Design Health: Can UX Change The World?

Fiona Murphy at UXDX EMEA. Video: https://youtu.be/oOEDVLQU0Vk

Readable transcript: edited from the recording's captions for readability (fillers and false starts removed, punctuation and section headings added). Wording is the speaker's own. Timestamps are positions in the video. Names marked [?] could not be verified against the audio.

Design as an alternative way of thinking

[00:00:00] Hello everybody, welcome to UXDX 2016. Fantastic introduction there, thanks very much, Hilary. I hope I can live up to people's expectations after that. My name is Fiona Murphy, I'm a co-founder and director of Frontend, and as Hilary pointed out, we're an Irish UX design agency. A lot of you might have heard of us, but for those of you who haven't, we were formed in 1998, and this made us Ireland's first UX design agency. In fact, we were probably one of Europe's first UX design agencies, and this gave us a great opportunity to work and, most importantly, to learn on an international stage.

[00:00:47] We worked across the world on design and research projects, typically solving complex problems. But enough about us. Can UX change the world? I've attended a lot of UX conferences and design conferences recently where it's been proclaimed that it can, and I'm not too sure if UX designers can achieve this on their own, but we certainly have an awful lot to contribute. In this new digital world many disciplines contribute and collaboration is key, but designers can offer an alternative way of thinking.

[00:01:27] Just as a way of example, I don't know if any of you here are familiar with Cameron Sinclair. He's a very interesting guy who does a lot of social good work, social needs projects. Recently he was working on a project in Kenya where he was tasked to build a water well. What he discovered was that with the same amount of money he could build a full-size basketball court. The water collected from the roof of that basketball court would not only supply the local school but would supply the entire village. And not only that, they produced excess that they could sell off. And not only that, they produced their first university students ever, and two of those went on basketball scholarships.

[00:02:11] You might notice that the basketball court is not a pretty building. Ideally it would be a pretty building, but in this circumstance it was not required. What I'm really trying to illustrate is that design is more than just aesthetics. It can be an alternative way of thinking and approach to problem solving.

Fitting the UX process to development

[00:02:31] Central to the UX design process is understanding your users and their contexts. It's creating ideas that solve their issues. It's validating designs, ideally with real users, and iterating until you come up with a solution that works. The UX design process doesn't always gel seamlessly with development processes like Agile or Lean Startup or similar. Developers often want to get coding as soon as possible, and the UX design process can seem very front-loaded with research and overall schemas, etc. Designers really like to get both a macro and a micro view of the world before they start designing.

[00:03:15] But the design process can be adapted to fit. You can introduce concepts like sprint zero, where you include research and you look at overarching architecture and different concepts. You can also look at detailed design for each sprint as opposed to overall detailed design, and you can run that in parallel with sprint cycles. You can look at component rather than page-based UI design and development, and you can also look at rapid user feedback loops. But I think the most important thing is you can look at all of these different processes, and it's about adapting them and combining them to best fit your organisation or your project needs.

[00:04:00] In terms of better product and organisational decision making, well-designed user research can be invaluable. It can be really, really valuable when you want to prioritise sprint cycles, and most importantly it can eliminate a thousand meetings, because essentially you're sitting down and you're saying, this is what the users want, this is what we should do.

A future vision of migrant healthcare

[00:04:29] To get back to the original question: can UX change the world? I think the best way to convey this is through examples, based on achievements rather than plans or suppositions. The first one I'm going to show you is a little bit unusual. It was a project we worked on recently, and it was a social needs project. It was a future vision of migrant healthcare.

[00:04:56] I'm going to start this project by introducing you to John. John is a UX designer in Frontend, but he also has a big heart. He's involved in a lot of social needs projects outside of his work in Frontend. Frontend is primarily a commercial agency. We've often toyed with the idea of giving back, but we've never really got around to it in a big way. Also, we wanted to work with the colleges and the universities and design colleges, so we wanted to engage with the next generation of designers.

[00:05:29] So when John came to us with a suggestion of a conceptual project that would explore if design could help in the current European migration crisis, and engaging students in the process, we thought this was a great idea. We approached the International Organisation for Migration, the IOM. They're an intergovernmental organisation, and they're funded by taxpayers all over the world. They work on a macro level defining policy, but they also work on a micro level, coordinating responses on the ground. For this project it was a perfect partner, because they're looking at both the strategic and the practical.

[00:06:11] We quickly identified healthcare as being a major issue, and luckily Frontend has a long history of working on healthcare projects. IOM are a 10,000-person lean organisation. Every taxpayer's dollar has to work. So often they're looking for the cheapest and the quickest solution to get on the ground as quickly as possible, and they don't always have the luxury of standing back and exploring different ideas. This collaboration really challenged their ideas of service provision and of problem solving within the organisation.

