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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

While we designed a new family of acoustic amps for Fender, we squeezed into an Airstream for two months to better understand the touring musician lifestyle. And when we wanted to better understand the environmental impact of the things we design, we visited a sewage treatment plant to see what happens when a product can't be recycled.

We go after big problems that have never been solved. And by going all in on the unfamiliar and uncomfortable, we’ve come up with creative solutions that we might not have imagined before.

As an industrial designer, I’m a builder. I experience the world with all my senses and apply my tangible building skills to make experiences and systems. Technology inspires me because it's always been an important vehicle to advance our current state. With technology racing forward at an ever increasing pace, some advancements can impact us on an unprecedented scale. As shapers of the future, we must strive to understand the consequences and implications of emerging technology. We do this by asking ourselves uncomfortable questions about possible outcomes during the design process in areas like healthcare, the future of work, and the circular economy.

In order to better understand how emerging technologies could affect our day-to-day life, my colleagues from multiple design disciplines—industrial design, data science, communications, interaction design—and I embarked on an internal IDEO project that could give us some clues. We got curious and asked ourselves, How might the way we’re communicating with each other change with new technology? How might we collaborate together in the future when we can show up in different realities? What could be possible if the digital and physical world blend seamlessly into each other? How will we protect our privacy if we can teach devices our most personal preferences, and what will happen to our data?

We named our project The Discomfort Zone.

In order to explore these uncomfortable, out-there questions, we had to experience them ourselves, and to experience the future we had to build it. Here are the tools that we built:

Personalized Intelligence: by building a camera that can be taught to take the best self portraits based on individualized feedback, we experienced the idea of actively teaching machines our preferences. The user trains it on their ideal lighting, placement, composition, head tilt, and facial expressions. While it may seem like a trivial thing to create, teaching machines to see us how we see ourselves can show us the path to building other devices—like health devices—that the user can teach to adapt to user preferences and feedback.

Complementary Media: a device that can be taught to recognize facial expressions and emotions, then generates an appropriate, customized emotional expression for each user—like a personalized emoji—helped us imagine more depth and expressiveness online using artificial intelligence. This tool can communicate real human emotion, which could lead to improved communication among children, for example.

Shared Realities: a tool, bridging the physical and virtual, that allows workers operating in VR to sense the presence and movements of colleagues around them as if they are on the same plane. An exploration of how virtual and augmented technology might improve collaboration, it allows people to respond to virtual coworkers’ cues without fully disrupting work in the virtual environment.

Network Empathy: code that enables a user to anticipate how large social or interconnected user networks will react to messages before they are posted, bringing deeper understanding and empathy to online communication. With cues from large online networks, smart technology becomes even smarter and empathetic interaction online becomes easier—especially when it is applied to high-profile communications, or at mass scale among networks that might be discussing politics, health, or education.

Meta Identity: code that is invisible to naked eye can be embedded in an object to make it readable by a machine—not unlike a barcode—and give it meaning online. Branding and production methods might evolve toward this physical tagging method, so that users easily learn about physical objects they see, and find them online. Making the physical as searchable as the Internet could further empower consumers to align their purchase decisions with their beliefs and values.

As designers, it is our responsibility to explore the discomfort zone, design holistically, and consider the full range of possibilities of what we create. For example, as much as Network Empathy was intended to be an inclusive tool, it could also be used to manipulate public opinion by predicting the reaction of large audiences. If we use Personalized Intelligence to teach our devices our most personal preferences, what becomes of this new personal data? And who is the owner of this information: the device, the platform, or the individual?

Because technology will serve us on an even more personal level, the stakes are high. Designers are uniquely stationed to be the connectors in an ever more complex ecosystem of stakeholders, and we must ensure the tool leaves the lab and enters an ecosystem with safeguards in place to have a positive impact.

