Everything's Dynamic

Solving the right problem

Sun, 22 Apr 2012 17:07:56 -0400

This new Ikea TV/Bluray/all common electronics/cabinet thing strikes me as an excellent example of solving the right problem. I think for most people, TVs and their associated paraphernalia are essentially commodities—the details and even the brands are irrelevant. The hardest part about putting together a TV-centered living room—the real problem—is making it all work together. And that’s the problem Ikea is solving.

This is also another nail in the Best Buy coffin…

There’s something about a thin layer of snow on top of ice...

Sun, 12 Feb 2012 05:37:50 -0500

There’s something about a thin layer of snow on top of ice that begs to be disturbed.

My first encounter with Danish healthcare

Sat, 11 Feb 2012 18:31:18 -0500

Last night, I cut my left index finger while cutting red peppers. The details aren’t too important, but it should be noted that the injury was very similar to one I received in college so I had a pretty good understanding of how serious the wound was.

In any case, this situation is a good opportunity to explore the differences in how I would have dealt with this situation had I still lived in the US versus how I actually dealt with the situation while living in Denmark.

Here’s what I would have done had I lived in the US:

Use a paper towel to apply pressure to the wound and keep the blood contained.
Get hydrogen peroxide, gauze, medical tape, and Neosporin from the bathroom closet.
Rinse the wound with water and then hydrogen peroxide.
Apply Neosporin to the wound.
Wrap the wound (and my finger) in gauze and use medical tape to keep the gauze sufficiently compressed.
The next day, change the bandage and repeat steps 2-5.
Monitor the wound’s status and, only if necessary, go to the doctor.

Here’s what I actually did (in Denmark)

Use a paper towel to apply pressure to the wound and keep the blood contained.
Get hydrogen peroxide, gauze, and medical tape from the bathroom closet (i got rid of my Neosporin, which was several years old, before moving to Denmark).
Rinse the wound with water and then hydrogen peroxide.
Wrap the wound (and my finger) in gauze and use medical tape to keep the gauze sufficiently compressed.
The next day, change the bandage and repeat steps 2-4.
Go to Matas, the closest thing to Walgreens that Denmark has, to get some more gauze and some Neosporin.
After not finding Neosporin or anything like it, call what is basically a nurse hotline to ask for advice on dealing with the situation.
As instructed by the nurse with whom I spoke, go to the nearest emergency room.
Remove the bandage I had applied myself and have a nurse put on special fingertip-shaped gauze along with a nice compression sleeve that goes around my finger and wraps around my wrist to stay on securely.
Receive a tetanus shot.
Get sent home with some extra gauze and compression sleeves so that I can change the bandage in 2 days.
(In the future, I plan on changing the bandage on Monday morning and then again a couple days later; if the wound has not improved significantly by then, go to my regular doctor.)

The two courses of treatment are quite different, and I think there are a few explanations for the difference:

The healthcare systems and the marginal costs borne by individuals. In the US, the marginal cost of an emergency room visit is almost always greater than 0, whereas in Denmark there is no out-of-pocket expense.
Wound care supplies are hard to find in Denmark. In the US, a person can buy gauze, medical tape, Neosporin, hydrogen peroxide, iodine rinse, etc. at Walgreens, CVS, Walmart, Target, other discount stores, and even most grocery stores. And many of these stores are open 24 hours a day. In Denmark, Matas is the closest thing to Walgreens or CVS, and their wound care selection is limited to gauze, medical tape, and hydrogen peroxide (which costs about $8 for a bottle that would cost about $1 in the US). Also, Matas closes at 6:00 pm and and is closed on Sundays. Bilka, the closest thing to a discount store, has band-aids and that’s about it. As far as I can tell, Neosporin doesn’t exist in Denmark.
Greater cultural homogeneity and greater trust in experts and top-down authority. In Denmark, for many things there is a sense of, “That’s just what you do.” It seems like everyone uses the same type of garbage can, the same type of dish towel, the same type of scrubbing brush to wash dishes…the list goes on. And since things often seem to work out for people, there’s not much of a reason to change things. The same dynamics seems to be at play for the provision of public goods, including healthcare. Taxes are very high (and getting higher), and most people seem to think they are worth it. The perception is that the system is the system and it seems to work just fine so that’s the way it goes.

