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Designing health


As the Irish election looms, our health sector is a major issue on the doorsteps. Leo Varadkar has stated that there is no quick fix to the system, and only incremental, strategic changes over time will improve the service. We spend enough (relative to other countries) on health to expect a better service and results. Recently launched was the Health Innovation Hub to encourage private companies to jointly develop products and research with the health services.

Last year, as I lugged my child’s bulky manilla folder of medical files from department to department in hospitals, and spent a half hour explaining her history to each of the multiple medical professionals I met, it definitely didn’t feel like the most efficient service. The waiting time for letters to be transcribed, signed, posted and delivered can seem like an age when we live in a world on whatsappslack and co. Realising the hospital pharmacy shuts at 5pm seemed a bit bizarre – don’t get sick out of office hours is the lesson. I also experienced the trolley crises. Next time you complain about a wobbly wheel on your supermarket trolly, go spend a night in A&E.

Things are moving though. Public consultation on Electronic Health Records (EHR) for all is ongoing with Richard Corbridge of eHealth Ireland (part of HSE) leading the initiative. However, PatientsKnowBest.com is pushing for patients to maintain their own records, as opposed to a hospital or state owning them. eReferrals from GPs are being successfully piloted. Unfortunately, technology is generally regarded by the HSE/Government as a cost, not an investment. Public sector websites for instances are procured under IT rather than creative/marketing.

Glohealth recently launched their ‘Skype’ GP service, which allows you to video call a doctor 24/7. Surely when this goes mainstream it will reduce waiting times in primary and secondary care centres? There are apps now that give real time surgery updates – to reduce the stress of loved ones in the waiting room. I suppose that depends on the outcome of the surgery. Technology is years ahead of our public system. I recently saw an app demoed that enquired as to why the user hadn’t left their house in days and hadn’t answered any of their  close friends calls? Are they feeling down? Would they like their GP to call them? This is the future.

The goal of all health systems should be prevention not cure. However the obsession to optimise the existing diagnosis/post diagnosis system means we are starting the plan at the wrong place.

Interestingly, when I look through the list of job titles in the HSE and entire public sector, there is not one person with a job title of ‘designer’. I say let the designers at the health system. We are trained to think about the user (patient) and to design a system with them at the heart of it. Not an IT system, but a customer experience. Who can remember the last time they completed a satisfaction/feedback survey from a clinic or hospital? NPS for medical professionals?

Is there anywhere in Ireland I can go and look at a map that shows how we are going to improve (and monitor) the nations health and the medical system when they do need treatment? Does anyone have that plan? I could probably sketch it out on the back of a fag packet if anyone ever asked.

Finally, regarding the huge cost of our health system. How much would one free mandatory health check per person per year cost us? How much would one free mandatory health check per person per year save us? Health has always been, but is now fully recognized as real wealth. If we put as much effort into designing our health system as into complex financial products and spin doctoring, we could create something world class.

The election is over but without a government in place we have no health minister. The HSE however are still in town and for all intensive purposes are the health system. In March’s Marketing.ie magazine, I looked at some of the issues in the health service in Ireland but also some of the amazing innovations going on globally. Smart design can sort our health system in Ireland and create an international template for best practice.

The idea of ‘user’ centricity or in this case ‘patient’ centricity is not new. It is however more of a written concept than a practised concept. Really understanding the entire patient journey can improve the interaction and outcome. However most Health Care Professional (HCP’s) have a small task to complete in the overall patient journey and are often unaware of what comes before and after them. Many private companies have intensive on boarding training that requires staff, no matter their level to work in all areas of the business for a period of time e.g McDonalds senior management work behind the restaurants counter. If the HSE / Dept. of health practiced this I am sure there would be a far more holistic view and better outcomes for all involved. Disney, Apple, Amazon, Zappos are some of the leaders in this area. As opposed to looking at healthcare in other countries look at how top brands do it.

To become more patient-centred, the Mayo Clinic in the U.S changed it’s design systems scheduling routines, staffing, and facilities to revolve around patients, rather than physicians or other care providers. It now schedules work based on what will provide the most effective and efficient experience for the patient, instead of what is convenient for the physician. Weekend consultant in Ireland anyone?

