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.

While those can be useful tools, the true beauty and power of workshops is in being pushed out of your comfort zone: a group of adults struggling to share opinions openly, dive into group activities, and ultimately enjoy the mindset change that comes through participation.

Since the pandemic began, we’ve been forced to bring workshops online—and fundamentally rethink the way we conduct them. Hosting online workshops is not about bringing what we used to do in the physical space to the online world: it’s something new, and we should create completely new tools to adapt to the online world.

Over the past several months I’ve started to prototype new tools for remote workshops. They’re still experiments rather than tools, but that’s okay: designing workshop tools is the same as designing anything else—it’s about prototyping quickly, and iterating for improvement over and over again. Here are four insights we’ve gained in the process.

1. Let the unexpected overflow from the screen

Creating an atmosphere that is strange, weird, and slightly unusual is key to achieving impact through workshops: it gets people out of their comfort zones and opens their minds to new ways of doing business. In the digital realm, most participants will be calling in from home (i.e., their #1 comfort zone), and you need to intentionally haul them out of their day-to-day.

Virtual backgrounds are an easy win: they can create visual interest and curiosity while also functioning as a tool for individual expression. One great ice breaker is to start by asking participants to create their own virtual backgrounds in teams, using Google Slides.

Throwing in a custom-made Snap Camera filter is also a great idea, because it offers participants a chance to hide a part of their face if they feel uncomfortable with experimentation. Instead, they can addd something new like donkey heads or puppy ears. As a facilitator, these tools allow you to get in on the fun with participants. It allows the group to feel that you are on the same team as you explore new territory together, rather than a facilitator insisting they do something uncomfortable.

2. Pick up non-verbal cues from participants

In a physical workshop, one of the key roles of the facilitator is to “read the room.” This is one of the hardest things to do online—all you can see is a participant’s torso with facial expressions, which may not be truly reflecting their emotions. Another way of looking at this, though, is that the online environment can create psychological safety, allowing for more open and honest communication.

To capitalize on this, I created a tool called the Mood Checker, which allows participants to rate their mood on a scale of 1-5, anonymously and in real time. Their responses are constantly aggregated on the facilitator view, allowing the facilitator to always keep track of how the participants are feeling. Initially I wanted the participants to use the slider throughout the day at any time, but after a few trials, we quickly learned that we should designate a few moments in the workshop where we ask the participants to reflect their thoughts on the Mood Checker.

A tool like Mood Checkers lets the facilitator read the digital room. Think about other ways you can utilize the anonymity of the online space to get honest, real-time feedback from your participants and to make your workshop the best it can be.

3. Incorporate physicality

One of the things that I watch out for most during online workshops is making time for everyone to move their bodies. Getting up and moving away from the computer makes everyone feel much more connected and has a positive effect on their wellbeing. Since I tend to do a design-themed workshop, it also helps us remember that good design can not be achieved without the notion of physicality.

An easy way to achieve this is to have the participants go for a walk, either by themselves or by staying in the call through their phones. We can leverage the fact that they are dialing in from different locations: with the phone’s camera, we can have the participants hunt for creative inspiration in their neighborhood. For example: “Take 3 pictures of new behaviors you see in the neighborhood,” or “Find and share your favorite typography that you can see from where you are.”

I also created a Remote High Five system, which, as you may have guessed, tracks the participants’ hand positions through the computer’s camera and plays clap sounds when your onscreen hand “high fives” someone else’s. While this was initially made as a fun experiment, it became an end-of-workshop ritual thanks to its physicality and joyfulness. It quickly became one of the iconic moments of the workshop.

4. There are always ways to realize ideas. Just start small.

Some of these examples may seem too wild or unfeasible depending on your technical know-how. But the important point here is to start small, prototyping ideas quickly and with the least risk. It doesn't have to be perfect on the first go; in fact, it will never be perfect on the first go. Just remember that there are always ways to make an idea happen: give it a shot, and iterate with small tests to improve your idea. It’s actually much easier to try out new ideas online because there’s really nothing to shy away from when, at the end of the day, all you’re facing is a computer screen.

Ultimately, the goal of a good workshop is to get participants to step out of their comfort zones and adopt a new mindset. It’s a shame that many people underestimate the creative potential of workshops and often opt for a generic format: when you tackle a workshop just like you would tackle any other design challenge, the outcomes can be quite transformative and magical.

