It also brings together a lot of other ideas I’ve been thinking about over the years, from the concept of “UX Cruelty,” which often results from “delightful” engagement-driving experiences that neglect the reality of anyone who isn’t the “ideal user,” to workflow planning methods and tools to avoid this cruelty by identifying different user scenarios and the experience requirements to support their needs.
I design healthcare experiences for a living. This includes:
Designing experiences for patients
Designing experiences that facilitate the relationship between providers and their patients
Designing solutions for leveraging large swathes of medical data to improve health outcomes at population scale
A lot of work is being done to bring design thinking to healthcare. I’d like to explore how healthcare can be a source for design philosophy. Not because healthcare has experience design figured out — not by a long shot, obviously. As an industry, healthcare is often rife with misaligned, and even malign incentives that can lead to awful results. But as a discipline of diagnosis, treatment, and prevention, healthcare is the endeavor of healing. The applications of healing — physical, mental, psychological— are themselves technologies. And I believe the technology of healing can offer a novel perspective to reexamine how we think about broader technology design.
Design is about choices.
Earlier this year, The Center for Humane Technology, an organization founded by former Google Design Ethicist, Tristan Harris, to “align technology with humanity’s best interests,” partnered with Moment, an app that helps people track their screen time, to find out how people feel after using different apps. They collected data from 200,000 iPhone users and ranked the apps that made people feel the happiest, and the ones that made them most regret the time they’d spent there.
What’s interesting about what their findings reveal is that four of the top ten apps that make people feel happiest about having used them are designed specifically to facilitate mental / physical health practices.
Here is just a sampling of the product design canon that has ended up on my own bookshelf:
Persuasive design has provided the educational foundation for technology creators and its essentially unquestioned (until recently) behavioralist philosophy has wound up directly embedded into the products they develop. Products that have gone on to affect how billions of people now experience their lives. At an existential level technology remakes culture: the philosophy that proliferates through the products we use in turn defines the values we absorb, the behaviors we adopt, and the social norms we internalize by using them. But in a very practical sense, persuasive design philosophy has simply provided a framework for defining which design choices are considered valuable, and which are not.
Healing offers a different modality through which to evaluate design choices, and expands the spectrum of available options for those choices.
What can we learn from healing technologies, both timeless and cutting edge, to inform a design philosophy for the kinds of products people are happy to have in their lives?
1. Pain Reduction (vs. “delight”)
“The quality of emotional responses elicited by a product is a measure of its delightfulness,” according to UX Magazine. “Delightful is the highest level of UX maturity.”
What if, as Erika Hall suggests, “Creating ‘delightful’ user experiences is actually “user-hostile when it wrongly presumes that your customer wants to be emotionally involved with your service at all.”
Put another way:
“Fast and invisible are often the better parts of delight,” Hall adds.
In other words, pain reduction can be more valuable — and pleasurable — than emotional engagement with a designed experience.
Rather than thinking about how we can more delightfully coerce people into doing something, how do we instead design to take away the pain standing in their way?
And yet, more than one-third of Americans over the age of 45 report feeling lonely. The prevalence of loneliness is especially high among those over 65 and under 25. Looking at high school students’ feelings of loneliness tracked since the 1990s, an interesting inflection point stands out:
How is it that our unprecedented social technologies have exacerbated our feelings of alienation?
While a growing body of evidence is revealing the health benefits of meaningful connectedness, design choices have been made to dope us into a haze of superficial “contacts” — weak ties and surface interactions.
Considering the impact that meaningful connectedness has on our health, how do we design for experiences that facilitate it?
3. Precision Medicine (vs. “happy path”)
Precision medicine is an emerging medical discipline of tailoring customized treatment and prevention approaches based on a patient’s specific genetic information and environment.
Advertising technology and feed filter algorithms have already scaled precision-targeting to create personalized, alternative media realities. But product design is still largely reliant on the starting point of a default workflow — a “happy path.”
Yet the happy path can not only fail users but actually create suffering.
Yes, my year looked like that. True enough. My year looked like the now-absent face of my little girl. It was still unkind to remind me so forcefully.
The design is for the ideal user, the happy, upbeat, good-life user. In creating this Year in Review app, there wasn’t enough thought given to cases like mine, or anyone who had a bad year. If I could fix one thing about our industry, just one thing, it would be that: to increase awareness of and consideration for the failure modes, the edge cases, the worst-case scenarios.
