Transforming healthcare infrastructure

(This article was published in the November/December 2010 issue of interactions magazine.)

It seems likely that we find ourselves at an inflection point in the evolution of healthcare. While the situation has certainly been brought to a boil by recent American political events, the opportunities for change fit into a much larger context; they have the potential to truly transform the delivery of healthcare globally.

Unlike some, I don’t believe our current healthcare system is totally broken. I’ve conducted design research in quite a number of clinical settings and have consulted for businesses representing many different aspects of the healthcare industry, including provider networks, medical-device manufacturers, and even health insurance companies. I’ve seen magic worked on regular basis, and from a historical (and global) perspective, the standard of care in the developed world is astoundingly high. I am in awe of the abilities of doctors, nurses, techs, and other clinicians to consistently function at a very high level despite the fact they’re forced to work with archaic infrastructure in less than ideal environments. (As for the insurance companies, perhaps the best thing to say is that they function to make money but could be dramatically more successful as businesses if they changed their approach to things.)

It is at this level—the level of infrastructure—where these big opportunities for transformation exist. It isn’t that we don’t know what kinds of patient and clinician behaviors and medical interventions result in healthy outcomes; it’s that at a systemic level, we’re not doing a good job facilitating these behaviors and driving appropriate interventions. The right changes here will provide a conduit for evolutionary change to cascade throughout the system to achieve dramatic improvements in the quality and cost of healthcare. Which isn’t to say that it also isn’t incredibly important for medical knowledge to continue to evolve; it’s just that we already know enough to dramatically drive up quality and drive down costs.

Many of the opportunities to improve our healthcare system can fit into three big categories: proactively engaging individuals to take better care of themselves; providing better interventional care beyond the walls of the hospital; and improving care delivery inside hospitals through standardization and better collaboration between clinicians, patients, and families. All three of these strategies require new infrastructure and perhaps a shift in the definition, role, and activities that characterize the hospital.

The first two ideas are mostly about what happens outside the hospital. These are things that architects wouldn’t traditionally worry about when designing hospitals. But that kind of thinking has gotten us into our current predicament, where the current built “environment” for providing healthcare is sometimes an impediment to necessary change. If we step back and define a hospital as the nexus for healthcare in a community, we have a platform on which we can imagine the ideal infrastructure for keeping people healthy as possible in a cost-effective way.

In the May+June 2010 issue of interactions, Hugh Dubberly suggested designers ought to help reframe what healthcare is and how it is delivered, as well as to reframe what it means for design to help. I couldn’t agree more, and in this spirit, propose reconsidering what healthcare infrastructure is necessary to better care for people, how design should address this new notion of infrastructure, and what this all means for the institution of the hospital.

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Introducing our new web site !!!

After years of mumbling excuses about the cobbler’s children and how busy we’ve been, we’re thrilled to announce the launch of our new site. It’s taken almost a year from our initial design explorations, but we’re really happy with where we’ve ended up.

While its been a very collaborative effort, it’s also been refreshing to design without the usual cast of stakeholders. (In order to overcome the well-known nightmare that is a firm designing its own site, we almost completely eliminated creative reviews by anyone not directly involved in the project.)

We think the new site much better reflects our design sensibilities and the direction of the firm. It’s still a bit of a work-in-progress. (For one, we plan on adding social bookmarking features in the Journal when we have a moment.) But we’re interested to hear your feedback—let us know what you think in the comments section.


Design by Nick Myers and Dave Cronin, with help from Jayson McCaulliff, Doug LeMoine, Imon Deshmukh, Martina Maleike, and Daniel Kuo. Copy by Dave and Doug, with editorial assistance from Steve Calde and Suzy Thompson. Code by the amazing Elisha Cook and Andrew Hoag at blackdrumm, and photography by the very talented Emily Nathan. Read More

Trying to get my head around “design thinking”

I have to admit that I’ve been steering clear of talking about “design thinking” for a while now. A couple years back, when I first heard about what sounded like an exciting new angle on design strategy, I eagerly scoured the web to figure out what it was all about. At Cooper, we’ve always concerned ourselves with challenges beyond skin-deep ornamentation, and we particularly relish working for clients who value the insights that we can bring to their strategic business decisions. I’m interested in anything that gives us leverage to help businesses get beyond the assumptions that stand in the way of truly serving human needs.

