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Good Morning and Thank you for the opportunity to speak with you today.
I’m very excited to have the chance to share some of what I’ve learned during my long
career in Consumer Electronics, that I hope will help you to create better experiences,
products, and clinical trials for both doctors and patients, alike.Now the original title
of this talk was “A Few Things Every Med Student (and Doctor) Should Know About Designing
Products and Experiences - Thoughts From the World of Consumer Electronics”.
And “A”, this is obviously way too long and awkward and “B”, was really just a
place holder that I never got around to updating.
Which is a good reminder that you should always make sure that anything you submit as a draft
is something you wouldn’t mind actually seeing in print (because sometimes, that’s
what happens.)
Anyway, I was thinking of an alternative title, and one thought that came to mind was:12 Minutes
That Will Change Your Life!
And this is certainly clear and bold and gets right to the point (and I think it’s accurate).
But maybe its just a bit too aggressive, and a tad ambitious, for a Saturday Morning.
Plus, as a recovering attorney I’m always sensitive to claims of “Fake News”.
So in the interest of fairness and full disclosure, the New and Improved Official Title for this
morning’s talk is:Stuff I Know! (‘hyphen’ that I think you might benefit from knowing,
too.)But First - But before we dig in I wanted to spend just a minute giving you a bit of
my background, so you’ll know where I’m coming from.
I’ve spent over 30 years in the Consumer Electronics field in a variety of roles including
Engineering, Product Marketing, Strategic Planning & Business Development, and Legal
& Regulatory Affairs, including 5 years at Sony and the past 22 years at Apple where
I worked on a number of health and medical efforts including HealthKit, CareKit, ResearchKit,
and the Apple Heart Study with Stanford Medicine.
I also have an unusual personal medical history that includes a burst AVM in my brain in my
20’s, a leaking appendix in my 40’s that went untreated for more than 6 months because
its unfortunately still true that transgender patients are frequently presumed crazy until
proven normal.
I’ve also had renal cell carcinoma, a recurring series of cerebral meningiomas, and if I rub
a spot in crook of my left arm, the tip of my tongue itches (which I understand may not
be totally normal.)
And the reason I was hoping to be able to share some of my insights here at Medicine
X is that during my time at Apple I had the opportunity to work with some brilliant physicians,
but by they time they were experienced enough to contribute to Apple’s efforts, their
world view was pretty well formed.
Of course smart people are open minded and always learning, but biases set in early,
and this is especially true in a field that’s high stakes, heavily regulated, and tends
to want to optimize behavior to limit legal liability.
And I’m not saying any of those things are inherently bad.
But I am saying that I realized that if I truly wanted to have an opportunity to change
the future of medicine and healthcare, I needed to find a way to infect your thinking while
your skulls were still just a little bit soft.
And so lets do that.WHAT: This is where most thinking starts.
Where most people begin the process of designing new products and experiences.
By saying, “YOU KNOW WHAT WE NEED?” or “YOU KNOW WHAT WOULD BE HELPFUL?” or “YOU
KNOW WHAT WOULD BE REALLY GREAT TO HAVE?”… and this naturally leads to:
HOW: The execution.
The place where folks get to show off how clever they are by doing something no one
has ever done before.
All the technical and medical and patentable bits.
Teams frequently start with with WHAT, and then move on to HOW, and then they’re done!
Or maybe not.
Because from a “Doer’s” mindset (and doctors and engineers are both powerful “Doer’s”),
the process of figuring out WHAT you want to do leads directly to figuring out HOW you’re
going to do it, and then its only natural to want to jump right in and not waste another
moment.
Its an understandable impulse.
But the progression from WHAT to HOW to ACTION! leaves out a critical element - The REASON
to do.
As someone much smarter than me once said:“You’ve got to start with the customer experience
and work backwards to the technology.
You can’t start with the technology and try to figure out where you’re gonna sell
it.
I’ve made this mistake more than anyone else.
And as we’ve tried to come up with a strategy and a vision for Apple, we asked:
?‘What incredible benefits can we give to the customer?’,
‘Where can we take the customer?’
Not, lets sit down with the engineers, and figure out what awesome technology we have
and out how to market that.”
This is a great way to think about the REASON to do something.
Not simply because you can, but because it changes the users world.
And I’ve come up with a simple way to determine whether a product or experience provides an
‘incredible benefit’ to the customer, that I’d like to share.
Its when the customer or your intended audience says this:
I Didn’t Know I Needed It and Now I Can’t Live Without It.
Think about this for a moment.
Think about the products or services that satisfy this test in your life.
Your Smartphone maybe?
Netflix or Hulu subscription?
Maybe something else completely.
It can be different things for different people.
And it can definitely change.
What would be seen as indispensable only a short time ago (lets say a DVD player) is
now a complete Who Cares! for most people.
This is the critical third element.
Before the “doing” can begin, in addition to What and How, you must also identify:The
WHY.
The answer to “So What” … to “Who Cares” … that moves beyond “Look what
I did!
- Look at how clever I am!” to being able to describe, as Steve said, the incredible
benefit you can give to your customer, to your patient, to your colleagues.Think of
it as your raison d’être.
Its not something broad and amorphous like “saving lives” or “making money”,
though those are both really important.
It’s specific and particular and when your intended audience experiences it, their reaction
is some version of “I didn’t know i needed it, and now I can’t live without it.”
And though we don’t have a lot of time this morning, I wanted to give you just one example
of where knowing the What and How but not the Why became a problem.This is an article
from the Washington Post from this past February.
And it describes a joint effort by IBM and Anthem and a doc at Harvard Medical School.
They created an app intended for patients to use to improve their healthcare experience.