So which approach is best? I like being able to do my own triage in the event of an injury like this one, and I don’t like not being able to have adequate supplies on hand to do so. Then again, I also appreciate having a professional apply wound dressing and hey, free tetanus shot!

This is a borderline case and had I not suffered from a very similar injury about 10 years ago (in which case I did go to the emergency room), I would probably have gone to the ER in my counterfactual US scenario. But at least I would have had the option of treating myself in the US. And isn’t self-provided care (assuming it is carried out competently) the best and cheapest course of action?

This picture is one of several that make up Copenphoto, a new...

Sat, 13 Aug 2011 21:19:00 -0400

This picture is one of several that make up Copenphoto, a new blog I started to capture life in the city of Copenhagen. I recently moved to Copenhagen to start a new job as an interaction designer at Novo Nordisk, so look for some upcoming posts about design, healthcare, and maybe some other stuff. As always, all opinions expressed here are my own.

Social Search as Innovation in Meaning

Thu, 28 Apr 2011 11:45:15 -0400

Yesterday, I had a sudden thought that I immediately posted to Twitter using two tweets (follow me @chrismonnier):

The brilliance of Google’s PageRank is that it uses links and such as a proxy for the trust placed in a given source. Social media scraps the ‘proxy’ part and allows people to get info directly from trusted sources (friends, people they follow, etc.).

The more I thought about it, I realized that the difference noted above can be thought of in terms of meanings (for a thorough discussion of “meanings” in the realm of products, I highly recommend Roberto Verganti’s Design Driven Innovation). Traditional search (which I’ll call robot search) has a certain set of meanings within people’s lives, while social search (i.e. seeking information using social media) has a different set of meanings.

Robot search has proven to be enormously useful and is a vital part of the online experience for pretty much everyone. And, like any product, robot search also has meaning to its users—there are emotions and attitudes associated with it. Robot search (especially Google’s traditional search) is consistent, reliable, and confident. At a higher level, these emotions and attitudes add up to a sense of trust—users trust robot search. A big part of this trust comes from the brilliant PageRank algorithm, which essentially quantifies how trustworthy the information on a given site is.

Social search represents innovation in the meaning of search. Instead of iteratively improving the robot search algorithm, social search says, “How can we deliver trust in a whole new and even more compelling way?” The result is a richer understanding of trust delivered not through an algorithm but through interpersonal relationships and interactions that leverage the credibility of trusted people. So if I’m curious about interaction design, I have come to rely upon and trust, for example, Dan Saffer (@odannyboy), as a person who thinks like me and who I can trust when he points to particular source of information pertaining to interaction design. If I’m curious about politics, Will Wilkinson (@willwilkinson)is someone I trust. For urbanism, I trust Stephen Smith’s Market Urbanism blog (@marketurbanism) I’ve never personally met any of these people, but by reading their blogs and following them on Twitter I have a rich mental model of each of their personalities, biases, and weaknesses. And as fellow humans (typos and all), it’s only natural to develop a sense of empathy for each one of them.

While I’ve come to think of Google as consistent, reliable, and confident, I don’t have nearly as rich a mental model of its personality. I also don’t have a good sense for its biases or weaknesses, and it’s hard to have empathy for such a sterile machine that always does the same thing. So social search has more substance behind the meaning that its users ultimately perceive than does robot search. As such, social search not only delivers trust much more compellingly but also delivers a richer overall experience. Social search is more than just sterile information seeking—it’s a way for users to participate in the human intellectual experience.

For example, if Dan Saffer tweets about an article and I don’t initially grok the article, the fact that Dan Saffer—someone I respect and trust—likes the article makes me think deeper about why my first impression of the article wasn’t necessarily positive. At its best, social search can enable users to engage in intellectually stimulating and challenging quests of knowledge seeking, like a good teacher challenging you to figure out how to solve a complicated physics problem.

The kicker is that in the end, this makes trust a two-way street. I trust the people in my social graph and I get a reciprocal sense of trust from my social graph, in the sense that influential members of my social graph trust their followers enough to challenge and engage their brains. This yields a perception of mutual trust, which ultimately translates into a much richer meaning for social search than for robot search.

