HXD 2020 Day 1 Summary

Mad*Pow’s annual Health Experience Design (HXD) Conference kicked off with workshops and a leadership forum. The rest of day one covered topics including LGBT patients and cancer, restoring humanity to healthcare, designing a culture where all bodies belong, and many others.

Leadership Forum

Adam Connor, Mad*Pow

A diverse, creative, thoughtful group of thinkers and leaders from across the health and wellbeing ecosystem met to discuss the challenges facing design and innovation practices in organizations today. The first round of small-group conversations covered how to lead in times of uncertainty, with attendees sharing that they were focusing on fostering human connections, leading by example, and sharing a message of resiliency. Next, groups discussed best practices for innovating in a risk-averse organizational culture. Strategies shared included: commit to transparency, establish a north star for guidance, enable creativity, and incorporate all stakeholders into design work. Attendees left inspired and supported to take action and push themselves and their own efforts in their organizations.

Motivational Technology: Applying Self-Determination Theory to Digital Health

Workshop: Dustin DiTommaso, Mad*Pow

Dustin DiTommaso, SVP of Behavior Change Design at Mad*Pow, started the workshop by ensuring session participants had a clear understanding of the terminology and concepts that would be used during the session. “We’re looking to create the conditions by which people can motivate themselves,” he said. DiTommaso further explained that when we think about motivation, we think about its link to behavior. Behavior is anything we do in response to internal or external events, and it can be affected by capability and opportunity. Motivation is especially important in health and digital interventions. Motivation needs to be present along with capability and opportunity in order for people to initiate and sustain behavior over the long term. For many health outcomes to occur, behaviors need to be done more than just once. They need to be occurring over and over again in order to get benefits. To help participants grasp these concepts, DiTommaso led a series of group exercises that challenged participants to examine their opinions regarding motivation versus the facts. DiTommaso shared motivation and behavior change techniques (MBCTs) that could be used, with a final exercise that encouraged participants to break the mold in what they’ve seen in standard or traditional practices.

Unthinking Design Thinking: An Adaptive Approach to Inclusive Problem-Solving in an Era of Rapid Change

Workshop: Lauren McAuliffe and David Franke, Mad*Pow

COVID-19 has sped up digital innovations in companies out of a sheer necessity to innovate quickly; however, David Franke, Client Experience Director at Mad*Pow, advised that when working to change the culture of innovation in an organization, sometimes we need to intentionally slow down and create a culture of personal maturity and trust. For Franke, personal development precedes organizational development. Humans operate out of a fundamental need for safety. We embrace change as long as we can say, “I’m going to be ok.” Creating an organizational culture where individuals are encouraged to be creative means allowing people to be curious and innovate without fear of failure or that the consequences of failure will mean that they aren’t ok. We need to show up to allow people to be ok with uncertainty. Ultimately, personal development precedes organizational development. Franke referenced Dara Blumenthal, PhD, and her “Generative Team Design” graphic as a helpful example of how to approach innovation and change. The session included several breakout sessions for attendees to talk about how their organization approached innovation and to brainstorm solutions to problems they are having in their organization.

Writing for Health Literacy

Workshop: Marli Mesibov and Rick Allen, Mad*Pow

Mad*Pow’s Marli Mesibov, VP of Content Strategy, and Rick Allen, Director of Content Strategy, kicked off their virtual interactive workshop by defining health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” Health literacy can then be broken down into three levels – basic, intermediate and proficient.

• The basic level is centered around the idea of using plain language. By avoiding jargon, unnecessary words, being too formal or too technical allows content to come across as more relatable. Following these points can improve audience interaction and comprehension with the content.
• The intermediate level encourages patient interaction with their health. By comprehending the language and words, a patient is equipped to interact with a provider to ask questions and gain a better understanding about their health.
• At a proficient level of health literacy, a patient can evaluate and analyze more complex information in order to make health decisions. The key is to create content that at the very least helps people get to a basic level of understanding about their health.

Ultimately, the goal of health content is to build empathy with an audience by balancing being professional with being human.

