Normally when I write a customer experience (CX) related blog post it is about something that went very wrong. After all, I’m just like most people. Something goes right I tell my husband and a couple of friends. Something goes wrong, tell the world! This time, I want to talk about the impact even a small great experience can have on brand loyalty – and how it can lead to changing hearts, minds and behaviors.

Believe it or not, despite all the multi-touchpoint experience design I do, I am 100% an in-store shopper… or I used to be.  The ability to see and touch the actual products I am going to spend my money on is very important to me, as is the money I can save on shipping. (Hey, that extra $10 can lead to an even nicer pair of shoes!).  All of that changed, of course, with the arrival of my daughter a few months ago.  What used to be long afternoons of wandering the mall for a great bargain have turned into wondering the halls of the web for…oh, say the cheapest deal on baby formula.  Sigh…

All during my pregnancy people were telling me to get ready for the world of online shopping.  I insisted that while I might break down for formula and diapers, NEVER would I be “one of those moms” who does all of her personal shopping online.  That said, towards the end, hitting the mall was not so much of an option. Resignedly, I opened up the Mac and went online.  And I hated it – with one exception… Diapers.com.  

What first got me was, of course, the free shipping… SWEET!  Then, I started to realize that they had a great selection and an easy to use website with a very quick and logical shopping cart flow (imagine that – they even got the shopping cart right)…  

But I digress.  Where I am headed with this story is that over these last few months I’ve come to realize that Diapers.com isn’t great just because of the online experience or even the live service and support experience, but because of the very human experience they provide. Here’s an example.

A recent order was, of course, a case of powdered formula. Unfortunately, one of the tins had the seal lifted, so I was a little nervous about not just using that tin, but the whole case.  I sent a note to Diapers expecting them to give me a return / exchange, but that this would probably take a week or so to process.  Not so – the response email was within 15 minutes and while short in sentences, very personal.  Not just an offer to replace the tin, but “we will get the entire case reshipped, toss the old one…” and all of this wrapped in understanding – “I can only imagine how upsetting that must have been with a new baby at your side”… And this is not an isolated instance.  I have had several very impressive exchanges like this with them. Bravo Diapers.com.

Now admittedly I’m an experience designer, so of course I want to share my big takeaways from my experience. Anecdotal and personal as they are, combined with what I have learned researching and designing others’ experiences, there are some significant “truths” here I’d like to reinforce for all you marketers out there trying to figure out how to turn new customers into loyal ones.

1) Make yours a truly human interaction – Anybody can provide standard, generic, “your business is important to us” service or support. It makes all the difference in the world when a product website or a company employee recognizes that I am a human being and would like to be treated as one, not just another customer.  This distinction – “I can only imagine how upsetting that must have been…” – makes all the difference. It makes an emotional and memorable connection and begins to create the relationship and affinity that ensures I come back for more. Remember that online doesn’t mean inhuman – it is an opportunity to be even more human. Here’s how…

2)  Use what you know and remember me – I share info with you so you can better serve me. So go ahead – show my recent purchases when I login, tie your recommendations to related items I have purchased, and be smart about it. If I just bought a little black dress from you, I might need shoes, but the odds are pretty good that I don’t need another little black dress. For example, what Diapers.com does so well is make it easy to reorder what I would logically reorder – e.g. food and diapers. And it doesn’t waste my time highlighting an order I am not likely to reorder – e.g. a specific toy I just purchased.   

3)  Make it crazy-easy to do business with you – Design your experience not from the perspective of what you can do and support, but from the perspective of what I need to accomplish and how / when / where.  Designing with me in mind leads me to trust you in a variety of contexts, not just the one I am most familiar with. Most important, keep it simple. Think about your favorite brick and mortar stores: more than likely they make it really easy to find what you’re looking for, to get help if you need it, to stumble upon other stuff you like and to check out when you’re ready. Too often shopping online is characterized by too many irrelevant choices, lousy search results, forced associations and no readily available help.