The point is that the social search experience offers a fundamentally different set of meanings to users than does the robot search experience. Social search allows users to take advantage of their humanity and ultimately results in a richer interaction, not only between human and computer but also between human and human. Robot search is inherently less-rich and limits the interactive experience to one between human and computer.

What counts as disruptive innovation?

Sun, 13 Feb 2011 14:05:07 -0500

This tweet by Timothy Lee got me thinking:

Disruptive innovations are simpler and cheaper than than what they replace. Laptops have always been more expensive & complex than desktops.

Are laptops disruptive innovations? Well, innovation can occur in multiple ways, and I like to think of innovation in two veins:

Innovation in technology - new electronics, parts, components, etc. that accomplishes the same thing as their predecessors and do so smaller, cheaper, and more effectively
Innovation in meaning* - new and different experiences that users have when using things that in turn change how, what, and why they do things

Cellular phones are a classic example of disruptive innovation. They are both (1) clearly technologically superior to landline phones and (2) offer new meanings to their users—talk to anyone, anywhere.

With laptops, however, it’s not so cut and dry. Laptops aren’t really technologically superior than desktops, but they definitely offer new meanings to their users. Laptops facilitate portable computing, which changes the way people work (in airports, in coffee shops, etc.) and in turn has driven the demand for wi-fi (and all the cool stuff it affords) and even things like cloud computing.

Where things really get interesting is if we don’t limit the scope to a particular type of device and look at the concept of portable computing. So not just laptops but also smartphones and tablets. Laptops—by creating new meanings and experiences for computer users—have paved the way for iPhones and iPads. These devices and their ilk are the beneficiaries of laptop innovation. Without the user experiences introduced by laptops, where would smartphones be?

So in the broader sense, laptops are part of the innovation story of portable computing. They introduced new meanings that future technological innovations leveraged to become truly disruptive devices.

Of course, smartphones have introduced new meanings beyond those of laptops. Internet in your pocket, geolocation, etc. And smartphones are also technologically superior to their computing predecessors (desktops and laptops). So smartphones meet the definition of innovation in technology and innovation in meaning.

So are laptops disruptive? Technologically, no. But in terms of meaning, yes. And ultimately the innovation in meaning has helped pave the way for not just portable but truly mobile computers to become the dominant forms of computing.

* Roberto Verganti wrote the book on innovations in meaning, and I think it is an important and often overlooked aspect of innovation. I highly recommend his book “Design-Driven Innovation.”

Interested in healthcare? Check out my other blog!

Fri, 21 Jan 2011 02:33:04 -0500

If you’re interested in participatory medicine, patient engagement, or user experience, and innovation in the context of healthcare technology, please check out my posts at the Perficient Healthcare IT blog.

Thanks!

The TSA as a Design Failure

Mon, 22 Nov 2010 05:02:00 -0500

The recent changes in policy at the Transportation Security Administration (TSA) indicate that the TSA is failing as an organization. They are failing not because terrorist attacks have gone un-prevented (they haven’t), but rather because the users they serve are receiving an experience that does not meet their needs. The root of this failure lies in a fundamental misunderstanding of who the TSA’s users are and what their needs are. In other words, the TSA is a design failure.

First, I think it’s important to highlight who the TSA’s users are. In a broad sense, there are two groups of users who “experience” the effects of airport security: (1) the people inside the plane and (2) everybody else on the ground. These two different user groups have very different sets of needs when it comes to air travel. People in user group #1 need a variety of things (easy check-in, friendly luggage policies, legroom, etc.), while people in user group #2 need really only one thing—not to be involved in a crash when an airplane hits the ground or a building on the ground.

The needs of the people in user group #2 have already been met. Whether intentional or not, one of the earliest security measures instituted after September 11th was targeted at meeting the needs of people in user group #2. With reinforced cockpit doors—a relatively lo-fi and simple fix—it became practically impossible for an airplane passenger to hijack a plane and turn it into a weapon of mass destruction. The need for people on the ground to not die from an airplane being flown into the ground or a building has been met. For user group #2, the problem has been solved.