Opening Remarks

Amy Heymans, Mad*Pow

 To kick off the 10th annual Health Experience Design (HXD) conference, Heymans shared her perspective on how to set a new baseline after the COVID-19 crisis. At Mad*Pow, the focus is on improving health experiences and health outcomes through design and innovation. Empathy is core to the philosophy and function of human-centered design and can be the guide in driving the change we want to see. We can imagine a better future through purpose-driven design, which moves human-centered design past micro-utility and toward social impact at the systems level. First, we clarify our purpose, considering social responsibility and the impact our decisions have – both positive and negative. Then, we design for context through a human-centered and inclusive approach, and we leverage evidence, behavior science, and the psychology of motivation to focus on changing the real-world behaviors that will lead to improved outcomes. Finally, we identify and work with others who have shared objectives – collaborating across the ecosystem to design for scale and systems-level change. Heymans closed by reminding attendees that the individual decisions we make will affect our teams. The efforts our teams make will affect our companies. The steps that our companies take will affect the lives of many. The collaborations we launch will orient a new direction and set a new baseline for the industry. Watch Amy's opening remarks:

The Same Only Scarier: Cancer Care and the LGBT Community

Keynote: Liz Margolies, National LGBT Cancer Network

To begin this session, Margolies asked “when it comes to cancer, does it matter who the owner of the tumor spent Valentine’s Day with? Or if an ovarian tumor belongs to a transman?” When it comes to sexual orientation (a label we give ourselves) and gender identity (our subjective experience of our own gender), it does. LGBT people are the second only to African Americans with regard to discrimination. When discrimination is combined with uneducated providers and other barriers to care, it results in higher instances of mental disorders, serious health problems and lower life expectancy – as much as 12 years lower in communities with high levels of anti-LGBT prejudice. Currently, LGBTQ+ people are more vulnerable to COVID-19 due to increased tobacco use, higher rates of HIV and cancer, and barriers to health care. And for those LGBT people diagnosed with cancer, they experience more distress, worse functioning, and lower satisfaction of care. After treatment, they frequently report poor or fair health. The National LGBT Cancer Network offers a Reexamining LGBT Healthcare toolkit, which includes simple, clear steps for improving healthcare for LGBT patients. To learn more, visit www.cancer-network.org. Watch Liz's keynote.

Digital Health and Clinical Nutrition - Closing the Care Gap

Keynote: Karolina Starczak, Nutrimedy

Nutrition is often associated with weight loss and other kinds of diets, which makes the majority of people skeptical. Medical nutrition therapy (MNT) and registered dieticians (RDs) are often new concepts; however, MNT uses biochemistry to create standardized protocols based on how different stressors – from burns to infection – affect the metabolic reactions that happen in our bodies. The nutrition care practiced by RDs has been studied for over a century, with findings that show a 50 percent reduction in unplanned hospitalizations for patients with cancer, a 25 percent reduction in overall length of stay, and a 31 percent reduction in the risk of starting dialysis among patients with chronic kidney disease (CKD), to just name a few. In fact, up to 50 percent of hospital patients are malnourished, yet only 20 percent of hospitals have a nutrition screening process. While most physicians champion MNT, there is still a gap in nutrition care due to low supply of RDs, unsupportive technology, uneven reimbursement, and lack of personalization. To reimagine nutrition, Nutrimedy has developed an evidence-based approach to make MNT as efficient as possible for patients. Nutrimedy’s app uses an intake form to build a personalized plan for users, and then helping users understand their progress. As Nutrimedy works to bridge the nutrition gap, collaboration on upcoming research is encouraged.

Health x Design Challenge Winners

During last year’s HXD, CHXD launched the RWJF Design Challenge, Bringing Health into Everyday Life. Prizes were awarded to two teams – one that addressed the problem at the systems level, and one that reimagined a system or space.
 
Prize Winner 1: Address a target behavior at the systems level
Team Members: Bella Steiner, MBA, MPH; Sarah Weng, MBA, MPH; and Sarah Graf, MBA

Their solution, Culdesac, is a community-based urban midrise apartment living concept. Culdesac uses people-centered design and technology to promote a living experience that facilitates quality social connection and combats loneliness, which contribute to overall health and wellbeing. Culdesac redesigns the urban mid-rise building experience by creating opportunities for regular organic interactions between neighbors, designing living spaces that adjust to residents’ lifestyles and life cycle needs, and promoting intergenerationality.
 