It had a symptom checker and scheduling and maps and telemed, and after 2 years the whole
thing was shut down.
And that’s okay.
“Tis better to have loved and lost than never to have loved at all.”
(I think Kanye said that.)
But this is the part that’s worth pointing out.
In the article the doc who helped design the experience says, “The short answer is nobody
really used the tool.
For a variety of reasons they just forgot about it.
This is what I would say in my defense: I still think its a good idea.”
And i’m not trying to pick on any of these folks.
I know they’re well meaning.
Its just that, especially when we’re talking about the intersection of technology and medicine,
its way too easy to fall victim to the “I think its a good idea” portion of the ‘hype
cycle’ that’s focused on innovation, and postpone trying to figure out if anyone really
wants what you’re offering.
Here are a bunch of recent headlines you may have seen.
Clearly there’s a REVOLUTION coming and you don’t want to get left behind.
How can you not worry about ‘analysis paralysis’ and feel like you need to start doing something
Now!?!
But as we’ve been discussing, if you only focus on What and How and aren’t able to
clearly articulate Why, you’re sitting on a two-legged stool (I’ll pause for a moment
while you conjure up that image.)
And before we move on I wanted to caution against the world of “It Would Be Cool”.
During my time in industry I would often be part of brainstorming sessions where someone
would say, “You know what would be cool?!”
And I wanted to point out that “It Would Be Cool” is the surest way to wind up in
an article in the Washington Post that I’ll probably be talking about next year.
When someone on your team says, “You know what would be cool” tell them the only acceptable
answers are “Flying Cars”, “Talking Dogs”, and “Chocolate Donuts that cure
metabolic disease and make you better looking.”
And if this were almost any other field we’d be done.
But we’re talking about healthcare and that means there’s one more thing we have to
consider:Presented for your edification are three amazing insights I developed during
my time at Apple: “Doctors are not Patients”; Clinicians are not Researchers”; and “Health
People are not Managing Disease.”
Now these may seem obvious, but when you’re deep in the middle of design and engineering
with really smart people its easy to forget that one size does not fit all.
Different cohorts have different interests and different ways of satisfying the “I
didn’t know I needed it” question.
For example:DOCTORS ARE NOT PATIENTS.
When developing a new screening algorithm, Engineers generally look for greater fidelity
and accuracy while Physicians are interested in whether the outputs of those algorithms
are actionable and clinically validated.
But Consumers, especially those who aren’t actively managing a disease, really have only
a single binary question:
DOEZ I HAZ 2 GO DOCTR?
And this leads to an additional insight:In the world of Digital Health the value of a
device or app to a Consumer/Patient isn’t fully realized until they CLOSE THE LOOP with
a health care professional.
As far I know this isn’t true in any other domain.
I can use the rings on my watch, the apps on my phone and laptop, and depending on my
skill and experience extract complete value.
But until we allow digital health technologies to lead directly to self-treatment (diagnosis
and prescription of medication) real value still requires intervention with a Health
Care Provider.
Which means:IN HEALTHCARE THERE ARE DIRECT AND INDIRECT CUSTOMERS.
And so when answering the WHY question, the raison d’être, we have to do it in the
context of:WHO: Who is the real customer for your innovation?
Who will truly say, “I didn’t know I needed it and now I can’t live without it”?
It may not be possible to be all things to all people, but you have to consider that
in order for your solution or experience to be successful, you’ll have to be compelling
to multiple audiences.And here’s a word of warning: Don’t fall into the trap of
imputing value from one group to another.
Information important to a physician may not be seen as particularly valuable to a patient,
even if it means a better outcome for them.
Remember the kitty’s binary question.
Also remember that for the kitty the element of mortality is in play.
Medical interactions are not purely intellectual for consumers.
A test or device that works perfectly may actually deliver “bad news”, which again
is fairly unique in the healthcare space.Now I recognize this is a lot of talking and so
to roll-it-up to something you can remember, I’ve borrowed a concept known as the Golden
Circle from Simon Sinek who has an amazing Ted Talk on Leadership I highly recommend.
Simon talks about “Starting with WHY”.
And Lex Sisney took Simon’s concept and recognized that in some domains you actually
need to start with “Who”.
And I think Simon and Lex’s modified Golden Circle is a helpful way to remind you how
prioritize the steps of designing a valuable and compelling product and experience.And
we’re just about out of time so I wanted to share one quick story.
I was working on a project at Apple and showed some interim results to one of the docs on
the team (a guy i really liked who was really smart) and he said “That’s not useful.
I don’t know what do to with it.”
And I thought, “Wait, those are two separate and completely different ideas.
The first says you know the data has no clinical value.
And the second says you don’t know if the data has clinical value, but you do know you
don’t want it interfering with your practice.”
And in the current paradigm those ideas may seem equivalent, but I want to suggest that
we need to leave space in medicine for “I don’t know what to do with it” as a Potentially
Actionable Insight - something that either, over time or when combined with other insights,
may lead to clinically significant information.
If we simply toss these out because we don’t know what to do with them, then we’re limiting
the future of medicine to only be the best version of what currently exists, and not
enabling the possibility of creating a new world.
A world of experiences that aren’t simply extensions of those we already have.And so,
in conclusion, if your goal is to design products and experiences for patients, for your colleagues,
and for yourself, remember to Start with WHY and WHO before WHAT and HOW.
Remember that in Digital Health the benefit to the consumer requires that they ‘close
the loop’ with a healthcare professional.
And consider that the way enable the world we want to exist means acknowledging that
the future should not simply be the present with fewer bugs.Thank you very much.
Any comments or questions, please feel free to reach out at any of the links below.
Thanks!