Therefore, the efforts of the TSA should be focused exclusively on meeting the needs of user group #1. The needs of the people in this group—air travelers—are myriad and include everything from the moment a person books a flight on the Internet to the moment they leave their destination airport. We can think of this list of needs as feeding into the “customer experience supply chain.”

A quick diversion about the notion of the customer experience supply chain. Originating in the design community, thinking of experiences in this way (explained at length in design legend Bob Brunner’s book Do You Matter) helps ensure that, throughout all of its various customer touchpoints, a system meets the needs of its users. Consider the example of a fast food drivethru system, in which the experience chain begins when the user drives into the parking lot and ends when the user finishes her food. An important component of a fast food drivethru system is ensuring that the customer receives the correct food. One way this could be addressed would be by having the employee at the pickup window—a key touchpoint in the system—remove all of the food items from the bag and show, in detail, each item to the customer. Remove the hamburger from the bag, unwrap it, remove the top bun to show the contents of the hamburger, maybe lift up the patty to prove to the customer that the onions are indeed present…you get the picture.

That’s not how fast food drivethrus work, because having employees dissect customers’ food in front of them is a solution that is disproportionate to the importance of that particular touchpoint. Customers would rather take their chances—which they probably know are pretty good—and just grab the bag of food and drive away. Yes, it’s important that customers get the right food, but in terms of the drivethru experience it’s not important enough to justify a dissection of the customer’s food. It is not worth ruining the enjoyability of the fast food drivethru experience for potentially preventing the occasional customer from receiving the wrong food.

Now, back to air travel. There are dozens of touchpoints in the customer experience supply chain, many related to how enjoyable a flight is, many related to how safe a flight is, and some related to both. The security experience affects both enjoyability and safety, but even if we limit the scope of touchpoints to those which affect safety (the drive to the airport, security, eating at the airport, the actual plane ride, and the drive away from the airport), we see that security is but one piece of the air travel experience chain. Add in all the other touchpoints that affect enjoyability (namely the process of purchasing the ticket, sitting on the plane, watching a movie, picking up luggage, etc.), and the overall importance of airport security on the customer experience is further lessened.

Now, obviously the stakes are higher when it comes to airport security than when fulfilling a fast food order. But just as verifying a customer’s order must live within the fast food drivethru ecosystem, so must security live within the air travel ecosystem. And air travel is inherently risky: you could die in a car crash on the way to the airport, you could die at the airport itself (e.g. from choking on some food), you could die due to a mechanical or system error on the plane, and you could die when driving away from your destination airport. Moreover, the alternative to flying—driving—is even riskier, but that’s a topic for another blog post.

It is within the context of the risks listed above that the relative risk of dying from a terrorist attack must be placed, and in turn the importance of the airport security process determined. Air travelers have, by definition, already accepted some level of risk, and unless terrorism dramatically amplifies that risk (which it doesn’t), there’s no reason for the security process to outweigh its respective importance in the experience chain*. Just as the fast food order inspection process should not dominate the fast food drivethru experience, the airport security process should not dominate the air travel experience.

The airport security process should be designed within the context of the entire air travel customer experience supply chain, with the ultimate goal being to optimize both the safety and enjoyability of air travelers. Against these metrics, the TSA’s recent “scan or grope” policy is an utter failure.

* Granted, at certain times (i.e. for a month following a terrorist attack somewhere in the world), the fear of a terrorist attack may be of greater concern than other factors, and as such the security process should be augmented slightly to account for the increased level of perceived importance among users, perhaps even some through some level of security theater.

Twitter and the cross-pollination of ideas

Thu, 18 Nov 2010 23:18:48 -0500

I just finished reading Matt Ridley’s The Rational Optimist (here’s a TED talk summarizing his main thesis and here’s an even briefer summary from Frog Design’s Design Mind) and found it fascinating. Ridley’s main argument is that humans have escaped a subsistence existence because of trade and the “sexual reproduction” (in other words, the mating of two different things) of ideas that trade fosters. So societies that trade are continually exposed to new ideas, the cross-pollination of which leads to innovation. Conversely, in societies that are isolated ideas remains tribal, expertise dies with individual experts, and progress wanes.

