IDEO and Fotile have had a relationship since 2009, working together on projects including a unified design language for product offerings, retail environments, and IoT strategy. For the dishwasher, IDEO and the Fotile research team came together for design research, shadowing Chinese families in different cities as they prepared meals from start to finish. Together they discovered that unlike in Western cooking, where several kinds of cookware are used for different dishes, Chinese cooks tend to use the same cookware to prepare all of their dishes.

That meant that the cookware needed to be cleaned several times during a single meal preparation, rather than once at the end. In this context, the sink serves different purposes over the course of cooking—it’s a place to wash and store prepped ingredients, rinse the cookware, and deep clean the dishes used in food prep and during the meal.

Based on this insight, IDEO made a list of product design recommendations that became Fotile’s Sink Dishwasher—a counter-level, multi-purpose appliance that specifically suits Chinese cooking habits. IDEO’s design guidance gave Fotile the confidence it needed to launch its product into the market, and served as a blueprint for the future iteration of Fotile’s Sink Dishwasher.

On March 25, 2015, six months after the project ended, Fotile launched the world's first sink dishwasher designed for Chinese families. Eight months later, its market share exceeded 30 percent, setting off a wave of innovation in the Chinese dishwasher category.

In 2016, Fotile introduced a three-slot dishwasher with an added compartment for cleaning fruit and vegetables—a direct response to a research finding that Chinese families are concerned about food safety. When this new model hit the market, Fotile’s dishwasher market share jumped to 41.1%. In China, Fotile is now synonymous with “sink dishwasher,” and the company has a widespread reputation among consumers as a symbol of a safe and healthy Chinese family kitchen.

Since its founding in 1994, Fotile’s Chairman, Mao Zhongqun, has made it his goal to “do nothing but build a high-end Chinese family brand.”

30%

Fotile Sink Dishwasher’s share of the market in China, just eight months after launch

41%

Fotile’s dishwasher market share after it launched a three-slot version in 2016

#1 selling brand

in the mainstream price segment of the Chinese dishwasher market as of August 2023

BoAo Group’s idea to design a new baby car seat was fueled by a newly revised minor protection law, which made using child safety seats mandatory beginning June 1st, 2021. As ZUOWE and IDEO looked around China’s emerging car seat market, the team noticed a singular focus on safety and safety features across most international and domestic brands. There was a clear opportunity for a new product that could meaningfully differentiate itself by not only providing safety features but also meeting the needs of modern Chinese parents.

To kick off the project, the IDEO team needed to answer two questions: What matters to the new generation of parents in China? And how will their style and approach to parenting affect their expectations for baby car seats? Taking into account the potentially different consumer needs in different geographies, the IDEO team headed to Shanghai, a city with more than 25 million people, and the city of Taizhou in Zhejiang province, which has a population of 2 million. They conducted in-depth home visits to local families, visited many brick-and-mortar mom-and-baby shops, and interviewed people like specialized nurses, parenting experts, and child psychologists. 

Despite the differences between the two cities, IDEO discovered commonalities during consumer conversations. Young Chinese parents were experiencing a perceived identity gap. As individuals, they felt they had distinct personalities and a clear sense of self. They actively expressed themselves through their clothes and belongings. But when they became parents, this sense of self weakened or disappeared completely.  Their identities shifted to being someone’s mom or dad overnight. This new generation was eager to show their unique approach to parenthood as they used to express their sense of self. But many products were designed for children, with little regard for parents. 

This core finding helped set the direction for the new baby car seat design and brand Maple&Co. However, there were still two significant challenges to overcome. One, IDEO needed to design a product with stringent technical regulations and standards on a tight timeline—ZUOWE wanted to launch the new car seat at an important industry trade show within the year. And two, the team had to help the organization transform its thinking and ways of working to be more consumer-centric.

BoAo’s strength lies in its 20 years of experience developing and manufacturing car seats for major domestic and international automotive brands. This gave the company an edge in overcoming technical barriers and driving mass production. But its engineering and manufacturing mindset had become a barrier to transforming into a D2C brand. With such ingrained ways of working, pivoting to a more creative process can be hard. 

To address this hurdle, IDEO set up co-creation workshops, bringing together ZUOWE’s newly formed baby car seat team and manufacturing experts from their factories to discuss design direction and details early on. The benefits of the collaboration were clear: It was easy to share feedback in a timely manner and make product design decisions very quickly. When IDEO presented a design that emphasized natural textures during a workshop on brand positioning, a member from Bo Ao’s manufacturing team said, “This feels very different. This could become a major selling point,” and that they had “never seen” anything like it done by other baby car seat brands.

A year after working together, ZUOWE Technology launched Maple&Co and the new Maple baby car seat across its main e-commerce channels. Modern and minimalist in soft natural colors and wooden veneers, Maple appeals to the aesthetics of young parents in China. Despite a series of micro COVID outbreaks in China, within three months, Maple had already achieved better-than-predicted sales and received favorable comments about the look and quality of the car seat from parents. Fast forward two years, additional collaborations with IDEO have enabled the young startup to grow its child travel portfolio from a signature car seat into a more holistic offering that includes highly functional, fashionable, and adaptable car booster seats and strollers that thoughtfully address the needs of modern Chinese families across various life stages at home—and on the go.

China's minor protection law mandated the use of child safety seats beginning June 1, 2021.

