Why inclusive HealthTech product design requires much more than quantitative research

Speaker A: Don't just look at data. Uh, you have to talk to people. There is a wide divide between what quantitative data will tell you out there about your audience and then actually talking to people and seeing them use it. So I think that's the literal starting point. Talk to the real people. Don't just Google your information.

Speaker B: Research is the first kind of activity to start with. I do believe very strongly in qualitative research, first kind of explorative research. And I do think it's. It really makes a difference if you go into the field rather than talking to people in sterile environments. It does make a difference in addition to research, I think something that we designers, as creative forces tend to omit is maybe the business case behind it.

Speaker C: Hello and welcome to this episode of Shine, a podcast by star. And Today. Today we're talking about designing health tech products. And to do this, we are joined by two experts, the first of which is Wendy Johansson, who is the founder and chief product experience officer at, um, Misalud Health, and Agnieszka Bilirice, who is a design director, uh, at Star. In this episode, we dig into what it takes to design an effective health care product, how we build that in an inclusive and ethical way, and what are the biggest challenges facing customer experience in the world of health tech today. So let's jump in right away, and the first voice you'll hear will be that of Wendy.

Speaker A: Hey, everyone. My name is Wendy Johansen and I am based in San Francisco, California and Guadalajara, Mexico. I am currently the co founder and Chief Product Experience Officer of Me Salute Health, where we're closing the health equity gap for Hispanics in the U.S. hi, I'm Agnes.

Speaker B: Agnes Kabilevic, design director at Star, leading our Polish team, splitting my time between working directly with clients on health tech products and building a multidisciplinary team of designers here in Europe.

Speaker C: Awesome, guys. Now we're going to start with Broad, and I want to understand the very first. What is the starting point if I am going to look to design a product in the world of health tech? Uh, and maybe Wendy, I can come to you first and we can even do a mini case study on how you came to that point with the current product?

Speaker A: Absolutely. You definitely want to start with the users, understand who you're building for. So, for example, one of the ways that we started was taking a look at Statista and other quantitative data that's available out there about our target market. In our case, it was the Latinx community in the United States. There's a ton of Research out there that pointed us in a certain direction that said Hispanic Americans over index on mobile phone and tablet usage compared to any other American. So we said, this is great, a digital health mobile solution for them. It's going to be perfect. And we went down that route and then we were wrong. So don't just look at data, you have to talk to people. After we got our first proof of concept out in two weeks, we actually went and started talking to users. I went to my local Hispanic grocery store, uh, pulled out the proof of concept on my phone, started talking to people in Exchange for a $10 gift card to the grocery store. And then I realized that while they all do have mobile phones, they know how to utilize them for WhatsApp, uh, Instagram, Facebook, YouTube. No one really had an email address in this kind of 40 to 60 category that I happen to be talking to in the parking lot. Nobody really understood. Two factor authentication, a secure password, uppercase, lowercase, eight characters, symbols really difficult to remember for these users. There is a wide divide between what quantitative data will tell you out there about your audience and then actually talking to people and seeing them use it. I think that's the literal starting point. Talk to the real people, don't just Google your information.

Speaker C: Got it. That's so interesting. And I think it's like a uh, classic startup mistake is to not actually talk to people. Because sometimes I guess when the people making digital products might not be like super keen on going, well, I am like, I don't really like going out and talking to people. So that's the problem for me. But great insight and I love the story and the fact that you potentially made that mistake as well. Agnieszka, over to you. Would you agree with everything Wendy said there or are we missing something or.

Speaker B: Absolutely. I do agree totally that research, uh, is the first kind of activity to start with. I do believe very strongly in qualitative research, first and kind of explorative research. And I do think it really makes a difference if you go into the field rather than talking to people in sterile environments. It does make a difference. In addition to research, I think something that we kind of designers as, ah, kind of creative forces tend to omit is maybe the business case behind it. So especially when we're already kind of starting to talk about some of the underrepresented, uh, society members, reimbursement strategy might be very, very important because we don't want to build an excellent product kind of that really will solve real people's problems and then decide that we don't really know how we're going to sell it, if it's how it all is going to go into the market. And I would say paradoxically, that will affect the people from lower socioeconomic background more than the one that can afford the product. So I think starting with reimbursement strategy, scheme or just generally a good and solid business case would also be advisable.