The precision medicine concept applied to design could mean avoiding this kind of UX cruelty.
In healthcare, “edge cases” can still have implications for millions of people. To help simplify the complexity of designing for an environment like this I developed a workflow planning tool at athenahealth. The goal is to easily document and account for the various situations in which users may find themselves.
Understanding the implications of distinct workflows on their own terms, rather than as deviations from a default, makes it easier to step away from the mental model of a “happy path” and design for a more inclusive range of real-life user scenarios.
How else can precision medicine thinking allow product designers to reframe “edge cases” and “outlier” scenarios and find scalable approaches for addressing the needs of diverse users?
4. Population Health (vs. “engagement”)
Population Health is an approach to healthcare that is based on evaluating health outcomes at population scale, and driving informed clinical decisions to improve those outcomes. The sheer amount of data we now have available and the tools with which we can wield it make population health a hot new area for healthcare, but Florence Nightingale was using these same methods out on nineteenth century, Crimean battlefields to assess causes of preventable deaths among soldiers:
You can’t optimize for what you don’t measure. So what ARE we measuring?
Clicks. Likes. Shares. Comments… Engagements. Often, simply whatever is the most obvious event metric to record and track — not necessarily the most salient or meaningful.
How happy are our users after using our product? How is their well-being affected? How much less pain and more meaningfulness have we contributed?
“Metrics,” Niels Hoven writes, “are leading indicators, not end goals. One of my favorite stories is from a friend who worked on improving the search feature at a major tech company. Their target metric was to increase the number of searches per user, and the most efficient way to do that was to make search results worse. My friend likes to think that his team resisted that temptation, but you can never be totally sure of these things.”
Metrics are, as Hoven adds, “just heuristics, actionable proxies that could be measured on a short time scale” They are not sufficient “stand-ins for long-term product health.”
Nor, for that matter, for the long term health of our user population.
We have been very busy measuring, and optimizing for engagement / user actions. How do we measure the health of our user populations in order to achieve better quality outcomes?
. . .
Y-Combinator, the famous startup incubator that has helped create successes like AirBnB, DropBox, Instacart, Reddit, and more, has a motto:
And the thing is….people WANT less pain, they want more connectedness, and better health! These are not things people DON’T want. They’re just often not what’s being designed for.
Taking a cue from Harris’s years of work on the Time Well Spent movement, earlier this year Mark Zuckerberg announced his intent to shift Facebook’s product directive towards “encouraging the most meaningful social interactions.” He wanted Facebook to become “more focused on trying to measure and have people tell us what is creating the most meaningful interactions in their lives. Not just on Facebook. It could be a message that you have on Messenger or WhatsApp, but it could also be that you see something on Facebook and have a conversation about that in the world with someone who’s meaningful to you, and that’s something that we need to understand.”
Looking to the technology of healing as a source of design philosophy isn’t about sacrificing commercial viability. It’s about employing a different framing for what people want, and a different way of thinking about our priorities in the way we design the products that shape people’s lives.
A practical guide for designing products that help people get stuff done
An interesting thing about the interface experiences we all spend so much of our time with is that they are designed for the same type of use case:
Netflix, for example, would love nothing more than for you to spend as little time as possible actually doing anything. Their algorithmic recommendations reduce the time you spend searching for content you’ll want to watch, and each successive episode plays automatically after the last one is over without any input from you, the user, at all.
Beyond just media platforms, content consumption drives retail consumption as well:
The undisputed heavyweight of optimization positions both browsing use cases with an essentially identical interface:
(Get you a consumption-oriented UX that can do both.)
The sheer ubiquity of these interfaces, designed not just to be consumed but to, in turn, consume our time, can make it difficult to realize that taking design cues from consumption-driven products — and their practitioners’ many design philosophies — may not be right for every product.
At athenahealth we make the software doctors use to manage patients’ clinical data and run their businesses. Our entire product is oriented around work-critical application flows, not passive consumption.
Workflow: A sequence of tasks to produce a desired outcome.
This is where workflow planning matters most. Unlike a typical consumption-driven experience, maximizing users’ time spent is not a success indicator for us. In fact, it gets us further away from our actual goal — helping doctors interact with their patients instead of their screens.
If, like us, you’re building a product that is about helping people get complex work done, then You Won’t Believe These Six Crazy — just kidding, you know why you’re here. You want to know how you can design more effectively to help your users achieve their goals. So let’s get into it.
