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 doubt creeps in, it's easy to continue with the process or the tool that we know best. But as designers, we have an opportunity to be a part of the conversation around how these new technologies will shape the world around us—and in order to do that, we have to know how they work.

IDEO designers often learn best by getting our hands dirty and making things, so we decided to invite the IDEO interaction design community to a two-day machine learning workshop to get our bearings. Our key question in building out the workshop was simple: How might we create a safe space to prototype, play with, and test new machine learning technologies?

The first day focused on inspiration, explanation, and experimentation. On the second day, we divided everyone up into teams and took a crack at using our new tools to get building. We discovered the value of bringing designers together to learn something new (and a little scary), but we also learned a lot about planning a workshop. Here are some principles that could help you next time you want to bring people together to dive into the unknown.

Have experts in the room

We invited Andreas Refsgaard and Gene Kogan, two artists and creative coders, who work specifically with machine learning. Gene even wrote a book that helps artists and designers start playing with the tools of the trade.

Andreas and Gene have been leading machine learning workshops for the past four years. They're experts at explaining complex tools to people of all technical backgrounds, and they were there to answer any questions that came up along the way.

Including experts makes people feel that the workshop is legit and ensures everyone gets the support they need to learn and build. If you're trying something brand new (like we were), reach out to an expert to get some tips and tricks to ensure your learning experience is successful. Without Andreas and Gene, our workshop couldn't have happened.

Be persistent

Once Andreas and Gene helped us put together our workshop content, we faced our biggest challenge: How do we convince a bunch of people to drop everything they're doing and attend a two-day workshop? 50+ emails and many rounds of confirmations later, we finally had more than 20 of our colleagues agree to make time for our session.

By the end of the day, the benefits of gathering in this way were clear: people had created full-on prototypes that could recognize disco moves or the difference between two friends. Setting aside the time to actually build, fail, and repeat was invaluable. We all have busy workdays, but making room for this kind of experimentation gave everyone a zing of new energy.

Turns out, if you bug people, they'll actually set aside the time and come to your workshop—and they'll probably have a good time, too. Use whatever communication channels you have to remind people: Slack, email, carrier pigeon, skywriting. When possible, share the agenda ahead of time. If folks know what they're going to get out of their time, they're more likely to RSVP yes.

Harness the power of collaborating within your community

The second day, we dove right back into building and quickly broke into our teams. As interaction designers, we’re often siloed—we’re usually the one interaction designer on a multidisciplinary team. But working on a team of other interaction designers has great benefits: You have a similar way of thinking and can bounce ideas off each other in unique ways.

There’s also something powerful about working on a creative project just for the sake of creating and learning. At IDEO, we often work on projects that have the potential to really impact people’s lives—in the worlds of healthcare, mobility, financial services. On the flipside, this workshop gave us the chance to make something truly weird and to not be afraid to fail in doing so.

Almost every project was full of funny glitches and nearly all of them were ridiculous—like a tug-of-war game where people had to meow and bark, and a game of ping pong controlled with your nose. Revolutionary stuff. This workshop gave us a break from our day jobs to work together and flex our craft-muscles in a way we don’t always get to.

The workshop structure sets the conditions for learning

By the end of the day, the eight teams created machine learning prototypes—but just a few days prior, many thought machine learning was totally out of their league. Without a thorough introduction to the topic and built-in time to get prototyping, it would have been hard to see these new skills come to fruition.

One participant said, “I had to step out of my current mind-box to realize that there are new possibilities I previously was not brainstorming.” Another said, “There were some really funny concepts that showed the power of simple programming combined with great ideas.”

There’s no way of sugarcoating it: Setting up a workshop is actually really hard, and a lot harder than we first thought. But once we got over our initial trepidation, we were able to give ourselves and our peers a unique chance to understand and play with a seemingly intimidating tool. Workshops are a framework that let us all show up as beginners. There’s comfort and power in this: We can ask questions, learn, and become stronger designers together.

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In our day-to-day work as designers, we stumble upon a lot of buzzwords: deep learning. Convolutional neural networks. Artificial intelligence. Staying up to date with new technologies is one thing, but understanding how to apply them is another. And personally, it's something the two of us are a little intimidated to tackle on our own.

When our team set out to build the first version of the social impact investment product Swell Investing, we decided to hack the Sprint process, IDEO style.

The Sprint method allowed the team to start prototyping quickly, collect immediate user feedback, and make small mistakes early. We conducted multiple design sprints in quick loops—folding the learning from week one into the structure of week two, and so on. We learned a lot in the process. Here are a few quick tips we picked up for running successful and energizing design sprints.

1. Anchor your sprint in a big question

Identify critical hypotheses to test. First, decide on the big question you want to answer. (Hint: This is the one that, when answered, will allow you to make the most progress.) For instance, during the Swell project, we asked: When it comes to social impact investing, are users more interested in returns or social impact?