We’re at the dawn of something big and unknown. New technologies are shaping the future in ways we haven’t even thought of yet. Some of them will have extraordinary benefits, while others, through unforeseen capabilities or even sinister intentions, may have unwanted consequences. But as designers, it’s up to us to explore them early, dive into the unfamiliar, and do what we can to shape the future for the better. We’d love for you to join us here in The Discomfort Zone.

The Discomfort Zone was a collaboration among many designers at IDEO. Special thanks to all involved, including the core design team: Leo Marzolf, Jochen Weber, Brooke Thyng, Christian Ramsey, and Nan Tsai.

So much of being a designer is being willing to embrace the uncomfortable. We create new products, experiences and systems for people whose needs are different than ours—sometimes really different.

In one sentence, who are you?

I am an illustrator who enjoys bringing any amount of joy to people through my creations.

What do you do? How did you learn how to do it?

I create different drawings using pencil and ink. The illustrations range from patterns to caricatures, unique creatures, and other one-off ideas. I grew up sketching and doodling and it has continued. When I moved to LA, I was suddenly surrounded by an amazing cadre of artists and creators who constantly inspire me, as well as push me to keep improving myself. That is how I learned my craft and continue to learn, because I believe you never truly finish learning.

What are your 3 favorite possessions?

Miniature Back to the Future 2 hover board; Magnum P.I. Tiki Mug; a drawing of my fiancé and me, which she drew. Not in that order.

What does a typical work session look like?

I have a running list of ideas and sketches that I pull from if I don't have an art show with a specific topic that I am working towards. Usually, I'll do some Google searches on the topic at hand and pull a bunch of reference photos for perusal during the pencil drawing stage. I sketch out the drawing inside a pre-drawn area, such as 4x6 or 5x7. Art that is easy to frame is always a goal of mine, because I love framed art and it drives me mad when I see things tacked onto a wall or cork board. After finalizing the pencil drawing, I'll usually step away for a moment or two to play a video game or watch a show. I like to do something that differentiates the time between stages. Once I come back to the drawing, I pull out all the different micron pens that I think I will use for the piece. I check the nibs, and then I begin inking. I put on dramas in the background to listen to, or things I've seen a ridiculous number of times. West Wing and Parks and Recreation are two such shows.

I don't like to start inking unless I am going to finish a drawing that night. Sometimes, a piece is too large, and I have to break it up over two nights. If that happens, I make sure the pens I've used on the previous night are away from all my other pens. I do this to achieve a consistency within the lines. Once finished, I scan the piece, put it within a predetermined frame, and pack it up for a craft fair or deliver it if it's for an art show. Rinse and repeat as necessary.

How do you get over creative block?

I used to stop drawing and just stew for a bit until it finally passed, which could take a bit of time. As I've gotten older, and ever so slightly more confident in my abilities, I push through it. I just keep drawing. Yes, sometimes the drawings are awful, but as Lauren (my future wife) always says, "sometimes you just have to pass a rat."

How do you see the world in 2078?

A lazy utopia, filled with autonomous everything. Humanity will have moved past Earth and outward into the stars while robots cater to our every whim and we become fat and happy. I could be confusing my vision of the world in 2078 with the timeline in Wall-E—who doesn't yearn for the saccharine dreams of Pixar in 2017. It is tough to image the future right now because at this moment it feels as though we are hanging by a loose wire, and any minute now someone with a spray tan is going to cut the wire and tell us all how huge his ratings are, as we all fall to our collective doom. I hope we make it to 2078, if only so that I can enjoy my hover chair and 128-ounce Slurpee.

What’s number one on your bucket list?

I should say something epic like bungee jumping off of Thomas Jefferson's nose on Mount Rushmore, but honestly, I'd like to have my own artist's studio. Some place I could retreat to and tune out the world and draw silly pictures. That to me is something I want to do before I fade out of this existence.

Who are you creative crushin’ on lately?