[00:06:51] Together we developed a student boot camp. We got a number of colleges involved, and 10 students over three days in Frontend worked on a number of projects. The response from students initially was phenomenal. We got applications from all over the world. The concept really was to explore ideas and for Frontend and IOM to refine these afterwards. The experience that we had with the students was absolutely incredible. There was a lot of work put in, and in fact a lot of the ideas that came out of boot camp were incorporated into the designs afterwards.

[00:07:32] By taking a UX approach we ended up looking at the problems completely differently from what IOM would typically have done, and the outcomes were completely different. We developed a number of concepts, and I'll show you these in a video later on. However, there was one in particular that stood out. What we knew from research was that a lot of the medication that goes out to migrants goes without a lot of information, and this adds to the anxieties and the uncertainties and the stress that migrants experience. So we looked at providing a standardised, graphic-based label that provided more information and also addressed literacy and language barrier issues.

[00:08:21] This is a fairly basic concept, but the IOM are really, really impressed with it, and they're looking at taking it further. This is the first one we're going to take further. So much so that they're presenting it to the World Health Organisation Global Health Cluster, and this is where all emergency healthcare providers come together to agree standards and practices on a worldwide basis. So essentially what started out as a collaboration with students ends up possibly making a huge change. That's quite powerful to us, and I think it should be to designers in general: design has the power to create impactful and hopefully lasting change. With that, I'm going to show you a quick video to give you an overview of the project.

Project video

[00:09:17] Civil war and poverty and terrorism are tearing communities apart. 65 million people are now displaced globally. This is the highest since World War II. Last year the International Organisation for Migration attended to the needs of 5.2 million people. Even though access to healthcare is a basic human right, because of the growing number of migrants and refugees it is becoming increasingly difficult to deliver that healthcare on the ground.

[00:09:49] Realising the pressure that IOM are under, Frontend volunteered to conceptualise a future vision for migrant healthcare. We approached the top design colleges, and what we wanted to do was to conceptualise ideas and come up with solutions for the challenges that the IOM are facing. It was a phenomenal response. We had applicants from all over the world wanting to come to Frontend and get engaged with this social needs project.

[00:10:26] Research is huge. It's very, very important for informing design. Without it you're designing in a vacuum. Canal [?], who was a refugee who had recently completed a journey, spoke to our students to help us in the project. "If we think these people are like Irish people, we cannot say it like this. There are so many people, they don't have information, they don't have knowledge of language, they don't know what they have to do."

[00:10:53] It was a great experience to meet and hear the story. It really puts things in perspective for when you're creating this kind of stuff. It's one thing to read about it, but when you have a person you can picture in your head, it changes from an international problem to a human problem. Empathy is a big thing in design processes. What's their current situation and what makes them want to use it? The research part is the start of this discovery journey.

[00:11:22] One of the main issues that we've come across is that a migrant might arrive and get tested for analysis of some sort, but not be around long enough to get the results. The students explored a whole range of ideas, and we took the team here at Frontend and worked with the IOM to develop those ideas and to see what was practical. There was a very clear need for a holistic solution and end-to-end service design, so this was the way in which we approached the project.

[00:11:59] A lot of what you see is almost like last month's problem, and it's changing all the time. Some of the things that we were thinking about, that it must be very transit, and there are train stations, and they're not; that's all stopped. The problem that we have right now is different from the problem when we planned the project, and it will probably be different in a month's time as well. Fundamentally, there is a duty to provide the same level of care to people whether they're in camps or they're in transit.

[00:12:30] Providing that continuity of care, though, is a real challenge. As patients move around, their healthcare records often are duplicated. So we looked at a cloud-based solution that would allow you to store their records electronically. As they move to a new station, they could access their records and their test results in their own language, and hopefully this would encourage patients to get the test in the first place. We could use remote video calling to provide healthcare directly to people on the ground. It would be good to get healthcare in your own language from a native or someone close to where you're from. It would also allow those healthcare professionals, who are often very, very busy but concerned as well, to give a service or give something back without interfering with their jobs.

[00:13:15] But movement isn't the only challenge. We're seeing people coming from different countries, which means we have different languages, literacy rates and hugely different cultures. One obvious area that was in need of improvement was medication labelling. Typically what happens is there's handwritten labels and they're stuck on Ziploc bags. Obviously this is inconsistent; it can cause confusion. There was a limited amount of information on the labels in the first place.