Speaker A: I'm 100% in agreement with that. And I think the way I like to sum that up, especially working with startups, is we need to have a longer term view than what we need to do right now. And I think so many businesses, whether it's at a startup or we are agency and we're building for our clients, everybody's very stuck in the now. And so taking that time and actually sitting down and saying, okay, what's three months, 12 months, two years from now? And it comes down to what you're saying, like how are we going to charge people for this when we're actually successful? That's a great question.

Speaker C: So we've got looking at the numbers, talking to people and then forecasting forward and understanding if we can actually make this solution or products sustainable. Is that a good summary? Cool.

Speaker B: And going out there as well, going into the field, just while you're doing this, don't stand in your office, don't do all of those activities out of the cozy, you know, four walls of your office, but go out there and really kind of experience the right environment in which you will be or your product will be working in the end.

Speaker C: So Wendy, being co located between the US and Latin America, was this because of the product or the other way around? Are we building the product because we went to the area and saw the challenges?

Speaker A: Maybe all of the above, but mostly because in the past decade or so I've been working with teams in Guadalajara, Mexico and uh, helping build the tech ecosystem when it comes to entrepreneurship, startups and all. And as we've come along, I've built really great friendships. People that they say you choose your family. I've created my own family. And so many of them have blood family members who have immigrated to the US and have found it incredibly difficult, difficult to navigate the health system here for various reasons. Socioeconomic, difficult to find and close the language barrier and then also just cost prohibitive. Especially in the US Many people think of it as a very first world country, but when it comes to healthcare, we are so far behind everyone else.

Speaker C: All right, so going back to the three points, looking at the data Talking uh, to people and being sustainable. Do you think those three points apply in that order for a feature versus starting a new product?

Speaker B: It's a tough one. I think that usually when we are uh, talking about the feature, we kind of already have the business case behind it. So I think the research and the explorative kind of mindset comes much, much more important in the future. Although you do have to have additional complexity of kind of knowing your roadmap well and knowing kind of what comes when. Because having this grand vision of where you want to get to, that's absolutely great. But knowing when is the right time to get down to work on a particular feature. It's kind of in between understanding the problems but also having a really solid kind of product team and collaborating with them and understanding the goals over time.

Speaker A: And I would completely build on that and say when we're looking at that long term vision, I would liken that more and kind of business model of that to the product. If that's not defined more at that kind of higher level of the product and where that's aiming, the features cannot align, adjust and iterate towards that direction. So I would separate that out and say talking to your customers and getting out there is more at the feature level on a regular basis. And then when we're talking about strategy vision, how that all fits in the long term sustainability, that's more at the product level so it can guide and direct all the features.

Speaker C: All right, thanks for the clarity. Next question is what are the considerations we should be making if we're designing health tech products versus any other kind of product? Because I think our uh, three step formula we defined earlier, ah is probably applicable to all types of products.

Speaker A: I think that's applicable to everything. We would be putting the lens of inclusive and equitable design on that if we were to apply that long term vision, how it fits with the business and actually talking and being with people who are utilizing that product, that applies anything from Fintech to Instagram to E commerce sites, all of that applies.

Speaker C: Awesome. So if we were to then dig into health tech products, are there any additional considerations we should be making in the design process?