“As a user, I want to do A, B, & C, so that I can complete the work I need to do.”
What would be the best design solution for this user story?
Is it like this…
Or maybe it’s like this…
Either approach would support the stated user need, but through two very divergent processes and, inevitably, interfaces. User stories tell you what to design. Workflow planning tells you how best to design it. And there are consequences for diving into designing for user stories before a solid workflow foundation is in place.
Without A Workflow Planning Methodology:
Design begins before downstream implications are understood
The resulting experience becomes a bunch of siloed pages or steps strung together vs. an integrated flow
Users end up faced with feature overload because the totality of the process has not been taken into account
And, worst case scenario, you end up reworking design (or even code) late in the game
How we do workflow planning.
Here’s our simple formula for how to break down workflows.
A workflow is the goal a user wants to accomplish — the thing that the product, or a particular part of it, is designed to help them get done— multiplied by scenarios — a set of circumstances that can affect how users accomplish said goal.
For example: if, as a patient, your goal is to prepare for an upcoming doctor’s appointment (filling out health history information, signing consent forms, paying the copay, etc.), the way you accomplish that goal would be affected by whether this is a brand new doctor you are going to see for the first time or if you’re coming in for a standing, weekly appointment. From the patient’s point of view, the goal is the same — you need to confirm the appointment and do any advance prep necessary — but the scenarios are completely different, and dictate distinct workflow solutions.
To solve for this, we’ve developed the 6-step process for workflow planning, below.
Step 1. Define your users’ goal / job to be done. (The reason they opened up your app or came to your site).
Step 2. Identify any scenarios that will impact this goal. What circumstances can be true about the world, the user, or the business objectives in different situations?
Step 3. Document the different workflows that result from these combinations.
Step 4. Are there other goals that a user wants to accomplish when they use your product, or a particular part of your product? Add them.
— Keep in mind, goals are not granular user stories; this is not the place to document an exhaustive list of tasks. A goal is the big picture thing a user wants to have accomplished — order a car, book a flight, file taxes — at the end of the workflow.
Step 5. Repeat the workflow documentation process. Add any additional scenarios you might encounter as you go along.
If you find you’re adding a lot of new scenarios for a specific goal, you might actually be better served by rethinking it as a different product / section altogether.
Step 6. Prioritize your workflows — because you can’t build everything at once.
Keep in mind, not every cell in the matrix will require its own separate workflow. One workflow may be able to support multiple goals and scenarios with some affordances for discreet needs. The point is to make sure you have your bases covered before diving into design.
Here’s a sample of a workflow planning process we did for the pre-appointment patient experience described above:
There are various ways to approach prioritization. It can be based on your product timeline or development cadence. Or you can focus first on the workflows that will solve the biggest pain points or address the most common scenarios. Up to you, so long as it gives you a roadmap for how to proceed. In the example above, our prioritization was based on building for the scenarios that require the most comprehensive information need first to then be able to easily modify for a range of variations.
Once you’ve got your workflows documented and prioritized you can move into diagramming the workflow steps.
Algorithms are the perfect tool for delivering individualized exploitation to billions. They may yet have potential for mobilizing collective power at scale.
Buy Me a Sandwich
Out in California, my friend is working on a new kind of energy storage startup. Here’s what they do. They buy electricity from the grid when it’s cheap (middle of the night), and store it in a battery in your house for you to use during the day, when demand is high. Participants will be able to save 20%-30% on their energy bills. And the best part is you don’t even have to do anything. The whole thing runs on algorithms.
Customers in the UK will soon find out. Recent reports suggest that three of the country’s largest supermarket chains are rolling out surge pricing in select stores. This means that prices will rise and fall over the course of the day in response to demand. Buying lunch at lunchtime will be like ordering an Uber at rush hour.
But what if an algorithm bought it for you at midnight instead?
Amid the infinite churn of natural and political terrors— juxtaposed with photos of babies made by people I love — blowing up my Facebook feed, I keep seeing a hipster hostage video selling me something called Paribus.
“Stores change their prices all the time — and many of them have price guarantees,” explains Paribus’ App Store description. “Paribus gets you money when prices drop. So if you buy something online from one of these retailers and it goes on sale later, Paribus automatically works to get you the price adjustment.”
Most likely the reason Facebook expects I’d be interested in this service (more on this later) is because I already have an app duking it out with Comcast to lower my bill.