4)  Do not underestimate the impact of the little things on an overall experience – Before the formula incident, I was a fan of Diapers.com, but now I am a true loyalist. The thing that nabbed me wasn’t how fast or cheap their service is, but literally that little line in the email about knowing how upset or frustrated I might be as a new mother. Just that little bit of empathy, that human touch is all it took to win me over. Fix the problem without that touch and I’m thinking you did what was expected. Include it and you alter how I think about you.

What is probably most amazing about this whole experience with Diapers.com is that now instead of comparing online experiences to live ones I do the opposite. I am comparing live experiences to my recent online ones.  My behaviors have changed as well. I only go to stores when I have to. I shop online not because it is cheaper, but because I am finding it can actually be more human. Now that is a statement to ponder!

In my 10 years in the field of IT at a large state university, I saw firsthand how the institution struggled to keep up with and meet students’ demands while maintaining the university’s core principles and commitment to quality. Many systems and applications were conceived, completed and deployed to meet these demands, but often with minimal involvement from students. Speaking from my personal experience as both a student and staff member, I can say that the results of many of these projects missed the mark, were overly complicated, or did not address the primary needs of the students. From an experience design perspective, they simply failed to start at the beginning – Who is the audience? What do they want? How do we help them get there?

There are many reasons why universities take this IT-centric approach, including limited time, budgets, and staff resources, or decentralized units that operate independent of a larger vision. Often informed by a computer science perspective, IT departments create their own online systems to digitize their paper processes, without considering the larger experience, context, or process in which their system is used by the student. This inevitably creates more systems and functionality, which adds to the complexity of the technical environment as well as the experience of the students, faculty and staff who serve those students.

In my experience the result of this approach was that students had to use one system to register for classes, another to check grades, a third to view transcripts, a fourth to navigate degree requirements, a fifth to make payments, a sixth to check on scholarships, and so on. In cases like this, students are left frustrated, struggling to find their way through myriad online systems, functions, and services.

Drawing on XD Principles could Improve the Education Experience

So how can the principles of experience design improve this? It is a common belief that the education “industry” in general is moving to a more business-centric model, rather than knowledge-centric. This “new” business-centric model for education reflects the realities and economics of growth in the 21^st century, and more and more universities are adopting it. In a time of rapid change and destabilization, consistent and continued growth is a common way of addressing new problems via expansion of resources. There is a prime opportunity during this growth period for experience design to partner with and inform the higher education industry.

One principle of XD is particularly relevant and potentially powerful for the education community: Co-creation. Since the primary audience is students and students are constantly experimenting with new technologies, even inventing solutions in their dorm rooms, make them part of the solution. Co-creation among students and the people building the systems and services the students use would…

a)      Allow universities  to leverage the expertise and resourcefulness of their audience

b)      Engage students in solving real world system design and implementation issues

c)       Incorporate valuable feedback about what students need and want at little additional cost

d)      Create buy-in and advocacy among the student population for the solution

With innovations like Pearson’s free, cloud-based learning management system, Openclass, now available, the time is right for a new approach to educational institution IT. Using a platform like this to focus on addressing the students’ core needs would allow the limited resources available at universities to be directed appropriately, with the end result being a satisfied customer whose needs are met and whose experience is vastly improved. Bottom line, having IT organizations at educational institutions apply sound experience design principles like co-creation to their solution development process is just good business. Class dismissed.

MISI XD AD and strategist Lisa Woodley leads a workshop at a Life Sciences Commercial IT Summit. The topic: how to prepare internal teams for the changes to come and create internal advocates when a company implements new technology solutions. Based on her experience helping companies understand and manage cultural change, Lisa writes a white paper. The topic: The Dawn of the Era of iT - how new trends in information technology are forcing IT organizations to be more customer-centric, with their “customer” being the employees they serve.

I travel to Moscow to present a keynote at UX Russia 2011. My topic is Beyond the Interface to the Interaction. I organize the presentation around three of MISI XD’s 10 Immutable Truths of XD. One of the truths I focus on is #6: XD Acknowledges that Employees are People Too. Among the points I make in my presentation is that companies have come to recognize that employees are customer experience professionals’ secret weapon. They experience the customer’s issues, they generate real world improvement ideas, and they build the links between the company and the customer experience.

