D4V is a Tokyo-based early stage Venture Capital in partnership with IDEO. Two years ago, D4V invested in healthcare startup Ubie, which develops a service called AI Monshin Ubie. The digital service was created with the goal of reducing the burden on healthcare professionals working long hours, under harsh conditions. AI Monshin Ubie automates a number of patient registration and documentation processes through digital tools, enabling doctors to spend less of their time on manual paperwork, and to dedicate their valuable skills and attention to the patients themselves. Currently, the service is installed in 200 medical institutions in 41 prefectures across Japan.

With AI Monshin Ubie, patients fill out preliminary forms on a tablet, rather than paper, entering information about their health history and current symptoms directly into their digital medical record. As patients fill out the questionnaire, the Ubie AI generates questions in real-time according to patients’ responses, which results in more appropriate and accurate data. The patient’s responses are automatically formatted for the doctor to review prior to and during the consultation. As a result, doctor consultation times and facility operation times are drastically reduced.

With the Coronavirus raising fears of a possible health system breakdown, Ubie has made improvements to anticipate and possibly prevent in-hospital infections. Until recently, Ubie’s services have been primarily used by large hospitals; but in light of the global health crisis, Ubie approached D4V—who partners with IDEO—to help rethink the onboarding experience and quickly facilitate the introduction of AI Monshin Ubie in regional clinics across Japan. D4V and IDEO have been working with Ubie for many years to collaborate in various areas, including UX, rebranding, international research, and more. Therefore, they had a foundation of knowledge from which to build these new features.

Typically, AI Monshin Ubie has been introduced to new hospital clients through direct, in-depth instructional visits from Ubie sales staff. This approach has worked well for rolling out the product to Japan’s 8,000 large hospitals; but for the 100,000 smaller clinics, Ubie needed a more efficient onboarding method to enable staff to get set up smoothly and independently.

During research, D4V and IDEO team members engaged with many different clinic staff members, including full-time doctors, part-time doctors, nurses and receptionists. The researchers found that staff tend to react skeptically to new tools and services, with a common preconception that they will add to their workload. One clinic director’s first impression of AI Monshin Ubie was, “It looks complicated.” But once he actually used the service, he realized that it was very user-friendly.

The team quickly understood that it was important to remove preconceptions by clearly communicating Ubie’s benefits and ease of use. They created a two-minute animation and designed three separate guidebooks. The animation adopted a friendly tone and expressed empathy for doctors, staff members and patients, highlighting how Ubie can bring benefits to each of them. The animation showed how Ubie fits into the existing workflow and explained complex systems in a straightforward and accessible way.

WATCH: A short video clip explains the benefit of their product and service to avoid the users’ concerns in advance.

The guidebook for doctors and directors explains how Ubie’s AI smooths the patient consultation experience and greatly improves the quality of medical care. It also introduces concrete how-tos around set-up, implementation, and ideal workflow. FAQs were also included, addressing concerns about whether or not elderly people would be able to use it.

Ubie business development leader Kenji Yamada says, “D4V and IDEO have a deep understanding not only of design, but of our entire business. They provide inspiration by bringing experience and knowledge that comes from working with other industries and clients outside of healthcare. We appreciate that they can share the knowledge that they’ve obtained with our business.”

Read the Japanese-language version of the Ubie case study here.
When You Feel Unwell, Ask Ubie: Check your symptoms for free
Learn more about Ubie: Global Company Website

In the emergency room, an intervention that’s administered too slowly could cost a patient their life. With COVID-19 fueling a surge in acute respiratory conditions, intubation—a procedure that involves inserting a tube through the mouth or nose and into the airway—is more common than ever. For patients struggling to breathe, the tube can be connected to a ventilator that pumps oxygen to the lungs, keeping them alive.

While a laser-focus on the present is critical for successful patient outcomes, hospitals and physicians often don’t have time to look ahead and anticipate the future of the operating room experience. As technology rapidly improves, there is a ripe opportunity and pressing need to evolve medical equipment to be more innovative and intuitive. Verathon Medical, a global medical device manufacturer, is supporting health care providers at the cutting-edge of care.

Verathon approached IDEO to redesign the existing product system for laryngoscopies and bronchoscopies—procedures that examine parts of the throat through intubation. During these examinations, a tube with a camera embedded in the tip is inserted through the patient’s nose or mouth. The doctor can then see inside the throat on a video monitor, and therefore more easily and quickly intubate and perform the exam.

To create a groundbreaking device, the team observed over a dozen laryngoscopies, bronchoscopies, and intubations. They noticed that many anesthesiologists relied on fixed equipment during the procedures. For example, some had grown accustomed to looking over their shoulder—away from the patient—to view the monitor.

During interviews, physicians and residents expressed difficulties with the current technology, sharing that the small screens aren’t conducive to team viewing or student instruction, and they must often use a separate computer to record patient notes. Others reported frustrating workflows, needing to constantly divert their attention and move their hands between the patient, prep tray, monitor, sterile bin, and disposal bin. These inconveniences and inefficiencies are not only cumbersome, but can increase the risk of infection and fatality.

The team relied on these insights to start designing a next-generation product. Through sketching, storyboarding, and building in real-time alongside doctors and clinic staff, designers quickly teased out additional findings and validated concepts.

