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.

COVID-19 has fueled a whole new waste stream, putting additional plastics and other material into the environment and harming ecosystems, animals, and human communities as a result.

At the same time, those masks and gloves and other personal protective equipment (PPE) are critical to slowing the progression of the pandemic and keeping our front-line workers safe. They’re disposable, yet they’re indispensable—presenting us with a difficult tension between our immediate public health needs and the long-term repercussions of this massive waste problem. Gloves floating in the ocean like seaweed threaten already endangered marine species and pollute the world’s tap water, in time delivering new risks to human health.

But an apparent lose-lose situation like this can also become a rich opportunity area for human-centered design. How might we design PPE that is effective at keeping people safe without polluting the environment?

One source for models and inspiration lies in another realm entirely: coffee shops. By exploring other industries—a design tactic known as analogous research—leaders can get inspired by how others have addressed similar questions. Looking to analogs allows designers to move beyond their expertise to see issues with fresh eyes, building new levels of understanding to their present design challenge.

The to-go cup has a lot to teach about disposability, desirability, hygiene and convenience; and as a consumer product, it’s seen more sustainability-minded innovation than medical disposables. By looking at the ways the coffee cup has evolved, we can gain new insight for understanding what is possible in the heavily regulated, fast-paced, and high-pressure world of medical supplies, where safety and sustainability are both paramount.

Next-generation solutions for the humble to-go cup

As a product, the disposable cup has gone through several eras of change relative to design and behavior. Initially, to-go cups enabled convenience and efficiency. But nearly all of the to-go cups that exist today are made of a combination of materials that make them next to impossible to recycle or compost. They were designed without any thought to where they would end up after being used, aside from the landfill or incinerator.

Environmental concerns then sparked a movement encouraging consumers to bring their own reusable cup. Committed environmentalists were willing to do this, despite the personal compromise on convenience, but the trend failed to scale and meaningfully reduce waste. Some cups are now made of materials that can biodegrade or be composted, but both processes are difficult to achieve at a global scale due to cost and lack of access and infrastructure.

In 2018, OpenIDEO launched a design challenge to invite new ideas for material and processes that could lead us into a more sustainable era for to-go beverage containers. The NextGen Cup Challenge represented a new horizon for sustainability that goes beyond the product to offer a vision for a system and business model where circularity is the driving principle. Contrary to the linear “take-make-waste” model of manufacturing that has characterized industrial products for centuries, a circular economy designs waste and pollution out of the value chain, keeping products and materials in repeated use, and regenerating our natural systems.

The NextGen Cup Challenge asked the question: How might we design the next generation fiber cup to be recoverable on a global scale, while maintaining the performance standards we know and trust? The Challenge, managed by OpenIDEO, was part of the NextGen Consortium, a global initiative convened by Closed Loop Partners and founding partners Starbucks and McDonald’s. The 12 winning solutions—categorized into innovative cup liners, new materials, and reusable cup service models—have the potential to turn the 250 billion fiber to-go cups used annually from waste into a valuable material in the recovery system.

When we see masks and gloves in the gutter, we can imagine a similar trajectory for innovation. But there’s a different set of barriers—psychological, regulatory, supply chain, and safety—to contend with. The question becomes: How can we apply circular design principles in the healthcare industry to enable a more robust and resilient supply chain of PPE, which can be safely reused to become regenerative rather than wasteful? Based on the learnings from the NextGen Cup Challenge, we see two rich areas for design: redesigning PPE products to be sustainable and adopting a systems-level perspective.

Redesign or repurpose the product itself

The NextGen Cup Challenge sought manufacturing and material innovations and technologies that improved the existing to-go cup, making it more valuable at the end-of-life, whether through recycling, composting, or biodegrading. For consumers, baristas, and retailers, these new ideas would require little behavior change—they offered the same convenience of the single-use cup, just made of something new and more sustainable. SoluBlue, for example, is a winning NextGen Cup Challenge solution that produces plant-based, food-grade, and non-toxic materials that quickly biodegrade after use, and can replace some forms of single-use plastics.