I've had a one-sided love affair with Dustin Harbin for a long time. I own two of his original pieces and his diary comics book. The man can use an ink nib like Aaron Sorkin can turn a phrase.

I’ve been creative crushing on Austin Salmi since I saw his doodles, patterns, and adorable characters on Instagram almost two years ago. Austin’s work, learned through practice and osmosis in his job surrounded by artists, has a giggly character about it that fits his intention to hide the ugliness of the world for a moment, and make lovely order out of chaos. I got to learn a bit more about him and his process in this installment of Creative Crushes.

We had just begun work on a project exploring how we might help a medical-liability insurance company increase patient safety by learning from past incidents. As we talked, our conversation shifted away from excitedly imagining ideas for data-driven tools toward ways our work might potentially do harm.

What if our designs ended up raising premiums for doctors and, in turn, healthcare costs for patients? What if they kicked doctors off their insurance? What if doctors stopped reporting adverse events to keep their premiums from rising? There was real potential that our work could result in reduced patient safety or increased cost of care. We could inadvertently build a tool that could be used against the very people we were trying to help.

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 and evolve without direct human supervision?

The seed planted during that bar conversation has grown into a set of principles, activities, and now a set of cards that our teams—both data scientists and designers across every other discipline—use to ensure we’re intentionally designing intelligent systems in service of people.

We’re far from the first people to ponder this. We’ve been inspired by organizations like AI Now and Data + Society, books like Weapons of Math Destruction and Technically Wrong, academic communities like FATML and CXI. In particular, we’ve been eagerly following O’Reilly’s series on data ethics (and encourage you to read their free ebook, Ethics and Data Science).

To develop our own set of guiding principles, we started with people. We talked to folks all across the globe: We interviewed IDEO teams about where they found challenges. We spoke to our clients about where they saw intelligent systems go awry. We spoke to the public about where smart designs seemed to cross lines. We observed and read about AI systems that had gone off the rails and worked to understand how this might have been avoided. We learned a lot.

We came up with an original design, iterated on them, and landed on a set of four design principles and ten activities that can help guide an ethically responsible, culturally considerate, and humanistic approach to designing with data. These activities are meant to provoke thought; they’re a vehicle for introducing new ideas and stimulating conversations around ethics throughout the design process.

To start, here are our principles:

1. Data is not truth

Data is human-driven. Humans create, generate, collect, capture, and extend data. The results are often incomplete, and the process of analyzing them can be messy. Data can be biased through what is included or excluded, how it is interpreted, and how it is presented. Unpacking the human influence on data is essential to understanding how it can best serve our needs.

2. Don’t presume the desirability of AI

Just because AI can do something doesn’t mean that it should. When AI is incorporated into a design, designers should continually pay attention to whether people’s needs are changing, or an AI’s behavior is changing.

3. Respect privacy and the collective good

While there are policies and laws that shape the governance, collection, and use of data, we must hold ourselves to a higher standard than “will we get sued?” Consider design, governance of data use for new purposes, and communication of how people’s data will be used.

4. Unintended consequences of AI are opportunities for design

Just as with any design endeavor, we know that we’re not going to get it right the first time. Use unanticipated consequences and new unknowns as starting points for iteration.

To get started with the activities, you can download the cards here. We hope that these activities provoke dialogue and provide concrete tools to help our community ethically design intelligent systems.

Thank you to the larger team who helped make these cards come to life—Ben Healy, Jane Fulton Suri, Jess Freaner, Mike Stringer, Justin Massa, Connie Oh, and KP Gupta, who designed them.

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A design researcher, a business designer, and a data scientist were sitting at a bar. It sounds like the setup of a joke, but the conversation was actually quite serious.

As a user experience and interaction designer with a hybrid art and tech background, I’ve long been a fan of the concept of using art and design as a Trojan horse to make tricky concepts accessible. Through intrigue, curiosity, and play, these experiences can bypass our biases and open the door to understanding, without requiring deep comprehension. If you’ve ever visited a children’s science museum and watched kids excitedly engaging with subjects that would bore them to tears in book form, then you’ve seen the power of experience and play at work.

