QUARTERLY OF THE INDUSTRIAL DESIGNERS SOCIETY OF AMERICA  SPRING 2020
Medical device design today pushes the
DREAM
boundaries of traditional industrial design
from form-giving and ergonomics of a singular
product to the infusion of advanced cutting-
edge technologies operating within an
increasingly complex healthcare ecosystem.
REALITY As a result, industrial designers in this field
must balance the friction-filled needs of
patients, doctors and third-party stakeholders
while envisioning new trailblazing user
interactions in order to deliver successful
healthcare outcomes.
I N F L U E N C E This is modern medicine.
NATIONAL INDUSTRIAL DESIGN DAY 2020
Each year on March 5, IDSA celebrates National Industrial Design Day with our vibrant community of designers nationwide. First entered into the U.S. Congressional Record in 2015 by U.S. Rep. Gerald E. Connolly, National Industrial Design Day declares that industrial designers “improve our lives in every way and are worthy of our recognition.” This year’s National ID Day celebration was one of our biggest and best yet, as IDSA Professional and Student Chapters across the country held networking meetups, happy hours, educational events, and more. We also held a contest to see which IDSA Professional Chapter could recruit the most new members by March 5, and the winner was IDSA Northern Lakes! Congratulations to all who participated, and thanks to everyone who gathered to recognize industrial design’s boundless impact on society, business, and culture.
QUARTERLY OF THE INDUSTRIAL DESIGNERS SOCIETY OF AMERICA
SPRING 2020 ®
Publisher IDSA 950 Herndon Pkwy, Suite 250, Herndon, VA 20170 P: 703.707.6000 idsa.org/innovation
Executive Editor (interim) Chris Livaudais, IDSA Exective Director IDSA chrisl@idsa.org
Graphic Designer Carl Guo 703.707.6000 x110 carlg@idsa.org
Advertising IDSA 703.707.6000 sales@idsa.org
Annual Subscriptions Within the US $100 Canada & Mexico $120 International $165
Contributing Editor Jennifer Evans Yankopolus
Subscriptions/Copies IDSA 703.707.6000 idsa@idsa.org
Single Copies Fall/Yearbook All others
jennifer@wordcollaborative.com
678.612.7463
$50+ S&H $25+ S&H
The quarterly publication of the Industrial Designers Society of America (IDSA), INNOVATION provides in-depth coverage of design issues and long-term trends while communicating the value of design to business and society at large. Image Credit: Intuitive Surgical
MODERN MEDICINE
44 Preparing for an Interconnected Future by M. Robert Garfield
24 The Dream, the Reality and the Influence of Science 48 Perfectly Right or Perfectly Wrong: by Tor Alden, IDSA, Guest Editor Sometimes Design Feels 26 A Collision of New Like Space Flight Technologies by Tim Hulford, IDSA by Bryce G. Rutter, PhD, IDSA, and Megan Kohnen, IDSA 28 The Rising Tide of User Experience by Paul Greenhalgh, I/IDSA
FEATURED
31 Educating a New Generation of Human-Centered Designers for the Medical Device Industry by Enda O’Dowd, I/IDSA, and
18 China Dispatch: Unmasking a Complicated Situation by Chris Hosmer, IDSA
52 Design for Healthy Aging by Susan L. Sokolowski, PhD, IDSA
3M Design, St. Paul, MN Cesaroni Design Associates Inc., Glenview, IL; Santa Barbara, CA Covestro, Pittsburgh, PA Crown Equipment, New Bremen, OH Eastman Chemical Co., Kingsport, TN McAndrews, Held & Malloy, Ltd., Chicago, IL Metaphase Design Group Inc., St. Louis, MO Samsung Design America, San Francisco, CA TEAGUE, Seattle, WA Tupperware, Orlando, FL Charter supporters indicated in bold. For more information about becoming an Ambassador, please contact IDSA at 703.707.6000.
Derek Vallence, I/IDSA
34 Designers as the Hub of Collaboration by Stephen Nelson, IDSA, and
8 Tribute: Mark Dziersk, FIDSA by Gerard Furbershaw and Jeff Smith
IDSA AMBASSADORS
Danny Gelfman
IN EVERY ISSUE 4 From the Chair by Qin Li, IDSA
38 Design vs. Human Factors: Medical Design’s Chicken and Egg by Mary Beth Privitera, PhD, FIDSA
6 IDSA HQ by Chris Livaudais, IDSA
40 Healthier Lives through Empathy-Guided Technology Innovations by Moni Wolf, IDSA
12 Design Defined by Dipali Aphale, IDSA
10 Beautility by Tucker Viemeister, FIDSA
14 Design DNA by Scott Henderson, IDSA 56 A Final Thought by Hector Silva, IDSA
QUARTERLY OF THE INDUSTRIAL DESIGNERS SOCIETY OF AMERICA SPRING 2020 INNOVATION
Medical device design today pushes the
MODERN MEDICINE
DREAM
boundaries of traditional industrial design
from form-giving and ergonomics of a singular
product to the infusion of advanced cutting-
SPRING 2020
edge technologies operating within an
increasingly complex healthcare ecosystem.
REALITY As a result, industrial designers in this field
must balance the friction-filled needs of
patients, doctors and third-party stakeholders
while envisioning new trailblazing user
interactions in order to deliver successful
Innovation is the quarterly journal of the Industrial Designers Society of America (IDSA), the professional organization serving the needs of US industrial designers. Reproduction in whole or in part—in any form—without the written permission of the publisher is prohibited. The opinions expressed in the bylined articles are those of the writers and not necessarily those of IDSA. IDSA reserves the right to decline any advertisement that is contrary to the mission, goals and guiding principles of the Society. The appearance of an ad does not constitute an endorsement by IDSA. All design and photo credits are listed as provided by the submitter. Innovation is printed on recycled paper with soy-based inks. The use of IDSA and FIDSA after a name is a registered collective membership mark. Innovation (ISSN No. 0731-2334 and USPS No. 0016-067) is published quarterly by the Industrial Designers Society of America (IDSA)/Innovation, 950 Herndon Pkwy, Suite 250, Herndon, VA 20170. Periodical postage at Sterling, VA 20164 and at additional mailing offices. POSTMASTER: Send address changes to IDSA/Innovation, 950 Herndon Pkwy, Suite 250, Herndon, VA 20170, USA. ©2020 Industrial Designers Society of America. Vol. 40, No. 1, 2020; Library of Congress Catalog No. 82-640971; ISSN No. 0731-2334; USPS 0016-067.
healthcare outcomes.
INFLUENCE This is modern medicine.
INNOVATION SPRING 2020
3
IDSA HQ
NAVIGATING THE NEW DECADE TOGETHER
2019 was a wonderful year to be a part of IDSA. With exciting new developments in our organization, we were able to focus our efforts on bringing more new, valuable content to our communities—online and at in-person events. I hope you had the chance to join local chapter activities, participate in the Women in Design and the Medical Design Deep Dives, and attend the International Design Conference in Chicago. We’ve been able to grow as a group and enrich our careers through this time spent together. To further tighten our community, we frequently gave local updates and shared exciting member achievements through multiple channels, including our website and social media. We celebrated collective successes, embraced creative thinking and encouraged knowledge sharing. We worked hard together to connect, learn and evolve. I deeply thank each of you—our community, members, volunteers, chapter leaders, Board of Directors and diligent IDSA staff under the lead of Chris Livaudais, IDSA—for making this all a reality.
4
IDSA.ORG
We are excited to begin navigating the new decade, but our hearts are filled with some concerns. With advancing technology comes opportunity. We have the ability to substantially improve day-to-day life, but we can also look closely at the needs of people from different walks of life to see where we, as designers, can begin to reimagine solutions to their unique challenges. There include 3D-printed houses for underserved communities, micro robotics for remote surgery, origami/modular solutions for urban living and artificial intelligence for our aging population. We are dedicated to doing the best we can to create a promising future. The more we explore, the more we need to act responsibly and thoroughly. Greta Thunberg rang in 2020 as Time magazine’s Person of the Year. At age 16, Thunberg is the youngest person to be honored in the magazine’s history. Boyan Slat, the founder of The Ocean Cleanup, has announced his mission to turn the ocean’s plastic waste from the Great Pacific Garbage Patch into sustainable products. William McDonough, the founder of Cradle to Cradle, notoriously once said, “Designers are the creators of the good and the bad.”
In this new decade, we must be responsible for creating a sustainable practice that produces less waste, promotes an efficient production ecosystem and sets the bar for how we operate as designers. If you’ve tried, you know just how hard this is to do. The effort goes far beyond design and deep into the entire system, from marketing to manufacturing, from education to execution, and so forth. We need to learn quickly, teach others and tell stories about our experiences. IDSA and the Board of Directors developed a new Deep Dive strategy focused on sustainability. The Sustainability Deep Dive is
a nationwide effort for the design industry to bring experts together and push for an environmentally conscious future. We also will continue to celebrate women in design. This year, our Women in Design Deep Dive will focus on women in leadership and how to empower one another. The Medical Deep Dive will now expand to include healthcare, with professionals and industry leaders guiding the conversation and helping us connect the dots from the hospital to the home to the individual. As IDSA focuses on being the hub of the design community, we will continue to bring curated content to our events and better tailor the experience for our attendees. We also want to elevate the IDSA brand and experience through meaningful partnerships. IDSA is dedicated to supporting the careers of our members throughout their entire career journeys. One critical way we can create new opportunities for collaboration, crosslearning, knowledge sharing and trend forecasting is by providing partnerships with diverse industry leaders at our events like IDC. This year in Seattle on September 14–16, we will integrate notable brands, designers, institutions and organizations to enrich and inspire our points of views as professionals. We want to create dialogue around the design process, our sources of inspiration, what challenges lie behind each creative practice and more. On behalf of IDSA, I’d like to express just how committed we are to creating an intriguing, consistent and elevated experience for all our members—from receiving the Welcome Package to our local events and conferences. We want to not only help grow your professional network but to also provide one-of-a-kind experiences that push the boundaries of design thinking, create opportunities for mentorship and collaboration, and connect us across multiple disciplines. Perhaps most importantly, we are here to support you in your career and celebrate the work you do as design professionals. I look forward to your continued support in 2020 and cannot wait to see what we can accomplish this year together as the Industrial Designers Society of America. Happy New Decade! And happy designing! —Qin Li, IDSA, IDSA Board Chair qin@fuseproject.com
INNOVATION SPRING 2020
5
IDSA HQ
2020 MISSION
I
n 2019, much of our work at IDSA HQ was about setting ourselves down a path toward reenvisioning the IDSA membership experience for a new era. All of it is built around the core idea of Community + Content = Value. It’s a phrase I’ve spoken and written about in great detail during my two years as Executive Director, and it has become a foundational element of our strategic approach. This short statement is now embedded in everything we do at IDSA HQ and will continue to drive our thinking as we move forward. Today, we find ourselves at the dawn of a new decade, and I remain very optimistic for the opportunities that lie ahead for us to bring expanded awareness, inclusion, progression and success to our beloved Society. Many of the goals the Board of Directors and I share for the future of IDSA center on celebrating the work of our community and creating unique opportunities for you as a member of IDSA year after year. The IDSA staff and the Board of Directors are working in closer harmony now than perhaps ever before. During a recent day-long workshop, we brainstormed programmatic improvements and envisioned new opportunities to prepare the organization for the growth that is surely to come. We’re excited to incorporate these ideas into our current offerings. I’m looking forward to a tremendous year ahead of us. The work we are doing now will further establish our place as the leading organization for industrial designers. I am very thankful for the many of you who have continued to champion our cause and actively contribute to our community during this time of metamorphosis. Centering on Community Regardless of membership status, a core tenet of IDSA remains to serve the profession as a whole and advocate for the impact we all believe industrial design can have on business, society and the lives of the people who use the products we create. According to the most recent data from the U.S. Bureau of Labor Statistics, there are more than 40,000 industrial designers living in the United States. This community of thousands of designers represents the nucleus of IDSA.
6
IDSA.ORG
By maintaining our focus on supporting the industrial design community and directing resources back to our membership, IDSA HQ has accomplished a great deal in just a few months. We have reengaged with dormant chapters and are working to establish new ones. As a result, we’ve seen increased activity and renewed energy around creating localized design events that build community and allow individuals to take proactive leadership roles. Every day we’re seeing more people in our community experience the value that real-life connections can offer. After all, personal one-on-one connections have long been the backbone of the IDSA experience. We are thrilled to have helped facilitate this resurgence in connections and can’t wait to see what comes next. Elevating our Content Over the past several months, our media channels have seen considerable growth and increased engagement. This is due in large part to highlighting our members’ stories and keeping a close eye on the pulse of industrial design and related industries. Just as in the early years of our organization, we are working today to build a platform that collects from, centralizes and showcases one of our most valuable resources: you. You are at the forefront of our profession and you are actively driving its evolution. Thus, it makes sense that the content at our events, on our website, in print and on social media is pulled directly from the collective knowledge base of our membership and is uniquely tailored to best respond to the transforming needs of our profession. The IDSA staff has been working diligently behind the scenes on a range of other content-related improvements. For example, we’ve made several adjustments to our website to improve navigation, content hierarchy and visual clarity. We also completely reworked our membership renewal communications, updating the language and processes to make renewing your membership much quicker and easier. These types of details are paramount to improving the interactions you have with IDSA and go a long way to create a delightful experience. You know as well as I do that designers love the details!
Experiencing Value The team at IDSA HQ is committed to providing frameworks and opportunities for you to engage with other design professionals and advance your career. Experience is a twoway street and requires active participation by you in order to thoroughly enjoy all the benefits IDSA has to offer. In this way, IDSA is dramatically different from the countless groups popping up on social media and other online platforms these days. It’s one thing to follow; it’s another to participate and connect directly with other members of your community. We believe it’s only through the act of participation that one can truly experience meaningful and lasting value. One way we are working toward the goal of ensuring experiential value is through our current initiative to restructure our professional chapters to be city-based communities. For years, many of our professional chapters have represented large geographic areas with loosely defined borders (think Rocky Mountain, Northern Lakes, Mid-Atlantic). In other
instances, chapters like Texas or Florida are located within large states but lack a strong place to call home. We’ve been lucky to have strong leadership teams in these chapters who have done wonders to bridge these geographic expanses. However, the unfortunate reality is that it remains challenging for a distributed community of designers to truly connect with one another in (what IDSA considers to be) a meaningful way. In 2020, you’ll begin to see changes that usher in renamed chapters and completely new chapters in cities all over the United States and internationally, with all IDSA chapters becoming city-based groups. We hope this will allow more opportunities for chapter leadership teams to meet and thrive by providing rich and meaningful content to their local design communities.
In This Issue of INNOVATION Back in early 2019, I spoke with Mark Dziersk, FIDSA, on the phone for a little over an hour. We swapped IDSA stories, and he offered some advice on how I could best serve the membership as Executive Director. During the call, Mark also offered his resignation as Executive Editor of INNOVATION, a position he held on two occasions for a total of 10 years. Before we hung up, he provided a few pointers on the process of making INNOVATION and some ideas for improvements. I think this is indicative of many of our experiences with Mark. He was passionate about our Society and always ready to share his insights to help others. The Spring 2019 issue was Mark’s last as Executive Editor. In this issue, a year later, our main theme delves into the complex and shifting landscape of medical device design with our guest editor, Tor Alden, IDSA. Tor is an accomplished designer with an expansive body of work in the consumer and medical design fields. He has curated an impressive collection of articles that reveal insights into the current and future medical design landscape.