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Workshops are everywhere, from training programs at big corporations to urban planning sessions at local town halls. Given how formulaic many workshops have become, you’d be forgiven for thinking they’re all about colorful Post-its and saying “yes, and...”

They were in search of a feature that would excite Card Members, especially millennials coming of age financially. Everything was in place, but their project whiteboard had one last empty box.

The IDEO and American Express teams paired up for a design sprint, and in the first few weeks of research, after extensive qualitative interviews, an idea emerged: a new, transparent and easy-to-use way to split large purchases into equal monthly payments, with a fixed fee and no interest. The feature, called Pay It Plan It, launched in the market in 2017. Since then, it has been used to create five million payment plans, totaling nearly $4 billion in lending. It represents a notable, widespread behavior change. Card Members are spending differently, by design.

But getting here took more than just a bright idea. At a large organization like American Express, in a complicated and highly regulated industry, and in a smartphone-first environment, transforming an insight about consumer behavior into a beloved tool for Card Members required a particular flavor of corporate agility. At the time, there was nothing like Pay It Plan It—at American Express, or elsewhere. Bringing it to Card Members would require a substantial technical and financial investment, affecting everything from payment terms to the way the smartphone app handled swipes. All of that was doable, but leaders still had to do it—they had to make the heavy lift to usher a concept sketch into becoming a meaningful part of customers’ lives. The success of Pay It Plan It as a feature driven by emotional insights—while driving the bottom line—has made it a beacon inside American Express. For many, it marked a new way of working within the company, a transformational shift in the way ideas are conceived and implemented.

The following story recounts the development of Pay It Plan It, told through the voices of the IDEO and American Express team members who worked on it.

1. Plus, and...

In 2015, Amex was looking for something new to engage consumers—particularly younger professionals who wanted to avoid the pitfalls of credit card debt. Innovation within the consumer lending space had traditionally been all about rewards and cash back perks, but Amex was committed to finding something different that empowered their Card Members. Was there something else? And if so, what?

Kyoko King is currently VP, Global Commercial Services at American Express; at the time of Pay It Plan It, she worked on consumer products, focused on new product innovation.
“It felt like a race to the bottom. We kept throwing more rewards at the customer, so they win out, but there's no actual edge. That was the challenge we set out to solve.”

Leigh Cohen is a Design Lead at IDEO, and a team member on the original design sprint.
“I remember we wrote on the white board, plus, and, next to an empty box. The reward structure of this new card was already defined—but then what? What goes in the box? What is this thing? It can be very daunting to come up with something that not only makes sense to Card Members, but also makes sense to American Express, and is also a smart way to help people spend appropriately and confidently.”

Jenny Shum is currently VP, Head of US Small & Mid Market B2B Marketing at American Express; at the time of Pay It Plan It, she was VP of Consumer Lending Products.
“We had aspirations to reinvent what a credit card could be, and the role it plays in a consumer’s life. But this is a very regulated industry, and we were afraid that we would come up with a brilliant idea we couldn’t deliver. And yet we didn’t want to be constrained by that.”

2. An emotional insight

Over a series of consumer interviews conducted across the country, the team honed in on a key set of desires: credit card users wanted more flexibility and transparency in how they paid for big purchases, and they wanted to feel like they had autonomy in how they pay for the things they buy.

Kyoko King, Amex: “We had done the side-by-side comparison of Amex versus other cards, we had done task forces looking at debit versus credit. We always had the knowledge that customers don't like our credit cards, but I don't think we ever went so far as to say, ‘They just emotionally don't like it.’ I remember IDEO saying to us, ‘It makes them feel bad. You guys make them feel bad. Customers have no control, no transparency.’ But here IDEO just said, ‘It's an emotional problem, therefore, the solution has to be emotional.’”

Travis Lee is Managing Director and Partner at IDEO, and guided the initial sprint.
“American Express is a service company. They think of themselves as trying to serve their customers as human beings—and the card is a means through which they provide service. It’s not their product. And that’s very different from a lot of companies. So what if we can think of lending as a service?”

Kyoko King, Amex: “Our team at Amex was all about growing lending—lending, lending, lending. That was even what it said on my business card. And then IDEO came in and said, ‘Well, it's all about paying. No one is thinking that Amex is lending them money. It's all about when they can pay.’”

