Entries in Zarla (14)


HFES Healthcare Symposium: Bridging the Gap

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Healthcare is a notoriously convoluted system with many intangible issues dictated by deep-rooted cultures and significant power structures. Human factors is a discipline with the reputation of being vague, yet with tactical applications: validate this, make that safe, etc. At this year’s Human Factors and Ergonomics Society’s Health Care Symposium, the theme of “bridging the gap,” for me, meant bringing together our knowledge of complex healthcare problems in an attempt to find the most meaningful way to address those problems.

Our natural reaction to complex, large problems is to simplify them. At the symposium, I saw presentations that did just that: a presenter used multi-variate analysis to distill conversation weaknesses into clear cut themes, another used generalizing language without site-specific implications, and many others pulled frameworks of understanding from other disciplines to explain observed phenomena. But does this desire to simplify the healthcare landscape accurately reflect its reality? In this symposium, three big-picture (and very complex) issues came up frequently—compliance, obscurity, and fundamentalism—for which simple sweeping analyses could not be put in place.


During a panel discussion on challenges in home health care, Dr. Eric Dejonge of Washington Hospital Center said that the “biggest human factors challenge is getting people to take their medication.” Mary Brady of the FDA added that part of the reason why in-home treatment is so difficult is because patients in need of home healthcare don’t necessarily consider themselves sick, rather they view themselves as “aging in the home.”

Chronic illnesses, like heart disease and diabetes, which require sustained long-term care (i.e. treatment therapies, home assistance) are a big financial strain on the healthcare system (and on family caregivers). Remedied through medication and lifestyle adjustments, it can be difficult to get patients to fully comply with treatment because it brings into question their autonomy, and without many acute symptoms, they’ve become accustomed to a different quality of life.

Human factors professionals are crucial in highlighting significant patient-initiated barriers that impact the design and development of medical devices and applications. The essential message behind patient compliance is that just because something is designed to be safe and effective, doesn’t ensure it will change a patient’s likelihood to use/leverage it. However, because compliance is a well-known problem, we can begin to understand it and create solutions to approach it (accountability features, gaming mechanics to encourage participation, etc.)


Being such a large entity, the minutiae of everyday events in healthcare become lost or condensed into generalizations of “how the system works.” How can human factors attempt to lift this veil of obscurity and identify the real problems that need to be solved? One way of doing it is expanding our methodology toolkit.

In sociology, there is a field of study called ethnomethodology, which looks at large systems of structure that maintain societal order. Ethnomethodological studies uncover the real problem that exists in society, not just the problem that makes it into record-keeping. For example, what may be recorded at a hospital is the incidence of a particular illness, to which our natural inclination is to find a solution for that illness. Ethnomethodology attempts to examine the motivations behind how that illness became a recorded event in the first place.

Ken Catchpole of Cedars-Sinai Medical Center presented an example of how adverse events (recorded mistakes) become documented. In this process of documenting an adverse event, what doesn’t get captured is what he deems “the more important close-call.” That is, the event that could have become adverse. In a subtle way he references a need for ethnomethodology to understand the healthcare landscape. In this case, he suggests that we need to solve the “close call” episodes using our human factors expertise, and not simply the recorded adverse events.


No complex system, like healthcare, is complete without structures in place that allow it to operate. The key quality of these structures is having a hard line perspective on “what works” and a resistance to changing the status quo. This resistance is most visceral when introducing new technology into a clinical setting; however, it is also seen in the human-to-human relationships and interactions.

Dr. Lucian Leape of the Harvard School of Public Health talked about the individualism stronghold among doctors, which enables a culture of disrespect in clinical settings. Disrespect, he argues, is rampant and widely the norm. At the same time, clinical settings have evolved into teamwork-reliant systems. However doctors are trained to make executive decisions, trumping all other input streams, should they feel the need. The legacy of individualism in a teamwork setting makes other team members feel bad about their work, discredits their efforts, and leads to a breakdown in communication. It has been demonstrated that these seemingly small interpersonal issues have a greater impact, which can compromise patient safety.


“Bridging the gap” for me, meant bridging the gap between the obtuse landscape in which healthcare human factors specialists must operate, and the desire to have simple and actionable solutions. Dr. Leape, in his highly inspirational and eye-opening speech, also mentioned that as treatment and clinical environments have gotten safer, they have introduced layers of involvedness that impact healthcare professionals and therefore patients. As human factors specialists, we need to leverage our notoriously vague disciplinary standing and attempt to identify complex issues and weaknesses in the system, and solve them in the most impactful way (which may not be a design or development solution, for example). This symposium was a great first step in getting folks to reexamine the utility of human factors and what it means in this setting: rather than being unnervingly vague, it can be refreshingly open.