Meet ERNEST

That’s why my colleagues and I created ERNEST, an installation that gives the viewer the job of training a rudimentary artificial intelligence. Using facial and emotional recognition tech, ERNEST shows the user imagery and tries to see how happy it makes them. Our goal for this project was to engage users in a game-like experience to help them understand how machine learning models are trained, and subtly hint at the areas where bias could creep in.

Fellow IDEOer Matt Visco and I wanted to make sure ERNEST didn’t look like a modern computer—we designed it to look vintage. With its old hardware and nostalgic graphics, ERNEST doesn’t feel smart on the surface. Its look is meant to evoke a time when computers carried the promise of a utopian future, prior to mass connectivity and the ubiquitous collection of personal data.

The full installation uses five monitors, two computers, and three Raspberry Pis, which power several video loops that reveal the training data behind ERNEST, and give passersby a sense of the experience even if they don’t engage directly with it.

How it Works

ERNEST uses computer vision to perceive the user ambiently through facial recognition, allowing it to detect when a user is looking at it and how far away they are. When a user gets close enough, ERNEST comes alive and asks the user to help it learn. It then shows the viewer images intended to make the user happy, and gauges their emotional reaction based on their facial expression using a pre-trained model. The facial tracking and emotional data is displayed to the viewer in real time, encouraging users to make faces at ERNEST. Viewers can then validate the accuracy of the model to help ERNEST know if it was correct or not.

(Sound complicated? The video below might make it clearer.)

We installed ERNEST in IDEO San Francisco’s lobby for a couple of months, and also brought it to the San Francisco Art Institute Fort Mason Gallery for the CODAME Intersections exhibition in November 2018.

The Results

Many participants loved to challenge ERNEST, often emoting in varying ways through numerous loops of the game. Once, a group of participants spent nearly 20 minutes playing with ERNEST, takings turns to compare how it perceived each person.

When viewers interact and play with ERNEST, we’re helping them see that machines can have almost human-like perception, reacting differently to different faces, and sometimes being uncannily accurate...or completely wrong. The wrong guesses were in many cases more interesting, and were in fact a very intentional part of the design. We wanted users to see that artificial intelligence is sometimes not as intelligent as we might think.

ERNEST is meant to be a game, but what happens when real-world AI makes the wrong guesses? Or what if those wrong guesses are uneven, indicating an unintentional bias, such as working well for some faces but not others?

We wanted people to realize that designing systems that can ambiently perceive humans without direct input is rife with ethical concerns. And already, systems like these are being deployed at scale. The Guardian predicts emotionally-aware tech is already a $20B industry. Even something seemingly benign like ERNEST causes us to wonder—if an AI is trying to make the viewer happy, who determines what “happy” is? What if bad actors train Ernest to think that disturbing content is “happy?” What if the technology is repurposed to provoke anxiety or anger? What happens if we deploy technology like ERNEST widely?

Of course, ERNEST only scratches the surface of these big ethical questions, but we hope that it helps give people insight into how artificial intelligence thinks, and the ways its thinking can be flawed. The more that we as a society can start to understand these systems, the better we can judge their quality, and work to design them to be in line with our shared human values.

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Artificial intelligence and machine learning are among the hottest topics of the tech world, but some of us at the frontier forget that many people feel intimidated—or even afraid of—these technologies. The pop-culture trope of machine intelligence gone rogue has been a part of our cultural psyche for a good 150 years. Think 2001: A Space Odyssey’s HAL 9000, The Terminator’s Skynet, and The Matrix’s... Matrix. Combine that fear with arcane tech-speak like “recurrent neural network” and “generative adversarial network,” and in addition to feeling emotionally intimidating, AI and ML can also feel incomprehensible.

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.