3. We could really break things!

As clear as it was that credit card users wanted more flexibility and control—not just more rewards and perks—so too was the realization that the Amex/IDEO team had let the genie out of the bottle: implementing this wouldn’t be easy. This wasn’t just another lending feature, but would require a fundamental rethinking of how Card Members paid their bills.

Dory Butler is VP, Digital Product Management; she led the digital team that implemented Pay It Plan It.
“People were nervous. We could really break things! It involved significant changes to our payment hierarchy, our accounts receivable systems, how we calculated what customers owed to us, and so on.”

Jenny Shum, Amex: “We were certainly aware of the potential this product could have—and we’d sized the financial benefits—but what was different here was the process of understanding true customer needs.”

Kyoko King, Amex: “You know when you sign a car lease or a mortgage, and there’s a stack of papers that you have to sign with ten different signatures, every couple pages? That's what we were trying to put onto our credit card. I remember our compliance person sitting me down and saying, ‘You're trying to put a closed loan into an open credit product.’ That was the first time I realized we were creating something so complicated—even if to a consumer it made complete sense and felt so simple.”

Dory Butler, Amex: “As a company, we've identified opportunities and gone after them in the past. But many times those opportunities are highly driven by business outcomes, and not as highly driven by customer outcomes. Pay It Plan It was all because of a customer need, but we could see that the business benefit of that would flow and follow.”

Kyoko King, Amex: “After that initial sprint it was kind of a no-brainer. If we could do this, we should do this. But it was very clear that we should do it only if the experience stays as simple as what we’re proposing. If it becomes a series of terms and conditions and things you have to click and fill out, then we’ll lose the essence of what it is we're delivering.”

4. Buy-in for the buy-in

Given the complexity of the implementation—and the simplicity of the desired result—the Amex/IDEO team planned an unusual internal communications strategy, rooted in the emotional insight at the heart of Pay It Plan It.

Leigh Cohen, IDEO: “Executives across American Express had to understand the value this product was going to bring—the emotional value to Card Members, and the financial value to its business. We wanted them to see the overlap between the financial confidence Pay It Plan It could bring, and their brand values of trust and security. And they had to see how it was delivering upon their internal objective as an organization to be thinking about smart lending, and what lending looks like for their current members.”

Kyoko King, Amex: “We couldn't pitch this in a PowerPoint deck. We had to translate that consumer insight to the pricing team, the technology team; we had to change minimum due, payment hierarchy, grace—three different components that are extremely difficult to touch. It was like a house of cards: everything could fall down. Usually if you touch any one of them, all those teams are like, ‘No, no, no, it's not worth it!’ It just wasn't something you could understand in a really rational format; there was so much emotion to it, there was a customer need we were solving for. Usually we had bullet points and boxes with words, and a P&L or business case that’s about the numbers. But here we began with sketches and drawings of what this could look like. That was very different than how we operated before. It was new. And it incited interest.”

Kelly Bjork is a Senior Design Director at IDEO; she helped lead the team that designed and implemented Pay It Plan It.
“These are rational people! You were talking to C-suite level folks who have their bill on AutoPay. They don't think about these things. So our work was putting them in the shoes, if you will, of the Card Member who this was targeted for. It's kind of that simple.”

Jenny Shum, Amex: “The magic of Pay It Plan It is that it gives consumers the confidence that they have a lending solution if they need it. I don’t think we necessarily went in with this intention, but that directly aligned to Amex’s brand heritage, of giving consumers control. The brand team saw how exciting this was, even before the business unit decided to invest in making it real.”

Dory Butler, Amex: “You have to continuously sell-in these ideas internally to have the level of investment that you need to do them right.”

Travis Lee, IDEO: “Innovation at this scale can't happen purely grassroots. You can't just get a single team leader excited about it, and expect it to happen. You have to get everyone’s buy-in, you have to get everyone’s excitement, you have to make sure they understand why it matters to do it, even if it's gonna be hard. And you also have to get the CMO pumped. All of these people have to greenlight it in their own way.”

5. How it spurred organizational change

In 2017, Pay It Plan It launched under a strategy nicknamed “Big Bang,” rolling out to 21 million customers in 30 days. As of August 2020, it is available to almost all US consumer Card Members, who have collectively created nearly five million Plans, totaling nearly $4 billion in purchases, with an average Plan size of $789. But as much as they have embraced Pay It Plan It, so too did Amex executives. The unique story of its implementation became company lore: here was an emotional insight that unlocked significant business outcomes.

