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.

When I started at IDEO six years ago, I had no idea what a systems designer was—only that I was one. Now, six years later, I have an answer, but I’m still perfecting the great-aunt-approved dinner table pitch.

The secret? It’s actually something you probably learned in your grade school language arts class: a good analogy.

If you’ve got approximately 10 minutes, I can tell you what I’ve learned about what I now proudly call my job—and how I’ve learned to explain it.

Systems and automobiles

An iPhone, the human body, buildings, cities, organizations, economies, the universe—all of those things count as systems, even though one can fit in your pocket and one is infinite. So what makes them all systems?

In a series of excellent lectures, Russell Ackoff, a pioneer in systems thinking, uses a simple analogy to explain systems: an automobile.

As Ackoff explains, a car needs to carry you from point A to point B. No individual part of a car can move you on its own—not the wheel, the axle, the seat, or the engine. But a car can. And if you take a car apart, you no longer have a car: you simply have the pieces, because “a system is not the sum of the behavior of its parts; it’s the product of their interactions.” That’s as true for a computer as it is for the universe—or any other system.

Systems design and architecture

Ackoff, a professor at Wharton Business School, criticized managers for focusing on business silos (marketing, operations, finance). He urged them to take a wider systems view—to think about the interactions that create the whole.

I couldn’t agree more. But if that’s systems thinking, what is systems design? What’s the difference?

Ackoff heralded one profession for understanding systems best: architecture. Architects begin with the needs of the client—bedroom, kitchen, living room, bathroom—but they don’t stop there. It wouldn’t make sense to design the rooms separately; they need certain adjacencies and sizes.

Importantly, Ackoff explains, the architect “will never modify the house to improve the quality of the room, unless the quality of the house is simultaneously improved.” To take this analogy a step further, think about it this way: you wouldn’t make the kitchen bigger if it meant getting rid of the bathroom. That would be a weird house.

Ahhh, so you're an architect?

Not exactly, although it’s no coincidence that I used to be a designer at an architecture firm. I think of myself as a “human-centered systems designer,” but that wouldn’t be the clearest thing to have on a business card.

IDEO is known for human-centered design, a process that takes inspiration from the needs and aspirations of people, most often end users. Human-centered systems design also starts with people, but requires looking at all the diverse stakeholders within a system—not just end users.

Let’s dive into another analogy: a school. If you’re designing a school, students are the end user. But the needs of teachers, parents, and administrators are equally important. For example, a few years ago we wanted to create a way for schools to change their culture. Since culture is intangible, it can’t be designed in and of itself. But you can design spaces, schedules, processes, roles, rituals, and incentives—tangible “levers for change” that help create culture. We zeroed in on the needs of school leaders, and developed School Retool, a professional development program that empowers principals to evolve their school culture.

When you’re designing a system with a lot of moving pieces, it’s hard to know where to start, and very easy to get lost in the “What if’s?” Design needs constraints, and focusing on human needs provides them.

But why human-centered systems design?

Let’s return to my man Russell Ackoff. He writes, “No problem ever exists in complete isolation. Every problem interacts with every other problem and is therefore part of a set of interrelated problems, a system of problems.” Ackoff even coined a term for systems of problems—he called them “messes.”

Indeed, our biggest problems—in education, health care, criminal justice, government—are systems challenges. And surprise: These are all human systems. When the parts of a system are made up of people, complexity is exponentially high because human feelings and needs are unpredictable and constantly changing. Despite good intentions, these important societal systems can be some of the least human-centered experiences we encounter today.

None of these problems can be solved in isolation, but it’s also easy to get a headache just thinking about tackling them.

Our most complex systems need human-centeredness the most. As a systems designer, I specialize in zooming in and out. I’m constantly jumping back and forth between the big picture and the details. I work with teams to bring the best of all disciplines together to design individual elements that form an integrated, cohesive experience for end-users. I ask questions like, “How might the environment support the new behaviors we’re trying to create? How might digital tools enable a new mindset?” I create intentional interactions between parts.

As the holidays creep closer and closer, I no longer dread the questions about work and career that come along with the appetizers. I finally have something my family is more likely to understand, thanks to the powerful and beloved literary device known as the analogy. Getting to this point feels like learning how to ride a bike—you pedal hard, gather speed, and finally crest the hill.

And if nothing else, I’ll just send all my family members a link to this piece. Hi, mom and dad!

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Fall has arrived in the northern hemisphere, and you know what that means: cool weather, warm cider, and sitting around the holiday dinner table with my extended family, trying to explain to them what I do for a living as a systems designer.