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Despite incoming regulations fueling a surge in purchases, car seats on the market rightly prioritized safety but did not consider the emotional needs and lifestyle preferences of a new generation of Chinese parents.

1 year

after the project ended, a new, differentiated baby seat product and brand, Maple&Co, launched

Top 6

during the 2023 “Double 11” shopping festival, Maple&CO secured the 6th spot on Tmall's new brand pre-sale list

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“Over a year ago, I had to take my cat to the vet for an unexpected and expensive surgery,” says one Card Member. “To be honest, I still don’t know if I’ve paid the bill off.”

Many crave the flexibility to pay for large purchases over time, but also want to avoid the pitfalls of debt. Others rely on debit or cash for small items—no one wants to accumulate interest on a cup of coffee, lunch with a friend, or box of Kleenex—but then miss out on valuable rewards.

American Express worked with IDEO to help them attract new customers by understanding what financially stable young adults wanted in a credit card. The team began by interviewing more than 120 millennials to understand their payment behaviors around debit and credit, and how they think about borrowing and spending.

One person described the monthly panic of receiving his bill—described as “statement shock”—and his habit of making multiple payments before his billing cycle closed to ease this anxiety. Others were wary of credit because of a large veterinarian bill or financial mistakes made in their 20s, and relied on debit because it felt safer than accruing a balance to pay off. Overall, the team learned that many consumers experience anxiety about paying their bills. And while financial products that offer more flexibility and control have been needed for years, they are especially valuable in times of economic uncertainty like today.

Based on this research, IDEO prototyped, iterated, and refined two concepts, with frequent feedback from users and the client. Called Pay It Plan It, this feature offers financially responsible consumers more transparency, confidence, and control.

Pay It allows Card Members to quickly pay for small purchase amounts under $100 with a few taps in the American Express mobile app. When that purchase shows up on their account, they can choose “Pay It” and still earn rewards on the purchase. This ensures Card Members can take advantage of rewards while lowering their monthly bill by paying for smaller items throughout the month.

With Plan It, Card Members can split up larger purchases of $100 or more—like an emergency trip to the vet or a new sofa—into equal monthly payments, with a fixed fee and no interest. When the purchase appears in their account, they can select “Plan It,” and will be offered up to three monthly payment plans, ranging from three to 24 months. Each plan comes with a fixed monthly fee and no interest. Card Members know exactly how much they have to pay each month, so there are no surprises. And if they pay the purchase off early, they no longer have to pay any future plan fees.

The design of Pay It Plan It did not come without challenges: Bill pay is critical, complex, and highly regulated. Pay It Plan It required a significant internal financial and technical investment, which was achieved after IDEO shared many of the emotional, compelling stories from credit card users with leaders at American Express.

The team worked closely with the American Express regulatory and digital teams to ensure compliance and seamless integration into the mobile app and website’s user experiences and interfaces. To heighten the sense of competence, control, and transparency for users, the designers focused on small interactions like status animations, proactive suggestions, and straightforward language. These interactions help Card Members anticipate upcoming payments and clearly understand Pay It Plan It.

Plan It was designed with transparency, control, and accessibility in mind: The payment plan fee is displayed in dollars to give the customer certainty over their total costs.

Initially, the team set out to create a new credit card with the needs of young adults in mind. But IDEO and American Express realized that Pay It Plan It could be scaled across existing credit card products to ultimately benefit and attract more Card Members. Now, almost all U.S. American Express Consumer Card Members have access to Pay It Plan It through credit cards, co-branded cards, and the well-known Green, Gold, and Platinum Cards. Since launching in 2017, Card Members have created nearly 5 million Plans, totaling nearly $4 billion in purchases, with an average Plan size of $789. Millennial and Generation Z Card Members have created approximately 44 percent of these Plans.

The flexibility and control offered through Pay It Plan have earned American Express positive press, including a call-out in The New York Times for being among solutions that “make it easier for their customers to borrow money, and to manage their monthly cash flow.”

At first glance, design-led innovation may seem difficult to achieve in large, established organizations like American Express, operating in a highly regulated and deeply rational industry. But the IDEO and American Express team successfully found ways to introduce new behaviors like rapid prototyping, cross-discipline collaboration, and leading with emotional customer stories within the existing organizational culture and structure. American Express has since established a permanent Pay It Plan It team dedicated to evolving the feature. Made up of employees across departments, this points to a new and collaborative team structure for the company.

By seeking to understand the human behind the Card Member, American Express has transformed credit and financial services for the better, helping both to be defined by empathy, utility, and transparency.

For more than two centuries, The Times held a strong reputation as a storied British newspaper. Then came the digital deluge. Publication after publication began adopting a relentless online publishing schedule aimed at capturing eyeballs and subscribers, and guarding against waning advertising sales and print readership. But The Times and its sister publication The Sunday Times thought there might be a different way forward.

As Editor John Witherow explains, “the power of an edition” had long endured at The Times, but began to erode amid a round-the-clock breaking news cycle. Witherow didn’t want to do away with editions, but rather to update the model for the digital age. Times owner News UK approached IDEO in 2014 to explore exactly that: what the edition of the future might look like and how its design could drive revenue and subscribers.

IDEO’s research and design phase included interviews with readers, journalists, editors, and marketers at News UK. The team found that people’s reading modes vary—some reflecting new digital behaviors and others adhering more closely to paper-reading styles.

