back to the consumers. We say, "Are we getting this right? What about this works for you? What about it doesn't work?" Through a process of ongoing testing and iteration, we can get as close as we can to a product that the consumer's going to really value and embrace.

Leslie Constans: Got it. You mentioned earlier when we were talking before we started the show that you had studied anthropology. I was just curious, as you talk about human-centered design, and understanding those underlying insights, how does your background in anthropology tie into this approach?

NV: I think it provides a mindset for approaching it. One is that you're always curious, and you begin to look at the way people behave and not just what they tell you. In anthropology, it's very much about what's called “ethnographic research” - Being with people, watching what they do and trying to understand it from that perspective. Because very often people will tell you things and then their behavior seems to indicate something different.

Consumers often don't say what they mean regarding health care

“What people perceive and what they actually do can often be quite different and we can learn a lot from they do.”

One example that I can draw from my own experience is I was doing research on how people use medications for self-care. Very often people would say, "Oh, we don't use very many medications. We don't really have a lot around the home" but then if I ask to see what their medicine cabinet looked like, it was overflowing with all kinds of different medications. What people perceive and what they actually do can often be quite different and we can learn a lot from they do.

LC: Right. Staying a little bit on the topic of human-centered design, I hear about it in other industries. I'm assuming it's a principle or a practice that others use. Maybe you can tell us a little bit about your view or philosophy on how it can be applied to transform health care. We talk a lot about changing the experience of people who are going through the health care system. How does human-centered design support that and how do you see that helping change that experience for people?

NV: I think the insurance industry, the health care industry at large has largely not focused on the consumer. It's been a service that we assume people need and want and haven't really addressed more motivations or needs that drive behaviors in health care. There's a greater realization across the industry that people have expectations that are being set by their retail experience.

They know that if they go to a hotel, the hotel remembers what kind of pillow they like, and they can really understand what their needs are, and address them. They're in turn expecting that same thing from their health care providers and from the health care industry at large. We need to, in order to be competitive, we need to be think about that, and we need to address those concerns.

LC: I want to turn our attention a little bit to some of the research you've been doing. A project called State of the Consumer. Can you tell us about the inspiration behind that and how it all came together?

NV: It's difficult to be a consumer centric organization when you don't know who your consumer is. We felt it was part of our role here, along with the Consumer Insights Group, to bring forward what we've been learning from all of the research that we've done. Both of our teams have been engaged in research over the years, and have learned a lot about who our consumers are.

Our objective in this book was to pull together those insights and information so that anyone can use it as they begin to think about their projects. They don't have to necessarily engage in additional research, but they have a place to begin, so they understand what are the drivers, what are the needs of individuals that they're trying to serve.

LC: Would you say this project, this book synthesized all of that great work that you and the others have been doing?

NV: Yes. It has taken into account all of the research that we've done, and from that distilled what we are calling archetypes. An archetype is a snapshot of what an individual might be like. The archetypes are essentially profiles of how people might act in certain situations. What are the things that motivate them? What are their pain points? What are their needs? Although they're fairly static, we understand that some of the features of those are archetypes might change over time.

When focusing on a consumer, it is important to know their archetype and what they’ll come to expect

“In many circumstances, people may be highly resilient, but there may be diagnoses that affect them, or loved ones, that create changes in that. Instead of acting like one archetype, they may actually shift to be more like another.”

For example, resiliency is one of those capabilities. In many circumstances, people may be highly resilient, but there may be diagnoses that affect them, or loved ones, that create changes in that. Instead of acting like one archetype, they may actually shift to be more like another.

LC: Why is it so important for the health care industry to understand consumers and how they're changing?

NV:  The expectations of consumers are changing because of their retail experience. They've learned to expect certain things out of websites, out of the face-to-face interactions that they have, and they expect things to be personalized for them. Those kinds of expectations now translate into their health care experiences and they're expecting and demanding the same thing.

The other thing that's happening in our environment is that there are disruptors entering the health care field, who have deep experience in consumer needs, and meeting those needs.

LC:  What are some of those things that you hear from consumers, from people you talk to? What are those experiences they're wanting out of their health care experience based on other retailer brand interactions that they have? What would they like to see?

NV:  I mentioned personalization, and I think that's a key expectation that people have, that if I log onto your website, that you know who I am. Going to the doctor's office, that I don't have to tell them everything all over again, because it should be there. Those kinds of things, my information travels with me is one piece of that.

In human-centered design, consumers know what they want and work to get the solution that works best for them

“Because we're not building the solutions for ourselves, we're building them for those folks, and it's very important that we understand where they're coming from and what their needs and their world views are.”

There's also an expectation about who owns that information. There's an increasing concern about data transparency and data vulnerability, and people want to know what's happening with their data and who actually has ownership of it.

LC: What do you expect to hear from consumers when you go out and talk to them and are there any things that surprise you? Maybe there's a story you could tell us.