Customer Experience (CX) - the idea of designing the end to end, multiple touchpoint, multi-modal experience as a whole as opposed to a series of discrete interactions – has been maturing as a discipline for many years. More companies are appreciating the power of CX to differentiate their products, services and/or brands in the marketplace and to create loyalty. Titles like Chief Experience Officer or SVP of Customer Experience are becoming more common. And new CX maturity models – measures of how committed an organization is to a strategy of customer-centricity – are being introduced into the marketplace by a variety of practitioners. What has not gotten as much play as we believe it should, is the role each employee plays in contributing to the desired outcome of a great, loyalty-inspiring customer experience. As Jerilyn writes in her white paper, “If you or your colleagues don’t buy into the value of your product, your brand and the customer experience you are seeking to create, you won’t be able to live that promise when working with your customers.”

No surprise then that Employee Experience has been a major theme at MISI XD in recent months, and will continue to be as the results of our work with our current clients develop into additional insights to the power of individual employees to make or break the customer experience.

Event #1: July/August Issue of Interactions Magazine Arrives

 The cover story by Professor Liam Bannon is Reimagining HCI: toward a more human-centered perspective. I was immediately smitten by the title because this has been a theme I have been preaching to my team and anyone else patient enough to indulge me over the last 5 years. It’s not enough to involve “users” in the design and development of interfaces to technological tools. There is no such being as a “user.”  We are people who use technology. We use technology in the context of trying to accomplish something. In order to design effective interactions (not merely usable interfaces to devices), designers must design with an understanding of the broader context of use and of the person using the tool.

Bannon’s article gives this seemingly self-evident yet often ignored perspective much needed context of its own. He outlines the history of the discipline of designing human-computer interactions. (The article is a must read for anyone interested in developments in the field of HCI over the last 30+ years.) When Professor Bannon gets to the present he observes, “This perspective of ‘human-centered design’ as a paradigm shift takes the term ‘human-centered’ to mean more than simply ‘considering the user’ in technology development. Rather it places our understanding of people, their concerns and their activities at the forefront in the design of new technology.”

He goes on to point out that understanding people reaches far beyond our use of any particular technological device to include matters of ethics and shared values. Today, he argues, human-centered design means understanding what it means to be human. Great stuff.

Event #2: The Resignation of Steve Jobs

He had been on medical leave since January, yet when he formally announced his resignation as CEO, Apple stock fell over 5%. This despite the fact that he will remain the company’s chairman. Regardless of what you think of Steve Jobs – and opinions range widely – there is no denying that Apple was reborn on his watch, climbing from #287 on the S&P 500 10 years ago to battling Exxon for the #1 spot as the world’s most valuable company. Listening to one of several retrospectives I was struck by a comment made by a Walt Mossberg, personal technology columnist at the Wall Street Journal that for me summed up Jobs’ transformative impact on the world of personal computing. Mossberg noted, “He makes products for the actual users of the products.”

In a SF Chronicle article about Apple alums who have started companies of their own, Matt MacInnis, the founder of the digital textbook platform Inkling noted, “We all tend to come at things from a software- or hardware-for-a-person worldview, because that’s how Apple operates so intensely at all levels.” By “we all” he’s referring to people who founded companies with names like Electronic Arts, Salesforce.com, Android, LinkedIn…enough said.

Event #3: A Project about Employees’ Attitudes and Behaviors gets C-Level Attention

Finally, this last Friday account director Lisa Woodley wrote an email congratulating her project team for the results of their work to help transform the attitudes and behaviors of the employees of one of our marquee clients. Our experience design challenge in this case had nothing to do with the technological tools these employees have been provided. There was no reconciliation of business requirements with functional specifications to perform, no usability issue to address. The problem was that people had lost touch with the intrinsic value of their jobs, and the resulting attitudes and behaviors were affecting individual and company performance. Our team’s challenge was to help them rediscover the thread between the tasks they perform every day and the very genuine corporate mission to make the world a better place. She quoted our client sponsor as saying, “Everything is really resonating, and people are passionate about what they are saying. The work completed so far is having an impact that exceeds my expectations, and my expectations were pretty high.”