This work led to the creation of the GlideScope Core: an all-in-one, portable product system that supports both video laryngoscopies and bronchoscopies. The base of the device—a wheeled cart—has built-in storage units for tools and a disposal bin, offering more mobility and accessibility for medical professionals.

The product’s tagline, “see more, do more,” points to the improvements made to the video system, including a large 10- or 15-inch high-definition touch screen monitor. Displayed images can be enlarged and rotated 180 degrees for improved visualization, team viewing, resident training, and classroom demonstration. To help doctors keep both the patient and monitor in their line of sight, the detachable screen can be secured to an adjustable arm that can be positioned directly over the patient. Additionally, the monitor’s patient annotation feature gives staff access to more of what they need in one device.

The product has been especially valuable for providers and patients during the coronavirus pandemic, when it’s imperative for doctors to keep their distance from patients’ mouths and noses. The GlideScope Core’s movable, detachable, and large, high-definition monitor makes it easier to take this precaution and intubate more quickly. This usefulness is reflected in the 5-fold increase in cart-based device orders for Verathon. While most providers typically order anywhere from 1 to 20 devices for airway procedures, one hospital system requested 600 GlideScope Core systems to meet current intubation demands.

Through modern technology and a focus on human needs, the GlideScope Core supports improved patient outcomes and creates a more seamless operating experience for medical professionals. The product underlines the key but often overlooked fact that often, in order to ensure the healthcare industry is patient-centered, medical device manufacturers and hospitals must also focus on improving the experience of providers.

Healthcare is notoriously difficult to change. Rules and regulations present complex barriers; health practitioners and organizations often have entrenched ways of working; and lives are literally on the line. Despite these significant barriers, the leaders at Newton-Wellesley Hospital (NWH) boldly committed to improving patient care through a new approach.

NWH is a community teaching medical center in Newton, Massachusetts. Because of its proximity to Boston—a city known for world-class healthcare institutions—NWH needed to differentiate itself. The hospital's new president, Dr. Michael R. Jaff, reached out to IDEO for help: "I knew that providing an unparalleled patient experience would set us apart from our competitors." But, Dr. Jaff’s particular approach was unique. He and Dr. Jodi Larson, Chief Quality and Experience Offer (CQXO), saw an opportunity to drive better patient outcomes through cultural and organizational change.

"You cannot learn any more than when you get to listen to your potential patients say why they would never walk into your place." —Dr. Michael R. Jaff

IDEO partnered with NWH for a year of work together, kicked off by defining the vision for NWH and ramping up to in-hospital prototyping and the launch of several new initiatives. A pilot project with the Women's Imaging Center (WIC) focused on solving departmental and employee challenges to provide a better experience for women getting mammograms.

Fueled by this potential, the WIC team redesigned key work processes and created a set of experience principles that inspired new service prototypes. Guided by principles like "Express mutual gratitude" and "Honor every voice," the WIC team tested ways for patients to acknowledge outstanding caregivers and created tools to gather better feedback from patients and adjust quickly. The experience of designing better services inspired the WIC staff to become ambassadors for the power of design thinking across other departments inside NWH and they continue to build on the work through new prototypes and experiments.

Next, IDEO partnered with NWH’s ambulatory surgery group. They took an analogous research trip to Boston’s Logan airport to see with fresh eyes how other high-touch customer service organizations provide customer value in a complex setting. Insights from the trip were applied through live prototyping of several new experiences inside the hospital, including a pre-surgery visit summary and pre-operation care carts.

Analogous research helped us realize that we can learn from other industries and incorporate some (cool) best practices if we allow ourselves to get over the ‘that would never work in the hospital’ mentality. - Dr. Jodi Larson

One of the most impactful prototypes was Care Modes, a tool to empower the NWH care teams to tailor their approach and interaction with patients based on the patients’ unique needs, beyond simply their clinical requirements. Four distinct approaches were identified for engaging a patient before surgery—Explain, Partner, Embrace, and Encourage. The Care Mode is determined based on the provider's understanding of a patient's degree of self-advocacy and their confidence that surgery is the best solution to their issue.

Historically, care providers have been trained to deliver consistent care above all else. However, Care Modes powerfully acknowledge that patients respond differently to different types of care. The Care Modes empower the team—from surgeon to nurse to anesthesiologist—with a clear framework for how to interact with and provide care for patients so they feel most comfortable. Based on the prototype's success with patients and impact on the staff culture, NWH has incorporated Care Modes into EPIC, the hospital's electronic medical record.

The importance of being patient-centered has been central to the healthcare conversation over the past thirty years; but new explorations reveal that there’s far more potential for innovation and improvement when the provider experience is considered in tandem with the patient’s. Each enables the other, and design for both together yields stronger solutions and better outcomes. IDEO's work with NWH demonstrates this vital shift in user-centered healthcare—one can't design services and experiences for patients without designing for their providers’ culture as well. When these go hand-in-hand, meaningful institutional change in healthcare is more than possible.