The same concept is hopefully being applied to PPE: Recently, the Canadian government announced two business challenges for the private sector that offer funding for PPE that won’t end up in landfills. One calls for businesses to develop compostable surgical masks and respirators that can be mass-produced for healthcare workers. The second challenge seeks technologies for "efficient and cost-effective" PPE recycling, which can transform potentially contaminated PPE into "valuable materials that can further be used in manufactured products.”

If Solublue can make a cup that biodegrades after one use, why couldn't we do the same with a face mask or a pair of gloves? Furthermore, as we consider redesigning PPE to be safe and environmentally-friendly, there is not only an opportunity to redesign the product, but to extend its value to other products. Binish Desai, for example, is an entrepreneur and environmental activist based in New Delhi who is transforming used PPE into bricks for homes and factories. Desai installs bins outside of apartment buildings and retail shops to collect used masks and gloves, then leaves them untouched for 72 hours. The gear is then sanitized, shredded, and sanitized again. Lastly, the sanitized scraps are mixed with paper sludge and a binding agent to form various brick molds.

Good intentions must be coupled with systems thinking

Sometimes the product alone—or a byproduct of it—can’t solve the problem. We’ve had the technology to produce a compostable cup or mask since long before COVID-19. But as demand for PPE outstrips supply, it becomes critical to consider the system surrounding the product to enable recoverability and reusability. In neglecting to design for how a product fits into the larger ecosystem, we risk exacerbating the issue. When items are improperly disposed of (for example, when a compostable cup is recycled, which is common) it can contaminate the entire bin, dumpster, and truckload with byproducts that devalue the actual recyclable material. This sometimes results in full batches of recycled materials being removed from the recycling line and sent to landfills due to a single incompatible cup, as it has potentially contaminated the entire collection.

New solutions need to be designed in tandem with new infrastructure, or designed to work within the existing system. Muuse, a NextGen Cup Challenge winning idea, created a platform for reusable cups that works within restaurant networks with the goal of eliminating single-use waste. Before the pandemic, consumers could “borrow” a cup from one of Muuse’s cafe partners, such as Equator Cafe in San Francisco, by scanning the QR code on the cup. Within the designated time period, the customer returned it to any of Muuse’s 40 cafe partners in San Francisco. Muuse inspected and cleaned the cups, and collected late fees through tracking technology, seamlessly integrating into the way the restaurant system operates.

Muuse can offer inspiration for redesigning PPE to be both safe and regenerative. Most people know that doctors wear sterile gloves during surgery. But fewer realize that surgeons can be particular about the gloves they use (e.g. latex, non-latex, nitrile, vinyl). In design research, we’ve noticed that some physicians prefer specific layered combinations of gloves, such as latex over non-latex or vice versa. When we look at other trades, many professionals have their own pair of reusable, personalized gloves, like welders, chefs, and athletes, that are sustainable, help them excel in their craft, and keep them safe.

How might we enable this for doctors? What new innovations—in reusable design but also in the washing and sanitation procedures that already exist in hospitals for bedding or scrubs —might achieve safety and waste elimination, while also enhancing physician desirability and performance? To support frontline workers during the coronavirus pandemic, Ford pivoted to produce face masks, shields, and ventilators using the same air filtration technology the automaker uses to produce the ventilated car seats found in F-150 trucks, putting their existing materials towards an urgent global need. Taking a cue from Muuse, what if a new system was designed to enable frontline workers to return these masks to hospitals, and hospitals to then return them to Ford? This reusable system would be keeping key materials in use in both the auto and medical world.

A future that is designed for both sustainability and safety

Alarming photos of masks and gloves scattered on sidewalks and washed up on beaches are a reminder that COVID-19’s impact spreads far wider and deeper than we yet realize. The virus and its reverberations have touched every aspect of life on the planet. But human safety does not have to come at the expense of environmental damage and climate change.