Readers, the team learned, chose The Times for its editorial opinion: a perspective that cuts through the overwhelming flood of information. They viewed the daily Times and weekend Sunday Times as one paper, despite the organizational distinction. And they were proud of their choice, valuing the papers’ consistency, trustworthiness, balance, and authoritativeness. Readers wanted these qualities distilled in a digital edition, whether on a smartphone, tablet, or on the web.

Those insights led to strategic recommendations spanning digital products, editorial, advertising integration, online membership offers, and social sharing. But the boldest among those was a publishing strategy that seemed to run counter to media trends: abandoning a real-time approach in favor of publishing separate digital editions.

The Times in March 2016 introduced an editions-based publishing schedule, with new editions available across all platforms four times each weekday: overnight, 9am, noon and 5pm; the weekend schedule shrank to three editions. A year in, they had broken that schedule fewer than a dozen times—making exceptions for major moments like the terror attack in central London and David Bowie’s death—but even in those cases, The Times refrained from incessant updates, instead resuming its regular pacing.

“The way we’re publishing now, taking our time over news...taking a more considered view of the world, it’s helped us offer something different from everything else,” digital news head Alan Hunter told Digiday in 2018. Readers demonstrated that this different approach was something they’d been wanting.

In the first half of 2016, new paying-subscriber sales were up 200% as compared to the same period in 2015. At the end of June 2016, there were 413,600 subscribers to The Times and The Sunday Times, up 3.4% from a year prior. Of those, 182,500 were digital-only subscriptions—a 6% rise and a notable figure given how much online news can be obtained for free.

Through collaboration with IDEO, News UK's own digital teams capabilities grew, enabling them to implement and evolve their new digital strategy. The capabilities of the newsroom grew, too: “The decision to move to four editions a day has freed up tremendous resources to focus on big stories,” says Emma Tucker, Editor of The Sunday Times—the kind of stories that "supercharge engagement." The approach is working: By August 2019 digital subscriptions had increased 19% year-on-year to 300,000, showing the progress the legacy publisher has made in attracting readers to its online proposition. Total subscribers for the two titles' print and digital products now stand at 539,000, and their websites total five million registered users.

More than 230 years after its first edition was published, the new Times has established solid footing in the digital age and designed its own future—one based not on the habits of its competitors but on its legacy and the reading behaviors of its audience.

For leading fast-moving consumer goods (FMCG) companies, one way to escape the echo chamber is to adopt a human-centered approach—to actively listen to consumers and reconnect with the realities of their lives. It’s about more than bringing them in at a certain stage of the project. Their needs have to be considered from the very beginning. 

What follows is a story from IDEO Shanghai about what happens when a prominent consumer company returns to its customer-centric roots and discovers new growth in one of its most established categories.

What happens after a company hits the category ceiling?

China’s FMCG sector is known for its intensity. Even the most established companies cannot afford to relax; the competition is genuinely fierce.

In China’s major metropolitan cities and regional hubs, competitors launch new products at a rapid pace, all in pursuit of increasingly diverse consumer needs. Beyond these cities, smaller and lesser-known brands are making moves, constantly experimenting, and fighting hard for consumer attention through social media platforms.

Before coming to IDEO, our client had already made significant investments in consumer research to maintain its competitive edge. After the project started, its leaders showed us an elaborate chart filled with rows of consumer identity tags, behavioral patterns, and usage preferences, all organized by data dimensions and densely packed across different quadrants. Years of accumulated consumer insights had informed their product development and marketing strategies, helping them achieve significant commercial success.

And yet, despite all these efforts, they seemed to have hit a wall. To spur new growth in one of their flagship categories, for example, they had tried various strategies, such as conducting research in smaller cities, launching new products aligned with mass-market trends, and attempting to keep consumers engaged by offering more choices. None of it was enough to break through.

What else could they try? That question prompted the company’s senior leadership to come to IDEO. They were looking for a perspective that differed from their usual approach—one that could reveal new possibilities on top of everything they had built.

A revelation from consumers

Even though the client already had detailed data, we decided to conduct in-depth consumer interviews during our design research phase. Our goal was to start from a more fundamental place—to understand how people lived day to day and the role these products played in their lives.

From the client’s perspective, this seemed like a wasted effort. They struggled to understand why we wouldn’t simply begin with their assumed starting point: “Why do consumers choose our brand, and what do they expect from our flagship category?”

But the way consumers actually choose products revealed the “why” behind that question.

Whether they were “core consumers” who already frequently purchased the brand’s products, or “extreme consumers” whose preferences were well outside the mainstream, the decision-making process for buying these products was the same.

It started with a broad desire, for instance, “I want to try something different.”

From there, their life stage, immediate circumstances, and emotional state shaped that desire into a more specific need: “This is the type of product I’m looking for.”

Only then did consumers consider: “Which brand should I buy?”

In contrast, the client’s original framing—“Why do consumers choose our brand?”—treated the endpoint of the consumer’s decision journey as the starting point.

From a consumer’s perspective, this might seem obvious; it’s something we all do instinctively every time we shop.

But what is intuitive to the consumer is rarely intuitive to the brand.

Mapping out a consumer’s actual decision-making process provides significant value for a brand. It establishes a consumer-centered through line that helps leaders navigate innovation in a mature category with greater precision.

Several elements naturally align along this through line: the deeper needs of various consumer types, the moments and motivations that trigger a purchase, the opportunity areas where a mature category can effectively meet specific consumer needs, and the competitive strengths the brand should build on to fulfill those needs. Not only do these components become clearer, but they also create interconnections among them.