The mission of Chicago's Museum of Science and Industry (MSI) is to inspire children to achieve their full potential in the fields of science, technology, medicine, and engineering. Leaders at MSI realized they needed to drive day-to-day operations and maintain historic exhibits while focusing on where to go next. To prepare for its next decade, MSI worked with IDEO to create a new business focus to support the museum’s aspirations for the future. The plan would allow MSI to respond to the demands of the marketplace and raise the funds to get there.

At the beginning of the project, MSI laid out its priorities: improve equity of access, enhance the museum experience, and create a more innovative culture. To dive into each of these areas, IDEO conducted immersive research with families, teachers, donors, and staff.

IDEO brought together 60-plus donors, board members, and staff members to engage in a design thinking exercise to unpack and address the tensions that come with choosing a new strategic trajectory. Instead of having a standard ballot vote, the IDEO team encouraged participants to get up and vote with their feet, helping the group of stakeholders physically align on the museum’s new direction.

At the end of the research and prototyping phases, MSI and IDEO developed a vision called Provoking Minds, Inspiring Futures, creating six detailed design briefs to equip MSI teams to bring initiatives forward. The briefs laid out everything from recommending a new Department of Next, dedicated to ensuring that the future is at the heart of everything the MSI does, to MSI Runway, a place for experimental, small-scale, and limited-run exhibits. The ideas were brought to life with an interactive exhibit, built quickly with everyday materials like plywood and circuit boards, to demonstrate that creating an inspiring vision of the future doesn’t have to be an expensive endeavor.

The team also focused on insights that highlighted accessibility issues some families brought up early in the design process—travel across the city via public transportation can be lengthy, and the cost of admission to special exhibits could be prohibitive. To address these concerns, IDEO came up with the Mission Accessible brief: Inspired by casino buses, MSI bus stop signs would be posted in various low-income neighborhoods, signaling a way to take kids and families to the museum for free.

During the project, the IDEO team identified some low-hanging fruit, like rethinking ticketing and improving the student field trip experience, and helped the museum create cross-functional innovation teams to apply design thinking skills towards solving those challenges. They researched, brainstormed, and pushed forward new concepts, meeting weekly to share and build on ideas. At the end of the four week period, each team prototyped their ideas—new outdoor programming, software tools for visiting tour groups—and pitched them to each other.

In 2019, two years after the conclusion of the project, the collaboration paid off. With its new strategic plan and additional resources, the museum has renewed its commitment to serving youth, and MSI’s team, including donors, are aligned on a collective vision of the future. MSI raised more funds than in any previous year, including the single largest gift in its history—$125 million, nearly half of its $380 million fundraising goal—that will help ensure the years ahead.

He had taken a disability leave from work to prepare for the removal of a tumor on his spine. The drives to his appointments had become routine, each trip a reminder of how much his body was changing—and how much he now relied on me. He said, “I’m going back to work after my surgery.” Despite my uncertainty, I didn’t argue. The surgery gave him a 50 percent chance of walking again, and for him, that was enough. But the probability alone was not enough to prepare me for what came next.  

At 22, I came face-to-face with the hidden costs of healthcare when my father became paraplegic. Since then, I’ve become his sole full-time caregiver. This role has profoundly shaped my perception of the healthcare system—not only exposing the many gaps in healthcare but also the massive opportunities to improve how care is designed and delivered.

Today, alongside my role as a caregiver, I am an interaction design fellow at IDEO, where I spend my days collaborating with other designers to shape and refine human-centered experiences. Part of our job is to listen with empathy to user pain points to craft useful solutions that foster trust and understanding. As both a caregiver and a designer, I deeply understand these pain points and how we can design solutions that ease the burden on the 24 million caregivers in the US alone—whether it’s creating clear, comprehensible medical bills or developing devices that help prevent further health complications. Here are four massive opportunity areas I believe we need to solve for.

Mitigating enormous burnout

The first few years were by far the most difficult. My peers were embracing the newfound freedom of adulthood, while I was responsible for everything from dealing with insurance companies to daily cleaning and bandaging his stage-four wounds. I was in and out of the hospital, drowning in paperwork and trying to make sense of my father’s condition, his medications, new routines, and medical bills. I spent countless hours battling with insurance reps, demanding appeals, chasing down unreliable case managers, and pushing charge nurses to advocate on my father’s behalf. The burnout was debilitating. But there are so many opportunities to lessen that load.

Technological tools that patients and their families can trust can help close the gap in an inequitable healthcare system. Already, AI tools like Hyro AI and SICURA by Nohold are taking on some of these pain points by reducing the complexities of dealing with insurance, treatment options, and medical jargon. Hyro AI is even integrated into many electronic health record systems, allowing patients easy access to their personal health information to understand and manage treatment.

But what if AI patient advocates could take things a step further, flagging biases, challenging questionable denials, and assisting with appeals? As insurance companies increasingly use AI to deny claims, such a tool could help level the playing field, ensuring that vulnerable patients aren’t silenced by the very systems meant to support them.

Navigating the system

My father was hospitalized for over a year following his surgery, moving between the ICU, skilled nursing facilities, and acute rehab centers. Each stay brought hefty bills, frequently arriving months later with little clarity about their origins. They were outrageously expensive, and I struggled to understand what we actually owed—or why we owed it in the first place. Between the maze of Medicare, state programs, and private insurance, determining financial responsibility was completely overwhelming, and cost transparency was non-existent.