Kyoko King, Amex: “The internal teams could see it: this was reflective of all the data and information we have seen and heard for years and years. But this is a new way to approach the problem! I often talk about it in terms of learning a new language. Amex internally thinks of itself as a rational company based on CBAs and models. The breakthrough—and the thing I'm most proud of—was bringing that customer emotion into internal decision-making, seeing Amex become emotional rather than purely rational.”

Jenny Shum, Amex: “Kyoko and I joke that we feel like we walked through a doorway to an alternate universe that we can’t turn back from. This is a long-term strategic investment that would have been hard to write the business case for—but that was also the exciting part, because it is transforming a business, versus delivering an incremental product. The challenge now is whether we will be able to galvanize the organization in a similar way, towards solutions for our customers.”

Leigh Cohen, IDEO: “The pieces came together in this perfect storm: the Amex leadership focusing our IDEO team on the opportunities that were strategic within their organization; our team's ability to unpack and uncover an emotional resonance with the Card Member, that really spoke to them wanting to be a more confident spender on credit; and then the internal buy-in and belief that this not only resonated internally, but also could convert externally.“

Kyoko King, Amex: “To be honest, this began as an eight-week engagement of just asking, ‘Okay, let's see what you guys can think of: a slap-on feature to our credit card.’ So for it to then result in something that was implemented across all of our cards—that is a big, big deal.”

Kelly Bjork, IDEO: “Getting something like this to market feels like sort of a small miracle to me.”

Jenny Shum, Amex: What has followed me from this project is really understanding the emotion of the customer—not just the words they tell us, but what worries them and why.

Illustrations by FagoStudio.

In 2015, American Express (Amex) came to IDEO for help putting the finishing touches on a new consumer credit card. Its reward structure was fixed—but what else might it be?

They worried about how they’d feed themselves or their families. Or felt the physical and emotional stresses of want and hunger. Of that number, 11 million were children.

Today, the picture has worsened. This year, a year in which American lives have been ravaged by disease or economic crisis or both, more than 50 million people will have faced the reality of food insecurity; almost half of them will have sought help from food banks and other sources of support.

This pandemic of hunger continues to unfold, year-on-year, across the United States—one of the richest nations on earth.

It is a crisis that moves inexorably forward, but also one that’s rooted in inequities stretching back into our collective history. Our food system, like many of our society’s most foundational systems, is racist by design. The labor of Black and Indigenous workers and people of color (BIPOC) forms the backbone of the industry’s essential workforce—specifically women of color. They serve or cook in restaurants; they perform dangerous, exhausting work in food plants; they labor on farms; and they bring deliveries to others’ homes and apartments. And they have been disproportionately impacted by the knock-on effects of the pandemic, including decreased food security. Additionally, racism—in the form of food systems that are effectively separate from and unequal to those afforded to white communities—has historically denied BIPOC access to preventative nutrition. The result? Disproportionate incidence of chronic health conditions and weakened immune systems, both of which are now further intensifying the devastating impact of COVID.

It is a story of injustice and inaction. And it demands we step up and help create change.

How might food leaders work to dismantle the systemic inequity in our industry and in the communities we operate? And how might we improve the lives of those most unjustly affected? We see three paths where design can drive efforts towards solutions.

Prioritize food workers’ livelihoods

The most straightforward way to reduce food insecurity among food workers? Pay them more money.

The food industry employs roughly 14 percent of the U.S. workforce, with the lowest median wage of any industry. In many states, it’s legal to offer restaurant workers a sub-minimum wage of less than $5 an hour—sometimes as low as $2.13. Black servers are typically not tipped as well as their white coworkers: A recent study revealed that for tipped restaurant workers in New York, white men made almost an $8 an hour more than black women.

Food manufacturers, quick-service restaurants (QSRs), and retailers are largely responsible for producing, serving, and distributing food; but the cruel irony is that their own employees—along with those growing and harvesting the food that they sell—are often food insecure and hungry. One out of six restaurant workers live below the poverty line.

Following the example of brands like Shake Shack and In-n-Out Burger, others must rethink their business models to offer their workers more than the minimum wage. Similarly, they can design competitive benefits, as Starbucks does, offering healthcare and tuition reimbursement to full- and part-time employees.