Patient centricity is currently a key focus for the pharmaceutical industry. Without the pharma industry of course the Irish economy would be a shambles. Traditionally a sales focussed industry the idea of really understanding a patients life and journey is now seen as key to being a trusted and helpful pharma brand. This of course in turn affects a companies culture and becomes a more attractive place to work. In a sector where talent acquisition is a huge factor this is a win win. Ultimately designing a better experience can improve the outcomes for all parties.

One of the key issues in health is adherence, literally taking your tablets, or administering an injection at home. Patients comply with their medicine schedule somewhere between 50-70%. So up to half of patient issues regarding non adherence could be solved. Companies like Health Beacon which monitors adherence by sending texts as reminders when medicines are not taken and AI Cure which uses artificial intelligence to confirm ingestion in clinical trials and high rick groups are just two applications of smart design to solve problems that were almost seen as impossible to fix.

Well designed technology has made it much easier for HCPs to access the data they require. Many GPs now spend more time looking at their screens than at their patients. Live consults with other HCPs online is an amazing way to speed up diagnosis though and is growing in specialist areas with the use of platforms like DefinitiveDx. HCPs use online resources to find drug information, prescribing guidelines and even view the highlights of a seminar that they couldn’t attend. These technologies need to be maximized in our system which is obsessed with a longer more staged based.

Burning books. Having experienced the health sector intimately in the last few years I have to address my personal pet hate. Paper based healthcare systems to me are something from another era. Without universal digital data the health system is hamstrung with administration and processes. Most tech companies have completely automated this part of their business. HCP’s should be delivering healthcare not health administration. This change needs dictatorial like leadership. I’m not sure who has the strength or vision to do this. Estonia have the world’s first digital led public sector. Flights to Estonia are commonly filled with Irish public sector fact finding missions. Stop finding, start doing. And get some design help while you are at it. Recognise this skill set does not exist in the HSE. The design industry is waiting to help.

This article was originally published in Marketing.ie magazine in February and April 2016.

As disciplines converge

We have all been in meetings where the client decides that all their agencies need to get round a table and share/contribute to the common good, namely the brand. The media agency looks over at the digital agency and identifies what piece of their pie they would like. The branding agency looks at the ad agency and decides, these guys need templates. The PR agency is wondering “why spend money on advertising and why have a digital agency, when they can handle everything through social?” And the ad agency wonders why the client isn’t only listening to them. So in the Marketing.ie world there are no boundaries anymore. No clear division of tasks. And the big integrated agencies are on the rise.

Design is no different.

There’s a convergence of service, business, industrial, product, UX, customer experience, graphic, packaging, motion, web and brand design. Key to this is the app world. The creation of apps draw on skills from all these disciplines, so convergence is no surprise. Multi disciplinary teams in the app world are the norm.

ICAD recently hosted an evening in the Sugar Club entitled 2X. Umesh Pandya of ustwo spoke about Wayfindr, an amazing open source system they designed which gives audio directions to visually impaired people to help them navigate the London underground on their own. In order to deliver a solution like this, there was a team of a range of skills required, all coming from the design agency. Check out their video on YouTube. Terry Stephens of global design group Moving Brands spoke about how they use motion design (video + animation) to set a brand mood before a designer would even lift a pencil or mouse. Moving Brands is responsible for the new Eir brand. Love, hate, or care less about ‘life on Eir’ the way they have taken the standard mood board to a new level was quite exciting. They considered how a brand lives and feels in the real world, rather than starting with an identity. An in-house multi-skilled highly collaborative team was key to the process.