What if medical bills were as clear as itemized receipts, with straightforward descriptions alongside hospital codes? Originally designed to prevent fraud, medical billing systems rely on cryptic codes like “ICD-10” and “CPT”—effectively standardizing claims but making them nearly impossible for patients to decipher. While these systems serve the industry, they often do so at the expense of patient transparency and accessibility. An app that translates these complex codes into a simple, easy-to-read breakdown would be invaluable.

Beyond that, there’s an opportunity to design a visual progress tracker or dynamic dashboard, helping caregivers and patients manage payments, track processing status, and reduce the financial guesswork that adds unnecessary stress to an already difficult journey.

As a young adult learning to manage my own financial responsibilities while taking on my father’s, I found myself in need of a financial “buddy”—someone who understood my situation and had the expertise to guide me. While some companies, like the AI app Cedar, are tackling this issue, there’s still significant potential for innovation in this space.

Providing physical care

Whenever my father developed a stage-four bedsore, I had to administer IV antibiotics every six hours for eight to 12 weeks. During these times, I was stuck at home, bound by the six-hour window, having to reposition him every two hours to help the wound heal and prevent new sores from forming.

When you care for someone with limited mobility, bed sores are one of the most challenging issues. In the US alone, nearly 60,000 people die from bed sore complications annually. They emerge shockingly quickly and can go from the size of a nickel to so deep you can see bone. For caregivers, the physical toll of lifting and repositioning their loved ones can be overwhelming; it often left me physically drained and emotionally exhausted.

After dozens of hospital trips and many sleepless nights, I decided to invest in a specialized bed that could handle repositioning. But insurance doesn’t cover them. And they range from $2,000 to $15,000. A pressure-relieving mattress adds another $500 to $3,000, and professional assembly—often required—can cost an additional $200 to $500.

Imagine if there was a smart, modular bed for paraplegics that automatically adjusted using an AI-powered scanning app to track movement and prevent pressure sores. It could offer personalized configuration by allowing users to add or remove features as needed, enabling customization at home. Additionally, an affordable smart mattress that monitors sores and relieves pressure could greatly benefit both the caregiver and the patient. Accompanied by an AI-powered scanning app, the bed could track movement and prompt timely repositioning. Companies like Tidewave and Arjo already use technology to help mitigate bedsores, and the ForeSite Intelligent Surface (IS) by XSENSOR uses AI to monitor the real-time emergence of sores. However, these solutions are largely limited to hospital settings. If a company could create an affordable version for home use, it could significantly improve the lives of millions of patients and their caregivers.

Accessing home modifications

When my father was discharged from the hospital, it was up to me to find a wheelchair-accessible home in the Bay Area. Whether it was too-narrow doorways, steps, or tight corners, none of the homes I toured had the necessary modifications for him to navigate in his power wheelchair. The home we finally found had enough space to meet his mobility needs, but we still had to pay out of pocket for ramps, touchless light switches, and other accessible features. Even now, he can’t leave the house on his own. He can’t reach the door handle from his wheelchair, and the ramps are too narrow for him to safely navigate alone, leaving him at risk of getting stuck—something that has happened more times than I’d like to count.

Instead of having to tour each house with a tape measure in hand and the wheelchair measurements stored in my phone, it would have been incredibly helpful to have an app that could instantly tell me if a wheelchair would fit through the doorframe or if adding a ramp was feasible.

Imagine if that app connected to stores like Home Depot or Amazon, curating a list of items I could purchase directly, without the hassle of checking measurements myself. Or, what if real estate or rental apps had a special section for homes that had already been modified or were built with accessibility in mind? With the right tools in place, I could have avoided much of the uncertainty and frustration, making the journey to find an accessible home much smoother for both my father and me.

What began with inexperience and uncertainty has evolved into a journey of growth and adaptation, both as a caregiver and a designer. Together, my father and I have learned a lot about how to live our new life—and each other. It has not been easy. And there is so much opportunity for insurance companies, healthcare providers, and startups to alleviate the unnecessary stress for caregivers and their loved ones. As the caregiver population continues to rise, the need for innovation is clear—without it, millions will continue navigating these challenges alone. As designers, we’ve only scratched the surface—there is so much more that we can do.

As my father and I prepared to head to Stanford for yet another doctor’s appointment, I remember asking him, “Are you prepared to never walk again?”

As you play, your job is to move a circle from one side of a line to the other. At each level, you have to wait one more second before you can cross the line. It’s both easy and increasingly boring—until you up the level of friction. The harder you make it, the more obstacles fill your path, and the more points you score. The higher the friction, the greater the fun, sense of accomplishment, and meaning.

This is a principle that’s true across play. Think about it: You could walk to the kitchen to grab a glass of water, or you could pretend your kitchen floor has turned to gooey molten lava, and hop  from chairs to rugs to the sink to get what you need. You could sit around at home mindlessly watching TV on a Friday night, or you could pay money to be locked in a room with your friends, forced to solve puzzles to earn your collective freedom.

As the Executive Managing Director of IDEO’s Play Lab, I lead a team of toy inventors and designers who use play to create effective and joyful products and experiences. Rarely does our work involve making things seamless. It’s usually about inserting obstacles, adding layers, and crafting challenges to help motivate and delight players, employees, and customers alike. 