We are also delighted to introduce a new article series for 2020 called “A Final Thought,” which is being written by Hector Silva, IDSA, and will cover a multitude of topics through the lens of design education and young professionals. Enjoy!
—Chris Livaudais, IDSA, Executive Director chrisl@idsa.org
Editor’s Note: In the final days of finishing this issue, we are facing an unprecedented challenge with the global COVID-19 (coronavirus) pandemic. The staff and I, in close collaboration with the Board of Directors, are monitoring this situation on a daily basis and strictly following guidance from the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC). Keeping our community safe is our utmost priority; therefore, many of our 2020 event plans are shifting as new information emerges. You can find the latest information on IDSA’s response to this rapidly evolving global pandemic at www.idsa.org/COVID-19.
INNOVATION SPRING 2020
7
T RI B U TE
MARK DZIERSK, FIDSA – SO MUCH MORE THAN A GIANT OF OUR PROFESSION
M
ark Dziersk, FIDSA, was INNOVATION’s editor for an unprecedented 10 years. With his passing at the end of January 2020, it’s only fitting for him to be the one being written about. He was a giant in our profession. His boundless energy and passion for design enabled him to accomplish so much in his six decades. Mark won awards, judged award programs, is listed on a plethora of patents and served in numerous leadership roles for IDSA, both as its President and Chair. Mark’s clients loved working with him, and his teaching, writing and speaking about design and innovation was extraordinarily inspirational to his students and those in our industry. Although his professional accomplishments were mythic, his enrichment of the lives of his family, friends, colleagues and acquaintances was his true legacy. Mark was more than a giant in the profession. He was a giant of a human being. The two of us would like to give you a glimpse into the person he was. It’s appropriate that the last time we saw him would be so representative of who he was. Mark attended a lecture series event at San Francisco’s California College of the Arts in late September 2019. It commemorated our 30-plus years as LUNAR’s co-founders, and as CEO and COO, respectively. In true Mark fashion, despite all of the taxing business travel he was engaged in as a McKinsey partner, he still mustered the energy to fly from Chicago to San Francisco on his own dime to attend our Tuesday night talk. He gave us big warm hugs before the event, and we could hear him giving us shout outs from the back of the auditorium during our presentation. After the talk, he spent the evening happily celebrating with us over food and drinks. The next morning he flew back to Chicago on an early flight to get back to work.
8
IDSA.ORG
We had many similar experiences with Mark as, did his LUNAR and McKinsey Design co-workers. The amount of time and energy Mark had for those with whom he worked was astonishing. After attending his memorial service and hearing friends, family and professionals outside of LUNAR and McKinsey Design deliver their tributes to him, we realized he gave the same intensity and generosity to everyone around him that he gave to us. All who spoke during the service shared similar stories about his many positive attributes and the enormous emotional impact he had on their lives. Two of his siblings, his best friend, an IDSA colleague, a niece, his daughters and a pastor wonderfully conveyed how Mark had so positively touched their lives and those of countless other people. It was clear that Mark made many, many people feel just as special as he had made us feel as his close friends and business partners. To Mark, all people were truly special, and he could see what was unique and wonderful in anyone and everyone. He also helped others see, feel and believe in themselves whenever and however he could. We both loved Mark, as did many others. He will be greatly missed but never forgotten. We believe that most of all, Mark’s capacity to love so many people was his crowning glory. Mark will continue impacting us and the many he touched through his love and his unbridled positivity, generosity and passions in life. We also are confident that many of them will pay it forward to others, based on what they learned through knowing Mark. —Gerard Furbershaw and Jeff Smith g@furbershaworks.com; designsmith@gmail.com
INNOVATION SPRING 2020
9
BE A U T I L I T Y
GREEN IS THE NEW BLACK
R
emember when matte black was king? Back in 1980 when Davin Stowell, Tom Dair, IDSA, and I started working together, we were sharing space with Patricia Moore, FIDSA, who had recently received her master’s degree in gerontology. She took the opportunity to sensitize us to older people’s physical abilities, which led me to ask, Why not design beautiful things for old people that work better for everyone? So 10 years later when Smart Design started designing a new potato peeler, we knew what to do. Today, thinking ahead and anticipating changing user abilities is normal. It is basic human factors. Now a basic factor is the climate emergency. It’s inclusive too—we all have to turn green in 10 years. Before OXO Good Grips, there was no such thing as universal design. But that didn’t stop people from enduring arthritis or trying to get their wheelchair into the bathroom. In 1990, Sam Farber’s wife was beginning to suffer from arthritis, so they asked Smart Design to address Betsy Farber’s need to peel vegetables. We solved the biomechanical problem with a cool black handle design. But manufacturing a peeler with a big rubber handle was obviously going to cost more than making a cheap metal part. OXO was a startup. We needed a profitable formula to go with the good design or no one was going to benefit! Davin Stowell and Sam Farber figured they could piggyback our tooling costs on the yuppie gourmet consumers who were buying expensive kitchen products. We did not tell consumers that OXO products were made for old people. But people with different abilities are always on the lookout for good solutions to their needs (it turns out kids can handle the big rubber handles better too), and Good Grips are easy to spot. Everyone loved those fun fins when they hit the market: Customers loved the way they feel, and retailers loved the bump in their margins. Humans have always had issues with garbage—we
10
IDSA.ORG
just throw it out (that’s why we call it garbage!). Then mass production made garbage really pile up. When polluted water and air get bad enough, we can take steps to clean up the sewage and manage the landfill better. We design recyclable green products for the crunchy granola set that help return nature to equilibrium. We can create sustainable development with a circular economy aimed at stabilizing resource depletion and the degraded environment. But as humans continue to reproduce and spaceship Earth sails off to toward warmer climates, it’s apparent that we need more renewable resources. Industrial designers are complicit—but creative! Could we use universal design tactics on the climate crisis? Embed concerns at the beginning of our design process that lead to products and services that solve more problems more easily? Push beyond the normal brief with pro-climate criteria that reach beyond reducing wall thicknesses, using green materials, or recycling or reusing bottles? The word “regenerative” was first used to describe the benefits of organic farming. John Tillman Lyle, a professor of landscape architecture, applied regenerative ideas to economics and industry in his 1994 book Regenerative Design for Sustainable Development. Like compost, regen products are fertilizer for their network; they literally feed power or other benefits back into their system. Opportunities for new technology, microsensing and micro energy can make a big impact. Small, efficient and distributed networks can make precise surgical moves. More than IoT of toasters and smartphones, linking microsensors invite their hosts into an interactive community ecosystem. Self-powered markers linked together form primitive artificial intelligence—a biosystem operating on its own power. What could be more green than the ultimate regen products that actually grow themselves? That cut out whole production steps. Using mycelia and fungus you can grow shoes, buildings and
“Decycling redefines recycling with a preventative step before customers buy anything—avoiding the problem before it happens.”
artificial meat (all you have to do is cook it). Soon we could order sofa seeds from Amazon and then grow a new IKEA couch! Stop making products—just let them grow! Decycling redefines recycling with a preventative step before customers buy anything—avoiding the problem before it happens. We don’t have to remove unhealthy products and molecules from the economy if we don’t release them in the first place. Selling carbon credits is preventive medicine. Going to the gym is actually buying what you don’t want: to get sick. We are facing the most critical challenge: survival. The biosphere is back at the bottom of Maslow’s pyramid. Technological progress is making the need for design and its impact more important. Universal design and inclusive design showed us how easy it is to incorporate solutions at the beginning so we don’t have to undo problems later. The coronavirus is showing us that the world must tackle global problems. Decycling and regen design give us plenty of new work. Even if we weren’t in an emergency, regen design would be good business too: new jobs, new infrastructure and building an ecosystem that supports us. Our climate emergency calls for four kinds of design: (1) remedial design, fixing things we have and making them work better, (2) proactive carbon-negative design that extends beyond products with a zero-carbon footprint, (3) preparation and maintenance design to deal with the current rising temperatures and reduced water, and (4) emergency design, which immediately responds to disasters after it’s too late, like finding food and shelter. This crisis is insistent and may take precedence over traditional design criteria like innovation, uniqueness, market differentiation and attractiveness. In the past, environmental impact meant to make less of an environmental impact. This emergency calls for increasing the impact with bigger environmental results, like bigger negative carbon footprints,
higher dikes, etc. Now we need massive environmental initiatives to restabilize the climate using mass production methods to amplified impact. Swarms of little good things add up to big solutions—bottom up, grassroots, quid pro quo! Cutting a pound of carbon burned reduces 3.3 pounds of carbon dioxide going into the atmosphere. Fixing the polluters is good for reduction, but burning less fuel doesn’t remove the carbon already out there! We need to clean up our 200-year-old mess by decycling the carbon—put it back. Reverse coal mining will become one of the fastest growing jobs! Forget about oil extraction—we need oil re-traction. Today “Less is more” has new meaning. Rolling back all carbon emissions now means tapping into all the forces available: creative, scientific, industrial, political and even military. Design is like judo: turn the energy of an attack into its own defeat. We can get radical results from painless design thinking when we get our products to do the work. Get an eco-black belt by specifying materials that contain extra carbon, like carbon fiber, or adding more carbon filler to plastic for a really matte black! How about turning atmospheric carbon into diamonds? (They are forever!) Isn’t it ironic that a little potato peeler’s win for humanity might show us how we can integrate climate solutions at the beginning of our design process too? Just like universally designed products are better for everyone, regenerative products are better for the whole world! Neutral is not good enough. Green is the new black, with beautility! More than eight years ago, Mark Dziersk, FIDSA, invited me to contribute this column to INNOVATION. He was the first champion of beautility. He turned out to be a real provocateur and supporter of good ideas! We’ll miss his regenerative good nature and endless energy. —Tucker Viemeister, FIDSA www.tuckerviemeister.com
INNOVATION SPRING 2020
11
D E S I G N DE F I NE D
THE MODERN MEDICAL ERA
M
edical innovation is finally having its moment in the spotlight as industry-level silos are breaking down and multidisciplinary professions are being born. Clinical professionals aren’t the only drivers for medical innovation anymore. The industry is gaining complementary impact from designers, consultants, academics and entrepreneurs. This can be largely attributed to increased media trends in personal health awareness, rapid advancements in science and technology, and a growing need for convenient people-centered experiences. The three big trends dominating and defining the modern medical space are big data, contemporary product design and accessible services. Below are examples of how these trends are being realized in society today. Big Data Minority-based misdiagnoses are still a common healthcare problem that people face today, due to the lack of diverse sample sizes within genetic research. This often leads to skewed outcomes and assumptions that can misrepresent or harm the groups of people who were left out of the data collection. Population health initiatives are beginning to alleviate this issue by leveraging the power of big data to provide better representation among a matrix of different socio-demographic traits. In 2020, we are seeing healthtechnology organizations like Color Genomics address population-wide research by democratizing access to highquality genetic information through its platform. Color Genomics enables the delivery of advanced healthcare through clinical genetics, resulting in more informed patients and more effective relationships with clinical professionals. The company makes precision health programs accessible, convenient and cost-effective for everyone, serving health systems, employers, research institutions and individual consumers. Color’s Population Genomics Platform offers modular and end-to-end solutions
12
IDSA.ORG
that enable organizations to effectively build and scale population health programs. Contemporary Product Design Maternity products have made leaps and strides through the physical and experiential modernization of everyday products. Willow is a revolutionary example of how good product design aims to eliminate critical pain points during the use of a breast pump. Pumping used to be a loud, inefficient and physically constraining process. Willow has made it so that pumping can be hands-free, audibly discreet and physically compact. Its simple design houses the pump, flange and milk bag all in one piece, making it easy to pump on the go. Additionally, Willow has an app that allows mothers to track their pumping sessions in real time. This 21-century women’s health product does more than just innovate on the breast pump experience; it elevates the daily lives of new mothers who are enabled to maintain an active and multifaceted lifestyle while providing for their children. Accessible Services In the United States, someone is sexually assaulted every 72 seconds. However, fewer than 30% of sexual assault victims report the crime, and fewer than 1% of sexual assault cases end in a conviction. Sexual assault evidence kits, or rape kits, are important tools that help victims report and seek justice, but the current kit format makes the experience long, difficult and often traumatizing for both the victim and the nurse. The procedure within the current kit can only be performed in some emergency rooms and can take between two and 10 hours to complete. Victims often choose to not report the assault or decline to have evidence collected due to the dated nature of the kits. Hark is an over-the-counter, post-sexual-assault health kit and a rape kit service that makes help more accessible.
Color Genomics
Willow
The post-assault health kit includes health resources for immediate care like Plan B, self-testing for sexually transmitted infections and information about resources after an assault (mental health options, rape kit information, reporting, etc.) This allows victims to consider their options on their own time and decide what they want to do. If they choose that they want to get a rape kit, they can either call the Hark phone number or log into the app to request a sexual assault nurse examiner (SANE), trained evidencecollecting nurses who will come to their preferred location to perform a sexual assault evidence exam (rape kit) and help the victim begin the reporting process. Hark is part of Antya Waegemann’s master thesis, titled “When No One Believes You,” at the MFA Products of Design program at the School of Visual Arts. She investigated the responses to sexual
Hark
assault victims and produced six redesigned alternatives, one of which is Hark. These examples are a few of many contemporary initiatives being taken to mold the future of medical innovation. More importantly, they showcase the breadth of the industry and the variety of tangible outcomes. While these products help illustrate the context of modern healthcare, more opportunities lie ahead to reach broader audiences through thoughtful design. —Dipali Aphale, IDSA dipali.aphale@network.rca.ac.uk Dipali is a designer based in San Francisco and a dual-master’s graduate from the Royal College of Art and Imperial College London.
INNOVATION SPRING 2020
13
D E S I G N DNA
BEAUTY IS THE SIGNAL OF THE GOOD An interview with Janine Benyus
Consider the lionfish. Described as one of the most invasive species on the planet, this poisonous predator only consumes, offering nothing in return—laying waste to reef diversity like an ecological brush fire. The invaded territory the lionfish mercilessly occupies slowly but surely loses all natural control, including its ability to sustain life. Janine Benyus, the founder of the bio-inspired design consultancy Biomimicry 3.8, creator of the Project Positive initiative, and author of six, going on seven, books on the subject of biomimicry, including Biomimicry: Innovation Inspired by Nature, believes that all species need to be positive contributors instead of invasive detractors— or we don’t get to stay here. Benyus’ work for giants like Boeing, Jaguar, Google, Kohler, Herman Miller and Microsoft centers on the premise that human beings should consciously emulate nature’s genius in their designs and that design has the power to fix the evolutionary knothole we are currently navigating. I recently sat down with her to talk about exactly how we’re going to do this.
