Interview with Amy Cueva of Mad*Pow on Designing Healthcare

At last week’s Partners Connected Health Symposium, I had the pleasure of chatting with Amy Cueva, Founder and Chief Experience Officer of the design firm Mad*Pow.

Amy delivered an inspiring keynote talk titled ‘Designing an Ecosystem of Care’ to over 1,000 attendees at this year’s symposium. I caught up with Amy after her keynote to chat more about how design is increasingly becoming an important factor in the world of healthcare.

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What does human-centered design mean, especially placed in the context of health?

The problem is that today in the healthcare field we aren’t achieving what we’re setting out to in terms of adoption and utilization. We’re creating a lot of technology, but we’re falling short of leveraging that to actually create better results. So, the core of human-centered design is to involve the people who will be affected by the solutions you create in the process of creating them.

This idea seems like common sense, but it doesn’t happen as much as it should. Engineers and clinicians are frequently plagued with groupthink and forget to look at what’s going on outside the organization and with the consumers and patients. Oftentimes when we work with clients, we are the voice of the consumer or patient. If the customer is a doctor or nurse we go with them in the field, and then bring that perspective back to the client. This process helps focus in on what is actually needed, rather than what the client is necessarily eager to develop.

I think a lot of times we’re so focused on innovation that we haven’t addressed the basics. Shifting that focus would be really innovative, actually.

Exactly. What is health about? It’s about people. It’s a human-based field, yet at the same time we’re losing sight of what that ultimate goal is.

Right, it’s becoming a technology and a business field. We try to ignore the effect that our solution or our business has, but I think if you understand who you’re affecting while engaging your empathy, you can still be successful at business. You’re just going to figure out a different way to do it.

One of the big things we’re doing now is building a behavior change discipline in-house. Behavior change is where the rubber hits the road in terms of how we can leverage technology to improve the human condition. However, behavior change is really intimate and involves factors like psychology, diet, stress, and underlying foundational factors. In our discipline we’re leveraging motivational psychology, self-determination theory and blending the psychology with design to create tools that will actually help people change their behaviors.

Rather than rewarding users with points, badges or financial incentives, we’re seeking to create a way that the individual sees the value in the change. In this way, the user changes to see himself as a person who values health, as a person who wants to be there for his kids, and wants more energy. The patient then internalizes this, and we just provide him with the mechanism, rather than forcing him down a defined path.

Do you think today’s hospital and healthcare ecosystem is equipped to do that?

That’s a great question. In the past, hospitals weren’t financially incented to care for patients outside of hospital walls. An in-person visit is what would drive a transaction. But the model is changing with the ACA, where hospitals are now focused on things like managing readmission rates. The system is now extending its interests beyond the hospital walls, which has given rise to home health, telemedicine and behavior change. Now, the transactional model is shifting to support health as opposed to the treatment of sickness.

We’re also seeing pharmaceutical companies start to become interested in behavior change and condition management. For example, if you have an app that helps people with diabetes and you have a drug that helps people with diabetes, why not explore the opportunity for a combined offering? Pharma companies are waking up and saying – we have to participate in this.

At the same time we’re seeing technology companies connect with insurers and employers to bring the solutions to the people who need them, and I think that’s what needs to happen more.

What do we need to see more of in the coming years to increase the integration of design and user experience with healthcare?

The mindset of consumer awareness is slowly but surely making its way into healthcare. Hospitals spend a lot of money on facilities, because we think architecture is impressive and this influences our perception of their services. What it’s going to take is an openness to (and a budget for) considering not just the physical space, but what the patient experience is like inside and outside of the hospital – our ability to help people understand their condition, care for themselves, and get the help they need. That’s going to continue to put innovation and design–fueled innovation into the world.

You’re also active as the co-founder and chair of the HxD conference. What brought this meeting about, and what is its focus?

We noticed that design was often absent from the conversation, and someone gave me the idea that I should put together a conference blending design and healthcare. The first conference was in 2011 in Boston, but now we are teaming up with Health 2.0’s Health Refactored Conference to put together a conference for both designers and developers who want to improve health. The new conference, Hx Refactored will be in Brooklyn in the spring. Everyone who comes to the design track of the conference cares about the patient experience and they see the potential of design to improve consumer and patient experiences. So we get doctors, nurses, patient caregivers, technologists, entrepreneurs, product managers, marketers and designers. Human centered design can provide us the methods to help.

Mad*Pow recently won an award from the International Academy of Visual Arts for the HotSeat app, which reminds seated workers to stand up from their desk throughout the day. I was interested to see that HotSeat focuses on health in the workplace. Why is that the focus and target audience of the app?

Fran Melmed, the owner of Context Communication, helps employees understand their health benefits and she formed the idea. She realized that non-activity is a big issue and wanted to create awareness around the fact that sitting is really bad for you. She thought that if she was able to help people get up more often through the nature of this program, then employers would have a healthier, more energetic, more productive workforce.

We did pilot the app with the American Heart Association, and it was proven to work. A lot of this stuff is so new that it hasn’t yet completed clinical trials. The solution for Joslin Diabetes Center will go to trial next year. There’s a bunch of other stuff we’re doing as well such as an HIV adherence app for the CDC, which we’re excited to see the results of.

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It’s an interesting new concept that apps are getting  clinical attention in terms of assessing their efficacy similar to the way we look at devices and drugs.

The reason why we want to improve outcomes is so insurers and employers trust them as a method. Traditional disease condition management involves a bunch of coaches in a room waiting for the phone to ring, and it really doesn’t work. Coaching plus technology can work really well. But companies aren’t going to switch their budget from the traditional method until the new method is proven to work. While it may not have to go through the FDA and same regulatory process that drugs need since they can’t harm anyone.

I also want to talk about is Mad*Pow’s new usability lab space for doing user tests and focus groups. What’s in the lab, and how has the community been putting it to use so far?  

We do usability testing on medical devices and things that are going to move toward clinical trials in the lab. For example we tested a hormone injection pen with 120 patients, so we needed a place where we could follow all of the protocols. The lab itself has a two way mirror as well as eye tracking and emotional monitoring technology. We can test mobile and medical devices then record or broadcast the sessions. We’ve had clients in Japan tuning in to a usability test as it’s going on.

Amy Cueva was interviewed on October 24, 2013 by Shannon Moore. @ShannonMoorePhD

Shannon Moore

Shannon Moore

    Shannon is an Associate Consultant at DRG Consulting, where she helps clients in the life sciences approach strategic problems. As a new-comer to Boston, she's very excited about all of the medical innovation happening in her neighborhood, and loves learning about the people and resources that make it so vibrant. Shannon also holds a PhD in Biomedical Engineering where she studied the biomechanics of bone regeneration. She can be reached at shannon@medtechboston.com.

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