And yet, as technology accelerates at an unprecedented pace and becomes intertwined in all aspects of our lives, from dating to healthcare to managing our time, we’re constantly trying to remove as much friction as possible. Digital tools promise to streamline our calendars, show us the shortest routes to destinations, enable us to make purchases with a single click, and even facilitate our relationships with each other.

But at a moment when technology promises frictionless living, we have to ask: What are we losing when everything becomes too easy?

Lessons from Gen Z

Gen Z is our first generation of digital natives, people roughly between the ages of 14–28, who have known digital technology and the internet for their entire lives. They have also seen the downsides: cyberbullying, superficial relationships, and broken attention spans. In many ways, they understand the costs of tech better than the rest of us. 

Last year, we tested early prototypes of creative and relationship AI tools with a group of young people to gain a deeper understanding of what they truly want from technology. They were universally clear: They’re happy to use AI tools that can make them more efficient, but they don’t want to get rid of the messy parts of life. As one of them told us, “I want to go on a date for myself. I want to go on a bad vacation. You know what I mean? I want to experience things and be like, ‘Oh, I hated that.’”

There are numerous videos on YouTube featuring young people questioning the value of tech making their lives more convenient. Some are going so far as to turn back the clock, embracing flip phones, embarking on digital detox journeys, and becoming digital minimalists. On YouTube, Jess Farnham shares how intentional tech breaks help her feel more grounded. Sakura Opal explains her switch to a flip phone as a return to intentional living. JV Scholz paints a picture of the creative rebirth that comes with limiting your screen time.

The comments on their videos reveal a growing groundswell: Consuming mountains of content is becoming overwhelming. These young people want to return to creating content through activities they loved as children, like writing stories and drawing. They’re also recognizing that our brains have lost the ability to sit with our thoughts or commit our full attention, factors that can be contributing to our growing loneliness epidemic, because intimacy requires time, focus, and effort.

Young people aren’t the only ones—brands are responding, too. Bottega Veneta shut down its social media channels to focus on in-depth, slow storytelling. Heineken and Bodega created the “Boring Phone,” a tongue-in-cheek device that encourages users to step away from digital distraction. Merriam-Webster’s 2023 Word of the Year? “Authentic.”

Designing for meaningful friction

Instead of assuming that we should always design for efficiency, we should look for opportunities to design for deliberate friction, perhaps making our lives a little bit slower and maybe even more challenging.

As human-centered designers, friction has long been a part of our toolkit. And not just recently with the proliferation of AI. In 2011, we partnered with the beloved nonprofit Sesame Workshop to develop Elmo Calls, an app that allows preschool-age children to call Elmo to hear advice, educational stories, songs, and jokes. Going to the doctor for a shot? Need help going potty? Call Elmo for support and a positive message about the challenge ahead! The app’s purpose was never to have kids glued to a screen, though.  Together with Sesame Workshop, we made a decision: Elmo will show up for a few minutes when kids need him most, and when the call is over, he will hang up. 

We did something similar when we designed a VR version of the classic ViewMaster with Mattel. The toymaker asked that we purposely design it without a headstrap, so that kids could interact with incredible scenes enabled by the new technology for a reasonable amount of time, but would put the device down when their arms grew tired. This purposeful friction moderates usage and ensures that kids can experience the fun while encouraging most of their playtime to be in the real world, with real people.

Can you imagine if our phones weighed as much as bricks? Our lives would be very different.

Maintaining the rewarding parts of work

Recently, we’ve been involved in several AI projects where the initial impulse is to outsource work to tools that can automate tasks, generate content, or make decisions on behalf of users. But, there is a danger in outsourcing all our work to AI, because not all work is created equal. True, there’s burdensome work that you don’t want to do, but there’s also rewarding work that you wouldn’t want AI to take away from you.

When an early-stage startup approached us for help designing an AI-powered writing hub for high school students and their teachers, our research quickly made it clear that both students and teachers value the process as much as the result. As one student said, “I feel like writing kind of helps you learn more about yourself, and I feel like just having a computer do that for you...you don’t really get to tell your own story.” Their teacher told us, “It isn't just about the strict grade that I’m giving them, but also making sure that their writing connects to them as a human being. It gives me a peek into who they are as a person.”

Writing isn’t just about writing. It’s testing ideas and practicing critical thinking. The effort that goes into it is well worth it if it lets us share our thoughts with others, gives us a sense of accomplishment, and enables us to learn more about ourselves and each other.

So, rather than create a tool that makes writing easier, Ethiqly was born out of the question: What if teachers could give individualized writing instruction to every student? The product we designed with our clients guides students through the steps of developing their own creative thoughts—surfacing topics they are excited about, providing the right prompts to draw out ideas, and helping them craft a story that feels authentic to who they are. It also helps teachers provide individualized feedback at scale. It’s not about having AI replicate our work; what we want is for technology to help us do our work better so that we can continue to learn and feel the exhilaration that comes with that accomplishment.