Last night, as I was feeding my Twitter addiction, it dawned on me that Twitter seems to offer humans the maximum-perceivable amount of exposure to new ideas. My Twitter feed is full of tweets about politics, design, usability, healthcare, innovation, pop culture, and in the last couple weeks the TSA (but that’s another blog post). I have some lists set up but I don’t really use them, instead preferring to just get all the different tweets in one big feed. One tweet might be about challenges of running a remote usability test and the next might be about the relative merits of a new healthcare proposal.

So thinking back to Ridley’s argument about the importance of star-crossed ideas finding each other to advance innovation, it seems like Twitter could end up being an almost infinite fountain of creative sparks and new ideas. Ashton Kutcher caught a lot of ridicule when he said this:

Years from now, when historians reflect on the time we are currently living in, the names Biz Stone and Evan Williams will be referenced side by side with the likes of Samuel Morse, Alexander Graham Bell, Guglielmo Marconi, Philo Farnsworth, Bill Gates and Steve Jobs — because the creation of Twitter by Stone, 35 (right), Williams, 37, and Jack Dorsey, 32 (not pictured), is as significant and paradigm-shifting as the invention of Morse code, the telephone, radio, television or the personal computer.

But the more I think about it, the more I think he might be right.

How I Voted in 2010

Tue, 02 Nov 2010 23:01:26 -0400

Here’s how I voted this year, along with a brief explanation for why I chose who I did. Further explanation below:

US Representative District 3: Erik Paulsen (divided government)
State Senator District 42: David Hann (divided government, assuming Mark Dayton wins the governor’s race; also support for school choice)
State Representative District 42B: Jennifer Loon (divided government, assuming Mark Dayton wins the governor’s race)
Governor & Lt. Governor: Tom Horner and James A. Mulder (viewpoints on economics, civil liberties, immigration; also general support for third parties)
Attorney General: Christopher Monnier (write-in; Lori Swanson is too much of an economic meddler and Chris Barden wants to require a Photo ID to vote, which is a dealbreaker)
Secretary of State: Mark Ritchie (only candidate who doesn’t tout his support (hopefully he doesn’t support it) requiring photo IDs to vote)
State Auditor: Patricia Anderson (divided government AND makes a nice (and very important) distinction between “pro-market” (good) and “pro business” (bad))
Mayor of Eden Prairie: Nancy Tyra-Lukens (probably the best person to ensure that the Southwest Corridor light rail line gets built as soon as possible)
Associate Justice - Supreme Court 2: Helen Meyer (from what I could ascertain she seems friendly to civil liberties)
Associate Justice - Supreme Court 6: Alan Page (pro-choice)
Judge - Court of Appeals 13: Randolph W. Peterson (opponent signed a petition opposing those who opposed the Iraq War)
Three Rivers Park Commisioner: John F. Gibbs (non-incumbent and claims to be a fiscal conservative)
Eden Prairie City Council: Dan Kitrell (transparency advocate) and Sherry Butcher Wickstrom (seems like an effective employee)

I consider myself a liberal libertarian, which in general means I favor limited government (limited not necessarily in size but more importantly in its scope of authority). A lot of the people I voted for are Republicans, and my primary reason voting for these candidates is because I favor divided government (I’m assuming that Mark Dayton will win the governorship in Minnesota). Recall that during the boom of the late 1990s we had divided government at the federal level with President Bill Clinton (Democrat) and Republican control of Congress. To oversimplify things, since Congress (both at the state and federal levels) has the most control over spending, I’m hoping that petty party rivalries will lead to less government expansion.

Another trend you might notice is that most (I think all) of the judges I voted for tend to be liberal. This is because it seems that among the issues that make it to the courts (social issues), I tend to favor a liberal perspective.

The Tokyo Tower, Tokyo’s answer to the Eiffel Tower....

Mon, 04 Oct 2010 00:38:00 -0400

The Tokyo Tower, Tokyo’s answer to the Eiffel Tower. Whereas the Eiffel Tower sits at the head of a beautiful park, the Tokyo Tower sits above a parking lot.