Speaker B: Definitely the regulatory aspect, uh, I think that comes in very, very important in the medical field. So you want to have your regulatory team on um, with the project very early because that's going to really define the constraints for later in the process. I think privacy becomes more important in health care and that's not only because of the regulations. It's not only about being hipaa Compliant. It's also about understanding that, um, health care and well being are those very, very private spheres of your life. And that goes beyond the formal kind of understanding of what privacy is. I remember, I think last product camp, Adam Rothmill, who was back then working for AstraZeneca, was having a talk and he was talking about how they were developing Voice, uh, operated products, which is. Voice is really great for a lot of, for example, accessible products, which really should tie very nicely in the healthcare setting. And I think they were working on some kind of oncology therapy application. And the use case that they were talking about was mother that was really uncomfortable using some of the features because she really didn't want to talk about maybe her state or symptoms in front of any family members, especially children. Uh, and, uh, maybe here. You know, it's not this classical type of privacy that we usually think when we start with this, it's not really about only the regulatory aspect, but those kind of protecting this very, very private and personal spheres of people's life and kind of allowing them to be in a place where they feel safe with their data and with the way they use our products, no matter what's happening around. Yeah.

Speaker A: And as you're talking about that, Agnes, uh, I think of this in my executional mind as kind of service design. Here are all the layers. Here's the actual user, here's the regulatory standard, and then here's everything around patient health information and privacy. And then I build that more with also the clinicians who are involved, potentially the labs, the, uh, pharmacies. You're going for imaging or a blood test. Like all of these are the layers of the service. And I think what's really important as we think about health tech design is to understand how all those layers play together. Because it's so easy to accidentally drop the ball or misinformation or more importantly miss a regulatory standard as, uh, we're working through those layers. How does a clinician write a prescription for one of our patients and is able to send that in a way that the patient can easily receive it on their SMS and go over to the pharmacy without actually compromising their data? Because. Because it's outside of the app. So we've got to think about all those layers and not just ease of use for that inpatient?

Speaker B: I absolutely agree. And I think the tricky thing about it is that many people only understand how important infrastructure is when it fails or, uh, when we fail to kind of align with the existing workflow. And it's usually too late by that time.

Speaker A: Yeah. And honestly in tech we're notoriously really bad about working with non tech people. We experienced this kind of bump in the road early on was how do we explain new features and make sure we're getting out ahead of time, training our doctors about new things that are happening on the Dr. Portal. And it's so important for us to really meet people and not just be tech people who get everything. It's like, oh, just log in the figma, click on the prototype. They don't know how to do that. And so just really meeting people where they are has humbled us in so many ways. Being able to work with lawyers, doctors every day who just their head doesn't live in tech. They are incredibly smart at what they do and we should not try to borrow part of their brain to learn to be tech people.

Speaker C: Yeah, sometimes we um, like lawyers would send documents attached to an email and then you open it and then you'd edit it and you have to send it back. And tech people would be like that's ridiculous, we just put it in a Google Doc. But then the lawyer, if they were trying to explain some legal nuance to us, then we would have no idea. We just assume that everybody should have our ability. Which is not correct but leads nicely into my next question which is ensuring that design is inclusive and ethical is important. Are there any strategies, ways of working like team setup that we can bring in to ensure that we do produce products that are inclusive?

Speaker B: We can start off the basic. Having a diverse team and having representations of a lot of different perspectives in your team is incredibly, incredibly important. And I think that's kind of a one, one on one. But I think it's not only that, it's also about ensuring we. Somebody's kind of looking at our hands. So sometimes not like having a diverse team is not enough. We also need to make sure that we have somebody else kind of checking. That's why the ethical review of research plans are important. Not only the formal one like you know, submitting to IRB institutional review board, but also like internal ones where really sit down and have somebody else for example, checked our interview script for kind of from an ethical perspective. Because I think a lot of harm is done out of a place, not really out of a place of ignorance, but kind of those unintentional omitments and kind of just not understanding how it is to live somebody else life and live some through somebody's else shoes. It's. I think that would be something that is really important to us more Than once we were surprised, uh, when we were, for example, caught up on an interview with a mother that has three children with ADHD condition. Like, a morning in the house. Like, that is not going to go exactly up to our research plan. Like, you have to be very flexible, but you should also kind of prepare both in terms of the interview script, but also in terms of your mindset, the kind of attitude and the way you go about the field research to really account for that and to make sure that your entire mindset is ethical in a way.