Always great to have a happy client. But what really struck me was what came next: “The outcomes of our success,” Lisa wrote, “include being invited to present our work at a meeting in October for all the CIOs of all the businesses under the [company] umbrella.” Our work focusing on employee engagement and how it enables better collaboration is going to be a topic of discussion at a meeting of senior technologists whose typical charter is to “leverage” technology in order to reduce costs (read: cut jobs) and increase efficiency (read: do more with less). And this CIO presentation will happen just a few weeks after Lisa co-leads an in-conference workshop on the importance of preparing employees for tool and platform changes at CBI’s Life Sciences Commercial IT Summit on Mobile and Cloud Initiatives; a 3.5 hour workshop about people at a conference for IT professionals.

Taken together these three events represent a powerful theme. Bannon, a professor and the director of a design center at a university, champions a more human-centric design approach largely to an audience of people who are academics, theoreticians and design practitioners. Steve Jobs is a champion of people as users of consumer electronics, commonly called customers. Lisa’s team championed the cause of people as employees. Practitioners, customers and employees – a trifecta of human-centricity. These are just three examples of what I see as a growing and welcome trend in the world of experience design as it applies to the design of technological solutions: the rise of the humanists. There’s hope for the planet after all.

Having conducted international research audits, interviews and field research with physicians over the past few years, I’ve noticed 5 commonalities of the physicians’ experience that seem to transcend physical and cultural boundaries. Understanding and appreciating these common themes can provide those desiring to do business with physicians with a foundation for further cultivating their knowledge of physicians and for developing a successful relationship with them.

1. Physicians seem to have a perpetual time deficit – while the reasons may differ – in the US a physician may be spending significant time finding a medication that is on his/her patient’s insurance formulary while a Spanish physician may be spending that time understanding local regulations – a common thread across regions is that physicians are being tasked with increasing responsibilities, more patients and yet there are still only 24 hours in the day. Physicians need tools and resources that help them work quickly and efficiently.
2. Medical school is not business school; practice management can be a struggle – for physicians who are intimately involved with the operations of their facility, practice management is a critical responsibility for which many feel unprepared. This is as true in parts of Europe and Asia as it is in the US. Physicians need advice, tools and resources to help them manage this aspect of their careers.
3. Physicians everywhere are worried about bureaucracy and legal troubles – malpractice and following regulations are concerns for all physicians. They constantly need to be on top of regulations, protocols and best practices so as to avoid legal or administrative issues. In an ever-changing medical and healthcare environment this can be a challenge. Physicians often feel very vulnerable with regard to these issues and value advice from trusted peers and experts.
4. Patient adherence remains a top concern – the challenge to get patients to adhere to treatment regimens is universal. Whether it is because the patient feels he or she knows better than the physician, or the patient has a misperception about treatment, or that simple absentmindedness leads to non-compliance, adherence is a major challenge and physicians take it very seriously. There is a multitude of patient education and compliance-related resources available. Physicians want efficient ways to point their patients toward the most effective information and tools.
5. Physicians are people too, and want to feel respected as physicians – physicians get the most satisfaction from their work when they are working with their patients, taking the time to understand their needs, and seeing them succeed through improved health and wellbeing – not when being marketed to or working out from under a pile of paperwork. Physicians have expressed that when they do not feel their patients appreciate their expertise, their time is undervalued, or when they are distracted by interruptions or burdened with administrative tasks, they do not feel respected and do not find their profession satisfying.  

The above form a preliminary understanding of the physician experience across the globe, but keep in mind there are also notable differences between physician experiences in different countries, shaped by local healthcare structure and medical regulation, culture, and the availability of technologies. Even within a single country there can be distinct nuances depending on the type of physician, the working environment such as hospital vs. private practice, and the region. For example physicians in the more rural regions of Italy have expressed feeling isolated as part of their jobs due to limited direct exposure to their peers, a distinct aspect of the rural Italian physician experience that shapes their dependence on online methods of peer communication. So what should companies be thinking about when developing new research initiatives involving physicians so as to ensure new research provides targeted insight and real value? Three things come immediately to mind.