Once you’ve got your big question, brainstorm and sketch different solutions, and then select two or three good ideas to prototype. Prototypes are something people can touch, test, or play around with. Putting different approaches in front of users in a single sitting is a great way to gauge interest in different product directions.

Tip: Limit the number of variables in your prototype, so you receive specific feedback on your big question. Designing a digital product? Start by designing landing pages that express each product offering, rather than the entire user flow. Testing two feature sets? Keep the branding the same and test different product features against one another.

2. Bridge the say-do gap

Use tricks that force users to make real—not hypothetical—decisions. The goal of any new product is to create something that people find valuable and are willing to pay for over other options in the market. But as designers, we know that often what consumers say they like is different from what they actually buy in the wild. One way we bridged this gap was by testing demand with potential Swell consumers: We gave them fake cash they could “invest” in one product or another. It was a great way to gauge whether the service had real value in the market.

Tip: Use the same currency exercise for all of your sprint prototypes, so that you can see how attitudes evolve with your design tweaks. For example, give each user $500 Monopoly dollars and see where they would invest their money. Designing a new shoe brand? Ask them which ones they’d buy, or if they’d prefer to spend the money on their tried-and-true Nikes. This exercise is about the conversation it provokes more than the payments themselves, so get curious!

3. Focus your features

Design for a light-touch, full-product experience. Ask yourself: What’s the smallest set of features you can design that will still solve users’ problems? Start with the simplest version of your product, get user feedback, and then add features. As your sprint loops continue, you can move from simple prototypes to robust product directions. With Swell, we focused on creating a hero page for each key interaction (landing page, sign up, and invest). This meant we were testing the functionality of the full product experience, just in a light-touch way.

Tip: Prioritize high-impact pages that people visit a lot, like the home page or sign-up flow. This way you’re getting the most detailed feedback on sticking points, without spending a ton of money building them.

4. Be scrappy: Build just enough to learn

Choose the format that best expresses the idea. It’s impressive to build a digital prototype in a week, but remember: You can learn a lot from paper prototypes! Make a conscious decision about the areas that you design in high fidelity (like screens) and places where a paper prototype will do the trick. Being scrappy will pay off in the end. We created a combination of digital and paper prototypes for Swell. Digital prototypes were reserved for value proposition and user flow testing, whereas paper prototypes were a great way to test new and emergent thinking.

Tip: Imagine that you’re designing a mobile-first experience. Designing for a phone instead of a computer will force the team to simplify messaging and features to their most minimal expression. This is something you can develop by putting a post-it sketch on top of your smartphone.

5. Keep the team energized

Use the Tabata training method of product design. Tabata training is a workout method that focuses on 20 seconds of intense work followed by 10 seconds of rest. This is a great metaphor for sprint prototyping: It’s intense, and that means that rest is just as important as the creative bursts. Make a point of managing team energy by having intentional down days. With Swell, we made sure to keep our energy up by working in cafes, getting breather spaces when we needed to focus, and even hitting up museums or exercise classes to stay healthy and inspired.

Tip: When you need a boost, take the project on the road. Try a day of cafe hopping where the team commits to sketching one feature at each stop. Sketching in new contexts and in focused bursts means you’ll have fun and be productive.

Special thanks to Kim Cullen for her contribution to the sprint prototyping process, and to the team at Swell Investing for going on this journey with us.

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Here at IDEO, it’s not uncommon to see dog-eared copies of Jake Knapp’s Sprint, a book that outlines the five-day process that Google Ventures uses to solve tough design problems. The books are stacked on desks, passed from designer to designer, and referenced in research planning discussions. Why? Because the Sprint process pushes you to think outside of the box, even at a creative place like IDEO. It helps you shift away from following your gut instinct and opinions; instead, it encourages you to let users guide your decision making. And it pushes you to move fast.

IDEO’s AI Ethics Cards are a tool to help guide an ethically responsible, culturally considerate, and humanistic approach to designing with data. The deck is made up of four core design principles and ten activities, all meant for use by teams working on the development of new, data-driven, smart products and services.

Today, data systems and algorithms can be deployed at unprecedented scale and speed—and unintended consequences will affect people with that same scale and speed. How can we always make sure we’re putting people first when designing large scale systems? Especially when those systems will change over time, even evolving without direct human supervision?

As you explore these questions and more, we hope these cards serve as a tool to help designers consider these challenges with a human-centered lens.

Download the AI Ethics Cards here, and read more about them here.

The team is on week five of their project. They’ve been conducting tons of human-centered interviews and broad design research, and they’re writing and re-writing what inspired and challenged them. The first few weeks were an exciting whirlwind as they generated hundreds of half-thoughts: vignettes, questions, and future possibilities to throw into what they called the “idea parking lot.”