Speaker A: Yeah. And having that lived experience, it's important. But I think in some cases, companies kind of check the box. For example, they could say, like, well, you know, we have somebody who speaks Spanish in our company. That's good enough. We can go ahead and build something for the entire Spanish speaking community. Our entire team is fluent in Spanish. Most of them are either based in Mexico or have moved to the US At a young age, including all of our doctors. And so they have that lived experience of either being a recent immigrant, a first generation, or, uh, still in Mexico with close friends and relatives. And one of the things I think is so important as we continue to go along is we take our engineers, we take our designers with us to these field visits when we're kicking off new communities, new groups, new employers, and we make sure that they're part of that onboarding. Like, hey, you're going to help people get the app set up on their phone and explain kind of privacy and, um, security to them about how all of this works. And being able to talk to people and see their reactions and being able to see their kind of environment with their devices. That's so incredibly important. To have so much more empathy versus just, you know, me coming back and saying, hey, here's a list of issues we need to fix because people don't know how to use their phones at a high tech level. And there's a whole different level of empathy when it comes to that. It's like, no, I need to fix this for this lady I was talking to. Versus okay, well, the boss told us, here's another JIRA ticket.

Speaker C: And I assume you experienced that firsthand when you were in the grocery store trying to, like, understanding about the email address and the passwords.

Speaker A: Yeah, Slow horror building on me as I realized, oh, no, we built for ourselves.

Speaker C: Wow.

Speaker B: Happens to the best of us.

Speaker C: And how long were you building? And feel free to not answer this. How long were you building before you went into the grocery store?

Speaker A: Well, luckily it was just a month. We are a startup. We moved really fast. It was really proof of concept mindset. Uh, we actually kicked off the development of our company with a hackathon because of course, the engineers and designers said, we've architected this long term system, It'll take us 12 months. I was like, cool, we're going to have a hackathon, you're going to be done in two weeks and then we're going to go talk to people. So that's where we started.

Speaker C: Yeah. You definitely, I assume, have had experience in the startup world to get an implement that that's awesome. That it was only a month of potential misdirection. But I'm sure most of what you built you were able to take forward and make small tweaks.

Speaker A: Yeah. Make everything simpler. And I think part of that is also being able to understand not just as part of the startup world, but everything we had done was really just based on some friendly conversations as well. You know, it wasn't just that quantitative data, the qualitative data we had, they were from people's aunts, cousins, nannies, house cleaners that we talked to. And we realized that was already a pretty privileged group because they were within our kind of network circle. So we wanted to just go out there and talk to real people at a bodega and then, you know, taqueria and really understand how they're feeling.

Speaker C: Awesome. So we spoke a lot about how we may change our, uh, divine process to build inclusive health tech products. I now want to flip that around and ask both of you how you think designing health tech products have changed you as a designer.

Speaker B: It definitely did change quite a lot of my approach to leading the team, I would say, and it's almost a little bit embarrassing because it really made in our daily life made a difference when it comes to our focus on wellbeing, which should have been important very much from the start, and it was. But I think once we started working more and more on the health and wellness products, we also paid more and more attention to wellbeing at work and kind of putting more and more initiatives like those no meetings day or, you know, reimbursement for mental health apps or kind of just restructuring the way we work and making sure we have moments of reflection, moments where we stop and pause, um, and kind of a lot of really, really nice initiatives, I think, rooted up from us focusing more and more on our health tech practice.

Speaker A: I'm a plus one on that. And also my background has been largely in B2B, building ad platforms, video analytic platforms, Video platforms and you can get hustled and rush to build something because there's a customer who needs it on Monday or they won't sign that million dollar contract. And that's one thing to ship as fast as you can because you have to. And being in health tech has completely shifted my mindset to no, we really need to slow down. Like, you know, there's slow food. I think there's this idea of slow tech coming out which is we have to be super mindful of the experiences we're building and not get rushed because it's a contract, because it's a partnership or whatever. We actually have to think about the implications regulatory, ethical and also just kind of unintentional in that long term for the users who are going to have access to this. And so I kind of like to say that we, I'm taking the slow food mentality for tech right now and it's really refreshing.