Idea for Twitter client

Sat, 02 Oct 2010 01:52:48 -0400

Sometimes I check Twitter and there’s way too much in my Twitter stream, and other times there’s too little. So my idea (which for all I know already exists) is for a Twitter client that always shows you “x” updates per 10 minutes. So if it’s a slow period, maybe it gives you tweets that it thinks you’ll like. And if it’s a rush period, it will filter the stream to show tweets from only your favorite followees.

I’ll design the UX if someone wants to code it!

No smoking while walking?

Sat, 02 Oct 2010 00:10:40 -0400

No smoking while walking?

Japanese road construction workers wearing LED vests.

Thu, 30 Sep 2010 04:44:50 -0400

Japanese road construction workers wearing LED vests.

Spiderman, protecting a street fair in Shinjuku, Tokyo.

Wed, 29 Sep 2010 02:11:19 -0400

Spiderman, protecting a street fair in Shinjuku, Tokyo.

I recently went to Japan (Tokyo) to do some usability testing...

Sat, 25 Sep 2010 02:50:36 -0400

I recently went to Japan (Tokyo) to do some usability testing and was awestruck by the volume and diversity of signage, particularly graphical warning signs. This is one of my favorites…is the sign trying to tell kids that if they try to ride the escalator (does the umbrella matter?) then it will scare them and make them sad?

Increasing patient empathy: what manufacturers can do

Fri, 30 Jul 2010 06:36:00 -0400

As discussed in a previous post, the key to getting manufacturers to have a vested interest in building empathy with them is to insert patients into the customer experience supply chain. Here is one thing hatmanufacturers can do to support this.

Manufacturers can open up their data to third parties: For devices that record and track data, the status quo works great for manufacturers and doctors. Doctors have access to the data and use it, and in so doing have feedback for the manufacturer. The manufacturer considers that feedback and may even ensure that the data provided to the doctor is usable and useful. It’s a very closed loop system where there’s a solid link between the inputs and the outputs. For many devices, this is the customer experience supply chain.

The problem, however, is that the patient is left out of the loop. Doctors may want to keep data from patients for a variety of reasons (e.g. they assume patients won’t understand it, they assume patients don’t want it, etc.) and manufacturers may have their own reasons. In the end, neither the doctor nor the manufacturer feels that much pushback from patients because—as non-decision makers—patients have little leverage. So patients stay on the fringes of the customer experience supply chain.

The problem with this arrangement is that for a lot of devices there is information that patients would find useful, if for no other reason than (as elicited in a previous post) than to gain a better appreciation for the capabilities of the device. Moreover, the very fact that patients want data but can’t get access to it is itself emblematic of a lack of empathy for patients. But given the entrenched nature of the customer experience supply chain discussed above and the manufacturer’s desire to preserve the status quo (“if it ain’t broke, don’t fix it”), how can patients get access to the data?

One way would be for the manufacturer to let other systems access the data in its devices, essentially paving the way for some other company to establish an entirely different system with its own customer experience supply chain. Except for in this new customer experience supply chain, the patient would be the focus. While this solution is far from ideal, it gives both the patient and the doctor a prominent role in each of their respective customer experience supply chains. Once this is the case, the incentives are aligned to foster an increase in patient empathy.

Image from here.

Increasing patient empathy: what patients can do

Fri, 30 Jul 2010 03:24:00 -0400

In a previous post, I explained how the unique economic structure of the healthcare market presents an inherent challenge for the cultivation of empathy between medical device manufacturers and patients. The gist of the problem is that manufacturers often sell their devices to doctors or hospital administrators, who then [usually] decide for patients which brand of device the patient is going to get. Since patients are not the decision-making consumer, there is little financial incentive for manufacturers to concern themselves with the patient experience and understand (at an empathic level) what it’s like to be a patient. Contrast this with an industry like consumer electronics, in which end users are decision-making consumers, and you can see why the consumer electronics world ends up with products like the iPhone and the medical device world ends up with products like the Monicard Home System pictured above.

Right now patients are sort of an ancillary component to what Robert Brunner and Stewart Emery refer to as the “customer experience supply chain” in their book Do You Matter?. In other words, patients do not have a significant impact on what manufacturers perceive to be the important parts of the customer experience. The key to building empathy with patients, then, is to get patients to become a legitimate component of the customer experience supply chain.