Designing a more rewarding future

If, at this point, you're rolling your eyes at my proposal to purposely add friction, don't worry. I’m not suggesting we slow everything down. AI is poised to bring incredible enhancements to our lives. There are many things we want to do as quickly as possible, from curing diseases to predicting natural disasters. Even mundane everyday moments, like finding directions quickly when we’re running late, benefit from AI’s frictionless speed. There’s plenty of drudgery we can get rid of, too. But we need to be thoughtful about where we apply efficiency versus just creating efficiency wherever we can. 

Imagine if instead of watching videos at 2x speed, they automatically paused and invited us to explore the content in more depth, allowing us to click on elements that catch our eye so that we can learn more about an object, person, location, or event. It could even compel us to reflect and comment on what we're seeing. What if our map apps didn’t automatically take us on the shortest route between points A and B, but instead offered a discovery mode option when he have the time for a more inspirational route? What if we abandoned endless scroll for a feed interrupted by challenges that prompt us to put our phones down and go interact with nature? What if it offered us rewards for time away from our screens, like a coupon for a cup of coffee at the cafe down the street?

Technology will keep evolving. AI will keep getting smarter. And there will always be new temptations to make life easier. But human-centered design has never been about making everything effortless. It’s about knowing when to embrace the effort—to design for friction, for complexity, for depth. Because it’s in those deliberate moments of challenge that life becomes more meaningful, more social, more joyful. Imagine what the world could look like if we design for meaning, not just for speed.

Looking to design for friction in your own products and services? Get in touch. We're here to help.

(This article was adapted from Michelle Lee's main stage talk at Config '25. You can watch the full talk here.)

Recently, my colleague Takashi Wickes designed a deceptively simple game called wait. wait.. wait…

“What might be” was suddenly overshadowed by “what must happen now.” The pandemic disrupted every aspect of our healthcare ecosystem and forced us to adopt an entirely virtual primary medicine model, something most health systems had previously only experimented with. It felt like everything was urgent, and getting anyone to focus on the future seemed impossible. Surrounded by all that chaos, I decided to look back to see what history could tell me about major shifts in this industry during other periods of great uncertainty.

The past is filled with patterns of human triumphs, mistakes, and missed opportunities. These moments can give us a strong sense of how humans, governments, markets, and organizations might react to profound change. A century before COVID-19, the 1918 influenza pandemic similarly upended global healthcare, exposing the limitations of existing care delivery systems. Looking back at this period offered significant insights into how a crisis catalyzes transformation. In that era, patients received healthcare in their homes, by general practice doctors who were also members of their community. Just as COVID-19 forced a rapid transition to virtual care, the devastation of the 1918 pandemic led to the expansion of healthcare systems, the professionalization of medicine, and public health reforms. Despite the realities of the moment, the feelings of fear and uncertainty people felt in public settings in 2020 were eerily reminiscent of the fears that marked the 1918 influenza crisis.

Each decade of our past tells stories about how change develops. The Industrial Revolution demonstrated how rapid technological advancements could reshape economies; the Space Race of the 1960s highlighted how global competition could fuel scientific breakthroughs; and September 11 proved how tragedy could bring a country’s diverse communities together in a shared purpose. Adding the context of examples from human history brings rigor and believability to the futuring process, upping the likelihood that people can understand potential opportunities and consequences in tangible ways.

But how do futurists do this? How do we pick which pieces of the past apply to what we’re trying to solve for, and how do we arrive at tangible takeaways? Here are three ways history can help you understand what could be.

1. A frame for ideation

History doesn’t always offer clear predictions for how change might unfold, but it can provide a scaffolding or starting point for the imagination. A historical lens anchors storytelling, making speculative futures more relatable and actionable by drawing on connections to known human experiences.

In 2023, IDEO partnered with LeadingAge California to explore a fundamental question: What does it mean to age well in a world of rapid change? Through a series of workshops, we examined how traditional older adult care, long centered on institutionalized models, could be reshaped by shifting demographics, emerging technologies, and evolving cultural expectations. We started by grounding our work in historical precedent to add credibility. Then, we crafted six bold, forward-looking narratives that reimagined aging as a deeply human-centered experience, one defined by purpose, autonomy, and connection rather than decline. These stories introduced new possibilities for older adulthood, where updated mindsets on aging, advances in AI, regenerative medicine, and assistive technology redefine what it means to grow old, allowing people to maintain their physical and cognitive health in previously unimaginable ways. Using the past as a framework clarified how services for this population could be reimagined to evolve in response to social and technological change. Within these constraints, we designed futures that felt not just visionary but entirely within reach, creating a roadmap that could help bring these ideas to life.

2. A way to stress-test plausibility

History helps make future scenarios more credible by grounding them in familiar patterns and contexts. This thought experiment requires thinking critically about the past. What factors spurred a particular phenomenon? What kinds of decisions shaped action, and by whom? What decisions did people decide not to make? By examining these dynamics, we gain insights into how similar forces might unfold under new conditions and use them to inform our stories. A backward glance at the mental health impact of isolation during 2020 could provide insights into the potential effects of remote work and virtual schooling on future communities. When we think this way, the past becomes a launchpad rather than a limitation.