The core insights from our design research defined those triggering moments and illustrated the map of how consumers actually make decisions. This clarity, in turn, helped the brand’s leaders determine where to focus their efforts in order to revive a mature category.

Building system-wide alignment from a human-centered insight

We took everything we’d heard from consumers, distilled the decision-making processes behind them, and translated everything into visuals on a series of boards, which we then brought into the client’s meeting room.

Step by step, we walked through the consumer’s chain of logic, highlighting what each need meant for the brand’s approach to category innovation. When we finished, a C-level executive at the company looked at the boards and said, “This is a billion-dollar idea.”

The insight disrupted the default reflex of category leaders, who often claim to prioritize consumer needs while unconsciously starting every decision from their brand’s own business priorities.

At first glance, taking a human-centered route may seem like a detour. In practice, it helps companies avoid the wasted investments that come from acting on incorrect assumptions. A clear understanding of what consumers truly need allows a brand to recognize which of its existing strengths to double down on, and which emerging opportunities are genuinely worth pursuing.

After that meeting, the direction for category innovation quickly took shape. The key insight regarding consumer needs and decision-making became a powerful anchor. The insight unified early-stage product development, mid-to-late-stage packaging design and manufacturing, and the marketing communications that followed the launch.

Beyond charting a new course for the client’s flagship category, the project established a framework for cross-functional teams to build a shared understanding and work toward a common goal.

In the end, the collaboration was successful because everyone involved in the project maintained a primary focus: human-centered thinking.

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“The Making of...” is a series of behind-the-scenes articles written by IDEO Shanghai designers about our innovation methods and work with major clients across industries in China.

Success can create its own echo chamber. The more a company achieves, the easier it is to rely on familiar ways of seeing the market—often without even realizing it.

Healthcare was once centered on the doctor’s office. Today, it’s moving into the home. Since the pandemic, demand for at-home testing has surged, with 82 percent of older adults saying they’re interested in taking medical tests at home, and many preferring to age in place. From at-home influenza tests and COVID-19 swabs to cervical cancer collection kits and continuous health monitoring, people are taking a more active role in managing their care, with tools that enable both testing and tracking from home.

Designing for this shift means supporting people without medical training—who may struggle to interpret data, who might be nervous about collecting samples, or who might wonder about the efficacy of a test they perform themselves. In my work at IDEO, I’ve identified six principles for creating home-use diagnostics and monitoring tools that are more intuitive, reliable, and easier to use.

1. Design for emotion

Medical tests can evoke powerful feelings: fear of receiving bad news, memories of lost loved ones, or general anxiety. As a designer with a background in social science, I recognize that emotions often drive behavior. Our role as designers is to anticipate these emotional responses and design solutions that support them.

On a cancer screening project, for instance, we found that some users postponed testing not because they didn’t understand how to use the tests, but because they were afraid of the results. To address this, we softened the typography, refined the color palette, and shifted the messaging to focus on taking care of one’s health rather than screening for illness.

On a separate project, we discovered a completely different emotional pain point: clunky health monitors can be perceived as a sign of aging, making people feel self-conscious about wearing them. Which is a fair point. Medical devices often look outdated compared to sleek consumer technology. This disconnect can be emotionally jarring—and socially stigmatizing. To rectify this, we focused on portability and aesthetic improvements. The goal wasn’t to turn a home heart monitor into an iPhone, but to make it feel like a tool for enhancing well-being rather than just surviving an illness.

Time and again, we see that providing patients with a premium-feeling device or thoughtfully designed packaging can transform a medical experience from being a source of embarrassment into a moment that reinforces confidence and self-care.

2. Make use of the unboxing moment

First impressions of medical devices matter. If users can’t immediately see components or have to dig through packaging material, they may assume that the testing process is complicated or time-consuming, too. 

During one at-home cancer screening project, we discovered that many people opened the box, took a quick look, and decided to postpone the test because it looked too overwhelming. By redesigning the unboxing experience to make the components and instructions more visible, participants reported feeling more confident and in control.

With some thoughtful changes, the unboxing moment can feel like an act of empowerment. Blank spaces on boxes can be valuable real estate for reassuring messages or simple diagrams, ensuring that essential information isn’t left buried in the instructions.

3. Keep it familiar

At-home screenings are a relatively new concept, and can feel intimidating. People often worry they won’t be able to perform the tests correctly—or worse, that making a mistake could invalidate their results. Thoughtful design can help alleviate these fears by leaning into familiarity and clarity.

When an IDEO team collaborated with Teal Health on an at-home cervical cancer test, they designed the testing wand to resemble a tampon—a form and function that many users were already familiar with and comfortable using. 

Similarly, for an at-home stool collection kit for another client, we designed components that mimicked the contours of a toilet bowl, making the overall experience feel more intuitive.

4. Make data relatable

Designing at-home health monitoring systems requires a careful balance between what patients want to know and what healthcare providers need to see. Providing too much information can overwhelm patients, while too little can leave them feeling powerless. To drive adoption and adherence, designers must connect the data to patients’ real needs and challenges, empowering them to navigate their health effectively. 

Recently, an IDEO team was designing an implant to monitor organ health. Data from the implant would go directly to the physician for review, but patients also wanted to see the results themselves. In today’s world, where smartwatches can track heart rates and sleep cycles, people expect feedback from health tools. When devices withhold information, it can feel as if they’re keeping secrets. To address this, we recommended a simple, intuitive interface: a stoplight notification system (green = all good, yellow = contact your doctor), along with the option to view a trend graph over time. Patients had the agency they desired, while more complex data remained accessible only to physicians. 