But now, the team has tears in their eyes. They are frustrated and exhausted. Post-It notes cover the walls in disordered clusters, and many lie crumbled on the ground. A stack of flip-chart pages on the floor contain sketched Venn diagrams and pyramids, remnants of attempts to wrangle the insights into a framework. The team is on edge, pointing to the clock, aware of every minute left before the scheduled call with the client. They’re not quite sure what they have learned, and they don’t yet know what ideas they would recommend. And they’re looking to me for answers.

This is the phase of design that gets talked about least: synthesis. It is where designers shift from the openness of “beginner’s mind” to attempting to make sense of it all. Synthesis is when things feel most unclear and unsettled, where the pressure to make new meaning from our learnings feels most oppressive.

The team knows it’s not enough to categorize observations into obvious themes. To innovate, they need to put the pieces together in new and insightful ways. They need to find a fresh mental model. And they have to imagine how this model yields a product, service, experience, or system that reframes the world in a new and better reality.

As a leader, there are few things as challenging as seeing people on your team struggle. It feels easy to offer a fast answer or a framework from your previous experience, hoping to alleviate their anxiety. But, in the end, I knew that my quick conclusions were not going to get the team creating groundbreaking ideas, and it also wouldn’t help them develop their creative muscles.

I remembered what my best teachers have done to help me through this onerous step: acknowledge how hard this particular part of the work really is, ask them great questions, and show them my confidence that they will find their way through.

In other words, I had to lead like a Constructivist.

Constructivism teaches us how we learn

One of the most difficult courses I took in graduate school focused on theories of learning. My classmates and I struggled to understand heavy academic texts, but every week we were asked to create learning experiences for each other based on these theories. Despite complaining throughout the quarter, I now realize how much graduate school taught me.

In particular, I find myself constantly referencing the Constructivist theory of learning. Constructivism, it turns out, has a surprising relationship to the design process.

Back in the 1950s, the psychologist Jean Piaget observed children to understand how people learn. He concluded that, counter to popular belief, knowledge doesn’t exist in the world, and you don’t acquire it: Knowledge exists in our own minds, through our own active construction. No one really teaches you anything, Piaget claimed. Instead, he believed that we are natural learners, constantly processing the world in order to create our own understanding.

It’s easiest to think about this theory by considering how young children learn language. Let’s say you are driving through the countryside and see a cow. You point to it and say “cow.” As the child looks, she forms a picture in her head, something like, “Ok, a ‘cow’ is big animal with four legs, and is black and white.” Later, you point to another cow, this time one that is brown and small. What’s happening in the child’s mind? Her thought process might sound like, “Wait! That doesn’t match what I understand about a cow. I thought a cow was bigger. This has four legs, but it’s not black and white.”

In that moment, the child has a choice. She can ignore you, and her mental model will stay fixed. Or, she can reconsider her understanding of a cow. Maybe cows are also brown. Maybe cows can be big and small. Piaget chose the perfect word to describe this state of misalignment: Disequilibrium.

Disequilibrium happens when you begin to see things in the world that don’t make sense to you. The things you thought you knew—the things that helped you feel stable and clear—are now in question. And, woof. This state is hard. We crave equilibrium.

To understand more, I spoke with Beth Hennessey, professor of psychology at Wellesley College. Beth is a former elementary-school teacher and now studies motivation and creativity across cultures. “Whether someone is sitting down to write a scholarly paper or trying to solve a problem in the workplace, Piaget would tell us that the state of disequilibrium is a really uncomfortable place to be,” she says. “But we don’t give up, because we don’t like being in that stage of confusion. It’s hardwired in us to create new frameworks to accommodate the information we get about the world.”

In order to bring yourself back to a calm state of knowing, you have to generate a new “a-ha” inside your mind that reframes your old information with the new information. A mental model that, through the force of your imagination and intelligence, connects those dissonant dots into new meaning.

Learning isn’t about the consumption of new information. Learning is the process of using our innate abilities to construct—or create—new understandings of the world. Learning, by its very nature, is a creative act.

Our natural process of learning is well aligned with the creative process. Design research methods—finding inspiration from diverse sources, meeting people at the extremes, finding empathy for others’ experiences—provide structured activities to purposefully shake up your understanding of a problem and put you straight into that state of disequilibrium. The approach helps you seek information that surprises you, rather than reaffirming what you already know.

We crave equilibrium. So when all this input shakes up our understanding of the world, the only way through it is to create new meaning. Synthesis is our natural creative process, and once you start to put those pieces back together into new frameworks of understanding, that’s when the new ideas start to flow.