So when I set off to learn more, I was a bit disappointed to discover that all the information I could find about “design thinking” appeared to prominently feature the Keeley triangle, some business success stories and not a lot more. (For those that aren’t familiar, Larry Keeley, an OG innovation strategist, devised the triangle as a way of expressing how successful businesses are balanced in the concerns about the desirability, technical feasibility and financial viability of their products.)

keeley triangle diagram

The Keeley Triangle. The d-school site appears to have been refreshed in the interim, but if I remember correctly, at one point, the home page featured a marker sketch of this diagram with the words “this is design thinking.”

To be clear, I have no argument with the Keeley triangle. It was part of the foundation of Alan’s arguments in The Inmates are Running the Asylum (Alan Cooper’s 1999 book about the challenges of creating great digital products), and throughout the years I’ve found it to be an incredibly useful device in explaining how design fits with business and technology concerns.

But I guess I feel like defining design thinking by the Keeley triangle alone is like explaining how to fly by stating the laws of physics. In a 1998 HBR article, one of the first articulations of design thinking, Tim Brown defined design thinking as “a discipline that uses the designer’s sensibility and methods to match people’s needs with what is technologically feasible and what a viable business strategy can convert into customer value and market opportunity.” I have very little to disagree with in this, yet I don’t find it particularly useful or interesting. And it really begs at least one big question—what part of “the designer’s sensibility”? The obsession over details? The ability to create incredibly disorganized Photoshop (or Fireworks) files? The propensity to wear black?

All this said, I certainly see promise in the vision and enormously appreciate the work that Brown and IDEO have done to popularize the idea that human-centered design methods are fantastic tools for improving all kinds of things—not just product skins and interfaces, and that businesses can get vastly more value when they ask designers to participate in the product (or service) conception process, rather than to just pretty-up an already-formed idea. So I was really excited when I finally got around to reading Roger Martin’s The Design of Business and discovered a conceptual model that has really helped me understand what part of the designer’s skillset is really useful for this big picture thinking.

Martin refers to this conceptual model as “the knowledge funnel.” The funnel starts with a mystery—for example, how to feed the newly emergent car-centric middle class of 1950s Southern California. Businesses then can create value by moving along the tunnel first to a heuristic, or simple idea about how to solve the mystery—a quick service hamburger stand; then to an algorithm, or the specific operational rules about how to achieve the heuristic—where the hamburger stands should be located, how they should be designed, what the menu should be, how to prepare every item on the menu, and how customers should be served.

Among other things, what emerges in Martin’s model of design thinking is that this “designer’s sensibility” that Brown speaks of is the ability to use an understanding of customers’ needs (as well as technology and business factors) to move inwards and outwards in this funnel by iterating through many different heuristics and algorithms to ultimately imagine and then validate a way of solving this mystery. Intrinsic to this ability is abductive reasoning— making logical leaps to imagine what might be true in the future.

These ideas really resonate with me, but I struggle with the notion that abductive reasoning abilities are unique to designers. Martin is dean at the Rotman School of Management at the University of Toronto, and his audience is largely business people. I understand why he wants to differentiate these sensibilities from the largely analytical skills that dominate modern business education. But when I first read and thought about the idea that abductive reasoning is “design thinking”, I had two reactions: first, this is what I’d thought business people were supposed to be doing all along; and second, I know plenty of designers who aren’t at all interested in or good at abductive reasoning beyond their medium of, for example, interaction design, visual interface design or industrial design.

Ultimately, I have grave concerns if imagining a better future becomes solely the province of designers or design thinkers, a world of business and political leaders will be absolved of their core responsibility—making things better. (Not that I’m suggesting either Brown or Martin propose this; in fact, they both very focused on how non-designers can learn to think like designers.) I also worry that the term “design” will lose relevance for all the other meanings we rely upon it to convey. As Michael Beirut recently put it, “Don’t say design, say innovation, and when innovation doesn’t work, make sure you saved some of that design stuff, because you’re going to need it.”

Given the big challenges we face in terms of the economy, environment and society, I think it’s a great idea that everyone learns more about creatively engaging with mysteries through abductive reasoning. Still,there must be a better term than “design thinking” to describe it. Any ideas? Read More

Into the groove: Lessons from the desktop music revolution

(Originally published in interactions magazine, I’ve expanded this a bit to include more examples.)

Musical instruments provide really intriguing examples of user interface design. While it can take years of training and no small amount of aptitude, an instrument in the right hands can provide highly nuanced control over the many aspects of sound that come together to form one of the highest forms of human expression. And even for those of us who will never achieve such heights of virtuosity, merely using such a “user interface” can result a great sense of enjoyment, immersion and fulfillment (what is often referred to as a state of “flow”).