Speaker B: Yeah, absolutely, absolutely agree on that. I would like to subscribe to the slow tech movement if I can. And I think that's the kind of the positive side of the regulations really. Like, you know, a lot of designers complain a lot about working with regulations because they are hard to understand sometimes. It's quite a big barrier of entry, I uh, would say. But in the end they make us kind of slow down. Yeah, they make us sometimes take proper steps. They really make sure that we're not rushing into sometimes stupid or worse dangerous ideas like other industries.

Speaker C: I would say super interesting. I feel like I'm getting life advice. I also think that we should title the episode the Slow Food for Tech. However, next question. I want to now come round to look at challenges facing customer experience in health tech. So what are the things right now that uh, are maybe preventing more people getting access to these products that are going to improve their health?

Speaker A: Regulation, regulation and navigating that tangled web of regulation and access. And you know, how do you get that free health care if you're a certain kind of person in a certain region? And the US is even messier than that, you have that federal layer of regulation from the government for the country. And then every state has their own, and then every county has their own programs on top of that. So you're navigating, you're trying to figure it out. And if you are like a big subset of our community, which are migrant farm workers up and down this, uh, California Pacific coast, you're moving from county to county, state to state, everything keeps changing. Your one favorite clinic in Los Angeles. Well, now you're in San Francisco now you're in Napa, now you're in Oregon. You have to kind of keep refining those solutions for you to access, especially when most of the injuries and illnesses we're going to see are physical. So it makes it incredibly daunting. And, uh, even one of my co founders, he's Mexican American. He has that kind of American dream. His parents were those migrant M farm workers. He has a story of when he was 8 and his dad really injured his foot very badly and he waited an entire season until December to go back to Mexico to get help. That's what you're faced with, hard choices where you feel like you have no solutions for you.

Speaker B: Yeah, I agree. And I think the economical factor is really important there. Uh, but there's so many other challenges too. Like shortage of physicians.

Speaker A: Yeah.

Speaker B: Like generally shortage of healthcare professionals, especially in U.S. it's something that I think is disrupting a lot of infrastructures or services that should be working correctly. They are designed correctly, but they're not working because of this lack of access. I think from the tech perspective, there's a few very interesting challenges that might be next, I think for healthcare. AI in healthcare is an interesting kind of challenge. I think this is something that on one hand, there's a growing trend of AI assisted products. On the other hand, I think there's quite so many things we still haven't figured out. Way too much focus on algorithmic performance and sometimes not enough on, you know, workflow integration, building trust in the algorithms, uh, measurable added value to the users. And in reality because of that, products are suffering. Yeah, like sometimes we still, I, um, think as designers and m, especially as engineers, I think sometimes don't understand that explainability might be more important than accuracy for some doctors. Yeah, like those kind of aspects might be still challenging for us, but I think it's coming. We're doing progress.

Speaker A: Yeah, we have that challenge between explaining medically how our services and programs work versus telling you as the patient, this is the value it's going to help change your life for. And there's that balance of credibility, medical standard, and this is just what it's going to do for you and sounding too markety. And I think that's a interesting, uh, tension that we constantly find ourselves up against as well.

Speaker C: How do we think health tech is going to change society over the next five to 10 years?

Speaker A: I think it has the power to make health access. I don't like this term, but I'm going to say it more democratized. And accessible. But on the other hand, I honestly think when I look at it, it's just going to improve the access for people who already have it and continue to widen the gap for the people who don't. And so during the pandemic, so many services across the world moved into telehealth because they had to. And that worked just as great for the people who already had healthcare, had mobile access, had Internet, had accounts and coverage. But for everybody else who didn't, the gap widened. We saw those numbers come in for example with uh, our community. For me, salud, it's Hispanics in the US five times more likely to contract Covid and once you did, three times more likely to die than any other American. It just continues to widen the gap. So I think it's doing good for some, it's doing worse for others. And it's incredibly important as a society and as a tech industry, healthcare tech industry, that we take a look at those inequities and if we're not focused on them, make it our 20% projects within our company, like do good for your company and then go do well for others.