Learning to love disequilibrium

While it is obvious that a child naturally refines and recreates their mental models of the world, we often ignore the fact that we go through this same process as adults. It is even more challenging for us, however, as our mental models have become entrenched and intertwined with our identity. It’s no longer just about understanding the word “cow”: Now it’s about designing whole new offerings, experiences, and organizations that go against the convictions that have solidified in our minds. Putting ourselves into that vulnerable state of disequilibrium becomes riskier over time, especially if we are high-status leaders.

As I’ve dug back into the Constructivist learning research, I’ve been thinking about what I am taking away from this investigation.

To begin, it takes a lot of effort to create new mental models, but we leave little room for the cognitive load of innovation, what with our endless news feeds and unrelenting inboxes. For example, while I constantly think about the time required to tick off my to-do list, I rarely evaluate how much emotional energy is required to take my work to new creative heights. I realized that I am misspending my energy. How might I more clearly recognize the areas where I’m committed to developing new solutions? How might I make space for myself to be in the challenging state of disequilibrium? How might I pace ambitions so that I’m not disrupted by too many things at once?

Hennessey doesn’t offer much comfort here. “Being in that state of disequilibrium is hard work,” she says. “If a lot of different aspects of your life are in a messy place, you’re going to struggle, because so much energy is going to need to be expended. Getting out of this state is not just cognitive demand, it’s also affective: It’s emotional.”

Recently, I found myself sitting in an important meeting, feeling frustrated and wanting to point out what was wrong. I was starting to make fast decisions and putting pressure on my team to do the same.

Then I realized that I was in disequilibrium. I was feeling stretched, insecure, and like my mental models were insufficient. I was pushing for things to make sense. So instead of getting angry, I admitted my feelings of discomfort, and asked my colleagues to help me find my way through the ambiguity. And we did.

Somehow, just knowing that you’re in that state of disequilibrium makes it feel less stressful. We can become conscious of the signals of our mental states, and we can turn them into positive feedback. For me, the signs seem to be frustration and impatience. Now, when I feel those bubbling up, I smile and realize I’m just in that pesky state of disequilibrium, and that I can be patient with myself and realize that a new state of knowing is on the other side.

Permission to struggle

It’s no wonder that my design team was in tears as they worked through the synthesis stage of their project. Their minds, hearts, and emotions were all engaged in the difficult question they were answering, and they were a vulnerable mess. They felt the pressure of time, the pressure of the cause, and the pressure of not knowing the answers yet.

As a leader, I was challenged, too. I wanted to find quick answers, be ready for the client, cut through the confusion, and get on with it. But if I had filled in the blanks for the team or pushed them to get it done fast, we wouldn’t have gotten to the depth of the design solutions that the team found over the following days and weeks. In fact, toward the end of this effort, our client who had been working in the field for 25 years said, “I’ve been working with these guys for my entire career, and I want to thank you for helping me understand them better.”

So how does this Constructivist learning theory help us support creative teams? What if, as creative leaders, we saw ourselves as great Constructivist teachers instead of orienting around our knowledge and expertise? How would Piaget’s theories change our behavior?

As good Constructivist teachers, we need to give people the permission to struggle. As Hennessy says, “Whether you’re a teacher or a manager, you need to make it explicit that you understand that innovation and creativity is hard work, that people will hit that state of disequilibrium, that people will hit dead ends, and that that is valued. The best thing a teacher can do is model their own struggles.”

Just like classroom teachers, leaders face pressure to accomplish a set of outcomes within a particular timeframe and often, unintentionally, send signals to their teams that their time messing about in search of a new mental model isn’t valid. This urgency may trigger teams to cut short those deeper, more difficult stages of creative work, leading to shallow solutions.

IDEO's “mood meter.”

Years ago, IDEO developed a tool called the “Mood Meter” to help prepare newcomers for design projects. It’s a graphic that shows the journey of the design process with various levels of joy and anxiety charted on it. The idea was to provide reassurance that, although there would be some struggles, the project would end happily.

I was personally not a fan of this tool because I found it unfair to tell people how they would feel before they actually felt it. And yet, it was always right. During the research phase, people were elated, and during prototyping, too. Making stuff was always fun. But during synthesis, the phase devoted to making meaning, that line on the graph would drop to its lowest point. And that’s when you need time to sit in the struggle.

There is a belief out there that designers are constantly optimistic and confident, but that hasn’t been my experience. Creativity isn’t all about fun. Acknowledging that allows us to design better environments and processes that support the profound vulnerability necessary to develop creative solutions.

After more than a decade of leading creative teams, I believe that some of the best work comes from some of these hardest times. Confusion, self-doubt, existential searching, getting lost, and then finding your way out of that state of disequilibrium—these are the essential experiences for the emergence of creativity.

Header illustration by Timo Kuilder. This piece was originally published in Quartz.

It’s a Wednesday morning in the IDEO San Francisco studio. Bright sunshine reflects off the Bay and through the floor-to-ceiling windows. But in the project space, the mood is darker.

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.