In the not-too-distant future, patients with chronic obstructive pulmonary disease could be equipped with a sensor that monitors their medication and inhaler use and prevents acute events. People suffering from clinical depression could be prescribed an app-based therapeutic program in place of a drug.

The digital therapeutics global market is estimated at $1.8 billion today, but predicted to reach $7.1 billion by 2025. Much of the growth is predicted to come through investment from traditional pharma, but there are several new players emerging from the tech and start-up worlds as well with the hopes of evolving into a digital therapeutic. Omada Health, which creates behavior change programs for managing chronic disease, makes its hundreds of thousands of patients feel seen and heard with personal coaching. Click Therapeutics develops software to support smoking cessation and address major depressive disorder in adults. The meditation app Headspace has convinced more than a million people to integrate meditation into their daily lives, with proven wellness benefits.

Companies like these are revealing transformative new approaches to helping patients tackle the thorny challenges at the core of chronic disease, mental health disorders, and a growing number of other diagnoses—and in the process, they’re creating and growing thriving markets where none existed before.

Might these digital products, one day soon, be prescribed by a physician who is concerned about her patients’ heart disease, diabetes, or weight? If Tesla released software that clinically validated reductions in car accidents, even for the most dangerous drivers, would that qualify as a digital therapeutic? We are just beginning to imagine and design the future of this industry.

But these products still face the age-old challenge: how to get people to actually use them. If patients don’t love and trust the experience enough to sustain engagement over long periods, many of these therapies—and products—will fail.

Any new approach needs to begin with the needs of real people, and to follow those needs toward products that are not only desirable, but also have viable business models behind them. Here are our four big takeaways drawn from IDEO’s experience working in this field, designing digital therapeutics that engage patients—and the market.

Put down the competitive landscape report

Innovations in science and health tend to be incremental, but by looking to other industries, it’s possible to identify opportunities for more radical change. Studying analogous experiences—services, products, and other offerings that deliver something tangentially related but not exactly the same—will clarify what kinds of experiences give patients a sense of meaning, delight and value.

A partner of ours in the biotech industry recently launched its first digital therapeutic, focused on helping patients manage diabetes. In piloting the experience, we encountered a big challenge: Patients were struggling to connect the at-home testing device to the bluetooth on their phones. Without it, the experience fell apart.

Instead of buying all of our competitors’ devices to look at their solutions, we brainstormed a list of organizations that were particularly good at helping people with a set of complex instructions—IKEA, ballroom dance instructors, piano teachers, NASA-to-spacecraft communications specialists, and others. We discovered that LEGO had made its first bluetooth-connected toy and—master of instruction that it is—had created instructions to guide even little kids through a simple series of steps. Inspired by LEGO, the team created a new set of instructions. Once they were integrated into the patient onboarding experience, nearly every patient was able to connect their medical device to their phones.

Prioritize the patient

It can be easy to fall into the trap of addressing the needs of payers and providers above the patients’. After all, if a digital therapeutic isn’t reimbursable, the underlying business may not be successful; and if a physician doesn’t know it well enough to prescribe it, a company can’t increase market share. These are critical pieces of the puzzle, but they need to come after the foundational concern of any new digital health venture: fitting your therapy into patients’ lives.

During early stages of design, we rely on user research to inspire countless possibilities, and revisit our insights when we need to refine (or flip) our ideas. User research informs the business model, helps define the path to market, and may also lead to other product features.

What does this look like in practice? Consider the digital mental health company Headspace. Headspace was designed to teach people the fundamentals of meditation, engaging them in an experience that might encourage practice and adherence over time. Initially, Headspace played with incentives like badges and friendly social competition, but it slowly came to understand that the most profound motivation was mental health itself. The company prompted meditators to remember why they meditate, and asked them who in their lives would be better off because they meditated. This consistent call for reflection and awareness led to higher overall engagement.

Headspace’s popularity has catapulted the company to $100M in annual revenue and more than a million subscribers. Once the company designed an experience that people loved, subscribers embraced the product and took it upon themselves to host Facebook groups, meet-ups, and events. Headspace then opened up partnerships within the formal health industry, adapting to the needs and requirements of providers, payers, and regulators. Today, Headspace is a benefit offered to employees of over 350 large companies worldwide, and providers and health systems across the globe offer it to their patients. If you design an effective product that patients love, players in the health system have incentive to offer access.

Design with and for your most extreme, hard-to-engage patients

Designing for extreme users illuminates the wide range of people who might use a product. In IDEO’s earlier days, we saw this most clearly when we designed physical products like ice cream scoopers and pizza slicers for older adults, people with arthritis, and children with limited motor skills. We ended up creating something those populations could use, but in doing so, we developed a universally easier user experience. The product design outshone its competitors and became a top consumer choice.

