how can we design to inspire self-efficacy?

I went to a talk yesterday by Josh Chuzi for Atlanta Design Week called Healing Environments: How Art & Design Can Improve Health. Although the context of the conversation came from his background in art history, he posed a very interesting question: how can we design to inspire self-efficacy?

The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Chuzi talked about healing as a multifaceted term as well, highlighting not only physical healing, but psychological, spiritual, social, cultural, and sexual healing as well. The common theme in healing, though, is to build (and I don't love this term) self-efficacy.

(thanks, Wikipedia)

The prevailing attitude in the healthcare environment today is to treat the physical body. According to Maslow's hierarchy of needs, we must address the physical, corporal needs first. I think, though, sometimes in the current state of healthcare in the world today, we take that need out of proportion with the others. As a medical device designer, I see that we certainly think first and foremost (and sometimes solely) about how medically efficacious a device or therapy is. While that has to be our primary concern, it often becomes our only concern.

We lose sight of the human element of healing. The need to feel nurtured, stimulated, and protected - emotional self-efficacy. The need for our family and friends in times of medical emergency - social self-efficacy. So how do we inspire patients and clinicians to strive for that?

And even more importantly, how do we inspire patients and clinicians in the developing world to achieve that goal as well? In places where empowerment is in short supply, how do we create products and processes to drive people to total self-efficaciousness?

Clever design takes these things into account. That's why music videos in India work wonders on rural literacy rates. That's why Paul Farmer's DOT program was such a success in Haiti. And why Greg Mortensen is able to effectively counter the Taliban's madrassas in northern Pakistan and Afghanistan by building schools.

No, clever design can't do this on its own. Empowerment and self-efficaciousness are a partnership of people, product, and process. I suspect that in the next 20 years in this country, we're going to see a dramatic shift in how doctors see patients. As costs continue to rise, we're going to have to. The process by which we pay for healthcare will change. And the products that we use will have to adapt to keep up. Health is about a whole person. While the medical profession is segmenting and specializing further, the processes and products that we use have to be able to synthesize those specialities into a whole person again.

a gorgeous Georgia night

Saw this gorgeous sunset when I went out for a run. It wasn't so much the sunset that got me - it was the quality of the light on the trees, the grass, and the houses that I noticed first. Almost ethereal. It's hard for an iPhone camera to do it justice.

When I dream about the South land, this is where it all begins.

I think good lighting changes moods. I think it brings people together. I've been obsessed with Morocco since I read in Sky Magazine that it has the most amazing natural light in the world.

And I think candid cameras do the same thing. That's why Polaroids at parties are a huge hit.

This wasn't taken on a Polaroid, and nor is it candid (it was taken with a camera clicker, one of the best inventions ever) but I did promise that I would post this picture -

(please don't reproduce)

From left to right: Andrea, Colleen, me, Jenn. Old friends that got together over good wine and under good lighting at Woodfire Grill in Atlanta.

question your assumptions

During my sophomore year of college I took a class in engineering thermodynamics. It was the kind of class that makes young engineers change majors, where the professor told us on the first day that 60% of us would fail the first test (we did). 

About that time in my life, I received a card in the mail from a mentor of mine. I'm a big fan of Quotable Cards (I'm a big fan of good quotes), and this particular card is still sitting on my nightstand.

Part of becoming an engineer is learning to make good assumptions. But part of being a great engineer is learning to question those assumptions.

It's this part that's lost in lots of designers.

In order to start the design process, you have to make assumptions. To solve a complex system, you have to engineer with information you don't have yet. The design process dictates that you generate design inputs - that is, physical specifications, dimensions, materials... what the product will look like - before you can even create a prototype. And professional engineers do a great job of checking to see that their product meets those design inputs. That's design validation.

But what about verification? What about verifying that my product does not what I wanted it to do, but what my doctor wanted it to do? what my patient wanted it to do? That's design verification. And that's where it becomes important to question your assumptions.

In the past two years I've learned a lot about myself as a designer. I've brought three products to market, taken a course in SolidWorks, and spent significant time in the hospital with clinicians and patients. I've been to a manufacturing plant in Mexico and created a new process for adhesive coating in New Hampshire. I've found that in my career what I'm best at is asking questions, and questioning assumptions. I spend my time in the top half of that graph - on asking why we're doing what we're doing, and how a product behaves with a patient.