 a)     Optimize what you know – use research dollars and time first to validate and then to probe further: Take advantage of findings like those outlined above and use new research as an opportunity to validate relevant findings in the context of your company’s specific challenge(s) in order to build on what is known. 

b)     Identify what you don’t know – fill in the knowledge gaps:  For example, some companies  have a deep understanding of physician online behaviors (which sites they go to, for which types of information, for how long, etc.) but may not have an equally robust understanding of what  motivates those behaviors, i.e. the “why” behind the physicians’ search for  online information. Many companies lack a thorough understanding of unmet physician needs, the physician’s physical environment, and the impact of influencers such as nurses and other office and hospital staff on physicians’ decisions. The key is to identify unanswered questions and prioritize the areas that will help ensure the success of the physician-vendor interaction.  

c)      Align and make research actionable – research with the company’s and the physician’s businesses in mind:  When forming key questions, think about what will be done with the answers to help better serve the physician. Start by mapping the company’s business goals to the known needs of the physician. With that alignment in place, clearly articulate the desired outcome of the research. Is the goal to identify a new business opportunity? To affirm or rebut existing concepts so changes can be made before proceeding? Thinking about the desired outcome helps ensure that research findings lead directly to specific actions that advance the company’s business goals and align with the physicians’ goals.

Effectively planned and executed physician research that leverages what is already known and focuses on the evolving challenges these professionals face benefits both the company and the physician. Keeping these tips in mind when conducting research drives toward a rich, holistic understanding of the physicians’ experience  and better positions the company to play a meaningful role in that experience.

The attendance validates that the virtual buzz about service design carries over to the analog world.  User experience professionals wondering, “What is this new shiny object?” My presentation only scratched the surface of the potential impact the service design field can have on typical experience design work. I’m eager to continue the conversation with a focus on these aspects:

• What are effective service design methods and approaches?
• What does it really mean to “do” service design?
• Who should own service design?
• Given SD is still predominantly an academic endeavor, who is most equipped to be “practicing” it?
• How can practitioners effectively evangelize SD in organizations?
• SD is still aspirational for many, so when it’s time to put those methods into practice, how can you prevent it from failing before it begins?

These are among the topics I’ll be exploring in upcoming months, so please follow and contribute to the conversations:

• http://www.twitter.com/ServiceDesignLK
• UXMatters
• http://www.linkedin.com/pub/laura-keller/3/728/b6a
• http://www.servicexd.com/wordpress/

In 2004, in a Scientific American article titled The Tyranny of Choice,  Barry Shwartz  posited a counterintuitive argument about the effects of having too many choices (e.g. do we need 38 different kinds of milk?).  He questioned why “people are increasingly unhappy even as they experience greater material abundance and freedom of choice? Recent psychological research suggests that increased choice may itself be part of the problem.”

I count myself among those who struggle with choice.  I am virtually paralyzed when handed the phone book sized menu at The Cheesecake Factory.  The only place I find an easy time eating out is at a wedding (i.e. Meat, Chicken or Fish works great). 

This idea of the tyranny of choice got me thinking about a similar phenomenon that occurs with rapid innovation and change.  The speed at which new products, interfaces and services are introduced is generally something to admire and celebrate as “Good”.  But it is as daunting as it is impressive, and there’s not always a positive experience for the customers or employees faced with all this change.

True Story: A company wanted to extend their website service into the mobility space with a new app.  Without betraying too much detail, the application was to be accessed only when a four-legged loved one gets lost.  As I read the RFP, the human impact questions of such an app started flowing: e.g. What do people do differently when they are in a state of panic?  What could be unique to a design that might help them remain calm/focused and successful in their search?  At the very least, how can we make sure that we don’t make an already difficult situation worse? Small as this project was, I really wanted to win it, as it was a great opportunity to research a rare, context-specific behavior, and one of those ‘feel good’ projects that could really help people in difficult times.   

Of course, the senior execs at this company wanted it on their iPhones yesterday and as cheaply as they could get it, so typical deadline and cost pressures were at play as well.  The good news was that my primary client knows and values the need for experience design research.  The bad news was that the competition (the incumbent agency) offered to build and fully deploy production versions of this mobile application on both Blackberry and iPhone for half the price of just our research alone.  How does one make a case for research when it’s twice the price of the actual product? 