In the world of digital therapeutics, this approach might entail designing for patients with limited experience using digital technology, or focusing on patients living with multiple chronic conditions, or with profound barriers to accessing care. These patients can help shape a more equitable and inclusive therapeutic experience.

One of our most challenging digital therapeutic projects involved creating an app-based experience to combat depression. To engage with potential users, we traveled to the rural Rocky Mountains to an isolated community where we met Dan, a cowboy and rancher living 40 miles away from his closest neighbor. Dan had struggled with depression for most of his adult life. On a good day, it was hard for him to get out of bed. On a hard day, he struggled with suicidal thoughts.

Before talking to Dan, we considered all of the technological features that could encourage adherence, like enabling offline access and fast download speed in low-bandwidth contexts. But through talking to Dan, it became clear that the tactical challenges weren’t the biggest problem to solve. Even in more populated areas, depression itself can be isolating. Dan helped us co-design a digital tool that even he would be willing to come back to, day after day. One of the key features a digital therapeutic could offer would be connection to others—in real life—and a chance not only to receive help, but to give it. Informed by Dan’s story, we designed an experience that could connect people living with depression to each other and engage them as supporters, mentors, and advocates.

Launch a thousand prototypes

One of the biggest challenges facing health innovation today is the belief that you need to have a solution before you really grasp what people want and how they want it. That’s how the industry is constructed. You would never write a grant proposal without telling the funder exactly what you will deliver, nor allocate budget at a pharmaceutical company without a detailed plan and anticipated ROI.

For digital therapeutics, those constraints are blown wide open. Our task is to come up with as many ideas as we can and test what will actually stick. Prototypes pave the way to a solid, working product, and patient input on prototypes can be used in countless safe, thoughtful ways.

Recently, we worked on a digital therapeutic that helps people manage the tremors associated with motor disabilities such as Parkinson’s Disease. Instead of the typical treatment, which solely relies on an oral medication known to have serious side effects, we were tasked with working on a software and hardware system that delivers targeted electric pulses to the part of the brain that calms tremors. We began with a long list of open questions about what patients living with Parkinson’s would find acceptable, usable, and engaging.

When we went into the field to interview patients, we quickly realized that they had no idea what it might be like to rely every day on a digital device that’s crucial to their health. They were curious about the inner workings of the therapy, and asked questions about the technical, logistical, and philosophical implications.

Our first prototypes included a dozen hats, headbands, or pillows that a patient might wear to charge the implanted device. We also prototyped many digital interactions, from Alexa add-ons to iPhone apps, that might guide them to administer digital medication. To take advantage of bio-monitoring data, we created numerous dashboards, exports, and communication portals that might help patients, providers, and caretakers make sense of what was happening neurologically.

A lot of those ideas were failures, but the things we learned were priceless. For example, it turns out that despite the growing number of retirees on Alexa, many of our patients didn’t trust a voice-controlled app with a task this important. It also turns out that the headgear a person needed to wear could easily make them feel embarrassed, unattractive, or emasculated. One of the most important discoveries was that faster charging is not better, if slower charging meant you could fold laundry, watch your favorite TV show, or weed the garden at the same time. At the end of the day, we designed a hundred prototypes before we landed on the key value propositions, features, and usability standards that would shape the experience.

Tying it all together

Breakthrough products and experiences like Click Therapeutics and Headspace all align with the framework outlined above. But to be clear: They aren’t successful because they have a silver bullet for engagement or the best theory of behavioral economics. They are market-movers because they focused on their users and designed their products around what they found. That led to creating something people love, and success quickly followed. It’s a formula you can apply to creating your own digital therapeutics—or any product you want users to love enough to use in their daily lives.

Illustrations by Nien-Ken Alec Lu.

The next era of digital health has arrived, and it’s booming.

But in practice, when we’re making something genuinely new, we often don’t have data to begin with, nor do we even know what kind of data we will need. We’re staring at a blank canvas, so the only way to dive in is to listen, observe, and sketch.

Making ideas real didn’t just mean collecting biometrics about patients and displaying the data in a smart way. It was much more important to use data to help experts and patients build and maintain a relationship, track progress, adjust course, and figure out next steps. These elements are all an integral part of how the service operates. And in the process, I came away with a few principles for data scientists to keep in mind when using data as a medium for design.

1. Be part of research

We needed to know what experts ask their patients to help support them in their journey to self-management, and what is reasonable to ask patients for. Is it fair to ask somebody who mainly eats at restaurants to accurately track the micronutrients of everything they eat? Probably not.