In another project focused on at-home bladder monitoring, we discovered that a device that indicates bladder fullness was life-changing for patients who struggled to empty their bladders. People who felt homebound by the fear of embarrassing accidents or infections reported that the device would help them gain the confidence to plan their days and reclaim their lives. Even though the device would require surgery, the possibility of increased freedom was so appealing that patients felt it was worth the risk. The quality-of-life improvements the data enabled—not the monitor itself—motivated them to embrace this new device. 

5. Lean into visual instructions

More words don’t always equal more clarity. In fact, overly detailed, multi-page instruction packets can discourage people from engaging and may give the impression that a test is too technical, even if the language is at a fourth-grade reading level. 

In one project, we simplified an 11-step test guide into a user-friendly design with three main steps. We reduced the amount of text, emphasized illustrations, and broke down the process into manageable parts to make it feel achievable. This visual-first approach not only made the instructions easier to follow but also reduced user anxiety and improved accessibility for people with reading disabilities and those who speak English as an additional language.

6. Look to family and caregivers

While we typically think of patients as individuals, it’s important to recognize that they exist within complex networks of family, friends, and communities that support and supplement their abilities. When we do research for at-home devices and monitors, patients often request to be interviewed alongside their caregiver, or vice versa. Successful at-home medical monitoring and testing must take into account the motivations and needs of everyone involved in the patient care ecosystem. 

Product teams may assume that older patients will not want to use even basic technology. This might not be true, and even when it is, it’s worth remembering that the end user might not always be the patient. At times, a caregiver might be more invested in the outcomes of monitoring or testing than the patient themselves, and could be more open to embracing digital and tech-forward solutions. 

It’s this kind of health ecosystem thinking that becomes crucial as at-home testing and tracking grow more prevalent. What we have now may feel revolutionary compared to the pre-pandemic era of mandatory in-person care. Many innovations that once felt like futuristic fantasies—such as headsets that help treat depression and saliva-based hormone tracking to support conception—are now available for home use. Still, the potential that lies before us is far greater. 

But only if designers get it right. By keeping human needs—across patient, caregiver, and providers—at the center, we can build more advanced solutions that help people take action on their own health.

Need help designing some at-home experiences of your own? Get in touch.

“Providing patients with a premium-feeling device or thoughtfully designed packaging can transform a medical experience from being a source of embarrassment into a moment that reinforces confidence and self-care."

In our healthcare work, we’re constantly partnering with clients to solve big, seemingly intractable problems that prevent them from delivering the care patients need. Bad UX. Tangled bureaucracy. Stigma. Disinformation. Systems that were never designed to communicate with one another or effectively serve people. These barriers ultimately decide who gets better and who doesn’t.

Over the decades, we’ve learned it’s easier to tame these monsters if you name them. So we’ve turned them into creatures to help people identify and defeat the obstacles that prevent them from delivering the healthcare experiences and outcomes that patients (and employees) truly deserve. 

Here are five bogeymen we keep encountering in our healthcare work, and some projects that have taught us how to vanquish them.

The Abominable Experiences Monster

Many medical procedures are more uncomfortable than they need to be. Women’s health, in particular, is full of experiences that feel a little medieval—painful, invasive, and undignified. Each one nudges patients toward skipping their next appointment.

The Abominable Experience Monster devours appointments. It also gobbles up early diagnoses, follow-up care, and long-term relationships between patients and clinicians that fuel good healthcare.

This is particularly true when it comes to cervical cancer screenings. When detected early, this form of cancer is completely preventable. But one in four American women is not up to date with their screenings. To address this issue, we partnered with Teal Health to reinvent the screening experience, focusing on much more than just the speculum.

Together, we designed a method for patients to collect their own samples at home, one-handed while standing, with clear instructions and welcoming packaging. In 2025, the FDA authorized the device. During the trial, 87 percent of participants reported that the new in-home experience made them more likely to stay current with their screenings. 

Taming this monster starts with a question that isn’t asked often enough in healthcare: “Does it need to feel like this?”

The Entrenched Complexity Monster

This monster stymies progress. Departments operate as fiefdoms. A patient’s record sits inside three different systems. A small change requires six committees. Clinicians who want to improve the patient experience run out of energy trying to fight the system.

Newton-Wellesley Hospital came to us because they saw an opportunity to drive better patient outcomes through cultural and organizational change. We worked together to imagine a different future for the hospital, then prototyped it in phases.

The team at the Women’s Imaging Center kicked things off by reimagining the mammogram experience. They defined the principles for the experience they wanted to create and designed prototypes to gather patient feedback. Then, they became ambassadors, helping other departments take on their own monsters. Patient-centered ideas soon spread, including a practice that the hospital integrated directly into its medical records: a method for flagging each patient’s communication and care preferences, allowing providers to meet them in ways that made them most comfortable.

The Entrenched Complexity Monster is tamed one project at a time. Each time a department demonstrates that change is possible, the monster shrinks a little more.

The Ingrained-Barriers Monster

For a teenager seeking mental health support, there can be multiple barriers to care: from parents who don’t believe in therapy and months-long waitlists, to school counselors who are overwhelmed with the needs of 400 other students and the high costs of treatment. Combine these challenges, and you’re dealing with a juggernaut. 