14
IDSA.ORG
Scott Henderson: What kinds of things are you doing at Biomimicry 3.8? Janine Benyus: When I wrote Biomimicry: Innovation Inspired by Nature, I quickly realized that designers were the audience. Designers should have biologists at the design table— not just to figure out how to stop toxins from happening at the end of the pipe but to really go upstream. That’s where we are going to figure out sustainability. At Biomimicry 3.8, we’ll work with North Face to figure out how nature repels water. We’ll work with Jaguar to look at how nature creates something really thin but really strong in order to redesign the A-pillar of the car to minimize the blind spot. We’ll look at the chemistry in packaging to figure out how to make the color white without using chlorine. If SherwinWilliams asks us how to make yellow, what they really want is a way to make yellow without using cadmium because cadmium is toxic. Life creates white in moths and beautiful colors on the petals of flowers and on the feathers of peacocks not by using toxic pigment but rather by scattering light through their structure and fibers. We look at what all these critters have in common with each other, and we ask what the design principle is behind these things. Through our Project Positive initiative, we do a lot of ecosystem services in the built world. For example, we’re doing four biomimetic buildings for Ford right now. We think that a biomimetic city or factory should work like the ecosystem next-door. The forest next-door cools the atmosphere 15 degrees, cleans this much water, builds this much soil, supports this much habitat, offers this much noise. With a site we’re building on, we calculate the eco-performance of the client’s regular buildings and calculate the performance of the ecosystem next-door. Then we use design to fill that performance gap, making their development more eco-friendly. We call this work Factory-as-Forest. The goal is that human developments are functionally indistinguishable from the wildlands next-door, meaning they do good things instead of bad.
Henderson: What if Factory-as-Forest became completely mainstream—every house, every building? What would the benefit be? Benyus: We start with the corporations because they do lots of civic gestures like building museums and picking up trash. While these historic gestures are all good, our goal in building Project Positive development projects will elevate them further by helping these corporations deliver sites that benefit the surrounding ecosystems, from cleaner air right down to a healthier watershed. The companies involved in our Project Positive projects—Google, Microsoft, Ford, Kohler, Aquafil—want to produce ecosystem services because they need to find their social license to operate. Nobody wants an Amazon distribution center or factory in their backyard. But what if that site actually cleaned up the neighborhood? What if these types of sites were something you actually wanted in your neighborhood? As humans, we don’t think of ourselves as capable of being a welcome species on the planet. The ultimate goal for every species is that if you want to stay here, you have to figure out how to contribute. Species cannot be freeloaders. We must all be positive contributors, or we don’t get to stay. We will go extinct otherwise and take a lot of other things down with us. Henderson: How does your work in Biomimicry affect consumer products that anyone can go out and buy or probably already owns? Benyus: If you have an iPhone, there is a bionic chip inside of it, which means it has nanonets, brain-inspired software that cancels noise and keeps the sound clean. When you go through the airport right now, you go through a bodyscanning machine where you hold your arms up that is inspired by Brazilian free-tailed bats. On the arms of a Steelcase chair you have a thin film you can’t see called Sharklet that uses the lotus effect and was inspired by Galapagos sharks, who don’t get bacteria on their skin.
INNOVATION SPRING 2020
15
D E S I G N DNA
These physical instead of chemical surfaces don’t kill the bacteria; they just repel it, so the surfaces don’t breed bacterial resistance. 3D printing is going to be full of biomimetic ideas. The palette of materials in the natural world is very minimal, but nature adds and subtracts structure as needed depending on the function. The reason we can’t recycle stuff very easily is that we use too many materials to make one specific product. With biomimetics, you can change the color, the function, the feel and everything else just by manipulating the structure of your 3D print. That’s where it’s going. Soon entire products will be made largely from a single material. If you look at the periodic table of elements, 99% of the human body only uses six of those 118 things—only the ones that are safe—and then reconfigures that tiny subset into millions of outrageously interesting designs. Every time we humans need a new function, we make a new material. That’s why we have 350 polymers. Life doesn’t. Life says, we have polysaccharides and we have proteins—what can we do with them? Life doesn’t import anything in on ships. Henderson: I love the idea that there are very few colors on this painter’s palette, but they can be reconfigured in countless ways to create amazing design. Benyus: In human-made design, we use almost all of the periodic table because we can—even the toxic stuff—but life doesn’t. It only uses the ones on the light part of the table, the non-toxic ones. To me that’s the operating manual for how to be an earthling—for us to be the positive contributors instead of the invasive species. The chemistry is right there! Henderson: It seems like much of nature is packed with pure geometry and lots of math. Using these principles that drive the natural world, do you think it’s possible to design an object or experience that meets the user’s mind with unimpeded flow, thus creating universal appeal? Benyus: You’re right in that there is all this mathematical stuff in nature. My new book called Nature’s Universals is about people who study these things and see them everywhere. Leonardo da Vinci was the first one to figure out Murray’s law of branching in trees. The same mathematical law is in
16
IDSA.ORG
your lungs. Anything that needs to distribute flow through a three-dimensional object is going to have the same exact mathematical formula. My question is, Why aren’t our pipes and our electrical circuits all using this formula? As a new branch grows out of the existing branch, that step-down ratio is predictable, not random. What this does is reduce friction and improve flow. Adrian Bejan’s constructal law states that all of life evolves with the purpose of reducing friction. Life’s entire goal is to have unimpeded flow. All of the shapes we see in nature are beautiful to us because we have a deep, instinctual sense that they work and work elegantly. Designers have a moth-like antenna for what works and a natural desire to re-create it. Henderson: I love the idea that beauty is not superfluous. Even if it appears to be an abstraction with no ties to functionality, its appeal might very well be related to elegantly complex functionality that we are subconsciously expressing because it is engrained in our inner psyche. If you look at the rough sketches of Zaha Hadid, they are really random looking—almost like she was allowing something to flow through her, rather than trying to laboriously contrive the solution with her conscious mind, surprising even herself with the outcome. What do you think of that approach, allowing design to happen instead of trying to force it to happen? Benyus: I think one of the common traits of being an artist is to allow the world to have its way with you. What is interesting to me is that we all have inherited what I call a cellular wisdom that we have really ignored and tamped it down for a long time, but it’s all there. This whole place where we have been outside of our watersheds—in other words, working against the tides of nature—is very recent. Evolutionarily speaking, though, this cellular knowing is within us, and if we just get out of our own way, we’ll let it flow through us again. One of the things we’ve tamped down is this innate sense of what’s good for us. The whole time we were evolving, beauty was the signal of the good. Evolutionary psychologists would say the reason women love flowers is because women were the gatherers, and they knew that a flower in two or three weeks
would become fruit and seeds. Flowers were the signal of the good. If you put your camp near sparkling water, that meant there was oxygen in the water and it would be healthy to drink. That’s why we like sparkling things—because beauty is the signal of the good. As I move more and more into sustainability work, I think we have decoupled what is good for us from beauty. There is a biological trespass there that weighs on our hearts. I could pick up an iPhone and be very attracted to it because beauty is a signal of the good, but it may be leeching toxins into my hands. For a product to truly work, it has to be good for us, and not just for our personal safety but what is good for our planet. All our evolution and cellular wisdom for what works is leading to this. Biomimicry is not just the mimicking of form but also what the process is—what it is made of and how it is made and also the larger systems aspects, like where is it going at the end of its life and where did it originate from. Those three pieces all have to be working for it to truly be biomimetic. If we want to get through this evolutionary knothole we’re in right now and stay on the planet, we have to work this out. That’s why I work in design. Henderson: Design thinking tells us to interview our intended user and base our solution on those findings. It’s a five-step process, almost identical to that of the scientific method. Since you are an actual scientist, what do you think about that as a process for creating great design? Benyus: The thing about studying the user is that the real user is much bigger than any one individual. What does the world want? What does the planet want? Is this design conducive to life, or is it conducive to someone walking into Walmart and in 20 seconds they want to buy it? I am not a big believer in human exceptionalism. Too many people out there believe everything rotates around humans. As Thomas Berry says, we’ve become autistic to the natural world. It’s a huge creative opening for us when you think about expanding the user and who you are designing for. What about making the solution as welcoming as possible to wildlife, a concept called habitecture? Like creating a building with niches in it on purpose so birds can have a
home there. It’s a whole new way to design. I also don’t think you can find that je ne sais quoi—design that delights and lifts the spirit—by using the scientific method. I don’t see the natural world as being full of struggle. I see the natural world as filled with exuberance and celebration. Design should reflect that. Henderson: Artists have chosen a difficult path with very little, if any, chance of success or payback. Are they being driven by a set of clues so compelling and relentless that there simply is no other road? Benyus: Scientists are very similar in this regard. They are hearing a whistle that the rest of us can’t hear. Our searches for patterns that give us clues for how to live here on this planet are urgent right now. We have all these laws and religions that keep us from murdering each other, but we have very few codes or guides for how to survive and thrive on the planet. That’s coming. You talk about climate change. We’re going to figure out how to do it in a million different ways—how to transition. But I think experimenting in this bubble of human exceptionalism without taking in clues from the natural world has got to end. This idea of what could go wrong—that has got to end. We need to take our clues from a system that works. Humility is going to be a big part of design going forward. We as humans are going to say to the planet, “What are you trying to tell me? I’ve spent a long time as a young, arrogant species, and now I am turning to you and looking for patterns that are not filtered through a bias where we only see ourselves over and over again.” We first need to quiet human cleverness so that we can learn something. Then we need to start listening. The third step is echoing, and the final step is to give thanks—to be a part of and not apart from. If we do these things, we get to stay here. —Scott Henderson, IDSA scott@scotthendersoninc.com This article is dedicated to Mark Dziersk, FIDSA, who emailed me only two weeks before his untimely passing, taking time out of his insanely busy schedule to tell me that he enjoyed my last article in INNOVATION, because that is the kind of person he was. Thank you, Mark.
INNOVATION SPRING 2020
17
CO V I D-1 9
CHINA DISPATCH: UNMASKING A COMPLICATED SITUATION Editor’s Note: The situation regarding the global COVID-19 outbreak has evolved since this article was written in late February.
T
he novel coronavirus and the disease it causes, COVID-19, have focused a beam of intense international light on China. The spread of misinformation and disinformation surrounding the epidemic’s spread is deeply upsetting because of the human toll being taken. Obscuring the severity of the epidemiological threat also masks a deeper economic truth about the world’s reliance on China’s supply base and China’s dependence on global businesses to continue to manufacture there. But unlike in past occurrences of viral outbreaks (SARS, MERS, avian influenza, etc.) where the disruption was acute but containable and things eventually returned to normal, this time feels different. When you’re standing on the factory floor, things also look very different. At this point I should mention that I own a company, AirPop, in China that designs and makes, among other things, facemasks for Chinese consumers to protect them from airborne contaminants like PM2.5 (a major component of human-made air pollution), volatile organic compounds, bacteria and even some viral matter. Our masks are similar to N95 dust-mask-style respirators with one vital difference: Ours feature a contoured, silicone-like, TPE duallayer seal that conforms to the wearer’s face, ensuring continuous contact with the skin’s surface. Continuous fit is critical when it comes to filtering aerosols like ultrafine particle pollution or your neighbor’s sneeze. (It should be noted that consumer respirators don’t filter the coronavirus directly, but if rated correctly and fitted properly, they can prevent you from inhaling aerosols and reduce contact exposure of airborne saliva from infected individuals nearby. Importantly, they also discourage you from touching your mouth and nose between hand washes.) It’s troubling that most images coming out of China show civilians wearing one-size-fits-all surgical-style masks that don’t filter aerosols, don’t restrict contact exposure of saliva and mucous (unless the infected person is wearing it) and leave large, open gaps on either side of the face that require frequent repositioning.
18
IDSA.ORG
INNOVATION SPRING 2020
19
C O V I D-1 9
So why aren’t people wearing appropriate masks that protect from an airborne threat like a contagious human-to-human infection? Part of the answer involves, again, misinformation throughout the entire commercial value chain. Despite very clear information, there is still mass confusion in the market about which type of mask is most appropriate for which type of situation, how to evaluate the filtration efficacy of one mask over another, which context you need which mask for, and which brands are trustworthy. While this is frustrating, it is also just the reality of any low-engagement or special-use product category in any market. Educating the market—consumers, retailers and channels—is hard work. There’s another answer that is simpler and more profound. Consumers are wearing the wrong masks because the ones they need cannot be made fast enough. Or at all. The ongoing trade war had already tempered orders to Chinese factories as foreign companies looked to diversify their production outside China because of the increased costs. This created many disruptive ripples across the manufacturing landscape, mainly with labor utilization. Then Chinese New Year, the largest planned disruption to the country’s economic output every year, happened to coincide with a public health catastrophe that resulted in citywide 24-hour curfews across the country. The holiday was officially extended, so most workers have not returned to work, and it’s unclear when they’ll be allowed to return. Factories have now been empty for more than a month, and most factory owners aren’t able to anticipate when they’ll be at full capacity, or if they ever will be again. As COVID-19 seizes economic activity in every part of the economy, many companies are invoking force majeure to shield themselves from business and legal fallout. The disruption is most significant for sectors like construction, retail, travel and investment, but it is especially detrimental for manufacturing, the beating heart of China’s economy. AirPop’s situation is not unique but is worth thinking about because of its relevance to the present moment. Masks, in general, are in extreme demand due to the epidemic. Medical/surgical and consumer respirators are sold out everywhere, particularly consumer brands. Replenishing enough of both types of mask is impossible, however. All the factories in our supply chain have been inundated with orders well beyond their capacity and/or they’ve been commandeered by the local authorities, who need to prioritize the epidemic preparedness effort around medical protective products first. In both cases, all available raw materials have been diverted and high-capacity production lines have been consolidated for this purpose. Not to mention, these emergency production lines are critically understaffed, as almost no one in the country is even allowed back to work, including the factory workers. So while we sit on the sidelines waiting and wanting to help, it’s hard not to marvel at the irony of this situation and to consider the macro implications of the “world’s factory” shutting down, even temporarily. The broader ecosystem of suppliers potentially grinding to a halt is unprecedented in the modern globalized economy.