Speaker B: Yeah, I think it's very interesting topic. Maybe the question is not only how the role of healthcare technology is going to change, but how the technology is going to also change our society. I think we tend to think too much about what's the next function, what's the next value added, what's the next feature and not enough how the technology that we ship out is changing the world around us already. For example, to build up on the AI topic that we just talked about, how does introducing an AI agent subvert the power dynamics between the patient and the physician? Uh, how really technology is changing the role of healthcare professionals and most importantly the relationship between them and patient. Because I think that might be the single most important change that is going to happen. And it's not one moment in time, it's just constantly evolving in a good ways. Yeah, like for example sometimes when of adding more access and really improving lifestyle, but also in a better ways when you know, introducing impersonal AI agents makes it so much easier to cross ethical boundaries and those kind of topics. So good on both sides to it. But I think really the disruption of the power dynamics, disruption of the existing relationships and disruption of the network around us.

Speaker C: As we said now we end every episode of Shine with the same question. But for this one, I think if I was to ask that question in the same format, it would be a little bit too easy for you guys. So I'm going to tweak it slightly. So the final question is going to be how can health tech products make the world a better place, but in a unconventional, uh, or unexpected way? I think there's obvious benefits to like more adoption of health tech, but are there any unexpected benefits that we may experience as this happens in the future?

Speaker A: I think having more digital access to health tech products helps people with all the big and little things. We're used to going to the doctor for the big things. Right. I have a cold, something's broken or hurts. But for all those little issues that you didn't know could become something larger. So perhaps as a woman I find a lump and because I have digital access to telehealth and it's less expensive, I can go ahead and just talk to a doctor and ask should I be concerned about a lump here as a woman in my 40s or 30s or 60s or 50s, and be able to be more preventative in a way that I think preventative health has kind of been more of a elite, higher socioeconomic offering and kind of accessibility level in the past. So I think there's a lot of potential for that. But we also have to see health tech kind of reshape and not just be porting existing healthcare models like primary care into just digital, over the phone, over zoom, et cetera. They actually have to rethink the programs, rethink the access, rethink the frequency of what that should look like. And that can be difficult since again, just particular to the US the entire medical system is made to bill insurance, not actually care about the patient or the provider.

Speaker B: Yeah. And I think very often unintentionally, um, we make lives of patients much, much better unintentionally, at least for, you know, some of the maybe business stakeholders. But when we build products in healthcare, the good part about it is that they really affect entire way of life of the patient. So when we for example, think and digital therapeutic for oncology, if we have a predictive algorithm that shows when you might be feeling more symptoms and more side effects, that doesn't only let you know better how to go with your treatment, it also lets you know how to plan your day, when to plan, for example, a visit, uh, to your grandkids and that could really mean another good day for someone that might not have so many. Yeah. So it's really impacting every little aspect of life. It could bring more focus on well being and the way kind of we talked about this slow tech, the way it changed us as designers I think it has the same potential for the patients using our products, kind of bringing more slow life mindset into their daily life. That's what I would hope for, at least.

Speaker C: All right, so the big takeaway is how can we take what we've learned from designing health tech products, this slow, methodical approach, and, uh, then apply that into our lives? Guys, thank you so much for your time. Thank you so much for coming on. I really appreciate your time, and I think we managed to illuminate the world of designing health tech products.

Speaker B: Thank you.

Speaker A: Thanks for having us.

Speaker C: Thank you so much for listening. Thank you to our, uh, guests, Wendy and Agnieszka. I think for me, the biggest takeaway, as I mentioned at the end of the interview, was the response to the question about how designing healthcare products has changed each of our guests. And the experience that they have had designing healthcare products, moving through the regulatory environment has almost given learnings for them in the rest of their lives. And then on top of that, Wendy's point at the end about how increasing the prevalence of health tech products is going to increase access to preventative medicine that previously may have been less accessible. And so with that, of course, I want to thank you so much for listening. If you have any feedback about the show, please head to Apple Podcasts and leave us an honest rating and review. And of course, again, thank you to our guests, Wendy and Agneska.