Prize Winner 2: Reimagine a system or space
Team Members: Deirdre Nichonaill, Estefania Ciliotta, and Houjiang Liu
 
Their solution, Smooth Commuting, is a plan to redesign the Boston commuter rail system in order to mitigate the negative health effects of long, unpleasant commutes. They target “extreme commuters,” whose one-way commute takes 90 minutes or more. These extreme commuters are most vulnerable to the negative health effects of extended commutes, including high stress levels that impact mood, productivity, and overall health3. They lack the time to relax, exercise, and enjoy quality time with loved ones, and their sleep schedules and eating habits suffer as a result.

Innovation in Life Sciences Track Description

Digital health, and specifically digital therapeutics, are two of the hottest topics in life sciences innovation today. Can these technologies truly deliver on the opportunity to support the consumerization of health, facilitate a shift in focus to wellness, and drive more measurable, meaningful outcomes? Or are do they widen the divide in accessibility to healthcare, increase the burden on providers, and create an undue risk of patient health data exposure? Join us to hear from innovative companies within the space who are creating products and services that deliver on the promise of digital health and a lively discussion about best design practices to support this.

Improving Patient Engagement & Outcomes in Chronic Care Conditions

Innovation in Life Sciences Session: Christopher Lento, Noom Inc.

Noom was tasked with creating an innovative way to change habits, minds, and lives by pairing digital solutions with pharmaceuticals to treat diabetes and hypertension. They wanted to create ways to help treat diabetes and hypertension that went “beyond the pill.” They knew that designing a product for specific diseases with specific coaching can drive treatment results. Noom began offering a program that combines the power of artificial intelligence, mobile technology, and psychology with the empathy of over 1,700 personal coaches to help people manage their diabetes and hypertension. The combination of personal engagement, technological prompts to take medication, reward for healthy behaviors, user-friendly app, and the use of AI to continue to improve all of those things has been very successful. Noom has published 15 studies and has received four NIH grants to continue its work. Christopher Lento, Head of Life Science Partnerships for Noom, closed the session by sharing his secret to success: learn as much as possible about the problem, develop a formula, build the tool, measure the level of success, develop a formula from that information and begin the process over again.

 Increasing Efficiencies in the Healthcare System

Innovation in Life Sciences Session: Judy Ma, 3M

Judy Ma, UX Creative Director at 3M, began her session reminding attendees that 3M is more than just Post-It Notes and Scotch Tape. 3M is a pioneer in adhesives of all kinds, as well as nanoengineering and designing healthcare products that can help people heal. Recently, 3M asked the question, how can the healthcare system be redesigned to increase efficiencies? We pay too much for healthcare as a rule, and some 30 percent of that is wasted. They wondered, what can be eliminated without harming patients or reducing care? The first step was learning how to find waste and improve efficiencies with data. Numbers tell the truth. Data analytics let you evaluate efficiency of the organization, as well as find ways to improve efficiency and health outcomes across the entire population. Aggregating this information lets you find the waste and inefficiencies, and then lets you create priorities for improvement. Of course, finding what needs to be changed is sometimes easier than driving behavior change. 3M has found that the change must fit the ecosystem of the organization – it can’t be something that just looks good on paper.

 
Design Practices to Best Support the Promise of Digital Health

Innovation in Life Sciences Panel: Christopher Lento, Noom Inc.; Judy Ma, 3M; Everett Crosland, AppliedVR

Because of the pandemic, digital health is at the forefront of healthcare now. The panelists all agreed that necessity is the mother of invention, and telehealth is being implemented and used in unprecedented numbers now. It’s important that we have design practices in place to continue that growth. As a panel, the speakers all agreed that those designing digital health systems will continue to build on what is happening during the pandemic to innovate new ways to offer healthcare. This will have to include discussions We will need to:

• eliminate the accessibility divide – digital health should be about making healthcare more accessible, not less.
• build products that acknowledge cultural differences and diversity
• discuss how payers will cover these new technologies
• ensure that there are systems in place that protect users’ data and privacy

 

The focus of telehealth and digital health solutions is ultimately about making care patient-centric, safe, affordable and accessible.

The Intersection of Health and Finance Track Description

Health and finance are inextricably connected as people struggle to understand their plans, their coverage, their out of pocket cost and how it all works. This couldn’t be truer for the Medicare and dual eligible populations. How can we help this population to navigate the system, to get access to the care that is best for them, and to manage their health? What sort of methods and innovations are Medicare insurers and government organizations pursuing to better support the Medicare population? This panel featured experts from Humana, Premera Blue Cross, and The US Digital Service to explore answers to these questions and more.