20
IDSA.ORG
In the abstract, supply chains suggest a linear model where value creation increases from one end to the other. But in actuality, supply chains aren’t linear at all; they’re crowded constellations where value is constantly exchanged in every direction between players of all types, sizes and geographies. Because there’s diversity and competition built into the supply side, a handful of companies going out of business every week or month won’t make a dent. But when all of them stop operating at the same time with no sense of when, or if, they’ll start up again, you have the beginning of an economic crisis. It’s similar to when your network goes down. You are forced to pause, do some troubleshooting, reboot servers and computers, and hope the network resumes in a few minutes or hours and you haven’t lost too much critical data and work. As an end user, about all you can do is cross your fingers. But unlike when your network goes down, when this sprawling physical network crashes, it may take years to fully turn back on. It may take a decade to inventory how much global economic damage was done, to assess just how seismic the wave of commercial disruption was and to quantify how much value potential was destroyed
for individual companies. Many companies won’t survive long enough to see their part of the network come back online. The companies that depend on those companies won’t survive either. And on and on. It is said that complex systems fail in complex ways, so the reboot of this mass manufacturing moment is not a simple button we can push. Well over 60% of the world’s consumer products and components spend at least a part of their production or assembly time in China. In theory, under normal circumstances some constituent parts of the greater China supply chain will resume operations gradually until eventually the entire regional production base ramps up to full capacity again. But looked at from a people perspective, this complex and messy human operating system requires physical, personal interactions. Parts need to be machined, shipped, received and assembled. Contracts need to be signed, stamped and hand delivered. Factory workers, who live and work in close proximity, need to be able to staff the production lines, congregate in the canteens for lunch and socialize after their shifts. People are both the catalyst and the lubricant of this complex machinery. When an epidemic forces human isolation for extended periods of time, we won’t know the economic implications of suppressed industrial activity for some time. But one upside has already become crystal clear: Normally hazardous levels of air pollution in China are down significantly since the start of Chinese New Year, by some analyses as much as 25% from the same time last year—a sobering reminder of the cause-and-effect relationship between globalization and ecological degradation. Understanding industrial design’s responsibility in the escalating three-way tug-of-war between economic health, environmental health and public health is the most urgent and consequential task we face as a profession and as a global community in the 21st century. —Chris Hosmer, IDSA chrishosmer@gmail.com Chris Hosmer is the co-founder of AirPop, a venture partner at Envision Capital/Tipping Point and an advisory partner at Open Colony. Chris is also Chapter Chair of IDSA’s newly established Jinhua, China Professional Chapter.
INNOVATION SPRING 2020
21
INTERNATIONAL DESIGN CONFERENCE
22
INTERNATIONAL DESIGN FOR BALANCE CONFERENCE
INTERNATIONAL DESIGN FOR BEAUTY CONFERENCE
INTERNATIONAL DESIGN FOR A NEW GENERATION CONFERENCE
INTERNATIONAL DESIGN FOR CONNECTION CONFERENCE
INTERNATIONAL DESIGN FOR HUMANITY CONFERENCE
INTERNATIONAL DESIGN FOR SUSTAINABILITY CONFERENCE
INTERNATIONAL DESIGN FOR DIGNITY CONFERENCE
INTERNATIONAL DESIGN FOR PLEASURE CONFERENCE
INTERNATIONAL DESIGN FOR DIVERSE PERSPECTIVES CONFERENCE
IDSA.ORG
September 14-16, 2020 Seattle, WA
internationaldesignconference.com INNOVATION SPRING 2020
23
M O D E R N ME DI CI NE
THE DREAM, THE REALITY AND THE INFLUENCE OF SCIENCE
Whether you believe God or the devil lives in the details, there is no mistaking their influence. The design of medical products is no exception. How and where a device will be used and the fact that it will often be used in conjunction with other medical products make attention to detail all the more important. We are now entering a new decade in which previously futuristic designs are becoming a reality. This evolution is impacting the design of medical products, forcing designers in the medical field to move away from looking at the design of single objects toward the design of entire systems and the delivery of care.
24
IDSA.ORG
Vital Signs From cars to coffee pots, people rely on products in their daily lives and trust that they adhere to safety and usability standards. Designers and manufacturers focus on details like interface design, user interaction and testing because users of all levels demand products that work easily and reliably. In medical device design, however, all these details can mean the difference between life or death. There is promise in the design of personalized medicine and a more efficient delivery of care where the boundaries between drugs, devices, software and patient data blur. This promise has the potential to improve the daily lives of patients and bring more advanced care along with lighter financial burdens. Patients and healthcare providers are accustomed to rapid innovation in all other aspects of their lives, so why not in healthcare too? That is our dream. Technology excels at collecting data about our social media lives, but what about our health-related data? In the United States, we have access to a different specialist for each health anomaly. In doing so, we hope all the specialists who take care of us talk to one another to coordinate our care. But how would they communicate when one hospital system’s medical records are sealed from another’s? Our social media selves may possess a more cohesive data set on us than our medical record selves, yet we still wish to make better health decisions that will increase our vitality and health. This is our reality. While there is always a science behind every device, drug and healthcare delivery system, what is the science behind our design? Yes, designing medical devices requires industrial designers to learn medical science, and in some instances, the results of their efforts (in collaboration with many other disciplines) may save lives. However, does that make the designer somehow more noble? Learning to design in the field of medicine or the delivery of healthcare is essentially like being back in school. A designer in this field is perpetually learning science and becoming more integral to the development process. We add value not found in other disciplines. We are the form-givers of the use interactions. We are the designers of the use experience from start to finish. We live on the fringe of the user and technology. That is our science.
A Humanizing Influence This issue of INNOVATION explores the design of advanced technology that pushes the boundaries of traditional industrial design (form-giving and ergonomics for a singular product) into the incorporation of advanced interaction design, often as part of a complex system that directly interacts with patients. Our contributors question processes and expectations in the development of a shared vision in this multidisciplinary space, discuss what changes need to occur in design education to better prepare young designers for this growing field, and consider the ever-changing global market, which includes sustainability and the notion that products may also include services. Until recently, medical and healthcare design seemed to be limited to beige and blue boxes built for eternal obsolescence. Today, with the help of new technologies, along with progress in usability, the need for design has never been more acute. Technology is pushing the medical and healthcare industry in ways never imagined with augmented reality, artificial intelligence and robotics, to name a few. With this push comes a pressing need for industrial and interface design to humanize the user experience. The good news is that design has stepped up to the plate. This is evident in the past few years of the International Design Excellence Awards (IDEA). Not only did the medical category earn the greatest number of Golds last year, but a medical product also won the Best in Show. New materials, bold design directions and simplicity were the main themes among the medical product winners, and yet the design of all these devices also demonstrated humility in their primary focus on improving patient care and helping to save lives. I am honored to have the opportunity to be the Guest Editor of this issue of INNOVATION, and I thank all our contributors for their insightful perspectives and dreams for the future. Together, medical device designers and educators are embracing the challenges and opportunities in front of us. We are creating a vision for cross-disciplinary collaboration that integrates UX and ID and growing our success in design that is focused on healthcare. I hope you enjoy! —Tor Alden, IDSA, Guest Editor tor@hs-design.com Tor Alden is principal of HS Design (HSD), an award-winning, certified ISO 13485 product development firm. His current focus is in human factors, design research and strategy.
INNOVATION SPRING 2020
25
M O D E R N ME DI CI NE
A COLLISION OF NEW TECHNOLOGIES
W
e are in the middle of a collision of new technologies that are changing design forever. Wirelessly connected products are the norm. High-speed data provides instantaneous access to more information than ever before. Machine learning is scouring everything ever published on the planet, and artificial intelligence (AI) is being applied to study big data to identify patterns and probabilities to assist clinical decision-making. Surgical systems with integrated micro robotics, 3D vision systems and synthetic haptics are extending surgeon performance. The intersection between these new high-tech platforms is reshaping the design brief, defining a broader scope and increasing responsibility for designers like never before. Three significant change agents are transforming the role of industrial designers and the complexity of R&D teams in the design of med-tech products. Big Data, AI and the Clinician Dashboard Today we have access to all the data. Everything published on every topic is available with a keystroke. Powerful machine-learning algorithms process this vast database looking for patterns and probabilities of occurrence in the future. But data alone is overwhelming and meaningless without some tool set to help us make sense of it. AI is serving this role. AI agents are increasingly providing highly curated results to healthcare professionals in ways that support and expedite decision-making. AI is reshaping the clinician interface by removing the rote task of manually scanning volumes, the intrinsic human error and the copious amount of time required by this
26
IDSA.ORG
traditional process. For example, using AI a radiologist will not need to study dozens of slices from an MRI scan because an AI agent will instantaneously scan, assess and flag all anomalies and identify the probabilities of their root causes. The implications are profound. Not only does this eliminate pressure on the clinician to manually scan disparate chunks of information under increasing pressure to improve patient throughput, but AI agents can draw from global databases, which can dramatically increase diagnostic reliability and improve patient outcomes. Visually simplifying and reducing the density of data presented to clinicians on traditional dashboards will decrease time to diagnose, reduce human error and stress, and free up precious time that can be reallocated to clinician-patient dialog. Multisensory Integration Robotic surgical systems represent the state-of-the-art in the complexity and design of systems that rely on multisensory integration. 3D vision systems with graphic overlays of imaging and physiological data combined with synthetic haptics and micro-robotics are attempting to replace natural-born multisensory capabilities. Never before has the role of human factors engineering been more important. The human factors that now need to be considered in complex surgical systems include issues related to eye tracking, eye-hand-foot motor control coordination and movement times, synthetic haptics, and visual and acoustic feedback, to mention a few. These human factors bring together highly specialized disciplines that never intersected in the past. Experts in motor learning,
motor control, synthetic haptics, robotics, acoustics and AI now join traditional industrial design and engineering teams, dramatically increasing the complexity of the development team itself. As global leaders such as Intuitive, Stryker, Medtronic, J&J and others build more advanced robotic surgical platforms that attempt to extend human capabilities, their R&D teams have gained a newfound respect for the design of the human body. As the fidelity of these new robotic platforms matures, their impact on the future of surgery will be profound. The Growing Chasm between Hospital and Homecare The omnipresence of the internet, Wi-Fi and cloud portals is bringing traditional services out of the hospital directly to the patient. Telemedicine is beginning to transform the delivery of healthcare, but getting there demands a rethink of doctor-patient interactions and what diagnostics can be accurately and reliably conducted remotely based on the fidelity of video and audio. Data speeds directly influence its reach. The throttle on this growth relies on the last few miles of rural infrastructure. While high-speed fiber networks are common in metropolitan areas and between populace cities, reaching remote rural homeowners is challenging. Short-term healthcare providers mitigate these challenges by building local high-tech walk-in clinics that are within a short car ride, but the future will be in bringing these services directly into the home. Getting to the home is not the only barrier to entry, however. While smartphones are commonplace in populated areas, flip phones with limited features and functionality are not uncommon in rural markets, creating a substantial barrier to connecting to online portals and services. Socioeconomics play a parallel role whereby individuals in rural areas who require healthcare services commonly have a lower education, a lower income and less sophistication with digital devices, further compounding the challenge of bringing healthcare into the home. Age also plays a role, creating additional physical and cognitive barriers to usability due to decrements in dexterity, vision and strength and a lack of familiarity with digital technology in general. As high technology continues to change at lightning speed, the gap between the haves and have-nots is creating a chasm that will fundamentally change the business model for reaching remote and rural markets. It’s not unreasonable
to predict that the mobile device, smartphone, tablet or modem will need to be part of the package of goods delivered to the patient by the healthcare provider. Getting the right technology in place in these remote markets is only part of the challenge. The role of design and human factors engineering will be key in providing intuitive and easy-to-use solutions that do not bring customer service hotlines to their knees. What’s Next The intersection of technology and healthcare introduces numerous new and novel challenges and opportunities for industrial designers today. It demands that the scope of the design brief expand to embrace all aspects of the user experience—to go beyond the traditional product to include the design of related apps, portals, websites, instructional materials and services to provide a unified user and brand experience that is meaningful and intuitive and delivers bona fide value to the user and ROI to the healthcare provider. Moving forward, new-product development teams will increasingly become interdisciplinary to address these expanding needs, leading to projects that are significantly more complicated and challenging to manage and execute. These sea changes in healthcare design will lead to an expanding role for industrial designers. Human factors engineering will also play an increasingly critical role in balancing user needs and human capabilities as the intersection between technology and healthcare design reshapes the complexity of design projects. The challenge moving forward will be to tame technology to avoid adding features and functionality just because that’s possible and instead stay grounded in utility and user needs. World-class design solutions must be entirely shaped and informed by the way people think, feel and behave. —Bryce G. Rutter, PhD, IDSA, and Megan Kohnen, IDSA bryce@metaphase.com; megan@metaphase.com Bryce Rutter, the founder and CEO of Metaphase, is a renowned specialist in ergonomic product design and the leading worldwide expert in the design of high-touch products for Fortune 500 brands. Megan Kohnen, director of innovation and business strategy at Metaphase, leads strategic initiatives to develop innovative research programs that use human factors to shape business strategies for numerous global brands.
INNOVATION SPRING 2020
27
M O D E R N ME DI CI NE
THE RISING TIDE OF USER EXPERIENCE
O
ver my 20 years working in medical device design, I’ve seen a positive shift in the understanding and respect of industrial design in the industry. At times, it has seemed like an uphill battle to demonstrate the value we, as a profession, add. However, with a bit of patience, some very talented designers and a better understanding of ID—thanks to the success of design-led companies in the consumer tech world—it feels like the doors have opened. So what’s changed? When I moved into medical device design back in the early 2000s, the focus was on developing technically robust products that were rigorously tested to ensure they’d survive their intended life cycle. For example, an inhaler needs to withstand being shoved in the bottom of a teenager’s backpack day after day and still work 100% of the time. Roll forward five years and the demand for human factors engineering grew as the regulatory bodies (FDA, etc.) required companies to prove “safe and effective use” in the hands of people. Working closely with our human factors colleagues, our work shifted to developing highly intuitive products with easy-to-follow instructions. More recently, though, there has been a significant shift in focus to user experience—UX in the broadest sense. While there is no regulatory requirement (yet?) to optimize user experience, several key factors have contributed to it becoming a bigger deal in the work we do as medical designers. Consumers of healthcare have become better informed and more demanding. Modern generations are less content to accept a healthcare solution when they feel it doesn’t meet their needs. With readily available resources, forums and product reviews online, consumers of healthcare have become savvier. It’s no longer enough to consider how a product you are developing measures up against competitor products. You also need to assess what else it might be compared to: how the user experience compares to other services, medical devices or consumer tech that the user may be interacting with. This is
28
IDSA.ORG
even more important when developing connected medical devices where a healthcare app has to measure up against tried-and-tested global platforms on the same home screen. The expansion of healthcare at home. As healthcare budgets become increasingly stretched due to the aging population, treatment of many chronic conditions has moved away from the clinical environment. With more and more treatments administered in the home by patients or caregivers, we cannot focus only on usability (what a patient can use) but must also optimize the user experience of a device (what a patient wants to use—acknowledging that no one really wants to use a medical device). Designers need to consider what will motivate end users (who may be very unwell) to inject, swallow or inhale their therapy multiple times a day—even when it doesn’t make them feel immediately better. When there isn’t a trained healthcare professional present to encourage and ensure correct use, how can we develop products and experiences that compensate for the lack of human interaction? The shift from treatment to prevention. Keeping people out of the hospital not only saves money—it can improve quality of life and speed up recovery for patients. Each year at CES we see an array of products spanning the health and wellness space: products designed to help us improve our sleep, monitor and encourage physical activity, improve our diet and reduce stress. Greater emphasis on prevention of illness requires us to develop products that encourage good habits and discourage bad ones. The realm of behavioral science—which has been used extensively in the consumer world to smooth the path to purchase, ease onboarding and, more controversially, hook us to digital services—is now being more widely adopted in healthcare to encourage compliance with medicines and treatments. Going forward, designers will play an important role in creating experiences that have a positive effect on human behavior.
The Tympa Hearing Heath Assessment System uses smartphone technology to increase access to care for those suffering from hearing loss.