Music is almost universally important to human culture, but instruments are not strictly “useful” and it seems strange to think of them as mere tools. That said, from the first bone flutes and stone tools, the evolution of musical instruments has closely paralleled to that of more utilitarian technology. As inventor and futurist Ray Kurzweil puts it, “[musical expression] has always used the most advanced technologies available.”

Not surprisingly then, as with so many other things, the dramatic increase of processor speeds has brought about a revolution in the way people use computers to make music. But, while computational power has been a critical enabling factor in this revolution, at least equally as important has been the ongoing evolution of the user interfaces of these new digital instruments.

novation launchpad
The Novation Launchpad, a hardware controller specifically designed to work with Ableton Live running on a computer.

A recent history of musical technology and interactivity

As with the broader universe of technology, musical instruments have co-evolved with the practice of music. New technologies are often first introduced as a way of replicating and incrementally improving upon a previously established way of doing things, and then they may eventually point the way to something entirely new. In the same way the first cars were designed as “horseless carriages,” synthesizers were largely first looked to as means to emulate the sounds of acoustic instruments, and it took decades before electronic sounds became aesthetically appealing in their own right. Read More

Dear Mr. Jobs, I have some ideas about how to improve your phone

Everyone knows that the iPhone is pretty great. The vast majority of my clients offer it up as their first example when I ask them, “What products on the market that represent the kind of experience you want to deliver?”

I mostly really like mine. But I’ve got to say there are a couple things about it that really bug me. Right up there after the fact there’s no one-gesture way of switching between different email inboxes is the way the little red notifications circles work with the phone.

It’s a bit confusing, plus requires unnecessary work

Whenever someone calls me, I don’t answer, and the caller leaves a voicemail, a “2″ is displayed in the little red circle over the Phone icon on the Home screen like this:

Maybe I’m kind of a simpleton, but doesn’t that kind of make it seem like I’ve missed two calls? Or that I’ve got two voicemails?

And that isn’t the worst of it. As confusing as that is, after using it for a while, I now mostly remember how it works (and even if I don’t, it doesn’t really cause me any real inconvenience.)

The really irritating part is when I go to the phone application, there are now two new red dots — one over Recent and one over Voicemail, like this:

Every single time, after I go listen to the voicemail, I have to click over to Recent to make that red dot with the number in it go away. Of course I know I missed the call, I’ve already listened to the voicemail. Why do I have to actively get rid of this extra dot?

You might be thinking “Relax, idiot. This isn’t Ms. Pac Man. You don’t have eat all the red dots.” But I kind of do, don’t I? Otherwise, the red dot starts to become useless. This might be fine with all your customers who bought an iPhone to replace their Razr, and those who don’t have expectations of their phone as a productivity tool. But my mobile is actually a pretty important part of the way I manage my work and more importantly, my attention.

What if we changed things around just a bit?

Now, I don’t want you to think that I’m just a hapless complainer. I have a couple ideas for how you can improve things. You can have them for free. (Though if you decide to use one of them, and felt like sending me a new 3GS or Cinema Display or something, that’d be cool.)

The easiest fix is to just change the logic so that for any missed call, you only display one circle. If they leave a message, it’s over Voicemail; if they don’t, it’s over Recent. (Which works for the transition between when it’s just a missed call, and when they’ve left a message. The number just switches from Recent to Voicemail when a message is left.)

But it still kind of bugs me that a given phone call can be represented in two different places. It seems a lot simpler to have a single list of calls to scan through when I pick up my phone after a meeting. Maybe it could look something like this:

It would work like a combination of Recent and Voicemail…

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Prototyping article on

Industry Trends in Prototyping, a whitepaper I wrote about prototyping for interaction design, recently went live on the Adobe Developer Center. Of course, they were interested in what I had to say about using Adobe software (which conveniently, we have no small amount of experience with), but I also tried to take a step back to look at the reasons why designers should prototype and different ways of thinking about and building prototypes. Check it out. Let me know what you think. Read More

Book review: Designing Gestural Interfaces

If you’ve been to the stunning new California Academy of Sciences in San Francisco, you may have noticed a number of interactive exhibits in the halls on the first floor. Among them are two game-like pieces by Snibbe Interactive that allow visitors to physically interact with a projected “natural” environment via motion sensors.

Bug Rug by Snibbe Interactive at the Cal Academy of Sciences, from a video of the installation.

One is called Bug Rug and is set on the floor of a Madagascar forest with insects running around under fallen leaves and branches. Visitors can scare the bugs by stomping around, or they can trap them to learn more about them by guiding bait into traps with a very specific gestural interaction. In the other, Arctic Ice, visitors use their shadows to block the sun’s rays, allowing ice to form so that a baby polar bear can find its way back to its mother.