The Ingrained-Barrier Monster festers in the gaps between systems that were never designed to support the people who need them most—especially young people.

Our solution? Design with them. We partnered with Kooth, the California Department of Healthcare Services, and hundreds of young Californians to create Soluna: an app featuring evidence-based behavioral health tools, free coaching, and resources designed by the people who will eventually use them. Soluna is now available for free to six million young people across California. 

The Fragmented Systems Monster

For a working family in Lima, Peru, accessing routine healthcare services is a patchwork experience. Affordable, comprehensive care can be extremely hard to find. The Fragmented Systems Monster thrives in these cracks. It costs patients both time and money and, at times, leads them to miss appointments altogether.

Intercorp wanted to build something different: clinics specifically designed for Peru’s emerging middle class, rather than modifying existing models that weren’t intended for them. Before launching a real clinic, they constructed a full-scale prototype—a fake clinic—where patients could experience every aspect of their visit: registration, waiting room, examination, and pharmacy. Afterward, patients provided feedback on what was and wasn’t working. That feedback shaped Aviva, a clinic that opened in 2019 and now offers over 30 specialties. Since opening its doors, Aviva providers have performed more than 3,000 surgeries and assisted with more than 5,000 births.

Taming the Fragmented Systems Monster begins with a counterintuitive idea: quickly build a tangible, rough version of connected care, allowing patients to guide you in getting it right.

The Convoluted Comms Monster

Today’s parents receive a lot of information from their pediatricians, but they also turn to wellness influencers, online forums, and screenshots shared by people in their networks. By the time they’re in the doctor’s office, their opinions on care have been shaped by numerous sources, not all of which agree with each other.

The Convoluted Comms Monster flourishes in this noise, derailing even the most critical conversations, such as those a pediatrician must have with a concerned parent about a new immunization or vaccine.

When Sanofi prepared to launch Beyfortus—the first-ever RSV immunization for infants—the biopharma company approached us with a big question: How might we help pediatricians communicate clearly with worried parents across languages and cultures and amid the swirl of misinformation surrounding new medical developments? Together, we created materials to facilitate these important conversations. Beyfortus successfully launched in time for the 2024–2025 RSV season. Demand was so strong that Sanofi tripled its manufacturing capacity, and the immunization has been shown to reduce infant hospitalizations by 82 percent.

Taming this monster is about providing clinicians with clear, human-centered resources to cut through the noise, ultimately helping the parents in front of them and the children who depend on them.

Taming what’s blocking the way

At their core, these monsters arise from human decisions, organizational habits, and inherited assumptions. While technical issues may exacerbate the problems, strategy or software alone cannot resolve them. 

The work is to find the monster, name it, and begin taming it by focusing on cultural behaviors and ways of working; in other words, prioritizing people, not just products.

We’ll be at HLTH Europe in Amsterdam later this month, on the lookout for more monsters. Bring us the obstacles in your work that feel too big, too tangled, or too entrenched for you to face. We’ll help you name them. And then we’ll help you tame them.

Have a monster of your own? Get in touch.

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Special thanks to Ellora Jaggi and Tanya Kar for their work making the monsters come to life.

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Here are the five bogeymen we keep encountering.

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Tucked away behind the brightly-colored restaurant fronts of East London’s Brick Lane is Second Home, a co-working space housing the design team of “vibe coding” company Lovable, one of the fastest-growing start-ups in history.

Founded in 2023 by Swedish software engineers Anton Osika and Fabian Hedin, and currently valued at $6.6 billion, Lovable’s mission is to make software development accessible to everyone, not just the 0.6 percent of the planet who are professional developers. The firm talks about their goal as “building the last piece of software.”

Nad Chishtie, Head of Design at Lovable, discovered his passion for building through his childhood obsessions with music, online gaming, and computers. Initially drawn to coding at the age of 8, he later “fell into design by accident” when he discovered he preferred problem-solving to programming. After stints at two hypergrowth companies, Cmune and Element, he had an epiphany. “With the launch of OpenAI’s GPT-3, I was able to do 70 percent of the coding work of seven full-time developers. I thought, ‘Everything's going to change.’” This realization led Chishtie to seek out the most ambitious people in this space, which ultimately led him to Lovable co-founder Anton Osika.

I spoke with Chishtie at Second Home about the skills people need to design with AI, Lovable’s unique culture, the pros and cons of collaborating with agents, and why humans—and optimism—will always matter. 

Ed White (EW): We’re increasingly hearing about a newer discipline called “design engineering” at companies like Lovable. What does that mean in practice?

Nad Chishtie (NC): It's essentially applying design thinking to code. Depending on your technical skills, design engineering could focus more on front-end development, microinteractions, or the architecture needed to support multiple initiatives. 

An interesting example of a design engineer is Niklas, who joined us as the team’s second designer and has a background in industrial design. Until last year, he hadn’t written code professionally. Now, he’s the third-largest contributor to the Lovable codebase. That’s because today there are two paths: Path A involves ideation, creating comps, and managing stakeholders, while Path B is about directly translating ideas into code with 100 percent fidelity. Path B wins a lot. It’s why Niklas’ learning curve was just a couple of months.

It’s difficult to find people with this skill set, but a single person with this shape can be as valuable as an entire team. 

Path B also means that, in design, we can drive initiatives forward without needing technical support or advocating for inclusion in the engineering roadmap. We can just implement ideas directly. 