Things are changing.  Super fast.  Rapid innovative leaps in mobile technology, ever-easier tools for building applications, cloud-based applications that consolidate and streamline development… all of these advances pose interesting challenges for the Experience Design community.  When it’s cheaper to build an application, launch it and ‘fail forward’ in a live environment than it is to do the upfront research to validate the wants and needs of your audience, your competition is developers, not agencies or large systems implementation shops.  It’s two 20-something college guys who work remotely, making money hand over fist pumping out $20K applications while we can run up that tab with a modest Discovery session.

Welcome to the New World

How do those of us who believe that design is a human-centric undertaking that benefits profoundly from research compete when innovation is in hyper-drive and the cost of failing quickly is perceived to be so much lower than the risk of moving too slowly?  The answer is we can’t compete with a “just build it” mentality. But we can change our perspective to fit the times. Here are three ideas for ‘guerilla’ tactics that can help ensure that the target audience gets a say in the experience/tools they will inherit. Note that the efficacy of each one is highly dependent upon your particular situation.  

1 – Beta research populations – Providing a new application or service to a broad audience increasingly seems to have become a contest to see who can deploy the fastest.  Well, one way to address the need for speed is to suggest a pilot program.  As opposed to putting out to everyone live, see if it’s possible to reach out to a small but diverse subset of your audience.  This is a great way to really see what people are doing with a live application, which can often satisfy the speed-to-market forces at play.   You MAY be able to do this.

2 – Managing the change – Just because you can’t have input into a design doesn’t mean you can’t help improve the impact that design has on people.  With cloud-based apps, ERPs and mobile apps, it’s likely you simply won’t have the chance to change an interface.   When the interface can’t change, focus on the people who must.  Sure, the preference is not to have people forced to ‘fit’ the technology. Nevertheless, sometimes that’s just the way it is. We have many examples of how we – experience designers working beyond the interface – helped bridge the gaps that can frustrate people and affect adoption.  You SHOULD be able to do this.

3 – Know your history – Always know what research has been done and leverage it. Don’t assume you are a pioneer in any research effort.  Certain clients, even entire industries have done their own version of research similar to what you might propose.  And there’s often general behavioral/psychological/sociological research related to the specific channel/ system/ device you’re charged with optimizing.  A little detective work can often uncover patterns and models that can help inform design.  You can ALWAYS do this.

Human evolution is increasingly outpaced by technological evolution.  Though our ability to adapt to new interactive paradigms  is impressive (e.g. even Grandma can pinch and swipe now), the pace of change has implications beyond the interface itself. As experience designers our job is to think beyond the interface to the larger context of the interaction; beyond the pinch or swipe to the human emotions and behaviors the interface is designed to serve. We can only do so if we insist on finding ways to engage humans in our design processes.

POSTSCRIPT:  It is worth noting the winning vendor for the lost pet mobile application did not successfully deploy the application, and costs were much higher than originally scoped.

Designing with a Service Perspective: A Bronx Tale 

On Thursday, June 23 at the UPA International Conference in Atlanta, MISI XD Account Director Laura Keller will be speaking about how MISI’s team of experience designers applied a holistic, service-oriented and community-centered approach to come up with a vision for the revitalization of NYC’s 4-mile long Bronx Grand Concourse. In the end, MISI’s approach – which did not include a specific architectural design recommendation – beat out 400 international architects and urban planners and landed a spot among the 7 finalists. Laura’s talk includes an overview of service design as an emerging field, MISI’s approach for the revitalization competition and the insights we gathered, as well as tips for applying a service perspective to design challenges organizations face every day.

A draft of Laura’s presentation is available here. If you’d like to learn more about why she believes UX professionals should care about service design, read her UXMatters article. For additional background on the Bronx Tale, you can read an earlier blog post on the experience.