It sends me updates via Facebook Messenger to let me know its progress:
And I message it back choose-your-own-adveture style responses:
This feature is part of a service called Trim, which positions itself as “a personal assistant that saves money for you.” (It makes money by taking a cut of the recovered charges.)
Trim calls its Comcast negotiator bot, knowingly:
And, indeed — we should all be thinking about the possibilities for algorithm defense.
Buy Me A Monopoly
The day Amazon announced its purchase of Whole Foods, shares in both Kroger and Walmart — which generates more than half its revenue from grocery sales — went into free-fall. Kroger’s in particular fell 8% in a matter of hours.
“Amazon has demonstrated that it is willing to invest to dominate the categories that it decides to compete in,” said Mark Baum, a senior vice president at the Food Marketing Institute. But the way Amazon “decides to compete” is to actually make the category uncompetitive, driving other players out until it has become the category.
Amazon isn’t abandoning online retail for brick-and-mortar. Rather, it’s planning to fuse the two. It’s going to digitize our daily lives in ways that make surge-pricing your groceries look primitive by comparison. It’s going to expand Silicon Valley’s surveillance-based business model into physical space, and make money from monitoring everything we do.
Concepts like Paribus, or Trim’s “Comcast Defense” are still primitive now, too, but extrapolate the possibilities out at scale. Imagine hundreds of thousands of people on a negotiation platform like this. That becomes the ability to exert real power. To pit Comcast and Verizon and AT&T against each other for who will offer the best deal, and have the leverage to switch all your members over en masse.
Reading Trim’s about page, it seems possible the thought could have crossed their minds:
So far, we’ve saved our users millions of dollars by automating little pieces of their day-to-day finances.
Now we’re starting to work on the hard stuff. Will I have enough money to retire someday? Which credit card should I get? Can my car insurance switch automatically to a cheaper provider?
Maybe Trim’s already thinking of the power of collective negotiating. Or maybe someone else will. The idea isn’t even all that new. It’s essentially how group insurance plans work. And unions. We’ve come up with it before. But we’ve never really tried it with code.
Buy Me A Pen
art by Curtis Mead
“When mass culture breaks apart,” Chris Anderson wrote a decade ago, in The Long Tail, “It doesn’t re-form into a different mass. Instead it turns into millions of microcultures, which coexist and interact in a baffling array of ways.”
On this new landscape of “massively parallel culture,” as Anderson called it, hyper-segmentation has become our manifest destiny.
Now we atomize the universal, dividing into ever nicher niches. We invent new market subsegments where none previously existed, or need to. We splash pink onto pens to create “differentiated” product lines:
Facebook knows your phone ID and can add it to your Facebook ID. It puts that together with the rest of your online activity: not just every site you’ve ever visited, but every click you’ve ever made. Facebook sees you, everywhere. Now, thanks to its partnerships with the old-school credit firms, Facebook knew who everybody was, where they lived, and everything they’d ever bought with plastic in a real-world offline shop. All this information is used for a purpose which is, in the final analysis, profoundly bathetic. It is to sell you things via online ads.
Buy Me Clicks
All day long, Facebook’s News Feed algorithm “is mapping your brain, seeking patterns of engagement,” writes Tobias Rose. “It can predict what you’ll click on better than anyone you know. It shows you stories, tracks your responses, and filters out the ones that you are least likely to respond to. It follows the videos you watch, the photos you hover over, and every link you click on.”
And Facebook follows you even when you’re not on Facebook. “Because every website you’ve ever visited (more or less) has planted a cookie on your web browser,” writes Lanchester, “when you go to a new site, there is a real-time auction, in millionths of a second, to decide what your eyeballs are worth and what ads should be served to them, based on what your interests, and income level and whatnot, are known to be.”
Facebook’s algorithms can create not only a private, personal pipeline of media, but an entirely individualized reality where information is repackaged for you — like pink pens — dynamically, in real-time, to whatever color, shape, or price point will extract the most value out of you specifically.
Four researchers based in Spain creat[ed] automated [shopper] personas to behave as if, in one case, ‘budget conscious’ and in another ‘affluent’, and then checking to see if their different behaviour led to different prices. It did: a search for headphones returned a set of results which were on average four times more expensive for the affluent persona. An airline-ticket discount site charged higher fares to the affluent consumer. In general, the location of the searcher caused prices to vary by as much as 166 per cent.