The Institute of Designers in Ireland (IDI), led my Marc O‘Riain, represents over 800 designers from a cross-sector variety of interests. The convergence in the industry is also reflected by designers seeing themselves as a community, industry and ultimately a lobbying body. Yes, a return to prosperity always helps industry bodies but national initiatives like Year of Design are definitely helping the industry’s PR. IDI have also just introduced The Register of Irish Designers. 
The term Registered Designer will be ‘a mark of quality assurance for the design industry, to its clients and the public as a whole that they adhere to the highest international design professional and ethical standards’. So Registered Designer label, rather than specific graphic designer or product designer, may become the new norm in business in Ireland. The Design Business Association in London hosted an event entitled ‘New horizons: what’s the real impact of design in business?’ The sessions, all of which proved most absorbing, explored the rise of those with design authority in the boardroom, the role of design thinkers and design doers, and the rise of strategic innovation consulting.

Call it what you will but design skills, the thinking bit, has now become valued more than ever. The ability to think like a designer is now highly sought, whatever their specific design discipline. The corporate world does not foster this skill set although badly needs it to solve problems, capitalise on opportunities or communicate complicated ideas. Simplification is the ultimate goal of design. Convergence means simplification – a simplified briefing for clients, a simplified customer journey based on a multi disciplinary approach. Great simple thinking that makes things better.

Finally, some important design dates coming our way should be noted in diaries. Design Week runs from November 2nd-8th, while the IDI Awards night is on November 26th.

This article was first published in Marketing.ie in October 2015.

Harder, better, faster, stronger

In 1990, I was still in school and recovering from Féile ’90.

Desktop publishing had started to take hold and was to revolutionise, democratise (some might even say homogenise) and forever change the design industry. Apple, now the biggest company in the world, was struggling to exist with the design industry as it’s only real customer. To make some people feel very old, System 7 was released in 1991. In 1990 the internet was virtually unknown and the closest thing we had in Ireland were imported Argos and Damart catalogues. Design was concerned with the print world. Many designers made their living from managing print rather than design. Repro house, The Type Bureau, threw the biggest industry design party in town. Design agencies were broad in their services offered and the industries they served. Specialised branding, packaging, POS, web (then digital), FMCG and B2B disciplines began to emerge, although Irish agencies were often still one-stop shops.

Much has changed, but a lot has stayed the same and in the opinion of some, regressed. To get an idea of how Irish design has moved on over the last quarter century, I asked a number of leading creatives and agency owners old enough to remember what they think has changed, and what’s been for the good. The rise of digital and the range of channels available remains a challenge for the design world. Many would argue that the web design agencies were more into development than creative. Mary Doherty of Red Dog says the constant, almost weekly, arrival of new digital channels – including mobile – is a challenge.

Gerry Whelan from Brandcentral agrees that although challenging, it means more opportunities and more work for designers looking at all of a client’s channels whereas before, it was about designing for single channels. Go back 25 years and there was no time and yet despite all the developments in technology, there is still no time.

Former Design Business Ireland chairman Alan Howard says there is not even time of the “overnight test” anymore.

Siobhan Griffin of Clickworks believes there’s and over-reliance on stock imagery. A government department recently sourced their logo online for $50. To think, 25 years ago, the job of selecting an image, buying it, scanning it, and getting it print ready took over a week, now it can take 10 minutes.

It’s not just about the increasing complexity but it is the “speed of change” which seems to be accelerating. But not all change is bad. Andrew Bradley of Bradley Brand & Design feels there is now a better focus on getting the design brief correct from the start and not jumping into the process immediately. As a result, the standard of creativity is higher as both clients and designers strive to differentiate more.

Good clients have an understanding and appreciation of design beyond return on investment (ROI), particularly with websites. Clients are more aware of what is happening internationally than before. It means Irish designers must raise their game, but it is also easier for Irish agencies to do international work – sadly, few do.

A quarter a century ago, a client went to a design agency for design. One in three designers work in – house and Bradley expects it to rise to one in two. Ad agencies, PR firms, media agencies, print management companies and digital agencies all offer design as a core service. So too are management consultants and big tech companies. The likes of IBM, McKinsey, Ericsson, Accenture and Deloitte are recruiting top talent from the industry. They see how design is core to the customer experience and something that is rightfully taking its place at boardroom level. Apple is probably the world’s most famous design – led company and clear proof of its commercial value. Since Marketing.ie was first published, design has become more competitive, faster, and more complex. But it is finally starting to become a core part of business – before, it was merely a vanity exercise for some. To continue on the right path, designers must understand a client’s business and that’s not just down to branding.