Putting the Cart Before the Horse? Social Media for Innovation


Using social media as a tool to generate insights and innovation can be generative, or it can bog you down in mounds of data with no effective or resourceful way to do meaningful analysis. This was my biggest takeaway from the MIT Enterprise Forum panel From Social Insights to Social Innovation. The panelists included Betsy Aoki (Bing), Ekaterina Walter (Intel), Nathaniel Perez (SapientNitro), Marcus Nelson (Salesforce), and moderated by Francois Gossieaux (Human 1.0), and was peppered with social media anecdotes, a few swear words and a slight air of cyncism. Maybe cynicism is a strong word, but I walked away with the sense that in using social media for innovation, we're putting the cart before the horse. We're celebrating a solution to a problem that isn't quite understood.

 The panelists at the MIT Enterprise Forum's discussion From Social Insights to Social Business Innovation, September 21, 2011


The problem we are trying to solve is that we need to come up with great ideas faster, and these ideas need to be beautiful and more in-tune with consumers (because consumers are getting more thoughtful about design). Social media has played a key role in certain facets of product development and redesign. For instance, Betsy Aoki gave the example of eliciting user feedback through social media streams to help fix bugs in initial launches of Xbox Live. However, when the conversation came down to using social media for the purposes of innovation, we got some great one-liners like:

If you pay people $100 to give you ideas, you will get ideas worth $100.

It's death by committee...if you get a lot of ideas, you're going to get a lot of stupid ones you need to weed out.

Social media for innovation is, in its simplest form, an opportunistic use of a well-established and genius appratus for bringing people together. There is already a captive audience that has selected to rally behind your brand (friended you on Facebook, etc.), and to many marketing/design/user experience folks, it seems wasteful to ignore this captive audience. However, social media for the purposes of driving innovation is forgetting one of its foundational principles: the element of surprise! Maybe I'm biased, but I'm all about contextual research, which attempts to seek out those surprises that we could never get through a structured entity that opens the floodgates to data points (not real insights or great ideas). The biggest challenge to the panel is figuring out what to measure in the plethora of data they get through social media. As of right now, what they know they can measure is engagement (how many times people talk about the brand, engage with the Facebook page, etc.) But in terms of sifting through data to find ideas, it's still nebulous. 

Innovation or marketing ploy?

The panel briefly touched on some more successful attempts to reach into the crowd to get good ideas. I won't name names, but some big corporations with newfound interests in sustainability and responsible design have been using social media to reach out, pleading with customers that they need help solving 'big problem x.' Come to find out, many of these pleas have nothing to do with any arm of that corporation that deals with innovation, rather, they are just big marketing campaigns. This plea is just a way to get consumers ramped up behind the brand's new messaging and to test the waters for launching new ideas already created internally. Sneaky, huh? According to the panel, what makes engagement with these faux-innovation initiatives so successful is the fact that they have a dedicated purpose, often use a platform that reaches out to people full of good ideas and have boundaries (deadlines, rules). Sadly, many of these faux-innovation intiatives end up hitting a wall because they were created for the sole purpose of delivering a message, not implementing the crowd-sourced ideas.

So what's the big lesson? Is social media useless when it comes to gathering meaningful insights that could lead to innovation? I'm not yet convinced of its utility. But I do think we should stick with what we know about social media for now: it's a great way to get people to like your brand and want to get to know you. It's very human.


A side note...

As an aside, in this discussion, there was a lot of reference to 'early man' as an explanation for much of the social behavior that we've identified as interesting to design around. For example, the claim that "we humans love status and power" is interpreted from the archaic descriptive social behavior of "seeking out better mates and better food." We love to assert these claims because it gives us permission to be self-defeatist about our 'baser' pursuits. Does saying that we love status and power therefore allow us to pursue status and power with the same zeal that early man would toward better mates and food? I just wonder what's the point of looking backward to explain the contemporary, and possibly inform the future. It's just bad science: we define who we are today by looking at the past. But since we didn't live in the past, we can only understand the past if we've defined it...we're defining something which is based on something that's defined. 


Social Science Recap [July 15-July 29, 2011]

Sorry for the delay!

Social Science Recap--July 15-July 29, 2011 Interesting internet finds linking anthropology, sociology, psychology (other ologies) to design, user experience, and technology. In this post: ethnography iPhone app, does Google+ have the more accurate Social Networking approach? Designing for culturally iconic products.

Ethnographic data gathering using your iPhone! Ethos, an iPhone app started by ethnographer Siamack Salari, was just relaunched.The app allows companies looking to do consumer research, reach out to their customers to submit videos of the way that products, brands, services, and other experiential information on these topics fit into their lives. Ethos is offering a 30-day free trial, so jump on it--it's a pretty penny without the deal!

A review of Google+ on Fast Company. Referencing the input of social science that informed the Circles feature in Google+.  SIDE NOTE: I am so not impressed by numbers. Numbers are relative, so why is it that we gasp and applaud at the rapid adoption by 10 million people of Google+? I wouldn't expect anything less from such a ubiquitous entity...let's come up with some new metrics that can gauge success, or whatever message we're trying to convey.