INNOVATION SPRING 2020
29
Where physical meets digital—two worlds collide. In the world of pharma, the trend toward connected products has increased rapidly over the past few years. Though still lagging behind the curve compared to the consumer tech world, the healthcare industry is embracing technology as a solution to improve compliance and, in turn, improve healthcare outcomes. Devices with integrated sensing allow us to get data on device usage and enable interventions when they are most effective. But the development of digital interfaces in healthcare is different than in other industries. While digital therapeutics (software-based treatments) are increasing in the market, an app is rarely standalone—often the digital interface is part of a broader interface, including physical touchpoints of the device, packaging and paper instructions. As designers, we need to consider how all touchpoints in the system can encourage the desired user behaviors. These systems require user experience, user interface, and industrial and graphic designers working toward a common goal. A digital healthcare revolution. It appears we are on the brink of a digital healthcare revolution. Tech giants and medical institutions, big pharma and medical-technology device manufacturers have begun to collaborate to bring about better healthcare solutions. The sharing of data, data science, analytics, artificial intelligence and skills in user experience design will have the biggest effect in pushing this forward and improving healthcare outcomes. Technology is the key to a better understanding of which healthcare treatments and approaches are most effective at an individual level. But this is only possible if we work smart and if consumers of healthcare allow their data to be shared so it can be used to develop better solutions. We need to design products that provide tangible benefit without requiring end users to change their behavior. How will the role of designers likely evolve? As the sands continue to shift, we’ll need to be versatile. We must continue to work most effectively with our colleagues in manufacturing, human factors and more while embracing the value that our colleagues in the digital, information and behavioral design world bring to the mix. Medical product design will never be straightforward. Designing products and experiences in a regulated environment is tough. It requires discipline. We need to be cognizant of the constraints and work creatively within them. A right-the-first-time philosophy will likely continue to be the norm. Products need to undergo rigorous testing (technically and with users), and design
30
IDSA.ORG
decisions must be backed up with evidence before they will receive approval for launch. In the consumer tech world, it’s acceptable (as long as investors share your attitude toward risk) to launch an experimental product on the market. You can learn in real time what consumers like, dislike and want and, therefore, iterate through multiple generations to an optimal product (the truest sense of design thinking). This approach to understanding customer needs is unlikely to become acceptable in the medical world. And for good reason. We often deal with products that have a significant effect on someone’s health and quality of life. The products we develop can take years to bring to market, costing hundreds of millions in investment. Those that make it to market will likely stay there for 10 to 20 years (yes, the very first medical product I worked on back in 2001 is still on the market today in its original unaltered form). So it’s understandable that our clients want to make sure we’ve done everything we can to understand market needs and minimize risk. My journey in medical device design has taken me to 50 cities across 20 countries worldwide. I’ve witnesses different working practices, cultures and communication styles—some of which reinforce stereotypes and some of which surprise. (Sweden has the strongest coffee, by the way). I’ve seen differences in how people deliver and consume healthcare—influenced not just by nationality and culture but by socio-economic background, age and education. My main observation is that humans are humans wherever we live. We are complex individuals with behavior rooted as much in a psychology reflecting thousands of years of evolution as in our individual backgrounds. It’s hard to predict how a solution we develop will perform in the hands of real people and harder still for us designers in the medical world because those who use our products may have such different challenges from us. Taking the time upfront to understand these challenges and ensuring regular touchpoints with users through the design process is critical. We have to base important decisions on evidence while not ignoring our designer’s intuition that allows us to do our best work. —Paul Greenhalgh, I/IDSA paul.greenhalgh@team-consulting.com Paul Greenhalgh leads design and innovation at Team, working closely with clients and colleagues to improve the user experience of medical devices through carefully crafted ID, UI/UX, packaging and information design solutions.
M OD ERN M EDIC INE
EDUCATING A NEW GENERATION OF HUMAN-CENTERED DESIGNERS FOR THE MEDICAL DEVICE INDUSTRY
I
n response to the growth in Ireland’s medical device industry, the National College of Art and Design (NCAD) in Dublin, Ireland, developed a studio-based MSc program in Medical Device Design. The program is open to candidates from a range of fields, including design, healthcare, engineering and business, and prepares them to play a leading role in Ireland’s vibrant medical device industry. The roots of the program date to the 1980s when U.S. multinationals like Baxter and CR Bard established European manufacturing bases in Ireland to take advantage of an educated workforce, cheap labor and incentives from the Irish Industrial Development Authority. Since then, Ireland’s economy has advanced. High levels of education have enabled a strong research sector and development in both industry and academia. Among the more than 300 companies with Irish facilities today are Boston Scientific, Abbott, Vistakon, Medtronic, Teleflex, Stryker, Cook Medical, Zimmer Biomet, DePuy Synthes, Hollister, and BD. In 2009, NCAD’s head of industrial design realized that graduates were being hired in the medical device industry. He saw a need for designers in the medical device industry who married design’s human-focused approach with the rigor of science. Working with University College Dublin and Trinity College Dublin, the MSc in Medical Device Design was created with classes that include medical science and bioengineering, alongside studio projects undertaken in collaboration with industry.
Bridging Design and Technology Students come to the program with either a technical background or a design background, and on occasion both. While designers can be too conceptual and emphasize aesthetics, engineers can be technology driven and fail to adequately consider users. The MSc program seeks to remedy these tendencies by teaching an iterative process of analysis and synthesis in an open studio environment. Students are encouraged to share ideas but also must confront the technically rigorous aspects of medical design. The aim of the program is to produce medical designers who apply human-factor methods as an integral part of the design process. Designers need to be a voice of empathy for the user, clinician, patient and caregiver. Until recently, many engineers and designers were discouraged from visiting the clinical environment, which was thought to be the domain of market research or product managers. Conducting contextual inquiry and mapping tasks and user journeys are becoming vital skills for both designers and engineers. Many bigger design teams may have a human factors specialist who can diagnose errors and pain points in a device but may not be skilled in elaborating solutions. A designer with the right training can use the insights gained through contextual inquiry to inspire novel designs and improvements. The designer can use sketches and sketch models to facilitate conversation and collaboration among engineers, designers, clinicians and patient advocates in a multidisciplinary team.
INNOVATION SPRING 2020
31
All project work in the studio is conducted with realworld collaborators, be they medical device companies, local hospitals or medical schools. Each year, the students’ first project, in collaboration with the Royal College of Surgeons, involves building a task trainer on which trainee surgeons can practice a procedure. The students begin with conducting primary and secondary research and mapping out the task in great detail. Capturing the perceptions, cognitions and actions of a surgeon as they execute a procedure is no simple exercise, and building a device to simulate the same is harder still. Concurrent with the project work, the students have classes in human factors, materials, and failure modes and effects analysis, as well as basic medical science at Trinity College Dublin. Students also work on industry projects that call for creative problemsolving rooted contextual inquiry. The students work with medical device multinationals and indigenous startups to produce design concepts based on research conducted with local hospitals. These industry collaborators value fresh thinking, and many of the ideas developed in the program have been patented over the years. Design in medical devices tends to evolve more slowly than in other areas. What is considered a major innovation in this area would be seen as an incremental improvement in another specialization. This is mainly due to regulatory constraints and the unique economic situation of the medical sector. With medical devices you must consider who will choose, use and pay the dues for a device. Usually these are three distinct entities. Normal laws of supply and demand are distorted by factors such as reimbursement codes and health insurance.
32
IDSA.ORG
Students get a sense of these factors in two week-long projects with local hospitals. In each, an open call is put out to hospital staff to work with the students for the week to solve a problem in the hospital. In the Mater Misericordiae Hospital, the MSc students work alongside students from the MA Interaction Design and MA Service Design programs to improve anything from wayfinding to information sharing. In St. James’s Hospital, they collaborate with bioengineering students from Trinity College Dublin. Experience in a hospital is a valuable chance to build empathy with the staff, patients and caregivers who will use your designs. It also teaches the complexity of medical care. For patients, caregivers and clinicians, it is often simple things that matter. Recognizing these details is a vital part of the designer’s job. In the second semester, students have classes and laboratories in bioinstrumentation with the medical physics team at St. James’s Hospital. This is an opportunity to learn about the complex science of human measurement that interacts with so many medical devices. It is an opportunity to look for inspiration for new devices. How might we incorporate sensors or measurements into a device? It is also a chance to look toward a utopian future beyond the device. How might we measure these vital signs before the condition develops and before the user becomes a patient? On the Horizon Recognizing the importance of new technology and all the interaction points along a patient journey means that students are not afraid of the messier spaces that many of the latest innovations in healthcare end up in. Medical device companies along with the engineers and scientists
who work in them are experts in the physical device they currently produce but often struggle with innovation beyond this space. The medical industry is at varying levels of advancement. While practitioners are always interested in the newest technologies, some institutions worldwide still use faxes to communicate. Efforts to create an accessible patient record system have fallen foul of bureaucracy and the market, where those who are developing the technology are unwilling or unable to allow the different record databases to talk to one another. A world where patients have access to their own data is still in the distance. Designing patient records in a manner that is both accessible to the patient and not a frightening experience for them will be a job for designers of the future. The medical device industry has come late to sustainability, and for many companies, “single-use” is a badge of honor for preventing the spread of infection. In the last few years, device companies have started talking about sustainability as a market advantage. End users have begun questioning the costs involved in the disposal of biomedical waste. For example, the rise of cheap consumer electronics has led to the development of singleuse chip-on-tip endoscopes; however, not all clinicians are comfortable throwing away a device that contains nonrenewable materials, many of which are on the critical list. As a result, a recent graduate of the MSc program has founded a startup to design an innovative endoscope for the circular economy. This company has received funding for a collaboration with the college to develop the device. This will require that the device be returned to the producer,
disassembled, sterilized and still have the same safety and efficacy it had the first time around. This is a complex threeyear project bringing together optoelectronics, medical device design and sustainability. The increasing importance of human factors in the medical device industry is often seen as another regulatory hurdle, but progressive companies are starting to see design and human factors research as a rich space for innovation, intellectual property and product differentiation. A future where data and automation enhance medical care will require well-trained human-focused designers who are not afraid of the spaces in-between. The designer’s job in this complex ecosystem is to ensure that the development team never forgets the user and to design the device’s physical and digital touchpoints in accordance with the user’s needs. Exactly the type of designer NCAD’s MSc program Medical Device Design is empowering. —Enda O’Dowd, I/IDSA, and Derek Vallence, I/IDSA odowde@staff.ncad.ie; vallenced@staff.ncad.ie Enda O’Dowd is a lecturer in the Product Design Department at the National College of Art and Design (NCAD) and joint course coordinator for the MSc in Medical Device Design. Derek Vallence is joint course coordinator and lecturer for the MSc in Medical Device Design at NCAD and also a part-time a lecturer for the school’s BA in Product Design.
INNOVATION SPRING 2020
33
M O D E R N ME DI CI NE
DESIGNERS AS THE HUB OF COLLABORATION
W
orking for Medtronic, the world’s largest medical device company, we are driven by a noble mission: “Alleviate pain, restore health, and extend life.” Although this mission statement is simple and elegant, the reality of achieving these goals through the medical device product development process is not. Stating the obvious, developing medical devices is an incredibly complex process. While every industry has its intricacies and all companies have their organizational challenges, the design and development of a new medical device, specifically at large corporations, is among the most complex. Through their work, medical device designers break down the barriers these complexities present. A Multifaceted Environment At Medtronic, we innovate in many ways, but primarily by creating new ways to harness the properties of technology, be they electrical, thermal, chemical, mechanical or digital, to treat or diagnose medical conditions. To sufficiently leverage these technologies, we require the input of individuals with deep expertise in all of these technical fields. We also rely on experts who are up to date with medicine’s continuously evolving understanding of how the human body functions. Even for the biological mechanisms we do understand, few specialists beyond medical doctors and researchers have the necessary comprehensive knowledge to be able to aid in developing a new medical device. An understanding of technology and physiology is not all we need to make an innovative medical device. We are still left wondering how someone will incorporate this new product in their work (doctors, nurses, techs) or their life (patients, caregivers). While we do know who our target users are, our ability to connect with them in
34
IDSA.ORG
order to gather input to refine our devices is limited by the nature of healthcare privacy, user prevalence, proximity and availability. This is the environment in which every medical device is developed. Further complicating the process are barriers that arise relative to the business of healthcare, the legality of intellectual property and the gauntlet of country-specific regulatory bodies. Whether you are a small startup or a company of tens of thousands across the globe, these are the realities of developing a medical device. To succeed in our mission as a company, every project team must rely on the deep expertise of the individual contributors who often—by nature of their roles—have narrow focuses. However, for a project to be successful, these deep experts must collaborate to see the big picture. Without collaboration, it is impossible to see how small decisions can lead to products that may function but fail to meet the needs and expectations of our customers. A Unique Role for Designers Designers are uniquely positioned to facilitate the necessary level of collaboration among the various clinical, technical and business contributors. We have found that applying the traditional design methods used by industrial designers for decades to the medical device development process brings user experience and meaningful outcomes to the forefront. By clearly understanding the context of use and user motivations, rapidly exploring ideas that focus on interactions and outcomes and creating clear and concise communication tools, designers provide a hub for the various workstreams to come together and explore how we as a collective work to achieve our mission. There is a common Venn diagram with three circles
that shows a successful product at the confluence of viability, feasibility and desirability (below). At a medical device company, the designer must understand not only the needs of the user (the desirability group) but also the needs and limitations of the other stakeholders so that a realistic and profitable solution can be achieved. At a large medical device company, a multitude of groups make up the three circles. In our reality, that simple Venn diagram is much more involved (next page). For example: Viability stakeholders may include marketing, finance, operations, sourcing, distributions and localization. Feasibility stakeholders may include mechanical, electrical, systems, material and chemical engineering, software and regulatory. Desirability stakeholders may include patients, family/caregivers, nurses, cardiologists, surgeons, hospital administrators and field staff. This means that a medical designer must have a much wider and deeper knowledge of the product space than may be required in other fields of design. Where other designers may have more personal responsibility and control over the definition of the end product, medical designers need to collaborate with the aforementioned project team experts to realize a successful product. Therefore, it is a core responsibility of a designer to build and share an empathetic understanding of who the user is and what they need from the product. At a large medical device company, project teams can range from 50 to 300 people. Designers are uniquely positioned to communicate to large project teams because of their ability to create visualizations and deliver actionable insights. These visualizations can create a clear sense of empathy and understanding among the team. Communicating effectively to every team member requires our designers to visually and verbally tell the user’s story in a clear way through multiple formats. For example, some team members will respond well to presentations. Others may have more success understanding a deliverable they can keep and review over time. Some of the most powerful tools for creating an empathetic understanding of the user for project teams are user personas and workflow storyboards created by the designers. Understanding who the user is, what their needs are, and the needs and limitations of other project team stakeholders are critically important for ensuring that design progresses in the correct direction. This knowledge helps to define the sandbox that medical designers can play in when creating concepts and seeking solutions that reach the desired output while staying inside the constraints of the project. However, this is merely the beginning of the development
process. A medical designer is then responsible for ideating, prototyping and testing through a user-centered approach. It is important that they collaborate and communicate with the project team every step of the way. Progressing the Design At a large medical device company, design is best driven by data, not by any one person’s preference. Therefore, field testing serves as evidence that a project is moving in the right direction or, if users are struggling with the concepts put in front of them, that a change needs to be made. This usually means that medical device designers need to build a regular cadence of testing and learn efficient ways to connect with user groups. However, recruiting users to test with, whether they are patients or clinicians, can be a challenge, especially when a user group is small and/or their free time is limited. Building relationships with field staff and recruiting firms can be key to making the needed connections with real users so that testing can be completed. Coming back to collaboration, these visits are not the domain of the designer alone. When possible, great value to the project can come from the involvement of nondesigner project team members. When they observe real end users, they become another advocate for the end user’s needs. This understanding enables them to see how their decisions impact the product’s user experience. One more aspect that makes the medical designer’s job unique is the focus on safety. The medical designer
Viability
Desirability
Successful Product
Feasibility
A standard design thinking Venn diagram.