So the identity guidelines and annual reports may not be the lifeblood of a design agency anymore but the arrival of more design – focused companies, and the range of digital channels is good news for the next 25 years. Finally, a somewhat nostalgic mention and farewell to scalpels (and A&E runs), spray mount, ZIP disks, Quark Xpress, fag breaks while files saved and illegible faxed proofs.

Special thanks to Mary Doherty, Red Dog; Gerry Whelan, Brandcentral; Andrew Bradley, Bradley Brand & Design and Siobhan Griffin and Alan Howard from Clickworks, along with countless others whose brains were picked in passing.

This article was published in the 25th anniversary of Marketing.ie Magazine – September 2015.

Persuading & Nudging

Persuading & Nudging

Design needs to capture the attention and set a tone but increasingly a designer’s thinking is used by organisations in a non-graphic way. Most of us in marketing try and change consumer behaviour. Changing may of course involve doing more of the same thing, Advertising may at time be guilty of the sledgehammer approach and design of the too-subtle-for-it’s-own-good approach.

Persuasive design – mainly on websites – and nudge theory are two ways of trying to change behavior. Persuasive web design aims to change user behaviour and perception through social influence online. It is more subtle than ergonomic design – simplifying the user’s interaction. Ultimately, if done right, persuasive design can result in a user interface or website which is more enjoyable and user friendly.

Most of us will observe the behaviour of other people to judge what is considered normal or socially acceptable, and then mimic such behavior. When applying this to persuasive design, it is known as “social proof”. When shopping online and looking at a product page, you may see a feature on the page with the title “People who bought this product also bought…” – this is social proofing. Facebook and Twitter use social proof by giving users the option to “like” or “favourite” content shared.

Another persuasive design technique is “Framing”. Imagine a digital service for sale where there are three alternative options to choose from which to choose. Two of these options are merely distractions. The first option is exaggerated and fully featured, while the final option is stripped back so much that it is barely useable. The option you want the user to choose is the middle option, it has more features than the minimal choice but less than the first – it feels “just right”, so such framing is often referred to as the Goldilocks effect.

As noted by UX guru Jakob Neilson and other researchers, the default settings on a user interface can greatly influence a user’s behaviour. You may want to pre-populate fields with default values that persuade the user or hint at what to enter on a form. The default setting is often viewed by users as the recommended option. Another example would be search engine listings. Most people will click the top listing as they see this as the recommended option, but it’s not necessarily the most relevant to the searched topic.

People will feel more comfortable using your website if they believe it comes from a credible and influential source. The “authority” principle is how to influence a user’s behaviour through trustworthiness. Layout, typography, colour schemes and visual appeal help, but it is not enough. To really make a user feel comfy more credible factors need to be added. For example, logos for accreditations and awards. When selling products on a website, the use of trusted security symbols and payment processors works best.

In his inspiring book, InfluenceDr Robert Cialdini says once we have made a choice or taken a stand, they will encounter personal and interpersonal pressures to behave with that commitment. The pressures will cause people to respond in ways that justify earlier decisions. So we like to believe that our behaviour is consistent with our beliefs. In persuasion design, we can apply this by requesting a publicly visible small commitment from the user. Once they commit to following you on social media for example, they are more likely to continue to “like” posts on your news feed as they have already committed.

Users can be persuaded with rewards for particular tasks – like following us on social media or signing up to a newsletter. Rewards include premium content. Users can be asked to “like” a brand on Facebook first to get access to content. Sites like Hubspot offer premium marketing content and information which can be downloaded as PDF’s. To access such quality content, you must first sign up to their newsletter.

Users will only give consideration to content which is relevant to their current task, and may react adversely if distracted by information which is wasteful. A person will uphold this “tunnel vision” until they have finished the task or reached a milestone. In persuasive design, these “seducible moments” (one for the meeting lingo bingo) – It is when a user is open to distractions outside of current tasks.