Initially, some of the engineering leaders questioned why the design department was hiring engineers. But after we became productive, their response changed. Now, it's one of the most requested roles within our company.

EW: What mindsets or skills are required to be a successful design engineer?

NC: You need to be a very strong systems thinker. Instead of focusing on a specific solution, you’re developing the system that enables that solution to exist.

In classic lean startup methodology, the focus has been on specializing both people and products. With AI, you need to do the inverse and adopt a generalist mindset—for two reasons. First, it’s more challenging to constrain AI models than to let them operate freely. Second, by allowing models to evolve and get better without constraints, your product improves, too. By thinking like a generalist, your product expands its footprint in tandem with AI’s growth. To design at the frontier of AI, you need to invert your perspective.

‍EW: What’s different about designing with LLMs?

NC: When you design software as a service (SaaS), the main task is to design constraints that make the system more deterministic. With AI, the goal is to develop something that is somewhat deterministic and also truly generative. Because if it isn’t generative, then it’s not truly intelligent; it just mimics patterns or picks templates in the background. This marks a shift in design from focusing on hard constraints to providing a broader design direction, while maintaining certain guardrails. 

EW: How is working with these models changing design?

NC: From a technological perspective, we’re ruthlessly trying to reduce the time between having an idea and making it tangible. This applies to Lovable as a product and also to our internal practices. For instance, in our development pipeline, we’re trying to streamline processes as much as possible. If someone here has an idea and is curious about its viability, they can quickly tag an agent and receive immediate feedback. Today, it’s standard for a tech company to spend minutes, hours—even days—testing out a single part of their code base. Our goal is to reduce that time to zero. 

In terms of people’s time here at Lovable, there are no sunk costs with LLMs. We can adopt a more experimental mindset and go from a customer insight to a tangible iteration within a few minutes. Then, we can share that with more people, gather feedback, and decide whether to double down on the idea or delete it. It's totally acceptable to pivot because the turnaround cycle was minutes. 

EW: Lovable is one of the organizations that’s early to work with agents on a daily basis. What’s that experience like?

NC: We try to think of agents as if they were people. They need to have the proper context about how our team works, what’s important to us, the principles and philosophies behind our decisions, and what constitutes a good or bad decision. We have banks and banks of knowledge and skills that codify our thought processes for ourselves and for agents. They’re like a human employee onboarding Wiki, but for agents.

‍EW: What do agents do in practice, and what roles do they play in design?

NC: One role is called a “Linter.” You write some code, and then a Linter will dynamically check it against our codebase. A simple example is keyboard focus. Imagine you have an application with 20 different features that need to be added at various times. Keyboard focus can be quite invisible, making it challenging to maintain coherence. We have a skill bank dedicated to keyboard focus. If you’re designing or implementing a feature, a Linter might review your work and say, “With my end-to-end view of the application, this is how we think about keyboard focus. In the specific view you’re working in, you definitely should do it this way.” 

Another role is a “Sweeper.” Whenever you propose changes in a pull request, Sweepers conduct a variety of checks. For example, a Sweeper agent might say, “You’re introducing a new mental model for the user here. Here’s a list of related mental models that you should consider. Should we extend an existing mental model instead of adding a new one?”

The final role we’ve found very helpful is the “Critic.” These agents critique your implementations as thoroughly as possible. You can even ask them to imitate experts. For instance, you could prompt, “You are [Danish usability pioneer] Jacob Nielsen. I want you to critique this from a purely UX perspective.” The models are trained on Nielsen’s entire body of work, so you’ll gain insights that reflect Nielsen’s expertise.

EW: What’s been particularly effective for you when you use these agents?

NC: Prompting Critics to ask questions rather than make statements. General-purpose AI is overly sycophantic. Having Critics ask questions flips that dynamic. It keeps you in control, which is crucial since humans are ultimately responsible for the outcomes of these systems, and it encourages you to continuously critique your thinking. 

EW: As you work more often with powerful agents, what do you think the role of humans is?

NC: Human designers must be held accountable. We must create usable, desirable products that feel cohesive. I believe that across all mediums—be it film, TV, music, food, etc.—we have an innate ability to sense whether the people behind them genuinely care and what values guide their work. Do they value speed, a sense of luxury, quality, or something more experiential? I think the same applies to software. For Lovable, the experience of using our product is always the responsibility of the humans on our team; we don’t delegate that responsibility to AI. 

EW: How are team structures changing?

NC: I keep coming back to the word “asymmetry.” We used to build teams in very symmetrical ways at tech companies: you’d have a product manager, engineers, a designer, and possibly a data analyst. This cookie-cutter approach was easy for hiring and HR purposes, but it didn’t necessarily lead to the best products or user experiences. 

Today, team dynamics are evolving. Generalists can manage the entire design process—from user insights and analyzing data to building an initial product and testing it with users. A single generalist can deliver 20 times the value of someone focused on just one part of the process.

EW: What does that mean in terms of the people you look for?

NC: The “K-shaped” economy is an apt analogy for what we look for in design engineers. We’re seeing a split between those who are “AI native” and driven, and those who are more cautious about AI and hesitate. These two types of people are diverging significantly, with compounding effects in both directions. We hire people who are optimistic about AI’s potential and are eager to learn.

We also focus heavily on the slope of someone’s career trajectory—not just where they are today, but where they could be in this quickly evolving environment. During my introductory calls with designers, I spend time discussing their motivations for entering design, major influences from past roles, and self-initiated projects rather than just work history. 