Helping Consumers Understand and Manage Their Healthcare Spending

The Intersection of Health and Finance Session: Pam Nyberg, Humana; Melanie Penney and Darci Brown, Premera Blue Cross

By designing end-to-end experiences, Nyberg shared how Humana is driving organizational change. She described a case study about Humana’s appeals process, which spiked in 2015. After doing a detailed investigation into the member and provider views on the process and learning the specifics around the operational processes, Nyberg’s team questioned how best to deliver the ideal experiences. She explained how Humana approached the challenge by taking an experience-first approach. At Premera Blue Cross, they had to deal with the following: How do you handle building a product that is comparable or even better than your competitor’s product only to find out that people are still choosing the competitor? That question inspired Penney and Brown to embark on an ethnographic study to examine what it’s like to choose a Medicare plan for the first time.

Helping Consumers Understand and Manage Their Healthcare Spending

The Intersection of Health and Finance Panel Discussion: Michael D'Amelio, Flywire; Christianne Johnson, Renee Thomas and Rachel Alberico, UPMC Health; Sarah Gordon, Financial Health Network

Mad*Pow convened a panel to discuss the elephant in the room…the public health crisis. The discussion centered on how to help people understand their health insurance – deductibles, out-of-pocket expenses, networks – and how to keep people from going into bankruptcy due to medical bills. The five-member panel discussed the need to simplify everything from terminology to products. With the onset of the COVID-19 crisis, many households are now in financial crisis. The group discussed the obstacles that need to be overcome and who is going to take responsibility in tackling the problem.

Patient Experience Track Description

During the Patient Experience track, we will look at modern methodology, technology, and techniques to better understand the patient perspective. How might we capture, measure, and communicate existing patient experiences such that they stimulate innovation and change? What are the right methods to truly empathize with patients in context? We will discuss the elements that are crucial for customized experiences that resonate as successful solutions.

Patient Centricity

Patient Experience Session: Laurie Meyers, Genentech

Laurie Meyers, Head of Patient Engagement at Genentech, talked through her company’s journey toward patient centricity, starting with its creation of a maturity model to measure its existing level of patient centricity. Based on the model, the company started at the “patient-friendly” phase with only 20 percent of its initiatives focused on the patient. Eventually, Genentech progressed to patient focus with 50 percent patient objectives. Although the focus was more balanced, the organization found it was still talking at patients instead of working with them. Meyers advised that centricity can become achievable when an organization’s behaviors change. Patient centricity is about working with patients as partners and including them in the decision-making process. She summarized Genentech’s best practices as:

• Always putting patients first
• Validating a problem statement with patients
• Cocreating with patients from start to finish
• Collaborating across the healthcare industry
• Asking how “this” will impact patients

Designing for Shared Decision-Making

Patient Experience Session: Nanci Gonzalez, DICE Group at Thomas Jefferson University Hospital

Nanci Gonzalez, a design researcher at the Digital Innovation and Consumer Experience (DICE) Group at Thomas Jefferson University Hospital, presented her team’s work in building a shared decision-making web application. Unlike traditional methods, shared decision-making allows providers and patients to work together to decide on the best health option. The most popular models are the 3 Talk Model and the AHRQ Share Model. Nanci and the team created an enhanced Decision Counseling Program web application to provide patients with a guided experience from learning about their treatment options to generating answers about their beliefs, values and concerns. After using the app, patients have a printout to take with them to discuss the final decision with their provider. Studies about this platform have been promising and have found that shared-decision making has produced positive results. There have also been challenges for both patients and providers. When sharing advice about developing and enhancing the platform, Nanci offered a checklist that includes identifying the touchpoints to understand pain points and opportunities, involving the audience in the cocreation and validation process, keeping it simple for users, and leveraging existing tools for less disruption of workflow.