An anti-Clinton ad repeating a notorious speech she made in 1996 on the subject of ‘super-predators’… was sent to African-American voters in areas where the Republicans were trying, successfully as it turned out, to suppress the Democrat vote. Nobody else saw the ads.
“As consumers,” Tarnoff writes, “we’re nearly powerless, but as citizens, we can demand more democratic control of our data. The only solution is political.”
I’ve had the same thought. In an article last year about how technology has gotten so good at degrading us even some of its creators are starting to have enough, I wrote, “We take it for granted now, that cars have seat-belts to keep the squishy humans inside from flying through a meat-grinder of glass and metal during a collision. But they didn’t always. How did we ever get so clever? Regulation.”
We’ve been classified and stereotyped and divided and conquered by algorithms. Lines of code deliver custom-targeted exploitation to billions of earthlings at once.
Can our individual fragments of power be scaled towards something bigger by them as well?
“Addressing our biggest issues as a species — from climate change, to pandemics, to poverty —” (to Jesus Christ, have you tried ever canceling your Comcast account?) “— requires us to have a common narrative of the honest problems we face,” writes Rose. “Without this, we are undermining our greatest strength — our unique ability to cooperate and share the careful and important burdens of being human.”
As individuals we are indeed basically powerless, and algorithms have proven a stunningly effective tool for extracting ever greater value out of our atomization. We have perhaps yet to imagine the potential of what algorithms deployed to concentrate our individual power into a group force can achieve at a global scale.
One thing is for certain — we ned to start thinking about defense.
The story of the biggest transformation of our time has a marketing problem: no one knows it’s happening.
There were many important events that happened in 2016. Some were deafening, trumpeting the seemingly inexplicable ascent of backwards-facing forces. But one event of great historical significance went largely unremarked upon.
In 2016 solar power became the cheapest form of new electricity on the planet and for the first time in history installed more new electric capacity than any other energy source.
Amid the sepia haze oozing from the past’s rusting, orange pipeline, humanity was placing a serious bet on a new kind of future. And you didn’t even know about it.
That’s a problem.
It was a bit like if you had a source of whale blubber in the 1840s and it could be used as fuel. Before gas came along, if you traded in whale blubber, you were the richest man on Earth. Then gas came along and you’d be stuck with your whale blubber. Sorry mate — history’s moving along.
— Brian Eno
“The beginning of the end for fossil fuels,” according to Bloomberg, occurred in 2013. “The world is now adding more capacity for renewable power each year than coal, natural gas, and oil combined. And there’s no going back…. The shift will continue to accelerate, and by 2030 more than four times as much renewable capacity will be added.”
The International Energy Agency’s Executive Director, Fatih Birol, said, “We are witnessing a transformation of global power markets led by renewables.”
“While solar was bound to fall below wind eventually, given its steeper price declines, few predicted it would happen this soon,” notes Bloomberg.
Later campaigns for the iPhone didn’t even show the product at all:
The product became the conduit to the experience. And the experience that solar has to sell is Future.
– Claim the Narrative of Future –
Two decades ago — back when it was still possible to talk about the future as anything but dystopia — a series of ads painted a striking vision of how that future was going to unfold. “Have you ever borrowed a book from thousands of miles away,” asked the ad voice. “Crossed the country without stopping to ask for directions? Or watched the movie you wanted to, the minute you wanted to?”
“You will,” said the voice, “and the company that will bring it to you: AT&T.”
Today I use a device to do basically 90% of what those ads predicted. (OK, I’ve never sent a fax from the beach, or tucked a baby in from a phone-booth, but you can’t get the Future 100% right). All of these things are so obvious and mundane now we barely even remember — some of us never knew — there was a time before. But, indeed, there was a point when this fantastical world was the future, and the future still seemed like a fantastical world.
There are no grand visions for the future now, no scenarios for humanity that don’t fill us with dread. A dying oligarchy tells us dissolution is freedom; regression is hope. It has disfigured our understanding of what’s happening in our world. The result is a gaping void in our collective vision when we look ahead. 17 years in to our new century there is a desperate hunger for a bright vision for the future, and at the moment arguably no one outside the world of clean energy has a legitimate claim to one. In the end, it’s not about utility bills or net metering laws or even solar panels for that matter. It’s about a vision of a Future worth demanding. Solar has the opportunity to be the voice of that vision for decades to come with a simple, cohesive, culture-focused messaging strategy.