Ultimately, a company’s success comes down to its teams and the products they build. The best team is the one with the highest learning aptitude.

EW: How do you create an environment or culture of experimenting and learning?

NC: One of our core values—“våga vara annorlunda”—means “dare to be different” in Swedish. We encourage our employees to challenge norms and embrace innovation by fostering an environment where failure is acceptable. We encourage rapid experimentation and urge individuals to continually challenge their own workflows. 

Many companies believe they need to adopt a single AI tool to write more code and then deploy it organization-wide. In contrast, at Lovable, we allow everyone to choose their own tools. It’s not only fun, but as the tools evolve and our understanding of how to use them expands, our organization adapts and grows as well. 

We have a few helpful rituals, too. Every Friday, we host open demos to showcase what we’ve been doing during the week. Someone might share, “I figured out this new approach that required overhauling our development environment. If we use agents in this new way, we could be 20 times more productive.” We celebrate these achievements as part of our onboarding process, in our Monday morning meetings, and during our internal company awards. 

EW: What’s important to remember when designing with LLMs?

NC: First, the models themselves are incredibly idiosyncratic; it's almost like having different children, each with their own strengths and weaknesses. To produce truly great outcomes, you need to understand these idiosyncrasies and build around them.

Second, you need to consider the entire system. You can't evaluate models, core product architecture, and user experience in isolation. You have to understand them all and integrate them to create a cohesive user experience.

EW: Any parting thoughts for designers?

NC: Be optimistic. Every door is open right now. I feel like a kid again, discovering technology for the first time. 

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“Design in the Age of AI” is a series of conversations with designers and makers from across industries and disciplines, building the future with AI, today.

“To design at the frontier of AI, you need to invert your perspective."

I help organizations cut through complexity by shaping how they show up, through brand strategy, identity, and storytelling.

Working at the intersection of brand and business, I bring an editorial eye and a bias toward making—turning ideas into tangible experiences that people can understand, trust, and believe in.

My work spans government, healthcare, financial services, media, and consumer goods, from launching Gen Z-focused ventures to building innovation labs and reimagining legacy brands. I relish moments of ambiguity and enjoy translating across teams, perspectives, and priorities to move ideas forward.

I started my career in editorial and digital design, shaping cross-platform experiences and identity systems in publishing and agency environments. That foundation still shapes how I work today: I’m detail-oriented, collaborative, and overreliant on the Oxford comma. I hold a BFA in Visual Communication from the School of the Art Institute of Chicago.

For 25 years, I've asked the same question: Who does this design exclude—and what are we going to do about it?

My work spans human-centered strategy, inclusive design, and qualitative research, with clients ranging from Microsoft, Google, and Verizon to the National Science Foundation, and San Francisco Unified School District.

Before IDEO, I taught elementary school in East Palo Alto and spent a decade doing design work with social service organizations—where I learned firsthand what it costs people when systems are built without them in mind.

I am currently writing User Error, a nonfiction book about digital access and the design decisions behind it. I live in Oakland, California.

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My expertise spans brand, communication, and product design across tech, education, the arts, and social impact.

I believe great work demands both high-level vision and obsessive attention to detail, and only happens through collaboration.

I bring an inclusive, hands-on approach and a deep understanding of business, which enables me to consistently deliver excellence while always asking why.

Before joining IDEO, I worked at the brand firms Pentagram and VSA Partners. I began my career as a designer, leading teams at the School of the Art Institute of Chicago and the Milwaukee Art Museum. I hold an MFA in graphic design from Maryland Institute College of Art and a BFA in communication design from the Milwaukee Institute of Art & Design, and have taught at some of the best design schools in the US.

I am responsible for IDEO’s long-term success in China and working with clients to use design as a tool to enable growth. Specifically, I have helped Chinese companies design holistic brand solutions through the development of their products, communication, services, and innovation teams, and I have helped multinationals expand their presence and influence in China.

I advise global leaders on developing China-led innovation and capabilities.

In over 15 years in IDEO Shanghai, I have worked on projects that use design to elevate the quality of the experience of healthcare products and services, streamline processes that increase productivity, create spaces and programs that promote and enable inclusive communities, and build next generation mobility solutions that are planet-positive.

Before joining IDEO, I worked at Philips Electronics and the Electrolux Group in Italy, the Netherlands, and Singapore on a number of breakthrough commercial products. I am a member of the Young President Organization in Shanghai.

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In this episode, Becca Carroll, IDEO's Chief Strategy Officer, talks with Sida Li, co-founder and CEO of Shared Context Lab, about staying anchored to a human need while the technology around her keeps changing shape, why she treats her business model with the same rigor she'd bring to a product, and what it feels like to build a company at this particular, disorienting moment in AI.

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The conversation also gets into how Sida makes design decisions: the language Cue uses to describe itself, the tradeoffs behind building inside iMessage instead of a new app, and a real story about a business idea that didn’t pan out.

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This is the second in a two-part series profiling founders from IDEO's Startups-in-Residence program. The first conversation is with Johannes Seemann, founder of Sooner, on designing GenAI for the emotional side of money.

Most personal financial tools are built to run the numbers and optimize towards a budget. While that works for some, most people experience money as a lived relationship that does not neatly fit into a spreadsheet. Johannes Seemann and Becca Carroll discuss why money is emotional before it is mathematical, and what a human-centered approach to building a generative AI financial product looks like in practice.

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