Achieving Care Integration for Children with Medical Complexity

Patient Experience Session: Denice C. Tahara, New York Medical College School of Health Sciences & Practice; Chuck Ruud, Independent Consultant

Dr. Denise Tahara, Health Policy and Management Division Director and an Associate Professor in the Department of Public Health at New York Medical College, and Chuck Ruud, MPS, a Strategy Designer specializing in business strategy and product innovation presented their new approach to and evaluation of healthcare delivery for children with medical complexity (CMC). Their strategic design used multiple methodologies within the “4Ds” framework of Discover, Define, Design, and Deliver. These included design thinking, systems thinking, human-centered design, behavioral design, and organization change management. Using focus groups for journey, care and service mapping, a better understanding of all pain points was revealed and then used during the design process to help define a new approach to care integration for CMCs. An implementation roadmap illustrated the steps in the process.

Restoring Humanity to Healthcare: The Iora Health Experience

Keynote: Rushika Fernandopulle, Iora Health

When Dr. Fernandopulle founded Iora Health 10 years ago, he was frustrated by traditional medicine’s reactive, transactional focus, poor outcomes, and huge amounts of waste. He decided that instead of waiting for medicine to make incremental improvements, he would build a new system from the ground up. He started Iora Health with a focus on relationships. As a primary care practice, the foundation is comprised of patients and their needs, instead of coding and fee-for-service payments. Iora Health uses a population-based model of payment that allows health insurers to pay a fixed amount for each member. This incentivizes Iora Health to keep patients as healthy as possible, while releasing it from the burden of billing and coding. Iora Health uses a team of physicians, health coaches, and mental health professionals to support patients. This approach places the focus on patients as human beings and then doing whatever it takes to keep them healthy. While initially costs may be higher, over two to three years of work with a patient, costs are less. How does Iora Health create this kind of engagement with its patients? According to one patient, “You cared about me. You taught me to care about myself. I didn't want to let any of us down.”

Designing A Culture Where All Bodies Belong

Keynote: Lindo Bacon, Author

In a world full of diversity, with people of all shapes and sizes, we all want to be seen and respected. Bacon encouraged everyone to visualize someone who struggles with weight, imagine the feelings that come along with that – the failure, helplessness and pain. Bacon then requested, for the sake of social justice and compassion, that we consider that losing weight isn’t the only goal. In fact, studies are finding that overweight people live longer than those at a normal weight. And for moderately obese people, weight discrimination may do more damage to their health than disease. To move forward, we must shift the focus from weight so we can consider patients as individuals. After all, just because a patient is slender doesn’t mean that they are healthy. In fact, their health risks may be overlooked. People deserve respect regardless of their health status. We can support people taking care of themselves without judging them.

Choose Empathy Over Fear: Inclusion in an Era of Isolation

Keynote: Nedret Sahin, Mad*Pow

When we are physically separate, we can decrease our emotional distance through empathy. We spend approximately 90,000 hours of our lives at work, so increasing empathy with our teammates is critical. To foster interpersonal risk-taking, we must value learning over our image. Sahin shared her own struggles with depression and anxiety, including the lessons she learned about empathy and team dynamics when she committed herself to a Partial Hospitalization Program. In fact, she adapted these lessons into a project team experience that creates psychologically safe teams where team members are empowered to admit their mistakes and find ways to learn from them. According to Google’s Project Aristotle, individuals on teams with higher psychological safety are less like to leave, more likely to harness the power of diverse ideas from their teammates, and bring in more revenue. Sahin and her team brought in an agile coach to learn behaviors to increase their empathy and sense of psychological safety. They committed to engaging when present, seeking to perceive more than seeking to be perceived, using teams, and moving forward by biasing their behavior toward action. Sahin asked attendees to commit to behaviors that can increase their teams’ empathy, review the Google re:Work guide on team effectiveness, model selective vulnerability and curiosity, consider a training, and iterate.

My Dearest Boobs…

Keynote: Brenna Monahan, OHSU

Monahan, a patient experience consultant, shared a poignant ode to her boobs, her body and her new “quilted” life. Her personal recollections of her own patient experience covered five-plus years of major life decisions, including pregnancy, childbirth, a hysterectomy, oophorectomy, bariatric surgery and a double mastectomy with diep flap reconstruction. She fearlessly told attendees about her struggles, her uncertainties and the gaps that she wished were filled.

Closing Remarks

Kathryn Hautanen, Center for Health Experience Design, Mad*Pow

Day one of HXD 2020 closed with an invitation to create collaborations with other likeminded attendees. The discussions continue at community.centerhxd.com!