It’s critical to understand people’s real needs in their context to understand what data is meaningful and feasible to collect. Qualitative field research is key in the process of developing empathy for those we design for and for getting a feel for what life challenges might get into the way of data collection. Understanding when we can collect data—and when we can’t—provides valuable information.

2. Sketch by hand and share

Informed by research and armed with crayons, we created a variety of data visuals aimed at tracking patient progress in various aspects of their day-to-day lives—basically, sketches of the features that might be helpful. Drawing is much faster than writing code. We made the visuals a prominent part of the project room to serve as a catalyst for brainstorming and discussion with other members of the team who aren’t data scientists. We explored trends of activity and sleep over time, and played around with visual ways to track mood and to inform people of healthier food options without asking them to count calories and micronutrients.

This approach allowed us to make significant progress in two ways. One, showing our sketches to experts allowed us to narrow down which metrics were useful, and to start tracking down potential data sources. Sketching in crayon versus writing in code also helps us fail faster and narrow in on the right questions to ask.

And two, sharing our sketches with the broader team, which included designers from a broad spectrum of disciplines (communication, interaction, research, software, business), made our work more transparent and helped us establish a common language. It also sparked conversations, inspiring us and helping us to gather further feedback.

3. Gather up and agree on all your data

Once we identified useful visuals, algorithms, and interfaces, we began hunting for the data that could fill them in and move us to higher fidelity prototypes. In our case, data included the client’s historical data, simulated data, and team data. We simulated data about meals and snacks and plugged it into publicly available nutritional APIs. This exercise allowed us to identify the types of data that might be suitable as input for these APIs.

We also bought a bunch of trackers for the team to explore ways we might keep tabs on activity, which showed us where a tracker might go wrong (moving your arm in a circle might count as a step, when in actuality you’re not taking a step at all) and narrowed down the types of data that are meaningful to collect (for example, movement vs. steps). By diving in with our own data, we were able to fill our communcation, interaction, and software designers in on how we would approach collecting patient info.

4. Look to the future

As we were exploring data solutions for the various components of this service, we had to keep in mind that design and development take time and resources. For example, tracking micronutrients via nutritional APIs relies heavily on the assumption that patients are willing—or will even remember—to share their meals. In reality, we didn’t know what patients were willing to share about the foods they eat, nor did we know what food-related information experts need to track a patient's progress.

Redirecting the team’s effort to a lower-fidelity solution to track these behaviors (say, allowing patients to share a food journal) can save a lot of time and effort while still informing the future development of the service.

As a data scientist, starting with people and crayons rather than data and a keyboard felt uncomfortable at first, but it made the process of identifying what’s important and doable much more efficient. Making data science a visual part of the project space also helped the data scientists on the team become co-designers from the very beginning—meaning that we could contribute a lot more to the project. Hopefully, the tips above will empower you to do the same.

A big thank you to Mike Stringer for his help shaping this piece.

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You might think the first thing data scientists do on a project is grab a bucket of data and run with it. And for good reason—that’s how many data scientists write about projects after the fact.

In business, new models and offers are further constrained by the need to satisfy current stakeholders and follow market trends. So how can you break free of present-day realities to envision a genuinely novel future?

In other words: Design can move us beyond the imagination-traps of our own experience to uncover truly new possibilities.

When I founded IDEO’s CoLab four years ago, one of our goals was to find new ways to catalyze visionary business leaders and to activate new models by assembling diverse perspectives from across industries. We frequently employ design fiction exercises with our partners to open up more exploratory approaches to tough problems—particularly the ever-changing nature and role of technology. The process helps connect the dots between an aspirational vision of the future and a business approach that can make that vision a reality.

How to apply design fiction to your business

The futures that we imagine are based on a few catalytic data or trends—“inevitables”—that serve as foundational elements of a future vision. By anchoring on these inevitable factors, we can then imagine the implications that ripple across a business, industry, or society. For example, five or 10 years ago, one might have assumed that smartphone ubiquity was inevitable and started to imagine the implications (good and bad) of everyone in the world having access to a super computer, the internet, a camera, and more. By extending from what’s already true to what might soon be true, it becomes possible to exert some agency in the way you move forward, even when you can’t know exactly what’s ahead.

The late Bill Moggridge (an IDEO founder who came up with the concept of a folding laptop) referred to this as “preferred futures.” In this view, rather than viewing the future as something that happens to you and can’t be controlled, you adopt the mindset that you can influence what happens, asking, “What future do we want to create? And how do we reverse engineer the pathway to get there?”