More and more people are understanding that no single touch point in an experience is an island. In order to craft truly successful experiences, all touch points need to work together. Just ask the in-store Home Depot service rep who couldn’t even find the product I saw on their website on her system when I called from my car to make sure they had it in stock…I drove to Sears instead. Ask the Comcast online chat rep who wasn’t authorized to offer me the deal the outbound call rep offered me a week later…when I had already switched to Verizon FIOS. Call it integrated, end-to-end, 360, call it service design…whatever you call it, everyday a new case is made for taking a holistic approach to experience design. Laura’s Bronx Tale is a great example of how putting people (aka users) first just plain makes sense.

For those of you who know me, this idea of designing a better end to end patient experience rich with cross touch point collaboration and more open dialogue has been a real personal passion of mine. When it comes to serving our clients, I have to be careful not to think too big and go too far outside of the box that is our healthcare system today.  But at the conference we went as far outside that box as we all possibly could.  Our goal?  Change the conversation around healthcare as a way to improve the patient experience, create a culture of healthier people, and ultimately – lower the cost of healthcare.

So – who’s breaking the rules?  Well… based on what our speakers had to say, just about everyone is finding some rule to break.  Whether it is a health insurance company looking for new ways to engage patients in healthy behaviors or a pharmaceutical company trying to understand what it is like to be a teenager going through the transition of taking ownership of their health (and managing a life-threatening disease), everyone who spoke was experimenting with ways to get get beyond technology for technology’s sake and instead get to a place where the drivers are positive outcomes, emotion and trust, and technology is merely the enabler.

One of the most provocative presentations I was able to attend was given by Matt Diamanti from the Mayo Clinic. Titled, “People are the Product”, Matt actually opened with the existential question, “Who Am I”?  Now – you are probably wondering, what does the quest for the authentic self have to do with patient experience?  Matt’s response: EVERYTHING!  

Because our digital world has simply become too routine of a component of our daily lives.  Instead of understanding our problems in terms of the people actually living through them, we opt for a quick fix of digital plug ins… more data, more apps, more noise.  In “People are the Product”, Matt suggests that if we start with the premise that we are all, at our core, emotional beings living in analogue 3-D and that we want to connect to other emotional beings live and in person, we might come to realize that at least part of our current health crisis is because of too much data and not enough human connection (as opposed to the other way around).  He further suggests that to get back to a truly healthy physical and emotional state of wellbeing, we need to quiet the noise, unplug from the mother ship and instead, emotionally plug into those around us… other people working through the same challenges. In some ways, this may sound like nothing new.  But my response?  FAR OUT!  Because going analogue may be just about as provocative and new as it gets in this current state of avatar doctors and do-it-yourself health management.

Sure – an implementable solution has to live somewhere in between these two extremes, but as I heard from many of our speakers, it is only if we can get the conversation out to these far ends of what can be imagined that we can get to a middle ground where the solution is implementable, adoptable, measurable and ultimately successful for all of us who use the system. A system that blames and isolates may get us better prices – but not better health.  Similarly, a system that completely forgives may get us better “managed” patients – but not better sustainability and, I would argue, even poorer health.

In the end, the Healthcare Experience Design Conference wasn’t about presenting answers, it was about asking questions and starting dialogues.  It was about challenging the notion that we are even solving for the right problems in the first place.

With so many questions, I think it’s time to start working collaboratively on answers. There are multiple disciplines currently looking at the changing face of the US healthcare system holistically as well as facet-by-facet. As experience designers, I and my colleagues at MISI are actively exploring and documenting what it means and feels like to be a part of this system, and what it should mean and feel like in the future.

FYI…There’s more to this blog post, but if you are interested in learning even more about today’s patient experience and why patient’s fail to follow their doctor’s orders, join MISI on 2/24/2011 in Philadelphia at the Patient Adherence Cocktail Convention hosted by MISI, WoolLabs, and Smart Brief. Visit Wool Labs for more information or to register

Among my many healthcare-related interests is the patient adherence experience. My colleagues and I are finding there is a lot of opportunity across the industry for collaboration on supporting treatment and wellness maintenance regimens.

Drawing on insights gained from several projects involving primary patient research, we are noticing the following themes in the reasons given for why patients fail to fully adhere to the regimens their doctors prescribe.