Design encourages us to look to unlikely analogs, like the unassuming and ubiquitous to-go cup, to be inspired to create a world in which safety and sustainability can co-exist, offering protection to all.

The landscape of litter has shifted over the past year. The pandemic has made disposable masks and gloves as commonplace as plastic bottles and cigarette butts on city streets.

In between refreshing our local COVID-19 dashboards and the U.S. election map, we’re proud to have produced another year’s worth of Octopus stories. Thank you for stopping by to read our design blog. Below are the 10 stories you loved the most in 2020. And here’s to a calmer, kinder 2021.

IDEO Designers Share the Best Creative Advice They've Ever Received

There’s no shortage of inspirational quotes, but meaningful, personal advice can change a career and a life. A preview of some of the creative advice IDEOers shared in this piece: “A bad movie is better than an unfinished movie,” and, "When you feel stuck, draw a card and do whatever it says."

4 Ways to Work Together When We Can’t Be Together

Sometimes while watching TV episodes filmed before the pandemic, I get pangs of fear when people shake hands or stand less than six feet apart. Everything has changed in the last 10 months or so. This story contains early ideas on how to navigate design work during a pandemic. A question we’re still asking from this piece: “As designers, how do we design our way through this?"

24 More Things We Want to Redesign

Applying for a job. The news. Hot dogs. IDEOers want to redesign those, plus 21 other things.

How a Kid's Perspective Improves Design Research

Whether your design research is happening in a boardroom or at an amusement park, author Ben Swire argues that adding a kid’s perspective can produce better design outcomes. Although this piece is about his daughter, he is not biased at all.

4 Reasons Warm-Ups Will Fundamentally Change Your Work

Olivia Vagelos is IDEO U’s resident warm-up expert. Not only does she have an entire database of exercises, but she also designs them on the spot. Her firm belief is that every meeting deserves a warm-up—read the piece to learn why.

How Would You Reimagine Learning? 5 Visions for Our Post-COVID Future

The coronavirus pandemic has pushed an estimated 1.6 billion students out of the classroom. As teachers adjust to this remote reality, OpenIDEO asked a question: “How might we adapt to remote learning while also using this moment to radically reimagine what we need our education systems to be?” This story shares five ideas to shape this future.

10 More Documentaries That Will Spark Your Creativity

Devin Peek is a visual connoisseur, so you can trust her documentary recommendations are well-vetted. (She even saw one of these at its premiere!) This post shares 10 more documentaries to spark creativity; her first post, from way back in 2016, is one of the Octopus’ most popular of all time.

4 Exercises That Prove Listening Matters

It’s noisy out there. Drawing from Krista Tippett’s work, author Allison Press designed and adapted four exercises that dive deep into the transformative power of listening.

How Quitting Plastic Got One Designer Thrown in Mall Jail

There are some surprising benefits to quitting plastic: IDEOer Shuya Gong saved money and produced less trash. On the flip side, she almost got thrown in mall jail, so take on the no-plastic challenge at your own risk.

5 Tools to Design for Digital Confidence

Every single day, one million people use the internet for the first time. IDEO’s Jason Fund and George Joseph share a set of tools, created alongside Google and the Bill & Melinda Gates Foundation, to help designers build digital services that work for everyone—even if your user is touching a smartphone for the first time.

In last year’s top 10 stories post, my colleague Saige wrote, “We can’t wait to see what 2020 has in store.” Upon reflection, I probably could’ve used more time to prepare for what the last 12 months delivered.

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

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

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

1. Let the unexpected overflow from the screen

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

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

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

2. Pick up non-verbal cues from participants

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

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

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

3. Incorporate physicality

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

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

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

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

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

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

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

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

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

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

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

1. Plus, and...

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

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

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

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

2. An emotional insight

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

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

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

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

3. We could really break things!

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

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

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

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

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

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

4. Buy-in for the buy-in

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

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

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

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

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

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

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

5. How it spurred organizational change

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

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

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

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

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

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

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

Illustrations by FagoStudio.

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

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.