Moleskine: Designing for Cultural Objects. Tricia Wang of CulturalBytes talks about Moleskine's new line of auxiliary products to support the iconic notebook. She ponders about other iconic objects that speak to our culture and what can be designed for them to support it's cultural ecosystem.


Social Science Recap [June 30-July 14, 2011]

Social Science Roundup--June 30-July 14, 2011 Interesting internet finds linking anthropology, sociology, psychology (other ologies) to design, user experience, and technology. In this post: proving 'retail therapy' as a method to fix negative feelings, useful mechanics for cooperative gaming, authentic materialism, sustainability barriers, and culture influences biological studies...

There is a reason why the term 'retail therapy' exists. A recent study by Atalay and Meloy in Psychology and Marketing shows that a person's bad mood does increase the number of spontaneous purchases one makes. Stopping oneself from using shopping as a form of therapy to feel better is only successful if stopping oneself improves mood.

Game mechanics to enhance cooperation. Travis Ross at Motivate.Play wrote an interesting blog post on game mechanics that can be used to satisfy gamers who want to partake in "unselfish play." Real life social dilemmas such as pollution, and overuse of non-renewable resources generally are spawned from doing what is best for ourselves and not necessarily what is best for others. Known as the n-player social dilemma, acting selfishly may have negative consequences for society at large. Ross explores game mechanics, adopted from social science theory to inform the design for cooperative games.

Stories of objects you love. The Portland Museum recently launched a website chronicling people and the objects they love. It makes me think about the random things I love, and why--like my sewn-together green Care Bear that my mom made for me before I was born. That thing is tattered, but sitting on my bed stand!

American need for space in conflict with sustainable design? Katherine Frederich claims, on Scientific American, that American's need for personal space is in direct conflict with major charges by environmentalists: reusing something, and minimizing non-renewable energy consumption. People don't want to buy clothes that other people have worn because it's seem as a violation of hygienic standards, and people want to live outside of the city for some peace and quiet. She offers a couple of solutions to these two problems, but takes a very one-dimensional view into what environmentalism is all about.

Gender and sports. Rosemary Joyce (awesome anthropologist at UC Berkeley, I listen to her iTunes U Podcast!) recently posted an article on genderizing sports, on her blog. Differentiating the sexes in sports is probably a recent phenomena (maybe late 19th century). Sport was all about competition, which promoted excess--a masculine trait. The bottom line is that suddenly biological (empirical) studies were coming out supporting the claim that men's and women's muscles are different and thus sport competition should be different for both. Just goes to show the power of culture over something like biology shaping lived reality. My favorite quote from those early studies was that women have more "expressive muscles," which are better suited for making "elegant movements."


Social Science Recap [June 15-29, 2011]

Social Science Roundup--June 15-June 29, 2011 Interesting internet finds linking anthropology, sociology, psychology (other ologies) to design, user experience, and technology. In this post: apps that show you that you're a blabber mouth. Claims can become fact pretty easily, a case of a scholar being called out. Channel your inner Zack Morris/Jessie Spano and check out old technology. Tall grass jewelry? And many more...

Click to read more ...


When you ask users to design... stifle innovation by giving the voice to the "just make it work for me" user, and not the creative designer.  Yes, I tend to agree with this statement, and that's why when you do "co-creation" activities with users it's often not centered around innovating something, it's centered around getting out unarticulated needs. 

In a recent Fast Company article, Jens Martin Skibsted and Rasmus Bech Hansen argue that companies are choking innovation by conducting user research. At least, that is their argument if you read only the titles in the article, which I'm sure many people will do.  If you read the actual content of the article, you will find even more absolutist language that merges two entirely separate concepts into one--innovation, and user research--and then argues that they should not be one concept.  It acts as if user research is one methodology for innovation, and that creative minds is the other methodology for innovation (the ol' "genius designer" argument), and that the former makes for less successful innovation.

I'm not sure where to start with this article because I'd first have to point out several claims it makes as being untrue--the first one being that user research doesn't ask users to innovate.  The authors conjure up Steven Spielberg as an example of a creative person, and question the reader if Mr. Spielberg would need to do "intense user studies" to gather insights before creating a movie?  Maybe not...but he does draw his inspiration from somewhere--often times real life.  I wonder how that's much different than knowing for whom you are designing?

I'm fine with their main argument:  that innovation often comes from creativity.  What I don't agree with, is their black and white methodology link to achieve innovation being through user research or just a great idea.  That's not exactly how user research works, and it's often not why user research is carried out. 

My biggest gripe with this article is that it has the potential to be taken at face value (someone may just read the article headers), and used as a resource against user research as a part of the design/ideation process. 


The Most Powerful Brands in New England

Protobrand recently released a report on the most powerful brands in New England.  ESPN made the top of the list (I'm surprised it wasn't Dunkin Donuts).  They predict that most powerful brand for next year is, get this, WWE. The report uses interesting graphics to communicate their findings, and you'd be surprised at some of their findings (particularly in revenue differences--take a look at Subway and Dunks).