INNOVATION SPRING 2020
35
M O D E R N ME DI CI NE
Operations Finance
Sourcing Distribution Localization
Marketing
Successful Product
Patients
Mechanical
Electrical
Caregivers
Systems
Nurses
Material
Cardiologists
Chemical
Hospital Admin. Field Staff
Software
A modified design thinking Venn diagram for a large medical device company.
must always be aware of the tasks that are related to safety and work to mitigate the risks that could lead to patient or clinician harm. At the end of the project, the team needs to be able to show that they have identified all the risks involved in using the system, developed mitigations for any risks that could not be eliminated from the system, and tested the system with real end users in realistic scenarios to provide evidence that the safety risks have been mitigated as much as possible. Identifying and implementing the appropriate method for managing risk requires further collaboration across the project team. This can be a challenging and timeconsuming aspect of the job, but it is critically important to meeting user needs. Knowing we have made the safest possible and most desirable solution for our end users creates a great deal of pride and satisfaction in the end product. The medical designer uses traditional design skills and techniques to build understanding across the diverse set of stakeholders involved in the creation of new medical products. They need to build a robust level of knowledge within technical and physiological fields to be able to understand the constraints
36
IDSA.ORG
of their projects. As designers apply the human-centered design process in this big and complex environment, we routinely find ourselves facilitating meaningful collaboration, increasing the chance we will deliver a great product that accommodates our complex technical constraints while satisfying our business goal of commercial success. —Stephen Nelson, IDSA, and Danny Gelfman stephen.m.nelson@medtronic.com danny.m.gelfman@medtronic.com Stephen Nelson is an industrial designer on the Human Factors & User Experience team at Medtronic. He is passionate about building medical systems that improve the experience for patients and clinicians. Danny Gelfman is the senior principal solutions designer in the Innovation Lab at Medtronic where he uses human-centered design to lead advanced concept development of new healthcare products and services.
CALL F R EDUCATION PAPERS
INTERNATIONAL DESIGN CONFERENCE September 14-16, 2020 Seattle, WA
For peer review, publication, and presentation at the 2020 IDSA Education Symposium Theme: DESIGN EXCHANGE Deadline: June 1, 2020 Submit Online: internationaldesignconference.com/education-symposium Design education often operates in the realm of the theoretical, where deadlines are self-imposed and outcomes are not always of practical consequence. Its goal is to acquire knowledge, skills, and habits of mind and to practice the application of these to solve meaningful problems via a deliberate iterative process. In design education, tools and methods are constantly evolving and being refined; however, the bulk of these advances in knowledge seem to rarely reach the professional community. On the other hand, design practice largely operates in the realm of the practical, with a fixed calendar and a strong focus on pragmatic considerations, including budgets and billable time. Designs are realized in the real world and go on to have long-term implications in the way we live, work, and play. Economic pressures ensure that there is increasingly less time for theoretical inquiry and applied research. As we enter into the fourth industrial revolution, the work of the designer is rapidly changing. How can practitioners and academic institutions better collaborate to ensure that the design community has a hand in shaping the fourth industrial revolution, rather than allowing it to shape us? The coming economic, ecological, and social changes urgently necessitate a meaningful conversation between design educators and design practitioners. DESIGN EXCHANGE seeks to nurture this spirit of collaboration and invites participants to come together as a community and LISTEN with EMPATHY, as we propose innovative and meaningful changes in the ways we learn, teach, apply, adapt, and perceive across the academic-practice divide. Our shared goal is to EXCHANGE lessons learned, best practices, case studies, research, and future outlooks. We encourage submissions from academia and professional practice, from novice designers and experts alike. INNOVATION SPRING 2020
37
M O D E R N ME DI CI NE
DESIGN VS. HUMAN FACTORS: MEDICAL DESIGN’S CHICKEN AND EGG
H
ow do you get a medical device to be easy to use? Great design! How do you reduce risk and prevent injury in medical devices? Design. (There’s even a risk standard that says so: ISO 14971). How does a medical device become widely accepted by a consumer market? That’s right—through design! Inarguably, design is the means by which human factors is applied, and human factors is the means by which a design is verified and validated. It is the ultimate chicken and egg situation. An Unbalanced Approach The fact is that design, the physical and graphical way a product is put together, is the most important element in every measure of success for a medical device. Through innovative technology design, we have new opportunities to advance clinical care. Through advanced material exploration, we have the opportunity to improve manufacturing processes, device functionality, and clinical utilities and outcomes. Through industrial and interaction design, we have the opportunity to provide products that respect the user and their expectations. Nonetheless, in medical device design it is commonplace to hear more about applying human factors than design. In this field, we rarely discuss design aesthetics, the qualitative beauty of a medical device. Rather, we focus on developing a set of design rules based upon research. In a highly simplistic view, the conversation generally starts with the impetus to understand user needs through contextual inquiry, magically coming up with a few concepts and then testing them with users. The application of human factors processes ultimately results in a validated, usable medical device. But do users really desire the device? Do they enjoy using it? Is the device itself appreciated as a designed object? In some early educational circles, there is a philosophy that a child can learn from testing; that is to say, if you want a child to learn vocabulary words, you have them briefly study, give them a quiz, show them what they missed and have
38
IDSA.ORG
them take the quiz again hoping for a better score. In this example, no real change occurred between testing because there was no true commitment to learning. The same can be said for a device design that is tested with users and then retested without a true commitment to change. In medical devices, there seems to be a trend wherein human factors is the golden rule. Because usability testing is mandated by regulatory agencies, it becomes the focus—the driving force that can be viewed either as a tool or as another task that must be done. For example, we may notice a few weaknesses while designing a medical device but choose to wait until after the human factors testing before making modifications that optimize the aesthetics of the design. We justify the wait for various reasons, such as internal politics or time constraints. Once we have the results, we may assess whether to actually implement any changes because doing so may be viewed negatively or belittled by our peers (such as they will have no impact on safety or will delay the development timeline for no apparent reason). Once the test results are compiled, we consider the testing itself: Was it a valid test? Were the right people in the test? Was the test set up accurately? Was the prototype functioning at the right specificity? We might find many reasons why a test fails in our human factors processes. We might find we have conditioned ourselves to accept mediocre design that is functionally safe yet doesn’t provide an optimal use experience. And why? Because often human factors methodology tests only to acceptability, and perhaps preference. We rarely, if ever, have an opportunity to truly assess the attributes of a design that leave a guttural feeling of enjoyment in using a medical device—specifically, its aesthetics and the design itself as a designed object. Envisioning a New Reality But what about the dreamers in healthcare? What is our responsibility for innovative medical device design? Consider for a moment the design theory of form follows function and fulfills fantasy (a great line by my academic colleagues). This theory is a challenge for medical device designers because
our healthcare providers, our physicians, do not live in any type of fantasy world (thankfully). If asked to dream of a new reality for their delivery of care, physicians may be a bit rusty; they simply do not have the luxury to go away and think about their clinical problems per se (consider how a surgeon’s job is to act immediately, for example). Rather, they seek solutions they know have worked previously, albeit perhaps from unrelated cases. They may be risk adverse; after all, their work may have serious consequences. It is the job of the designer to understand the clinical science and then envision a new reality: to enable a medical device user to enjoy the delivery of care, such as to easily and accurately perform surgery, to be unafraid to self-inject, to enhance the caregiving love given to those in need. This is the job of a medical device designer. It includes the responsibility to push for features that are important to the use experience as a function of emotional response that may be counter to cross-functional group think yet respectful to clinical science. Designers must not be afraid to fully execute the inherent value of their design processes. They must consider the limitations of a user group (i.e., human factors) as uncovered by their knowledge, skills and abilities and reach beyond that: Strive for more than just acceptability in the context of the socio-cultural beliefs of a user group and more than the “don’t make me think” mantra of device users and aim for designed experiences that embody artistry and elegance. Technological advancement will always offer new opportunities for innovative design. However, in order to be successful, innovative technology development must work with innovative design. Good design makes products useful. This is true whether designing a consumer product or a medical device. The design must meet not only functional criteria but also the psychological and aesthetic criteria. In doing so, usefulness is emphasized. The aesthetic quality of a medical device is integral to its usefulness. Every day people use devices intended to support their well-being, but that intention translates to
reality only if the devices are well executed and beautiful. This includes being unobtrusive; the devices themselves are neither works of art nor decorative objects. Rather, their design is thorough to the last detail; nothing is arbitrary. Care and accuracy are inherent in the use experience. A well-designed medical device is self-explanatory to the extent possible. It is understandable with as little design as possible, concentrating on the essential aspects that assist the user in making the right decisions or actions while preventing potential negative outcomes. Good medical device design celebrates simplicity in respect of the user. As medical device designers, we have fully embraced Raymond Loewy’s MAYA (“most advanced yet acceptable”) principle, which theorizes that a product design is bound by functional constraints of math and materials logic, but its acceptance is constrained by social expectations. This is especially true in medical devices. While this theory provides a strong foundation, it is time we give better appreciation for the functional ornamentation (the form semantic) in medical devices. It’s time to acknowledge that through design we can cause an emotional reaction—a feeling of delight or surprise over the object’s function and beauty. My approach to design is admittedly biased on the human and centered on the delivery of care. Throughout my career, I have worked on both sides of the fence, design and human factors. I have worked alongside physicians, nurses and healthcare workers within a Level 1 trauma center and for large corporations and a consulting group. A consistent truth runs through these experiences: Design and usability go hand and hand. —Mary Beth Privitera, PhD, FIDSA mb@hs-design.com Mary Beth Privitera is currently the principal of HFE/ research for HS Design, Inc. and co-chair and faculty for the Association for the Advancement of Medical Instrumentation Human Engineering Committee.
INNOVATION SPRING 2020
39
M O D E R N ME DI CI NE
HEALTHIER LIVES THROUGH EMPATHY-GUIDED TECHNOLOGY INNOVATIONS
A
t Microsoft Healthcare, many of our design team’s insights and contributions are derived from knowledge transferred from other industries and business settings along with entirely new insights and technology advancements. When I transitioned from designing consumer devices and joined the Health Futures team at Microsoft Healthcare about five years ago, my inspiration and motivation came from my desire to help people live healthier lives. From the start I have believed that we, as designers, contribute daily in unique and unexpected ways toward improving life. Empathy, a Source of Innovation Designers can inspire game-changing solutions that have a direct impact on people’s quality of life through the various insights derived from their research and by supporting interdisciplinary team members in developing empathy for one another, product users and stakeholders. Whereas many circumstances in today’s medical industry are out of our control, designers can make tremendous impact in one particular area: empathy. When teams invest in efforts to develop empathy for their users and stakeholders, crucial project objectives and priorities become clear. As we develop that empathy, it is important to remember that the medical industry entails a rather large and complex set of entities. These entities can include patients themselves, clinicians, payors, policymakers and pharmacists. They all have unique considerations that must be taken in account as we develop a deep understanding of their objectives and their journeys and recognize important connection points. For example, we must consider how the various roles within the delivery of medical/health and well-being products impact the marketing of these products. As designers, our mission is to bridge important communication gaps between scientists, engineers, biotechnologists, strategists, and healthcare and medical experts. For example, we learned that physicians and their clinical staff love their patients but not necessarily their
40
IDSA.ORG
computers. This is an attitude that does not resonate with technologists, and it’s difficult to sympathize with opinions different from your own. With this awareness, we must find engaging ways to provide breakthrough technologies that increase interaction with what the healthcare providers love (patients) rather than focus on what they don’t (computers). With the medical industry’s increased focus on preventative care, designers can transfer the insights they gained from developing successful consumer products to their work with healthcare categories. However, in the complex world of healthcare, designers cannot rely on their own research and experience-based conclusions. They must heavily lean on expert medical knowledge and input throughout the design development process. Only strong relationships with healthcare professionals will enable us to sufficiently empathize with their objectives, challenges, mitigations and emotions. From here, those gathered insights must be digestible for technologists and developers as they explore new solutions. As in other industries, designers must also remain vigilant in recognizing those who are excluded by our design proposals and provide solutions that reach a broader range of users and are more reflective of our diverse world. Future Advancements via Technology Two major technology areas are primed to change the healthcare industry: artificial intelligence and augmented reality. Artificial intelligence (AI) is the ability of a computer program to think and learn. As new algorithms are developed that allow insightful information to be derived from massive amounts of data, numerous applications will arise, including ambient AI, remote patient monitoring via the internet of medical things (IoMT), precision medicine and health analytics. The majority of primary care doctors struggle with today’s electronic healthcare records. Information is incomplete and, at times, too difficult to locate. Finding
Today, patients struggle with complex and seemingly complex information in order to manage their health conditions.
information and generating new documentation is time consuming and takes away valuable one-on-one time that could be spent interacting with the patient. With the help of AI, much of the note taking can be performed by the computer. This allows doctors to focus more on their patients. After each patient visit, AI can assist with finalizing the documentation in the electronic healthcare records. This is an exciting and new playground for designers. As AI is integrated into the daily workflows of clinical staff and peripheral user groups, their physical surroundings as well as their devices’ functionalities and interactions will change. Designers must plan for interaction paradigms and entirely new and tailored form factors that support interaction flows (hardware and software) that might otherwise be confusing and ambiguous. AI-enabled precision medicine and population health analytics are becoming a reality. The future of personalized connected devices in healthcare is limitless. Imagine that medical devices could empower and support patients to improve their conditions with less active involvement of their doctors and caregivers! We have the ability to design less intrusive devices that increase efficiency in the interactions between patients and providers, ultimately encouraging patients to remain active physically and socially. The designing of personalized devices (software and hardware) will enable people to tailor their device support system to fit their individual cognitive and physical abilities. Several pioneers have already started to explore this via a new closed-loop device systems for diabetics. A self-adjusting device loop (insulin pump connected to the patient’s skin patch) regulates the patient’s insulin intake at
a much more refined level and provides an array of additional advantages over today’s traditional methods. The device’s AI assists in the recognition of patterns in the context of behaviors and events over time; thus, it can directly encourage the patient on how to improve those patterns to better control their blood sugar. In this example, the clinical staff will have a custom view of the patient’s cloudconnected data and will only have to jump in to provide ad hoc guidance, allowing patients to improve their health without interruption. Augmented reality (AR) provides an interactive experience in which real-world objects and environments are enhanced by computer-generated information. This information can be in the form of visuals, sound, haptics and even olfactory sensory modalities. With AR, clinicians will be able to view organs from various angles, different scales and graphic augmentations in ways never before possible. Without compromising their focus on primary tasks, surgeons will communicate with on-site and remote team members. They will be able to switch between multiple screens projected into their headset instead of having to look away to view monitors mounted around them on the walls of the operating room. Imagine the impact AI can have when combined with telesurgery! It will enable surgeons to collaborate with remote colleagues in real time. Many surgical procedures can be performed less invasively in ambulant settings. Once AR and virtually reality technologies have improved processing power, streamlined costs and improved interaction experiences, they will drastically change the industry. Applications used to train medical students or
INNOVATION SPRING 2020
41
> S u s t a i n a b i l i ty D e e p D i ve June 3-5, 2020 Decades of global human activity and the expanding greenhouse effect have created a situation that needs to be addressed with more urgency than ever. We think design can help. Action must be taken today if we have any hope of creating paths forward to a sustainable future. As the developers of products and services used by billions of people around the world, industrial designers hold a crucial position: one that demands we look for ways in which our work can ignite social, cultural, and institutional change. By leveraging our resources, processes, and voice as designers, we can establish new ways of thinking and methodologies in our studios, companies, and corporate settings that, in turn, can help to ensure the ongoing health of our planet and its precious resources. The Sustainability Deep Dive 2020 is a virtual event spanning three days. It will feature a comprehensive mix of expert presentations and skill-building sessions meant to produce a wellspring of innovative ideas and possibilities that are desperately needed to bring about change. Each day of the Sustainability Deep Dive will focus on one of three themes, building in narrative and application examples to help you walk away with the knowledge and actionable tools required to immediately make a difference in your organization: Strategy, Process, Product Experience.