Improve the quality of mass-produced food

Many low-cost foods are intentionally designed to be sold in mass quantities to people who can’t afford higher quality items. This perpetuates a supply chain that values long shelf-life and cost-efficiency over nutrition. A complete overhaul of existing product formulations is required to maintain the convenience and comfort that people seek, but eliminate ingredients proven to contribute to higher rates of heart disease and diabetes, such as high-fructose corn syrup or processed or refined carbohydrates.

A June 2020 study revealed that as households stock up on shelf-stable foods, they appear to purchase products with less nutrient-dense ingredients—often ultra-processed, calorie-dense comfort foods. This is setting the stage for an increase in childhood obesity, particularly for economically vulnerable families.

Convenient and nourishing comfort foods are rare. Designing them and putting them on shelves across the nation is an excellent challenge for the food industry’s formidable R&D capabilities.

There are examples to be inspired by, however. Pierre Thiam, a celebrated Senegalese chef and leading authority on African foods, founded Yolélé Foods to bring fonio, a West African grain, to a global audience. Fonio is a versatile ingredient with a nutty flavor; it’s included in the Future 50 Foods List, an effort from the World Wildlife Fund (WWF) and Knorr to highlight foods that support human and environmental health. One of Thiam’s vehicles for fonio is pilaf, and Yolélé Foods’ affordable, microwavable bags of seasoned pilaf are sold online and at brick-and-mortar stores nationally. This product innovation unites what is not only feasible, viable, and desirable; but also more sustainable and nutritious.

If it works for fonio, why not for brown rice? It’s one of the most familiar, nutritious, and affordable food staples in the United States, yet few have attempted to make it desirable and easy to cook. It’s an enormous opportunity. And design is a way to reconceive brown rice into products that are as simple and convenient as the more ubiquitous ramen and macaroni and cheese filling pantries nationwide.

Give more people access to nutritious food

That separate and unequal food system? Karen Washington, a food justice activist, calls it food apartheid. And the evidence to support that frame is all around us. Poorer neighborhoods have fewer grocery stores with nutritious food options; fast food chains dominate instead. There is a need for quick service restaurants (QSRs), retailers, food banks, and federal food assistance programs (SNAP)—all players that influence food access—to design new ways for healthy food to be available to everyone.

Free food is a critical support for hungry people. But there is a stigma attached to accepting it, and it can be a deeply demoralizing experience to stand in long lines and receive a bag of food you don’t like or can’t eat. During COVID-19, we’ve witnessed heroic efforts by food banks and pantries to increase their services. Food banks originally created drive-thrus to overcome the stigma of free food, but now, even more have added this feature to facilitate contactless service.

Northern Illinois Food Bank (NIFB) partnered with IDEO to improve their My Pantry Express program, a digital food pantry service that refers to their customers as “neighbors.” The program offers their neighbors a choice of what food they receive. Typically, food banks determine their success based on pounds of food or “meals” distributed, but NIFB wanted to use more human-centered metrics to determine if their service offers food that people actually want and will eat. The team discovered that offering choice in food selection, even in a limited way, created higher neighbor satisfaction and more referrals—94 percent said they would recommend the program to a friend. We can use design to identify what people value most, then use these findings to improve services, meet more people’s needs, and in this instance, get more nutritious food into more hands and homes.

Learn more about IDEO's partnership with NIFB.

Looking ahead

Given the number of cracks the pandemic has revealed in many of our national and global systems, it can be hard to know where to begin reimagining better solutions. But food is fundamental—and improving the food system is achievable. As we look to the coming year and the post-pandemic recovery period, let’s ask ourselves:

• How might we ensure that the people producing and serving our food have equal access to food for themselves and their families?
• How might we rethink our success metrics to be more human-centered?
• How might we create products and services that are not only profitable, but nutritious and sustainable?
• How might we put our R&D efforts towards creating beloved food products that are convenient and nourishing?
• As a leader in the food industry, how might we look first to the ways we can support our own employees before directing community support efforts beyond our organization?

By prioritizing people’s needs and developing human-centered innovations for business, nutrition, and food access, we can move leaps and bounds toward more food security and access and health for all.

Photos by Rizki Prayugo and Aniketh Kanukurthi

In 2018, according to the United States Department of Agriculture, 37 million Americans didn’t have enough to eat. At one point or another that year, in other words, they struggled to put food on the table.