Lack of understanding of adherence and compliance – patients and caregivers do not always fully understand adherence or compliance, and do not always understand their behavior’s impact on treatment efficacy and overall health.

Lack of incentives and motivation – remaining or becoming healthy should be enough incentive to adhere to treatment and wellness regimens, but patients often require significant evidence or instant results to reinforce changes to their behavior. How many of us have started an exercise regimen just to get frustrated and drop off after a month? Especially for conditions that can be asymptomatic, such as heart disease, or conditions that are not necessarily considered severe, such as acid reflux, seeing the benefits of adherence and maintaining motivation can be a challenge.

Lack of support – once patients receive a prescription or receive instructions on required behaviorial changes, they can feel alone, especially if the regimen is complex. They must take action, often with limited resources or tools and without even someone credible they can trust for guidance, emotional support and information. The effort can feel overwhelming.

Lack of transparency and accountability – patients, first and foremost, are responsible for their behavior, but who else has a stake in their adherence? Who should be monitoring their progress? Their physicians assume responsibility when it’s check-up time, but who should be responsible between visits? And even during a check-up, when it comes to adherence and identifying the challenges and addressing them, the physician most often relies solely on patient self-reporting. Is it reasonable to assume this process can ensure the best outcome?  

Too much assumption – speaking of assuming, it happens a lot on the part of the patient, the physician and the other players in the system. Patients can make many assumptions, such as that a medication is enough without accompanying life changes. Physicians often assume that once they have given treatment instructions to a patient the patient understands, or at least knows where to turn for additional credible information. Hospitals, pharmacies, and insurance companies often assume patients have the necessary knowledge and resources to successfully finance and coordinate care, filter through health and wellness information, and maintain treatment regimens.

These themes may not sound like anything groundbreaking, but they bring to light additional valuable questions.

How do different roles view these barriers to patient adherence?

Is what patients view as being their greatest barrier to adherence the same as what physicians, insurance companies and pharmacists view as being the greatest barrier?

What would it take to tackle each of these barriers?

What are the opportunities across the industry to support patient adherence better?

While there is still a lot to explore, there are certain areas for opportunity that are rising to the top – here are some initial thoughts:

Physicians – as the US healthcare system evolves, physicians will have to define their role as not just a healer or a gatekeeper to treatment, but as a proactive health educator and facilitator, thinking of patients holistically. (See JMH’s post on Personal Healthcare Strategists). In order to accomplish this, physicians will need the support of hospital networks, insurance companies and technology providers.

Insurance Companies – they already have the incentive to keep people healthy, but they are not fully taking advantage of the touch points they have with their customers. Wellness programs need to be better designed to facilitate patient adherence. Incentives, third party partnerships, facilitating information gathering, and the provision of meaningful and easy-to-use tools are areas for opportunity. 

Pharmaceutical Companies – pharma already diligently produces condition information through unbranded and branded outlets. However, there is an opportunity for pharmaceuticals to partner with physicians by expanding their unbranded information outreach efforts. Patients and caregivers are reluctant to trust pharmaceutical companies when information is provided through their marketing channels; however, they trust information that is thorough, credible and delivered through channels perceived as being unbiased. There is an opportunity for pharma to deliver its research-based evidence transparently through trusted information channels.

Pharmacies – big name pharmacies are quickly evolving from being a place only for medication retrieval to being a resource that focuses on customer service and provides information, as well as select treatment and preventive services, such as flu shots. Among many opportunities for pharmacies is the improvement of their communications and processes with physicians and insurance companies. They have a unique opportunity to step in on the side of making medication adherence easier.   

There are more opportunities to discuss, including opportunities for patient support networks, government sponsored programs, and services provided by commercial third parties ranging from local fitness centers to emerging social media tools. I want to open up the conversation.

What is your role and expertise? What do you think about this topic? About the various opportunities? Join the conversation – leave a comment to this post or, better yet, register for our Cocktail Convention on the topic of Patient Adherence, Thursday, February 24, 2011, in Philadelphia, PA. Come share your thoughts and experiences live and in person. Visit Wool Labs for more information or to register.