After watching kids play with both, and speaking with someone intimately involved in the installation of the works who’s watched people interact with both quite a lot, it’s pretty clear that visitors tend to be more engaged and successful with Arctic Ice than with Bug Rug. In pondering why this is the case (beyond the obvious fact that for most people, baby polar bears are a lot more compelling than bugs), I’ve landed upon the theory that the physical interaction of using one’s shadow to block the sun’s rays is a lot more natural and discoverable than placing one’s hands next to each other palm down, with thumbs touching to move things around on the ground.

With the increasing prevalence of physical and gestural interactivity, from the iPhone to Jeff Han‘s election night Magic Wall spectacle on CNN, to the Wii, it’s likely we’re all going to be faced with the excitement and challenge of interacting with and designing devices and environments in new ways. One of the biggest challenges associated with physical interactivity is the lack of transparency into the “commands” or actions available with a given device or environment. The graphical user interface was, in many ways, a huge improvement over the previous idioms of the command line because it made it much more obvious what commands were allowable in a given context. Looking into the brave new future of physical interactivity, we’re confronted with the need to create idioms and vocabulary that are as discoverable and useful as possible to avoid stepping back into command line-like arcana. Read More

IxDA-SF holiday party. w00t!


We had a blast at last night’s very rockin’ IxDA holiday party here in San Francisco, featuring the excellent sounds of My First Earthquake (fronted by ex-Cooperista Rebecca Bortman), Nobody from Ipanema, and The Invisible Cities.

This seems like a good occasion to extend some serious props to Dani Malik and Kim Lenox. They’ve taken IxDA-SF from its fledgling incarnation as a networking happy hour to what it is today — a vibrant community centered around a series of monthly presentations and discussions that span the diverse perspectives and backgrounds that make up the field of interaction design. Big thanks to Dani, Kim, and the IxDA-SF crew for making this happen. Read More

Whimsical interaction design

Let’s face it: Most interactive experiences are pretty darn serious. Of course, there are those that are appropriately so. We don’t want people having a laugh in the operating room or on the trading floor — though, who knows, the latter might have been just the thing to stop the fear-driven capitulation in the markets last week. Still, even most consumer user experiences end up feeling very straight-laced.

As what must be a bit of an escape from the general heaviness of past few weeks, I’ve found myself pondering the idea of whimsy in interaction design. Now, there are the kind of experiences that are primarily playful, like games and other kinds of entertainment (for example, around here, we’re all really loving Brian Eno and Peter Chilvers’ Bloom, a generative music toy for the iPhone), but I’m thinking more about ways to add a touch of playfulness to the everyday.

It must have been Droog, the famed Dutch industrial designers that first inspired me with how just the right touch of whimsy can bring a modern functionalist design to life without reducing its utility. (Ironically, “droog” means “dry” in Dutch — a term often used to characterized the deadpan lowlands sense of humor. As they say in their faq: “The droog mentality could be summarized as ‘dry’. ‘Dry’ as in dry wit, unadorned informality, ascetic irony. ‘Dry’ as that essentially Dutch inclination to ‘do normal’ and at the same time critically investigate what you’re doing and the way you do it.”)


The Come a Little Bit Closer Bench by Nina Farkache for Droog is both attractive and fancifully inventive — it allows people sitting on it to move closer and further away from each other as the seats glide over marbles.

So that’s certainly one kind of interaction design. What about software? Read More

Rhetorically speaking

One of the hardest things about being a designer is that we have to spend a lot of time and energy convincing people to believe in our ideas. Not only do we have to come up with a great idea in the first place, but then we almost always have sell that idea to a big group of people that you must work with to turn these great ideas into reality.

Of course, we all love to believe that the elegance of our vision is self-evident upon a simple walk through and that our beautiful renderings will stun our audience into adulation. Unfortunately, even if you’re very good, this probably only happens some of the time.

The rest of the time we have to explain ourselves. We have to put words around our pictures in such a way that we get our audience to engage, consider and hopefully support our plans and schemes. And this better not be slight of hand. This is no political campaign—if you trick someone into believing you, they can always change their mind after they vote.

Lucky for us, this isn’t a new problem. With its roots in the philosophical pursuits of the ancient Greeks, rhetoric is the study of effective spoken and written communication. It is based upon the idea that form and content may be distinguished from each other, and that certain common forms may be applied to communicate a variety of content. As boring and old fashioned as it might sound (kind of like learning Latin), I’ve found that returning to these basics can be invaluable in clearly articulating the kind of conceptual thinking that often forms the foundation for our proposed design ideas. Read More