It will likely be a long time before the healthcare system is truly consumer-driven and patients are eagerly pre-ordering the latest stent from Amazon.com. So in the meantime, here are some practical ideas for how medical device patients can become part of the customer experience supply chain right away.

Patients can become effective communicators with their doctor(s): Effective communication means asking good questions (do research online before going to the doctor!) and being honest about any feedback or concerns one might have with their device, as well as being assertive and demanding that the doctor not shrug off what she considers to be a trivial issue. Doctors don’t remember everything a patient tells them (they’re human, after all), but the more feedback they hear from patients the more likely they are to pass that feedback onto the manufacturers.

Patients can communicate with each other: In a lot of industries, word-of-mouth is considered the best form of advertising. Indeed, there’s likely a lot of word-of-mouth “advertising” that goes on between doctors. Encouragingly, patients have begun using the Internet to swap stories and share their device experiences with each other. As long as patients maintain effective communication with their doctor (see above), information shared between patients will eventually make its way to doctors.

Again, the key is for patients to influence the decision-makers, and by talking with doctors about what they’ve read on the Internet (even if patients bring up a bunch of rumors), doctors are more likely to pass that feedback on to a manufacturer. In the case of errant rumors, for example, a manufacturer might use such feedback to improve whatever aspect of their system was causing the rumors to be propagated in the first place. And voila, empathy for the patient.

Patients can demand their device’s data: Just as one might expect a diagnostics report or explanation from a mechanic prior to having work done on a car, patients should expect the same level of transparency (at least!) from their doctor. I suppose the mantra would be, “Trust, but verify.” If a patient has a device that spits out data, then that patient should feel entitled to not only getting a copy of the data but also to getting an explanation of the data that they can understand. By familiarizing herself with the data, a patient is more likely to learn about how their respective device works. Patients can be lectured all day about how device X measures parameter Y and delivers therapy Z, but until they can actually connect the dots between their health and the data tracked by the device, they’re less likely to fully appreciate the capabilities of the device.

When patients appreciate the capabilities of the device, they can become more involved patients. Not only does this translate to more effective communication with their doctor (see above), it also positions the patient to take on a more consumer-type role when they need their device replaced or need to add an accessory to the device. As such, the next time their doctor prescribes a device, the patient will be able to offer an informed opinion to their doctor, something which would have a significant influence on the doctor as purchasing decisions are being made.

Next up: what manufacturers can do to increase patient empathy.

Image from here.

Why patient empathy is challenging for manufacturers of medical devices

Tue, 22 Jun 2010 06:11:00 -0400

A hot topic in the design world recently has been the importance of building empathy between businesses and their customers, a concept well documented in the book Wired to Care, by Dev Patnaik and Peter Mortensen. The basic case for empathy is actually pretty intuitive-by spending time with customers a business can better understand their needs and therefore deliver better products and services that more effectively meet the needs of customers. Formal efforts to build empathy with customers have been underway for quite some time with consumer electronics products (a classic example might be Jan Chipchase’s globetrotting research conducted for Nokia), but one area where there remain structural challenges to building and capitalizing on empathy is between medical device manufacturers and the patients who use their products.

A fundamental dynamic of the medical device industry is the disjointed relationship between the patient, doctor, healthcare administrator, and the medical device manufacturer. This relationship is especially complex in the case of sophisticated devices that are not sold directly to patients and which are instead sold first to doctors or hospital administrators and then resold (via a prescription) to patients. The following diagrams illustrate (in a simplified manner) how the sales channels are structured for a typical sophisticated medical device versus a typical consumer electronic product.

While there are some similarities between the two models (for example both have “middlemen,” the Doctor and the Retailer), there are two important differences between the two models: (1) the medical device model contains an “Administrator” component, and (2) the sales flow to the patient in the medical device model is a PUSH flow, whereas in the consumer electronics model it is a PULL flow. While the presence of the Administrator component is indeed an important part of the medical device sales model, this analysis is concerned with the effect that PUSH vs. PULL relationships have on how much weight is given to empathy for the end user at the manufacturer during product development.