I think we can all benefit from questioning our assumptions. Making an assumption is answering the question of how to do something. Questioning assumptions is about asking why we're doing it in the first place. It's about being mindful of decisions, of interactions, of relationships. So go ahead and jump into a problem headfirst. Make some assumptions. Move forward. And then come back and ask yourself why. Look at the assumptions you made, and question whether or not they were the correct ones. Give someone else a chance to surprise you. Give yourself a chance to surprise you.

surprise & delight, and the story of lexus

Today, I was driving down I-20 on my way home from work, and the 18-wheeler in front of me had a tire explode. This isn't the first time I've had a run-in with rogue tire treads - two months ago, a flying tire tread knocked my side mirror out of its position. In fact, when you have a 35-mile commute each way down a highway known to be a tire graveyard, you know it's only a matter of time before you're the unfortunate victim of a flyaway tire.

(photo courtesy of...)

It's in situations like this that I really appreciate my car. I drive a 2002 Lexus ES 300 - a grandmother's car, although I'm pretty sure that neither of my Indian grandmothers ever had a drivers' license - a hand-me-down from my father that's been through 8 years of everything that Atlanta driving has to offer. The more I drive and the more I design. the more I appreciate the thought that goes into Lexus's design choices. There are few companies that I respect more (Apple being another, for their superb focus on design intent). Lexus stands out for a few different reasons:

1. Lexus doesn't engineer cars. They engineer experiences. There is an R&D director that I work with that talks often about the principle of "surprise & delight" - that is, not just meeting design requirements, but exceeding expectations. Surprise & delight is about understanding your design intent, about taking care of tasks that your user didn't even realize they were trying to accomplish.

So they employ hundreds of human factors engineers to study how people interact with their cars. The company understands very well that what people need out of a car isn't the maximum amount of horsepower or payload. People buy cars for the experience of driving. Lexus doesn't focus on features - sure, they have beautiful interiors, state of the art navigation systems, and a thousand other features. But when that tire tread blew up in my face, what I noticed wasn't the automatic stability control that kicked in - it was that I heard only a muted pop in place of a loud bang. The environment inside my car stayed calm, even when my heart skipped a beat.

2. Consumers are far more mature in the car-buying market than they are in other consumer goods. No one tells me to buy a compact hybrid when what I really need is a pickup truck (but lots of people will tell me that I need a Macbook Pro over a Macbook Air). We understand our needs far better in automobiles than we do other things. And that's why Lexus is so successful - they know they can engineer the experience of driving because it's something that people understand very well.

I know how to check my gauges and change my tires, but even the engineer in me doesn't crave horsepower over simple creature comforts.

3. They anticipate how the driving experience should be - from start to finish. Lexus makes sure that at no point in my driving life, I drive anything other than a Lexus. From the showroom to the test drive to routine maintenance visits in which I get a Lexus courtesy car and free gas, the company always has their best foot forward to make things easy for a customer. Sure, they may lose a little bit of money filling the tank back up for you after you've spent the day cruising around in one of their new models while getting your timing belt replaced, but they more than make up for it in loyalty when you buy your next car.

welcome, new friends!

There's been a recent upswing in visitors to the blog, and although it's still modest traffic, there's a good number of you coming in from overseas - welcome!

(photo courtesy of... )

When I first started blogging, I stressed an emphasis on creating good content, so that anyone reading was consuming interesting and thought-provoking posts. I don't always hit that mark, but I'm always, always open to suggestion and comments!

If there's something that you'd like to talk about, please don't hesitate to ask.

If there's a design or development issue that you'd like to write about, talk to me about a guest post.

And finally, if you're subscribing on Google Buzz or Reader (and therefore I can't track you as a visitor... if you know a way around that, can you let me know... Shan... ?), thanks for the emails with your thoughts - they are sincerely appreciated. A lot of you have some really sharp insights - don't be afraid to share them publicly with other readers.

how information moves to create empowerment

Late last year I met with some folks in Boston who are working on some neat emerging technologies for diagnostics in the developing world. Since then, we've all been trying to brainstorm ways to engage others who are interested in this topic into the conversation. Recently, Aaron posed a really interesting series of questions to me in thinking about the world after their diagnostic technology becomes widespread:

(photo courtesy of... )

"How does the data move; what is done with the data when it gets there? How does it influence caregivers, governments, funding sources, etc? Can we predict what we might learn?"

I have an endless curiosity for questions like these (as Thomas Friedman calls it, this is my "inner fire truck"). Although my design skills are still in their infancy, and I hopefully have a long road in global health and technology ahead of me, these are the best kinds of questions to ask to move further down that path. Essentially, development is about empowerment, and empowerment comes from information. When you design for the developing world, and with the developing world, the primary concern is access to information. What information do these people need to make appropriate decisions (and how does that differ from the information that we provide for traditional devices in domestic hospital settings)? How can we deliver that information in a usable and readily accessible format? What will happen to that information once we obtain it? What other things can we couple it with to make the most of it?