From a less commercial angle, nudge theory uses positive reinforcement and indirect suggestion to achieve it’s aims. Obama and Cameron have used nudge in forming policies. Examples of nudge include the image of a fly on urinals to improve the gent’s aim, reducing energy use in US homes by telling the bill payer how their usage compared to a neighbour’s and green footprints leading to bins reducing littering.

Many elements of persuasive design overlap with nudge, but design thinking is core to both. Now, Google “choice architect” and see how much persuasion you can spot in your daily browse.

This article first appeared in Marketing Magazine – Design Brief – July/August 2015


What clients want

John Moore on the art of agreeing a client – agency prenup.

Whether you are from the design agency side or the client side (often known as “the dark side”, a moniker in itself which is psychologically most probably a bad start for a relationship), you will probably either have experienced frustration from the other side not listening, not explaining, or simply just being plain stupid. Sadly, it’s a common occurrence.

Mark + Paddy’s (Google them) excellent series of posters highlight some great , albeit worryingly common, client comments…”I’ll know what I want when I see it“, or “I really like the colour, but can you change it?” or “I’m the target market” and “I don’t like it“. Another includes “We need more images of groups of people having non – specific fun“.

Or you find them asking “Can you turn it around in Photoshop so we can see more of the front?” and even “we can’t use the national anthem because it’s too IRA”. Pixel Fox Studiosposters highlight some of the common language used by clients who don’t want to pay. Like, “there are more projects lined up so charge extra next time”.

Even “we are a big name to have in your portfolio” and “this is just a five – minute job..” sometimes, “other agencies charge much less..” or “We’re a non – profit organisation”. So yes, there are inexperienced or just plain bad clients, but there are also many experienced clients who have behaved this way but have never been properly challenged.

Agencies are more likely to rant among themselves, or stew and suffer rather than confront. The average size of design agencies being under five people is a problem and sometimes the balance of power in the client / agency relationship can be askew.

On the flip (dark) side Shan Preddy of Preddy & Co design training and consultancy in her books on the UK Industry writes about what frustrates clients most in dealing with agencies.“Navel gazing purists hanging on to a design to the detriment of commercial viability” is a personal favourite comment of mine. The lack of a true understanding of a client’s business often ranks number one. Design agencies being obsessive about brand guidelines is a common complaint, and being particularly protective and defensive when other agencies are involved. They are guidelines, not a rule book.

The lack of confidence and professionalism in presentations is cited as an issue by clients. As is the ability to deliver from the start to the end of complex projects. In general, clients appreciate and enjoy the creative work but can feel let down by the rest of the package. Up To The Light’s survey reveals nearly three quarters of clients wish their agencies were more proactive, while 61% wish they were more self – critical.

So nothing particularly new here. Good design comes from good relationships. And a lot of trust. So why not design the relationship from the start. Clearly map out the scope, agree staged sign off procedures, understand subjective likes and dislikes, understand what has and hasn’t worked before, agree how the day the day work will function and how problems which may be encountered en route might be solved.

Understand why previous agency (and client) relationships have failed. Finally, agree what success (from both sides) looks like and how you will be paid. It sounds very boring and practical but often after an exhaustive pitch clients and agencies jump into the honeymoon stage without a real plan of without really knowing each other.

Only fools rush in, as the song goes. The partnership needs to be designed, otherwise it quickly becomes an unreasonable order – taking operation. Treat the relationship as a brief in itself. To use the marriage analogy – it is built on ups, downs, compromise and sharing moments of success. Design needs to be seen by marketers as a true profession, not a trade.

If design is purely seen as tactical and aesthetic, many client comments like the ones above will continue. It seems simple, but the more professional designers become the more it will become a profession – and that would not be a bad thing at all.

This article was originally published in Marketing.ie magazine in May / June 2015

Design: Experts in weaving webs

why creating websites should really be left to designers

Once upon a time there was a powerful ‘being’ called the webmaster. The webmaster was the holy trinity of writer, designer and developer. Often from a network IT background, their role was more security guard than marketeer. The site’s design, accessibility and ability to change for marketing reasons was usually far down their list of priorities. Continue reading “Design: Experts in weaving webs”