These methods were extremely useful in 2023, when we partnered with the DC Federal City Council to reimagine the future of downtown Washington, DC, a city with both a storied past and a future that can change radically every election cycle. To generate bold, forward-thinking ideas for revitalizing downtown neighborhoods, we convened over 100 stakeholders. We asked them to identify the past and present to surface patterns of transformation and areas of opportunity in the city. With that foundation in place, the teams developed plausible future narratives, layering ideas such as new pedestrian zones, green spaces, and artist live/work zones onto physical maps of each neighborhood. These activities helped them create stories of the future that didn’t just feel aspirational but were deeply rooted in the city’s identity, its people, and the existing infrastructure. By looking to history, the workshop unlocked new pathways for action, moving closer to the goal of a thriving, community-driven urban future.

‍3. A method for predicting outcomes

The future is about identifying strategic choices that will shape the future we want to build. History reveals how communities, industries, and organizations responded to change, offering a glimpse into potential outcomes that could have a significant impact.

IDEO’s 2024 collaboration with San Francisco public television and radio station KQED explored how public media will have to evolve to remain relevant and essential in a rapidly shifting landscape. In a day-long workshop, the IDEO team guided the KQED board through a method developed by futurist Sohail Inayatullah called “The Futures Triangle,” which examines the weight of the past, the push of the present, and the pull of the future. By discussing these different forces, we surfaced a key tension: In an era of hyper-personalized content and decentralized media consumption, KQED’s legacy of trusted journalism and civic storytelling can be both a powerful foundation and a potential constraint. So, how will these existing forces shape the future? With this insight in mind, participants crafted stories and created artifacts from the future that drew a picture of a public media ecosystem more deeply embedded in community life, one that reaches audiences through interactive, on-demand, and participatory experiences. They explored how KQED could expand even further as a multimedia organization and community convener to become an agile, responsive, and dynamic force for engagement across generations and platforms. By analyzing the historical forces pushing and pulling the public news source, the group identified key strategic choices KQED could make today to shape the desired outcome of a more inclusive, innovative, and community-driven future for public media.

To build bold, forward-looking futures, we must look backward—not to recreate the past, but to navigate the future with intention. History provides more than context; it offers structure for creativity, a stress test for credibility, and a mirror through which we anticipate consequences. When we weave these insights into our foresight practice and design efforts, we can imagine futures that are rigorous, plausible, and transformational, drawing on the past to shape scenarios that inspire action and meaningful change. Years from now, when futurists look back on today, they will be reading the signals we left behind.

At the end of 2019, I embarked on a project exploring the future of primary care medicine, looking ahead a decade to imagine stories about innovative home diagnostics, expanded virtual care, and transformative shifts in delivery models. Then came COVID-19.

But somewhere between unlocking a new badge and being reminded that your streak is on the line, you wonder, “Am I actually getting healthier—or just getting better at this game?”

Gamification, the technique of borrowing principles from game design to nudge behavior, promises motivation wrapped in fun. It has taken hold for a reason—it works. At least in the short run. Our products now nudge us at every turn. Fitness apps keep us running (literally) after digital rewards; loyalty programs make us strategize our coffee orders like it’s the Olympics; and even financial markets have started to feel more like Vegas, where winning means flipping assets before the music stops. But the important question isn’t whether gamification works. It’s who is it working for?

When game mechanics are used for product strategy without understanding consumers’ deeper motivations, it breeds fatigue, churn, and mistrust. It’s not just bad design, but rather a larger risk to customer loyalty and long-term growth. Gamification strategies that emphasize winning can also unintentionally encourage overconsumption, while attempts to gamify health, community engagement, or sustainability risk reducing meaningful behavior change to shallow, performative tasks.

In a well-designed game, the relationship is symbiotic—you play because you love the experience, and in return, the game designer thrives as more players buy in. But gamification can sometimes feel like a system imposed upon you, where participation is required to unlock basic functionality, avoid penalties, or simply keep up. When this happens, gamification starts feeling more like an obligation—or worse, a trap. The game stops being something we choose to play—it plays us instead.

So how do we harness gamification’s immense promise in a more productive way?

At the IDEO Play Lab, we leverage game design to help businesses drive deep, sustainable engagement. Because most successful products don’t just lean on gamification’s surface sparkle—they dig into the sturdy mechanics of game design itself.

Here are some of the myths of gamification and real ways thoughtful game design can lead to better products.

Myth 1: To make an experience sticky, just add points or badges!

Reality: The deeper opportunity lies in leveraging game thinking to make transformative experiences.

Reducing game design to points and leaderboards sells it far too short. True game-thinking involves designing systems that embody the foundational mechanics of games—like challenge, choice, feedback, and progression—to create deeply engaging, motivating, and transformative experiences.

One example: We were partnering with an organization to develop a digital platform to support the mental health of people aged 14-25. We could have simply added a point or reward system to make the app engaging for this young audience—after all, social media and other apps do just that. But we knew that the benefits of working on one’s mental health aren’t tied to those types of metrics; in fact, employing them can have the opposite effect. Instead, we ran game design workshops to explore specific mechanics and principles that would tap into users’ intrinsic motivations, then used those as a springboard to explore compelling—and beneficial—new features. One of the simplest—and most popular in testing—was a fidget drawing board, where users could make little finger drawings on a starry background that would fade after a few seconds. This playful interaction was a compelling feature that drew our testers back again and again. No leaderboard needed.