Of course, you have to optimize your physical design for the environment that it will be used in, but these are questions of design intent, and they're far more interesting than questions of form or function.

a fun post, a serious note, and pictures of the dog

Despite my best efforts and a flu shot, I'm sick. For the past two days I've been running a fever of about 101 degrees, and laying in bed with just the dog and a bottle of Amantadine to keep me company.

It's only tangentially related to talk about trauma centers, as I'm not actually in a trauma situation. The flu in a relatively normal, healthy adult shouldn't be much cause for concern. The upside of being sick is that I've had some time to go through emails that gmail has designated as "Everything Else" in my Priority Inbox (is anyone else using this? To any degree of success?). Last week, our VP of R&D's wife sent me an email from her daughter, an RN in Georgia, about trauma centers and funding. There's an amendment on the ballot for a November 2nd election for increasing the car tag fee by $10 to fund trauma centers in Georgia. For those of you in Georgia, spread the word, and make sure you make it to the polls on November 2nd.

In a former life, I did three months of eye-opening research in the trauma center at Grady Memorial Hospital in Atlanta. Grady is something of a joke between most well-to-do Atlanta families (and I use that term very, very loosely) - the ones that live north of I-20. Even the residents at Grady would tell us, if you've had a serious accident come to Grady, and then get out as fast as you can. Due to the large contingent of repeat homeless patients, the trauma team would call the ER "Hotel Grady" - drug addicts, chronically afflicted homeless, and alcoholics would deliberately self-injure to be allowed back into Grady for a warm bed and a meal to eat. The trauma center was constantly put on diversion due to overcrowded wards, and then would still have to accept patients because other trauma centers were on diversion too.

Needless to say, I'm all for the amendment. Check out the details here.

Now for the fun part of the post. I've been laying in bed, reading interesting blog posts, listening to Josh Ritter, and taking poor-quality iPhone photos of the dog. Some particularly memorable shots (if you want to use these pictures, please drop me a line!):

What Sawra thinks about me being sick.

Toy-hoarding. No, you can NOT play with my toys.

Getting a little camera shy. It's so funny to watch her rub her eyes.

Content that she gets to sleep on the bed all day.

Sawra is a 7-and-a-half-month-old Yorkie/Maltese mix, and the cutest thing ever.

depth, breadth, and the "real world"

There are two things on Earth that grate on my nerves to no end. One is bananas; the other is when people refer to a certain milestone or experience in their lives as a mark of "the real world." Graduating from college, returning from a trip abroad, or finishing a substantial service endeavor are all good examples of activities that seem to fall outside the realm of the "real world."

I don't know, it looks pretty real to me... (photo courtesy of... and read the headline for good measure)

This phrase always makes me wonder, what fake world were you in before that?

In adult life I think people value professional depth. For most people, school is about creating depth in one subject area to pursue after graduation. Work is about becoming a subject matter expert in one field. Graduate degrees are about depth of understanding in one very specific topic. But although our society encourages to specialize professionally and develop a depth of understanding in a particular topic, it personally idealizes those who do the opposite - who have a breadth of interests and engagements in addition to their (to use another buzzword) core competence. The phrase "the real world" is about experiences that create professional depth. But what you do outside that "real world" is what makes you a great designer.

To be a good designer is to possess depth. It's very, very important to understand fully what tasks are needed to achieve a given outcome. That's depth. That's understanding the realities of the use case. To design products for mitral valve repair, I have to have a complete and thorough grasp on the anatomical details of the heart and the physiology of its components. But to understand the user is a different scenario - what are the pain points in the surgeon's particular technique? How many patients does a nurse see in one day? What are the most challenges tasks on the agenda in the operating room? Being able to address depth issues, or task-specific challenges, is to meet your design criteria. But being able to address breadth issues, things that a user can't necessarily articulate for themselves, things that are tangential to the task at hand but functionally related to the use of a device - addressing those issues is what creates products that defy expectation.

It's one reason that I'm such an advocate of engineers having ethnographic experience in user sites. Understanding the technical details of what you're designing to is one thing; but understanding physical environments, workflows, structures, and attitudes are priceless. Processing these connections in one setting can help us translate dissimilar experiences into useful inputs, can help us come up with good questions to ask when we're designing something new. Even just being able to touch something, rather than hear about it, gives us a whole new dimension on what it is we're designing. Watching a patient being transported into the ICU on an Army base in India has helped me translate the mechanical requirements to keep Foley catheters in place for patients in Belgium. Even if that observation didn't take place in the "real world."