If you want to talk about digital and health, you have to talk about emotions
Beep-boop. Even robots in health are an emotional experience. Miss out emotions and you’re just building systems
The following is a talk delivered by Mark Brown to HIMSS Liège 2019 at University of Liège, Belgium on 2nd April 2019
Healthcare systems have healthcare system problems. People have people problems. Health care systems exist to deliver health care. That’s a difficult job, but it isn’t a new one. Who has access to these treatments, how and when is a political decision.
People, on the other hand, have people problems. They’re experienced in their body, in their lives, in the things they can and cannot do. No one wakes up and feels ‘Today I am experiencing a healthcare system problem.’ Instead, people feel pain, discomfort, shame, embarrassment, horror, terror, boredom, frustration, relief, joy.
Everyone has healthcare needs. Those needs don’t happen in healthcare systems, they happen in people’s lives. Having better health means having a better life. Increasingly, healthcare is becoming something more that the delivery of episodic treatment. More people live with more conditions for far longer. Who you are and where you are and what is happening around you is where your health happens.
Solving problems healthcare systems have in delivering healthcare is great but it isn’t the same as solving problems people have in their lives.
Digital is often seen as a cost-effective way of delivering at scale healthcare interventions or shaping health behaviour. Digital solves problems like geography, time and communication. But even then, if the ways it tries to do that don’t fit with people’s expectations and people’s sense of their lives and what their health conditions mean, the most likely outcome is they won’t be used.
Improving healthcare through digital technology is one important job. Improving people’s lives through digital healthcare is a different job. Often, the development of digital health products views the health of the person through the eyes of the healthcare system. If the patient would only use the technology in the way that it was intended, we think, the results would arrive.
Patients are just trying not to feel awful. Creating digital things that actually find a home in people’s lives by making things better is a different job.
Our bodies terrify us
The key to making the gains we need to is to understand what people want to happen in their lives and what causes them greatest joy and greatest discomfort. Our bodies terrify us. The reality of ill health is an emotional as much as it is physical. Our bodies are a story that we live each day.
Human centred design in health isn’t just a matter of better UX. It’s about really understanding from the foundations what it feels like to experience ill-health.. This is the realm of emotion: of pride, of fear, of shame, of hope and of knowing the best thing and doing something else instead.
Focus on joy and discomfort by taking what you know about healthcare and digital and exploring it with people in the context of their real lives.
Spending time with people first is vital. Don’t just ask them if they like your product. People are polite and will help you get the best version of the wrong thing. Ask them why healthcare doesn’t work for them. Ask how they would like to feel. Ask them what they would like their world to be like. Find out what joy would look like in the solution of their problems.
This is not easy if you are not ready to be surprised or discomforted. People often do not know what they want because they’ve never seen it. Digital offers possibility, but only if it’s a possibility that you want to explore.
Good user experience is great. But good use experience should be a given. What’s more important is understanding what the gap is between what healthcare knows should make someone feel better and the way people actually think, feel and behave. People need different things because they feel different things.
A homeless person needs a different diabetes app to a person with learning disabilities. A person with multiple morbidities might need a digital thing that meets all of their needs because they experience all of those morbidities at once as one lived experience.
Digital presents endless possibilities for diverse holistic interventions, not endless scale of standardised ones.
Hack the things that keep people from health, don’t hack the people themselves
Digital disrupts. Digital healthcare should disrupt the situations that affect people’s health, it should not disrupt the lives of those it is intended to help. When a digital intervention is not delivered face-to-face by a clinician in the same room as a patient, the majority of the success of that digital intervention is not efficacy in trials, it is acceptance in context.
‘Does this thing get me closer to what I want from life?’ is the question people ask. ‘Does this thing deliver appreciable impacts to our health system?’ is the question healthcare systems ask.
Working with people early, working with people often and working with people over time is the way to marry these two questions together. Work with humility, curiosity and solidarity.
To deliver the gains people need, we need digital that does what it does best: Becoming a seamless part of people’s intimate everyday lives. Digital can cross boundaries into people’s behaviour, into their habits, into their dreams. It happens in their houses, their beds, in parks, in bars, on street corners. It happens in your hand.
Begin with what matters to people. Health problems are lived by people. Digital tech shouldn’t be hacking the person with health needs, it should be hacking the things that stop the person being as well as they can be. To really make people’s lives better beyond the hospital or consulting room, digital technologists need to be the champion of the patient, not the system. Put digital possibility to work to answer the problems that people have. Be close to them.
People are amazing: how can you make technology people want to hold close to their hearts if you’ve never seen what makes them smile?