NV:  I am always surprised in doing research, that's the beautiful thing about it is that you're always learning something new. One of the key things that we learn time and again when we do this research is that our world, as researchers, does not always reflect the world and the experience of the people that we're doing research with. It's great to keep us grounded in the other people involved.

Because we're not building the solutions for ourselves, we're building them for those folks, and it's very important that we understand where they're coming from and what their needs and their world views are.

In terms of things that are unexpected, it's always amazing to know the resiliency that people maintain as they're going through health experiences. They find a way to navigate a system, to ask for help, to construct life hacks that allow them to maintain some level of normality in their lives, despite the fact that they may have severe health challenges going on.

LC: Yeah, that is amazing. Are there any life hacks that particularly took you aback, or you found very creative around getting around the health care system?

NV:  It's not so much getting around the health care system but making the health system work for them. One story is people who take normal, everyday things that we have, whether it be an Alexa or a low jack for the car, other kinds of things to help them cobble together a system to deal with say an aging parent who is losing cognition.

 People who find ways through social media channels about how to deal with illnesses that are not particularly well known, or addressable by traditional medical standards. People find ways to try to make their lives better, either through reaching out to other people, or just by getting creative.

 The other thing I wanted to point out in our research, a couple things that keep coming back to us are concerns about the complexity of health care and the need for us to get the basics right. They don't know necessarily what doctors to pick, whether or not something's going to be covered. Those kinds of questions, and they really, the role of insurance in their mind is helping them to navigate through those situations.

“There's some consistent needs in terms of wanting to be addressed and understood as a human that are very essential to how we need to respond to people.”

LC:  Using human-centered design, what are some of the top trends and opportunities you have gleaned from research you've done in this consumer experience space?

NV:  As part of the work that we do, we also are looking not just at what people tell us in the course of research projects, but are really trying to look for signals out in the environment, that tell us about changes in social dynamics or other kinds of technology trends that are coming down the pike, that we need to be aware of, so we can respond to and prepare for.

Some of those trends have to do with a heightened concern about trust and privacy. There are events that have happened outside of health care that caused people to wonder, "Just how is my data being used," but that translates then to how their health data is being used and some scrutiny about that.

The retail transformation of health care is a huge one that we are considering all the time, in the fact that people want more convenient services. They want upfront payment, they want easy access to things that are available to them almost on a 24/7 basis. Another one that I find is interesting, too, is the gig economy.

We're finding that many traditional health insurance projects are geared toward employer groups, but there's a growing number of people who are what are called 1099 employees, people who are independents, who may be part of small startups, but really don't have the benefit of a large employer group. They're on their own in terms of looking for health insurance, and with those growing numbers, we need to think about how that can be addressed.

LC: So, the gig economy are more independent or self-employed people?

NV:  Right. Freelancers, self-employed folks, right.

LC: Got it, okay. That's interesting. I was wondering if you could share your view on some of the actionable ways that our industry can improve health care for people and families using principles like human-centered design, putting the consumer at the center of the experience?

NV:  I think it's important to look at what the needs of your particular constituencies are. Because I think there are universals across all of the archetypes that we saw, and all the research we've done, and frankly, research I've done in the past in other areas.

There's some consistent needs in terms of wanting to be addressed and understood as a human that are very essential to how we need to respond to people. But there are also regional and other differences that may need to be addressed by specific kinds of research in those areas.

But what I would say is what we really need to think about as a health care industry is how can we personalize things for people? How can we address what they need? How can we help them to navigate through the complexity of health care? It's a very confusing thing at the best of times when people are challenged by health care crises or worries. It becomes even more overwhelming.

How can we extend a hand out to them and help them through this difficult terrain of the health care organizations?

LC: Is there anything in particular that you'd want to share? It's such a fascinating profession and world that you're in, and you're very passionate about it. I'd like to know what keeps you excited about this work.

NV: It's going back to people and talking to them. That's just the lifeblood of what I do. It's really important to me to understand where people are coming from and to learn from them. I'm always amazed at how generous people are with their information and helping us to understand things.

It's also gratifying to know that what we give them in return is a platform for talking about their issues. Many times people express gratitude as just having the opportunity to say what's on their mind. That's mind blowing for me. Going back to consumers is definitely what's exciting, and we get to be creative. What's not to love about that?

LC: Nancy, what is one thing you would like people to know about your work in human-centered design and consumer research?

NV: It's always important to keep asking why. Sometimes you may get an answer in the course of an interview with someone, for example, and you could take it at face value, or you could say, "Tell me more about that. Why is that?" That's where some of the really deep insights come from. Also, as we begin to analyze the data and to come up with concepts to keep asking each other why. "Why do you think that's a good idea?" That too helps us to stimulate the creativity and make sure that we're bringing the best to the job.

LC: I want to thank you again, Nancy, for being on our podcast today. It was a great conversation and thank you for sharing all your expertise and insights with us.

NV: It was good to be here. I was glad to have the opportunity to talk to you.

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