>
Re g i s t e r To d ay !
Virtual Event
idsa.org/SDD2020
M ODERN M ED IC IN E
In the future, patients should benefit from a customized patient-centric information flow.
to co-design future operating rooms are inspiring the first examples. In the area of physical rehabilitation, AR will have highly enhanced and customized environments that respond to each patient’s capability level. Therapists will be able to incrementally raise the difficulty level and motivate patients without overwhelming them. Very soon, designers will have opportunities to explore hardware, hardware interactions, multifaceted software interactions and services for a wide range of demands. Solutions will span from rather broad to specialized use cases and objectives, such as a light weight, size reductions and cleanability, and will have evolved to support unobtrusive, mistake-proof interactions and applications. The Design Discipline Is Evolving In the future when looking back on the breakthrough innovations in AI and AR, the design icons that will have defined this technology will be the ones that integrated hardware and software and created delightfully humancentric products. To me, industrial design is no longer only about the creation of mass-produced hardware. We must expand our design thinking as it has been embraced by designers since the Bauhaus 100 years ago and learn more about the inner intelligence held within each product. Our responsibility for good design must expand from physical ergonomics to optimizing cognitive loads and workflows. And we must expand our focus from single products to interconnected products and the transfer and communication of information. Without compromising ergonomic comfort and safe device usability, we must find ways to invoke trust and motivate users to engage.
In addition to maximizing our empathy for our users and stakeholders and leaning on our relationships with specialists in the various fields, we must skillfully balance our vision for the future of healthcare with reality. Without losing sight of the huge potential impact new technologies can have, we need to creatively support the current and future clinical workforce for their individual skills, capabilities and work environments. We need to be careful not to break established workflows in the consideration of safety as we propose new devices and work environments. We need to skillfully integrate with existing constraints such as architecture and/or device interdependencies. In conclusion, innovative devices can widen the types of data and tools available. AI and AR can enable users to consume contextually relevant information. User-friendly system experiences can transform disjointed services into more impactful services that can expand from hospitals and doctors’ offices to remote patients and users. Whenever we are in tune with our users and collaborators, we can teach each other and learn from each other. Ultimately, we can introduce solutions that will help create a healthier future. This is my design dream. —Moni Wolf, IDSA moniwolf@microsoft.com Moni is a principal design director for Microsoft Healthcare. She combines her core strength in design with software development, medical science and engineering to deliver holistic product experiences.
INNOVATION SPRING 2020
43
M O D E R N ME DI CI NE
PREPARING FOR AN INTERCONNECTED FUTURE
D
esigning medical devices is unique. A good design requires a blend of safety, usability and aesthetics. Surges in device and contextual complexity, including the omnipresent role of technology and performancebased reimbursement, continue to evolve this domain. The increasing scale of device manufacturers and a resulting portfolio effect have also altered the demands on industrial designers. As device manufacturers grow through acquisition and organic innovation, industrial designers work within increasingly diverse product development teams and must evolve to thrive. Additional competencies for industrial designers in the medical domain include systems thinking, risk management, user interface (UI) development and user experience (UX) design. Further, as with many technologydriven domains, industrial designers must have proficient soft skills to excel as cross-functional partners. Industrial design practitioners and educators need to adapt to this new normal. To do so, we need to think critically about our role in the development process, advance our hard skills and elevate our soft skills. Turning the tools and methods for capturing user needs and design inputs inward is a good first step. Diversity in Products and People In-house industrial design teams now face the challenges that once defined external consultants exclusively (e.g., a wide variety in project scope and ever-changing domains). Essentially, the role of industrial design has expanded as device manufacturers aim to support procedures end-toend with complete product portfolios, known as the portfolio effect. Industrial designers work on products ranging from handheld tools and capital equipment to graphical user interfaces.
44
IDSA.ORG
This expansion in product diversity has occurred for good reason. It allows systematic solutions benefiting the patient, the user and the device manufacturer. Advantages of the portfolio effect include a cohesive user experience, increased safety and an ability to offer broader cost discounts. Beyond expanding the range of project contributions, the portfolio effect has also increased the interconnections industrial designers have with other research and development disciplines. Device manufacturers employ diverse teams with every discipline found in a research university catalog, including roles common to product development and those exclusive to medical device design. Traditional stakeholders (e.g., mechanical engineering and marketing) are primary partners for industrial designers, but the mix of cross-disciplinary interaction is changing. Systems engineering, software engineering, and research and technology groups play an ever-increasing part day to day. These disciplines have been integrated in the development process historically, but the degree to which industrial designers interact with these stakeholders has intensified. The ubiquitous nature of technology and the portfolio effect are driving this shift. The rise of the hybrid usability specialist/human factors engineer/industrial designer magnifies the need for better cross-disciplinary interaction. Successful industrial designers appreciate cross-disciplinary perspectives and work in tandem with partners to develop design solutions. Strengthening our partnerships with other disciplines is a huge opportunity to advance the industrial design profession. These partnerships will also accelerate industrial design into the fourth industrial revolution (e.g., artificial intelligence, internet of things, augmented/mixed/virtual reality, quantum computing).
A Complex Responsibility While the technology evolution in the healthcare ecosystem builds momentum, one underlying constraint is constant: The human body is the most complex system a designer will encounter. It is complicated because it is variable— no human body is alike. This complexity, found in both the exterior and interior of the body, is exclusive to medical device design. Thus, creating a straightforward design solution that accommodates this variability is immensely challenging. Implantable, indwelling and percutaneous products offer unique design constraints. These devices must consider the internal anatomy of the patient, a less familiar (because it is less accessible) problem space. Additionally, product solutions must last for years, if not decades. Often, these solutions involve working with a predefined legacy technology or delivery mechanism, and any revision to existing approaches is perceived as added risk. Moreover, these design constrains lead to the misconception that substantive design changes, and thus contributions from industrial designers, are out of scope or are limited. This misconception is common within engineering disciplines, as well as among some industrial designers. Arguably, there are opportunities beyond the handle, or more broadly, the design of the handle’s exterior plastic housing. If the perception is that industrial designers are the handle people, then that is all industrial designers will be tasked with or asked to contribute. Instead, we need to shift ourselves to a higher system-level or interaction-level focus (e.g., consider the handle a part of a system that provides tactile and positional feedback that is necessary to build user trust and efficacy). We must be systematic thinkers relative to our role in development. The scope of industrial design should be as diverse and interconnected as
the products we work on. It is important to define discrete problems and craft solid deliverables, but we should not lose sight of the broader system perspective. Industrial designers can influence the ecosystem, the workflow and the technology. If we do not adopt this mindset, industrial design will be pigeonholed. The Hard Skills Written communication is vitally important. Today’s medical device projects require succinct, yet comprehensive design deliverables to satisfy regulatory bodies and communicate design requirements to cross-functional partners. However, design education curriculums traditionally do not require rigorous documentation of design methodology, limiting the exposure of industrial designers to expository writing. Also, the drive toward internship-ready portfolios does not involve discussion of risk management, user interface design documents, version control or good file name hygiene when building design asset databases. These factors are vital when working under design controls in regulated industries, as is the case with medical device design. The necessity of UI/UX deliverables creates a gap between the design education curriculum and industry practice. This is exasperated by how outnumbered industrial designers are in practice (easily 10:1 for each engineering discipline). Since industrial designers cannot be desk-side to oversee the implementation of every pixel or review the curvature of every fillet, we must build rapport and trust with our counterparts, which begins with effective documentation. Expanding the rigor of design education is a logical fix to this industry-academe gap. The latter constraint is more problematic. Building trust is hard. A good first step is ensuring cross-functional alignment.
INNOVATION SPRING 2020
45
M O D E R N ME DI CI NE
Review
User Needs Design Input Design Process
Verification Validation
Design Output Medical Device
The FDA’s waterfall process for the design of medical devices, from Design Control Guidance for Medical Device Manufacturers, 1997.
Look Inward before Working Outward Most medical device companies research users, but few take the time to reexamine their internal processes once standard operating procedures are in place. The design of medical devices requires subject matter experts, and design teams relish the chance to talk to users and observe their behavior. Likewise, the design research toolbox can improve our cross-functional interactions. Treating our counterparts as subject matter experts of their own disciplines supplies rich opportunities for engagement. We should analyze our interactions using the proven tools at our fingertips: qualitative interviews, communication framework diagrams and value-stream mapping. Rather than getting frustrated that an engineer did not implement a widget as intended, design research methods can uncover where the error occurred and why. Was there a misalignment in organizational priorities, a gap in documentation or a simple miscommunication, or was a technical constraint ignored in the design specification? Introspective analysis of our cross-functional interactions can answer these tough questions. Nested within the Design Control Guidance for Medical Device Manufacturers, 1997 issued by the U.S. Food and Drug Administration (FDA) is a diagram outlining a waterfall process for the design of medical devices (above). The
46
IDSA.ORG
process starts with user needs and cascades to the design input phase. This flows on to the final medical device with a few other stops along the way. The first two phases set up a program for success. Understanding the users, tasks, goals and use environments is an essential step. Additionally, the FDA asks teams to question assumptions and continually review the outputs of each phase. This process also applies to better understanding our cross-functional partners and ourselves. The upside to self-reflection and cross-functional inquiry is not confined to medical product development. Nevertheless, the portfolio effect, diverse teams and complex responsibilities position those in the field to gain the most from the effort. Turning the tools and methods for capturing user needs and design inputs inward will help industrial designers build more meaningful partnerships and prepare the profession for an interconnected future. It does not hurt to regularly check-in and challenge our assumptions either. —M. Robert Garfield mrobert.garfield@abbott.com M. Robert “Bobby” Garfield is a senior human factors engineer and industrial designer within Abbott’s Electrophysiology and Heart Failure Division in St. Paul, MN.
SIDEBAR RESEARCH METHODS FOR CROSS-FUNCTIONAL INQUIRY There are multiple generative and expository methods in the design research toolbox. Each method plays a unique role in the product development process. Design research methods can also be used for self-reflection and cross-functionally inquiry. Qualitative interviews, communication framework diagrams and value-stream mapping are particularly helpful in understanding team dynamics and improving collaboration. Qualitative interviews are a means of gathering detailed information about a person’s experiences and beliefs. They are the first step in understanding our counterparts. Interviews can be highly prescriptive or more open ended. Semi-structured approaches are a nice balance. A simple interview guide allows for in-depth dialog that stays on topic. A qualitative approach provides more depth than surveys because interviewees can share their perspective in narrative form with added context. Transcription, coding and other analysis turn conversations into meaningful datasets. To maximize the utility of qualitative interviews, frame the discussion in a way that guides the conversation without leading the responses. For example, to better understand team interaction, do not ask, What are the biggest ways the industrial design department aids/hinders your department? A better approach would be to have a counterpart describe their role and then define the role of industrial designers in the development process. This subtle adjustment can uncover novel insights without tipping your hand. The feedback from qualitative interviews is meaningful on its own and can be used as inputs to other research methods.
Communication framework diagrams visualize and characterize team communication in complex settings. They are constructed based on research about the flow of information between personnel. Data analysis involves the use of coding schemes to categorize modes of interaction, including verbal and nonverbal paths. Research queries can extend to communication preferences, frequency and topic. A product development inquiry might ask, How often and by what means does the industrial design team communicate with systems engineering (and vice versa)? The construction of communication framework diagrams can elicit problems in crossfunctional interaction. By exploring team communication patterns, it is easy to expose areas of opportunity and improve the flow of data during development.
Value-stream mapping is a method of documenting processes and flow. Adaptations of the method are often employed to identify touchpoints and key stakeholder values. The practice can be applied at different scales, including the flow of data, materials and people through an ecosystem. Its use to analyze the development process of a whole company, a single project or an individual deliverable is particularly helpful in strengthening cross-functional partnerships. The exercise identifies operational issues and ensures that outputs and measures are tailored to the audience. It also uncovers responsibility overlaps and gaps. For example, a value-stream map of a development process might help reveal that mechanical engineers enjoy working with industrial designers since the partnership reduces their responsibility for exploring surface geometry, whereas software engineers find the partnership a burden due to gaps in the flow of information.
INNOVATION SPRING 2020
47
M O D E R N ME DI CI NE
PERFECTLY RIGHT OR PERFECTLY WRONG: SOMETIMES DESIGN FEELS LIKE SPACE FLIGHT
On the subject of space flight, Chris Hadfield once said, “For an astronaut, especially at launch, half of the risk of a six-month flight is in the first nine minutes.” That’s putting it lightly. Underneath his calm demeanor, I think he is sharing an intimate moment with us. After years of dreaming and aspiring to reach space, you find yourself at last on the launch pad moments away from everything you’ve trained so hard for. You climb into your rocket—which you know is actually a bomb that will either explode perfectly right or perfectly wrong—and in this moment the main question on your mind will be, Wait, what the hell was I thinking? I remember a similar feeling in 2014 when I joined Intuitive Surgical as its first in-house industrial designer. I sat down at my cube, looked up into my future and dreamed about the studio we would build, the designers we would hire and the amazing things we would do. Then I looked back down at my cube.
48
IDSA.ORG
The intuitive experience inside the console is contrasted by the physical complexity that makes it all work.
There was no question that this was the place for me. Long before I arrived, this medical technology company had already designed, developed and manufactured the first four generations of the da Vinci Surgical System, which combine robotics and immersive 3D visual technology to enable surgeons to operate inside the human body with enhanced vision, precision and dexterity. As a designer, I found sitting behind the console of a da Vinci System for the first time almost transcendent. The core of this experience is a skillfully crafted human-tomachine synchronization where the system is guided by the surgeon as a natural extension of the surgeon’s eyes and hands. It is undeniably a labor of love, an inspirational act to design an interaction like this—to make a machine and a human being fit together so well. I could recognize what a triumph it was. I walked away from that first demonstration wondering, How can we make every part of using the system feel as natural and intuitive to users?