But if you were to ask someone in China, they’d laugh amiably and follow up with another question: “What part of China are we talking about?” And it’s a good question—whether the food you crave is sweet or spicy, hearty or healing, you can find it in the Chinese kitchen.

Even growing up in a Chinese family, the diversity of Chinese food came as a surprise. I thought there were two types: Panda Express and the Cantonese food that my parents cooked. It wasn’t until I traveled through China, tasting everything from spice-laden cumin lamb to tropical coconut soup, that I realized how much I was missing. With thousands of years of history, 55 racial minorities, and 9.6 million square kilometers of land, China’s food culture is incredibly diverse. I learned to embrace my heritage by learning how to stir-fry, braise, and steam.

And yet the dominant view of Chinese food in the West is not only narrow, but tinged with prejudice. Growing up in a homogenous community in suburban New York, I was no stranger to words like “oily,” “cheap,” and “gross” being applied to the food of my heritage. On the surface, this might not seem like a big deal, but it reflects a deeper judgement about which cultures hold inherent value.

I always saw this as normal—just the way things were. But as COVID-19 has spread across the globe, so has anti-Chinese xenophobia. Across the world, businesses have banned customers of Chinese descent. Racial slurs fly freely. In March, an acquaintance of mine woke up in the hospital after being attacked by strangers for no reason other than his East Asian features.

I wanted to do something to help. But what?

I’m no politician. I’m not an Instagram influencer. But I do have a few skills that turn out to be surprisingly relevant. The first, which I practice on a day-to-day basis here at IDEO, is storytelling. The second is cooking, eating, and writing about food. It turns out, the combination of the two is a powerful thing.

I’m talking about gastrodiplomacy, the promotion of cultural awareness through food. As ingredients like kimchi, harissa, and turmeric have made their way into the mainstream, they’ve become a starting point for people to take an interest in other cultures. But while I’m encouraged to see signs of that trend with Chinese food, it’s nascent at best. And I want to help it grow.

And thus Journey East, a digital zine about Chinese food culture, was born. The name is an play on the classical Chinese novel Journey to the West (西遊記), which tells the story of a Buddhist monk venturing west from China along the Silk Road. It serves both as a nod to my personal journey from America to Asia, and a reminder of my core goal of shedding light on the beauty and diversity of Chinese cuisine.

I have so much to say on the topic of Chinese food that I could easily ramble on forever. To stay focused on my core goal, I wrote a set of design principles for Journey East:

1. Tell a human story. Food tastes better when you know the story behind it (I’ve always believed this, and researchers seem to think so, too). That’s why I start each issue with a history of the region and the reason I find it personally meaningful.
2. Make it a conversation. There are plenty of places that will hand you a list of ingredients and tell you how to cook them. There are fewer that invite you to ask “how” and “why”. Though I don’t claim to be an expert, I always encourage readers to reach out to me personally about the recipes I publish. The resulting conversations have been my favorite part about Journey East. (In particular, one of the highlights has been seeing a friend’s vegetarian takes on the recipes.)
3. Accessibility over authenticity. When it comes to food, it’s easy to get hung up on what's "authentic" or not. But much like design, some of the most innovative home cooking comes from constraints, which are visible in the incredible variety of food from the Chinese diaspora (did you know that you can stir-fry watermelon peel as a substitute for winter melon?) By starting each issue with an illustration rather than a photo, I encourage readers to think of my recipes as inspiration rather than instructions.

Launching Journey East has been rewarding in many ways. I’ve learned to pivot quickly, grown as an illustrator and writer, and expanded my culinary repertoire. After falling in love with the sambal-laden Malaysian oyster omelette and ketchup-infused Hong Kong pork chop rice, I’ve thrown out all my preconceptions about what ingredients “belong” in Chinese food. But the best part has been hearing from readers who learned something new. Opening hearts and minds won’t happen overnight, but if I can do even a little bit to help people see Chinese food and culture in a fresh light, I’ll consider it time well spent.

You can read previous issues of Journey East (and subscribe, if you’d like!) here.

Lo mein. Orange chicken. Honey walnut shrimp. If you ask the average American to name some Chinese food, they might go with some of these. Where I live now, in Japan, the answer could be ramen or gyoza.

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.