In the above models, a PUSH flow represents a decision made by the giver/seller, whereas a PULL flow represents a decision made by the receiver/buyer. For consumer electronics, the sales flow model is straightforward. Consumers own the purchasing decision, and—simplifying greatly—if they value a product, they buy it. if they don’t value a product, they don’t buy it. Whether from a Retailer or directly from the Manufacturer, the flow is always PULL in nature. As such, the Manufacturer has a natural incentive to build empathy with Consumers. After all, by better understanding their Consumers, Manufacturers can better meet their needs and ultimately sell more products.

For sophisticated medical devices, however, there is a structural challenge that puts Patients one step removed from Manufacturers. For medical devices, the flow starts with Doctors and/or Administrators choosing (via a PULL flow) which devices to stock, a decision which Patients-who can only get a device through a Doctor’s prescription-are essentially stuck with regardless of their individual preferences. In other words, Doctors/Administrators (I’ll refer to them simply as “Doctors” for the remainder of this post) PULL devices from the Manufacturer and then PUSH those devices onto patients.

As a result, for medical devices Doctors emerge as the primary customers and Patients become secondary customers. As decision holders, Doctors hold a tremendous amount of very concentrated power. Naturally, this results in Doctors having a rather strong voice with the Manufacturer, who from a first-order economic incentive standpoint has every reason to bend over backwards to please the Doctors. So employees at the Manufacturer spend time with Doctors at conferences, training sessions, or advisory boards collecting quantitative and qualitative information and all-the-while forming empathic bonds with Doctors. Patients, however, end up getting short shrift, something that’s easy to justify when Patients account for approximately zero direct revenues. As marketing personnel tally their annual market research budgets, it’s easy to conclude that the benefits associated with building empathy with Patients do not outweigh the costs, which makes the decision easy. After all, why spend time learning about and building empathy with Patients when they never buy anything?

So does this mean that Patients are forever destined to miss out on the benefits that arise from building empathy? In my next post, I will discuss some possible solutions for helping empathy become a vital part of the medical device development process.

Image from here.

Disclaimer: I work for a large medical device manufacturer (not the one that made the device pictured above.)

Android vs. iPhone: Which is more open?

Sat, 19 Jun 2010 20:14:00 -0400

Guest-writing at Megan McArdle’s blog, Timothy B. Lee riffs on the growing frustration that developers have with the closed nature of the iPhone platform versus the relative freedom offered by the open Android platform. I agree with Tim that this is a big weakness of the iPhone and that—if Android ever gets its act together—this could be the Achilles’ heel of the iPhone. In thinking-out-loud about how Android could get its act together, I realized that there is one area in which the iPhone is more open than Android: the user interaction paradigm.

One of the main differences between the iPhone and Android respective user interaction paradigms is that Android has two off-screen buttons—one for moving Back within or between applications and one for accessing a Menu of actions available within each application. The iPhone puts this functionality in the screen, which whether by design or by chance ultimately leaves the decision of how to implement this functionality to the designer of each application. The net result is more user interface (UI) freedom on the iPhone. This may seem trivial at first glance, but upon further inspection I think that there’s actually something significant there.

Granted, app developers still have to concern themselves with Apple’s Human Interface Guidelines (and straying too far from these could—based on Apple’s ambiguous approval rules—result in an app getting rejected), but in practice there is actually considerable diversity between iPhone apps. The downside to such freedom is a lack of consistency, but the upside is that market forces within the iPhone App Store can function to separate the apps with bad UIs from the apps with good UIs.

In contrast, Android’s interaction paradigm (with the two off-screen buttons) is somewhat constraining from a UI perspective. Granted, there is probably a lot of diversity between Android apps, but they all suffer from the usability handicap created by being forced to use off-screen buttons. This handicap makes it all the more difficult for Android apps to truly break away from the pack in terms of user experience. A mobile platform is only as good as its apps, and one of the main things that makes an app good is a good user experience.

So I would argue that neither the iPhone platform nor the Android platform is as free and open as a mobile platform could be. The best solution would be a platform that has no constraints on how applications are coded (like Android) and gives UI designers maximum latitude for creating compelling interactions (like the iPhone).

Image from here.