Don’t Bounce Off, Don’t Burn Out Intuitive made the decision to build an in-house ID team because leadership saw design in its future. That was the spark, but the path was undefined. It was humbling in those early days to take in over 20 years of innovation and ask how ID could possibly improve upon it. My sense was this would be the fun part. The hard and risky parts would be managing a transition from a design-as-service model (the consultant model Intuitive had previously employed) to a model that would launch and sustain an in-house design team. We needed to build the space, the capability and the trust from scratch. We knew there was huge potential, but first there was much to learn. It turns out that the first and most valuable lesson was humility. Even those of us who had backgrounds in medical device design had never been involved in something as complex as this, from the advanced robotics in the system to the workflows and norms of the operating room. We had
INNOVATION SPRING 2020
49
M O D E R N ME DI CI NE
The iconic ergonomic profile for the controller for the Ion Endoluminal System was developed as a tight collaboration between industrial design, human factors, clinical and technical teams.
to go back to basics. We had to build relationships. We had to learn about the product, the workflows and the industry. Design needed to reach out for knowledge and learn from others to earn trust and build understanding. Today, as we continue to build our team, we look for this capacity in a designer. We know we are going to give them a lot to learn and challenge them to grow—no matter where they come from and what they’ve achieved in the past. This kind of humility is the core of how human-centered design works, and this is the basis of good design. When we work this way, we include others and build consensus. We go outside of ourselves and our comfort levels. We base our decisions in iteration and observation and move forward together confidently as a team. We become great collaborators and great partners furthering Intuitive’s overall mission of striving for better patient outcomes. There is no better way. A lesson in humility is also a lesson in design. The second lesson we learned as a group was to be ourselves and speak up. It was vital to bring a designer’s perspective to the teams we were working with, and from the beginning certain things needed to be discussed for ID to have a path to success. We found that when we strengthened existing values, the road was smooth and comfortable, but proposing new values often gave rise to more bumps in the road. This is often where designers fail. A metaphor I refer to often is that this is like a space capsule reentering the
50
IDSA.ORG
atmosphere: Come in too steep and you will burn up. Come in too shallow and you will bounce off. Finding the balance between being humble and empathetic enough to connect and blend with the insight of others and confident and capable enough to motivate others into new territory—that was the ultimate project. The hardest thing about speaking up is knowing when and how to do it. Don’t let that stop you. It is a natural instinct to reflect the language and voice of the majority in order to get by. It’s true that when collaborating with engineers a designer must learn the language of engineering. It’s also true that the designer must be brave enough to find and use their own voice to ask questions and share views. Something important is lost if they don’t. It is difficult to keep that steady, balanced angle of approach, blending with others and sharing our views, but that balance is required. Enter the Atmosphere The results are better when everyone speaks and understands each other’s language. While we have been creating products together at Intuitive, we have also been creating culture. One particularly steep learning curve at Intuitive is vocabulary. There are acronyms for everything. A designer must grapple with the laws of inverse kinematics and robotics while also grappling with how to pronounce “pneumothorax” properly in a room full of thoracic surgeons. It can be tough, but once designers absorb these concepts
The da Vinci SP Surgical System.
for themselves and can converse in these terms, their ability to collaborate improves. For our part as designers, we’ve added a few terms into the mix. Now it is not unusual to hear words like “intention” and “affordance” spoken by non-designers in feature prioritization meetings. The key to culture is the shared ownership of values. It is here where we have seen the power of language in culture as well as the necessity of speaking your words. Words alone aren’t enough, though, especially when it comes to design. We say in our design group, “Show me don’t tell me.” This phrase emphasizes the essential fact that the work is where the truth is. In any medical device company, the designer’s work will be challenged and questioned relentlessly, and in that sense, it will be purified. Never wait to give form to your ideas, and bias toward action. Share your ideas before they become too precious. Bring all your senses into the conversation. This is often where the real dialog begins. Stick the Landing Over the past year, the da Vinci SP System and the Ion Endoluminal System have won many awards. It is a boost for our design team to be recognized by our peers—an even bigger boost to see our work embraced by the physicians for whom we design. We can’t describe the satisfaction that comes from designing for the well-being of others.
These systems are the first of what we intend to be a long legacy of in-house design at Intuitive, where we strive to present the best industrial design can offer in concert with uncompromized engineering, clinical functionality and human factors and the influence of the clinicians and care providers who partnered with us. You see all of Intuitive in this remarkable technology, not just Intuitive’s design group. I feel like the health industry is about to experience the beginning of a golden age for design. While design flourishes over the next decade, with exciting technologies coming into play and medical device companies investing in design like never before, many designers will be finding their way. They will find the opportunity to start something meaningful and to grow and learn, and they will bravely risk those first nine minutes and adapt their approach along the way. I am excited for the coming decade of exploration and accomplishments in healthcare—and perhaps equally excited for the lessons this industry has to teach our profession. By exploring what design can bring to healthcare, we will discover so much about design. —Tim Hulford, IDSA Tim.Hulford@intusurg.com Having always worked at the forefront of human-centered design and technology, Tim Hulford is the founding member and creative director of industrial design at Intuitive.
INNOVATION SPRING 2020
51
U N I V E RSAL DE SI G N
DESIGN FOR HEALTHY AGING
I
n the United States, 48 million people are over the age of 65. The National Institute of Aging predicts that this demographic will double by the year 2050. Growth can be attributed to better medical care, diet and lifestyle (e.g., smoking cessation and staying active). What is most notable, is that the oldest-old population—people over the age of 80—is forecasted to triple by 2050. In Asia and South America, this demographic will quadruple. Aging is defined by Emily Karolidis, a graduate student at the University of Oregon, as the progressive deterioration of organs and tissues, resulting in a reduced capacity to regulate internal processes. Historically, products designed for the aging demographic have been underrepresented or designed in a manner that neglects modern insights or data collected from the user. As a design educator and researcher who focuses on the creation of performance products for underserved users, I see the incredible opportunity that the aging population provides to teach, conduct studies and innovate products. What is Healthy Aging? Knowing that longevity is connected to being healthy, our research team at the University of Oregon (UO) wanted to learn how we could better support the aging population through product innovation. We conducted a study to understand from aging users what healthy aging means to them. Two-hundred and ninety-four subjects (43% men, 56% women) participated in our study with a mean age range between 70 and 79 years. Overwhelmingly, we learned that healthy aging equated to being active and having independence. Activity was important, no matter one’s physicality. Activities reported ranged from working out to walking and from going out to see friends to getting around the house, especially going up and down stairs (with and without wheelchair or cane
52
IDSA.ORG
support). When asked the question “What products could be developed to improve your mobility?” subjects suggested a wide range of products, including apparel, footwear, gym equipment, furniture, tools, medicine, better pathways and exoskeletons. We even had requests for teleporters. In all, the desires of the aging are similar to ones of the younger population. We all want to be active, connect socially and have suitable products to enable those endeavors with independence. We all seek innovation and use innovative products (77% use a computer and/or mobile device), but the aging population is wary of technologies that collect metrics because they could potentially compromise general privacy and access to health insurance. We all also desire aesthetically pleasing products that do not scream “I belong in a hospital” or that brand us as inferior. We all want to be designed for respectfully. Educational Approach As part of our study, we developed a senior/graduate level course for students at the UO College of Design to experience working with the data collected and interfacing with aging users to innovate new products. The course is currently in process and utilizes a universal design approach. Students have been tasked to create products that are usable by everyone without the need for adaptation or specialized design. The course invited students from all disciplines within the college to participate across two campuses (Portland and Eugene) to foster an interdisciplinary creative experience. Because students in our college practice in a variety of creative disciplines (architecture, historic preservation, interior architecture, landscape architecture, art and product design), we structured the work around themes of mobility, memory and metrics with design solutions that could touch the body, intermittently touch the body and surround the body (right).
SURROUNDS THE BODY
INTERMITTENTLY TOUCHES THE BODY
TOUCHES THE BODY
HUMAN BODY
An approach to developing design solutions for healthy aging products.
Design Research Considerations In addition to the traditional research considerations used to design products (e.g., form, business, marketing, materials and manufacturing), less explored aging-specific research zones can provide beneficial insights to anyone working on products for this population. Some of these include: Activity: As the body ages, deterioration of nerves, ligaments, muscles and skeletal structure can cause pain, arthritis and paralysis, resulting in a reduced capacity to move the body and to be active inside and outside of the home. As staying active is a major desire to healthy aging, it is important for designers to understand the anatomical mechanics of mobility and the diseases that affect it. Designers also must understand how mobility can be enhanced through therapies, surgery and medications and identify ways that products can aid or replicate these remedies. In a traditional sense, when we think about designing products for mobility, we think about cars, bikes and footwear, but with the aging population, it could include items like braces, utensils, supports, canes, walkers and wheelchairs. Anthropometry: The research field of anthropometry involves the collection and understanding of body measurements. For the aging population, there is very limited and relevant anthropometric data for designers—most has been collected from U.S. military personnel under the age of 35. It was not until recently that 3D anthropometric data of aging users was collected through a study call Size North America. This type of data is quite useful to designers; we can measure any part of the body, take cross-sections of the body to understand how measurements are distributed, develop better sizing systems and use 3D files of the body to build product CAD files upon. As the body ages, its shape changes, which directly influences how we should form, fit, size and body map product functions (next page). Memory: Memory is the brain’s ability to encode, cache and then recall information and previous experiences. In our study, we found that participants had most difficulty recalling names and words. Numbers and dates were also challenging but clearly delineated from names and words. This knowledge is important when designing products where users have to recall passwords or work in environments where the recall of object names is necessary for executing important tasks. Simplification of information,
INNOVATION SPRING 2020
53
U N I V E RSAL DE SI G N
Body scans of aging male bodies when chest and hip measures are controlled, from the left, at 40 years, 60 years, 80 years (courtesy of Human Solutions of North America).
like the integration of logos, patterns or color codes on products, could be more helpful to aging users. Senses: The five senses of hearing, sight, smell, taste and touch allow us to understand and perceive the environment around us. The decline of the senses is what we usually notice first about an aging individual where they may not hear or see as well as they did before. When the body loses its ability to sense, it can affect other bodily functions like gait, thermoregulation and memory—which then ultimately affects independence and mobility. Thinking about how we can enhance the senses through design could include developing perceivable color palettes, graphics and textures; engineering sounds that can be recognized clearly with hearing aids; or designing kitchen appliances that can enhance the eating experience through taste and smell. User Insights: Lastly, there are great opportunities for designers to gather user insights with the aging population. Although researching the consumer is common to our design practice, our experience with aging users has been really fun and insightful. We have found that aging users are more straightforward and willing to spend time chatting about ideas, especially with our students. For our research and course, we have been partnering with the Eugene/ Springfield Osher Lifelong Learning Institute (OLLI). OLLI is a nationwide intellectual and social community of engaged adult learners that connects members to emeritus and current university faculty, as well as professionals from the community. Local organizations like OLLI provide endless opportunities for professionals, academics and students to
54
IDSA.ORG
connect with the community and learn from each other to design better products. In the future, a quarter of the US population will be comprised of people over the age of 65. Considerations about enhancing activity by developing products that assist with mobility, fit/sizing, keeping the brain active and engaging the senses are imperative. As designers we have a great responsibility to learn about this population and consider universal design principles when creating products that may have been briefed for younger consumers so everyone can be included. —Susan L. Sokolowski, PhD, IDSA ssokolow@uoregon.edu Susan Sokolowski is the founding director and associate professor of the Sports Product Design Graduate Program at the University of Oregon. Research Sponsorship and Acknowledgments Susan L. Sokolowski is the PI of the Universal Design for Healthy Aging project, funded through the 2019-2020 UO Tinker Hatfield Innovation Award. Project partners include Mark Fretz – UO Research Assistant Professor/Associate Director of Outreach, Institute for Health in the Built Environment and Esther Hagenlocher – UO Associate Professor Architecture and Interior Architecture. Research and student critique support has been provided by the Eugene/Springfield Osher Lifelong Learning Institute (OLLI). 3D body scans were provided by Human Solutions of North America.
October 6 - 7, 2020
DIVE
DEEP
WOMEN NEW I N D AT E S D E S I G N Columbus, Ohio A gathering built to recognize the unique talents, initiatives and challenges of women in the industrial design industry. Join us for one and a half days of dialogue and fellowship with some of the leading female and female-identified designers who are making an impact. Hear from designers who represent all stages of a career and who work across a broad spectrum of practice areas including industrial design, UX, service design, and more. idsa.org/WID2020
INNOVATION SPRING 2020
55
A F I NAL T HO UG HT
VALUE INTERNS
I
t’s the time of the year when thousands of students flock to job boards in search of the perfect internship, many hoping for the opportunity to finally start paying off their loans. One would think that in 2020 most companies and design studios would be offering paid internships. It’s surprising to see how many aren’t. Five years ago, I was the internship coordinator at the University of Illinois at Chicago’s Industrial Design program. Even then, the number of unpaid internships that came to my inbox was astounding. Luckily for the students, the school had a strict policy of rejecting these opportunities, viewing them as harmful to student growth and development. I recently spoke with Norio Fujikawa about his thoughts on unpaid internships and found that his view of interns is admirable. As the executive creative director of Astro Studios, a prestigious design firm in San Francisco, he gets hundreds of applicants for their yearly internship program. He conducts his interviews for the intern position the same as he would for a full-time position, because everyone, even interns, are a part of the design team. Intern or not, they are contributing to the work, and therefore, he believes, they should be compensated. He added, “I just don’t see an unpaid internship opportunity ever happening in San Francisco. Not only is it impossible to live here without getting paid, it’s just unethical. It’s also detrimental to the profession.” Meanwhile, in another expensive city across the country, a counterargument is being made. New York– based industrial designer Karim Rashid made waves in the design community by defending the use of unpaid
56 56
IDSA.ORG
internships, claiming that the professional experience is much more valuable and less exploitive than paying to learn at an expensive university. Even with the caveat of a three-month limit on an unpaid internship and the possibility of a stipend, I am baffled by this ideology. A major issue here is definitely the cost of education, but even so, the target population for internships can’t live humanely without an income, even for just three months. Whether a recent graduate or current student, it’s more than likely that they’re barely meeting their financial obligations, if at all. Internships exist because there is value in teaching students and recent graduates how to navigate the professional world of design. The whole point is to give them the opportunity to be a part of it, to mentor them and to give them the confidence to showcase their talents, even if they’re still working on improving them. In a field that relies so much on talent and creativity, young designers need to learn how to fairly and competitively value their work within the safe walls of an internship. And for that reason, it’s truly a disservice to put interns in a position where they are expected to work alongside professionals but not be compensated for their contributions. We should be asking ourselves, How much do we value interns? And further, how much do we value the next generation of designers? How much do we value the future of our field? —Hector Silva, IDSA hello@advdes.org
INNOVATION SPRING 2020
57
Stay Curious. hs-design.com