It sounds pretty heady—perhaps something to be left to experts—but the process of creating design fiction is actually accessible to most people by following a four-step process. This exercise is inspired by an activity from a class at UC Berkeley’s Haas School of Business called “Designing the Future” that I taught alongside two IDEO business designers, Becca Carroll and Sandeep Pahuja.

1. Pick an industry and describe its role in the consumer’s life

Let’s take insurance as an example. Insurance is a safety net for when something bad happens. But insurance customers don’t simply want protection—they also want to understand and manage risk, find the most agreeable policy to ensure support when they need it, and trust that their claims will be processed and paid. These criteria are often referred to as the “jobs to be done”—in short, they are the things the consumer has “hired” the product to do.

2. Write a story about the future, free from today’s constraints

If you focus on the “jobs to be done” (and don't get caught thinking about existing insurance companies and how they operate), you can begin to imagine new ways to do those jobs for customers with the help of new technologies and other shifts (behavioral, regulatory, etc.) we believe will be relevant in the future.

For example, if we take the job of understanding risk, there’s a story to be told about machine learning and the explosion of sensor data, which will allow us to create more sophisticated risk models. More sophisticated risk models could lead to a more personalized approach to assessing risk and ultimately the ability to provide more relevant products to customers. In this future, perhaps insurance companies shift from being the safety net after something happens to proactive behavior change coaches who help protect you before something happens.

When writing a story about the future, we continually ask, “What future do we want to create?” This helps us focus on the ultimate goal of creating value for people and preventing harmful consequences, not just creating new technical capabilities and hoping for the best. In this case, we answer it by imagining how the experience of insurance might take on an entirely new form and function when enabled by the tools of the near future.

3. Back out to the assumptions that would make this future real

Taking this vision of the future as possible, we can work backwards to uncover the assumptions need to be in place to support it coming to be. Our go-to provocation is inspired by Roger Martin and Jennifer Riel: What would have to be true to make this future a reality?

Asking what has to be true is a powerful tool to help you optimistically articulate the key assumptions implied by your story and connect them to your current offers and potential path forward. It’s easy to come up with a long list of reasons why something won’t work, and this often leads to risk aversion and incremental thinking. By surfacing the criteria for success you can pragmatically assess how realistic these assumptions are and design experiments or milestones to demonstrate if you’re on track. Invite your colleagues to get imaginative alongside you and uncover even more ideas.

Elon Musk famously published his master plan (and then a second) for Tesla that stepped through five key assumptions that would allow Tesla to move the automotive industry towards an electric future. These included making electric vehicles high performance and cool—a shift from the pervasive negative view of EVs’ aesthetics and functionality; and changing the notion that these cars are too expensive for average consumers, riding the scale/cost curve to reduce the price and range of vehicles, and making them more accessible to the mass market.

4. Prototype

So now you know what would have to be true. Are those things possible? Rather than speculate and debate, prototyping is your way to find out. Begin with scrappy, low-fidelity prototypes to test your assumptions and continually iterate forward, incorporating your learnings into higher-fidelity prototypes. Getting really clear on these key assumptions enables you to take an evidence-based approach to making investment decisions in risky innovation projects.

As quickly as possible, you’ll want to test your assumptions in the market. This is another sticky point where risk aversion and desire to jump to scale can grind progress to a halt. Designing in-market experiments that are right-sized and laser focused on testing key assumptions is an organizational skill that is difficult to cultivate. Successful startups often are forced to be quite scrappy in the market and increasingly, larger companies are building these capabilities. The founders of Airbnb famously tested their idea out by renting out air mattresses in their apartment during a conference. Established companies are getting into the act too, LEGO, Coca-Cola and General Electric have all market tested new products on crowdfunding site Indiegogo.

It’s unlikely that there’s only one viable solution to get to any preferred future—there are many avenues that may get you there and thus it’s important to diversify and have a number of bets. Many entrepreneurs will tell you that their current business is not exactly like their original business idea. Often, it’s pretty far from it. That’s because the steps required to go from idea to reality involve a lot of prototyping, experimentation, and openness to change along the way. Whether you work in the field of innovation, you’re an entrepreneur with a startup, or you have an idea for a business that you’re ready to explore, using the principles of design fiction and cross-organizational collaboration can help.

Hear more on design fiction and cross-organizational collaboration in this episode of IDEO U's Creative Confidence podcast.

Illustration by Mark Conlan.

There’s no such thing as a truly original idea, or so the saying goes. Even the most imaginative inventors and artists are limited by the boundaries of their own experience, and every fresh idea is derivative of something that came before.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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