Myth 2: Make an experience feel like a game with competition!

Reality: Games do not have to be zero-sum.

Games often have a winner and a loser—one person’s success comes at the expense of another’s. But not always. Over the last two decades, we’ve seen a big rise in new kinds of gaming experiences—cooperative games, cozy games, storytelling games, and more. Games like these leverage game mechanics to build community, encourage expression, or even intentionally lower the stakes to design for new kinds of emergent experiences

On a recent project, IDEO worked with a client that was looking to introduce generative AI workflows into employees’ day-to-day work. They told us that the team responded well to competition and recommended leaning into that to motivate and incentivize participation. So, we split the group into two teams and started tracking achievements to see which team could achieve the highest overall score each week. At first, the teams enjoyed tracking points and competing. But when we introduced a challenge where harder tasks earned more points, participation collapsed. Some tried, but after high scores hit the leaderboard, they felt embarrassed to share lower ones. Others skipped it entirely, assuming they couldn’t measure up.

So, we changed course. Instead of rewarding skill, we gave points for effort and encouraged mentorship over competition. Participation rebounded immediately.

Dialing in the right mechanics for a leaderboard is trickier than you might think. Done poorly, you might discourage the very behavior you’re hoping for. Ultimately, gamification should encourage progress, not perfection.

Myth 3: Gamification works because it’s fun.

Reality: Motivations are much more complex than just fun, and game elements work best when they are tied to more meaningful values.

Fun is suuuuuper subjective. It’s not even helpful to say it’s a motivation. It is an outcome. Some games create fun through storytelling and narrative explorations (think Dungeons & Dragons); other games offer fun through the satisfaction of strategic or tactical problem-solving (think chess). Game designers look at these deeper, more nuanced motivators when they shape an experience.

When we designed the initial prototype for Ethiqly, an AI-powered writing platform for teachers and students, we began with a fundamental belief: motivation goes deeper than fun. Ethiqly is built to support the writing process, not replace it. We applied a play-centered design methodology to uncover intrinsic motivators at every stage. Students don’t just complete tasks—they explore writing voice, style, and critical thinking. Meanwhile, teachers take on the role of game designers, shaping the learning environment through challenges, feedback, and progression systems. Instead of automating away the parts of the writing process that bring users satisfaction and purpose, like students building confidence and skill in developing their point of view, we built experiences that work with their intrinsic motivation. Just like in a great game, the platform gradually increases difficulty, offers meaningful choices, and delivers helpful feedback that sparks growth. Gamification, in this case, works because it isn’t just icing on the cake—it’s a deliberate system for sustained engagement, where technology augments human creativity rather than bypassing it.

Many of the industries that are leaning into gamification—exercise, eating habits, medicine, education—tap into motivations that are similarly complicated. Organizations need to take care to align the ingredients for fun with the criteria for other meaningful outcomes.

Myth 4: Gamification has universal best practices.

Reality: You can’t slap any old game mechanic onto any experience and expect to improve it.

Picture what would happen if you added dice rolls to chess—a game that is deliberately devoid of randomness. You’d change the very essence of it. Similarly, you can’t just add badges to a workout routine and assume it will make the workout better. You might even ruin the original, desired experience.

IDEO once helped design an FDA-approved program to help people quit smoking. The team made early games that were fun to play, but something didn’t feel right.  So, we took a cue from roguelike games, a genre that uses repeated failure to make players’ eventual success more meaningful. (After all, the journey to quit smoking can often include repeated failures.) Some roguelike games even require you to fail in order to level up. Inspired, we applied this kind of game psychology to design a core loop, providing feedback that users could reflect on, understand, and apply on their next attempt. The setup gave users a reason to continue and ultimately succeed.

Layering game elements onto existing activities requires intention and design to dial in the right experience.

When done well, leveraging game mechanics isn’t about points, competition, or chasing fun; it’s about designing experiences that tap into deeper human motivations. The best games can shape how people engage, learn, and grow. But getting it right takes more than a leaderboard—it takes thoughtful design.

At IDEO, we apply play and game mechanics to complex challenges, designing experiences that empower rather than manipulate, motivate rather than pressure, and create lasting impact beyond the next dopamine hit. If you’re looking to build experiences that go beyond the surface and truly engage, let’s talk.

Imagine this: You’re halfway through your fitness challenge, hitting milestones with satisfying progress bar updates and an occasional trip up the leaderboard.

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.

Most AI products today are built for work—a space with clear problems and established systems. One founder noticed a gap: personal life is messier, harder to systematize, and mostly left behind by the AI boom. So she built Cue, a personal AI that lives inside iMessage and group chats, to go where the other tools haven't.

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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.

Mina Seetharaman talks with Scott Shigeoka, author of Seek and Head of Curiosity Cultivation at the Eames Institute, about what distinguishes genuinely curious leadership from performative curiosity, how power dynamics shape curiosity, and why practicing curiosity can restore energy rather than drain it.

Mina Seetharaman talks with David Epstein, author of Inside the Box and Range, about why total freedom often produces average work, how leaders can design useful limits on purpose, and what organizations such as General Magic and Pixar reveal about the relationship between boundaries and creativity.