[00:13:43] What we did was we worked with the IOM and identified a solution for creating a standardised labelling system that aid workers can put onto the Ziploc bags themselves. We looked at important information on medication, conveyed that graphically, and made sure that more people understood the key messages that were on those labels. Obviously the medicines didn't go out with leaflets or anything like that, and we knew that a lot of migrants had smartphones. So we put information at the bottom that could be easily scanned and that would integrate with an app that would give the migrant or patient extended information.

[00:14:27] I think traditionally people see design as being an add-on, something that you put onto the end of the process. But really design is about fundamentally thinking things through and making things work. This collaboration is really coming at an opportune time, in that we're now able to see how we can continue providing healthcare to people who need it most. The potential is huge. I would propose, once it's ready, testing it out and running it out as a pilot. We hope that it will make the lives of everybody who's dealing with these crises much easier, through greater efficiencies, greater communication, greater understanding amongst all players. Good design and human-centred design can make a huge impact.

What commercial healthcare shares with the migrant crisis

[00:15:34] Thank you very much. Your appreciation is very well received. To get back to the commercial world, a lot of the issues that we faced in this project we also face in the commercial world. When we're doing research in world-class hospitals, whether that be in Dublin, in the US, Germany, wherever, with patients, nurses, doctors, the same issues are coming up. We've got literacy issues, we've got language barriers, we've got medication labelling issues and continuity of care issues.

[00:16:20] A lot of you might be very surprised that faxes are the glue that hold our healthcare systems together. Frightening. You might get an MRI scan done in one clinic and the results are faxed to your consultant because email is considered too insecure. You might think that their systems talk to each other, but no. Typically, hospitals and such will procure their own systems that don't necessarily integrate with others. So it's hardly what you would describe as cutting edge.

[00:16:59] But what's different in the migrant situation is that you're dealing with a crisis, you're dealing with a great amount of urgency, and you're dealing with very, very, very vulnerable people. This raises the stakes, and IOM have to respond quickly. Also, in order for IOM to effect real change, what they needed to do was to create small, well thought through, meaningful approaches that could grow and scale. So rather than creating an electronic health record that integrates with a number of countries' different healthcare systems, we looked at EHR light. That's essentially a self-contained healthcare record that resides with the migrant, albeit in the cloud.

[00:17:42] What we need to do is get the initiatives out there, demonstrate the effectiveness and share success stories. And I think that mainstream healthcare could learn an awful lot from this.

Estonia and e-government

[00:18:17] Are there any other examples where UX and design thinking make a huge impact? Obviously, Apple is an example that we all know. GOV.UK: they've embraced service design, and it's really changing how they're providing services in the UK. However, there are a few lesser-known examples, and Estonia and their approach to e-government is an interesting one. Design thinking, service design and UX have really changed the way in which they're delivering service to citizens.

[00:18:49] It was one of the first countries ever, of governments ever, to declare internet access a basic human right, and I think a basic human right is a very telling ethos. Technology and innovation is core to the government. Ministers are often described as IT or cyber ministers. They understand the value of embracing technology and, mostly, making it easy for citizens to use. For over 10 years they've had electronic ID cards based on chip and PIN technology, and citizens can pay for transport, vote online, do online banking, get a mortgage and even sign legal documents digitally. In fact, digital signatures save Estonia 2% of their GDP, and that's the equivalent of their defence budget.

[00:19:48] After they gained independence from the Soviet Union in '91, they wanted a transparent and open government. You could almost consider them like a start-up country. But very early on they demonstrated firm political leadership. In the 1990s they were offered an old telephone exchange system by Finland, which they declined because they wanted to get more up-to-date technology. This took a good bit of courage, because they had nothing in place at the time. But they appreciated that working off old legacy systems can stifle innovation and can negatively impact user experience down the line.

[00:20:28] Another important point of the approach that Estonia took was that their first ICT services were not made obligatory. People weren't forced to use them. They focused on the services that people wanted, like taxation and banking and the like, and they introduced them step by step based on citizen needs. Also, their approach to citizen data is very interesting. In Estonia, citizens own their own data, and they can see if anybody has accessed their data. For example, if they can see that somebody without authority has accessed their medical records, they can report it to the data inspectorate [?], and if that unauthorised person can't justify their intrusion, they can be fined. So it gives the citizens more control over their information.

[00:21:23] More recently, the direction that Estonia is going is that they are so confident their e-government systems and infrastructure are better than anywhere else in the world that they have launched their e-residency programme. Essentially this allows businesses and individuals to register themselves as an Estonian e-resident, and it allows them to conduct business hassle-free, easily, using their systems. It doesn't provide them with automatic tax residency or citizenship or anything like that, but it does promote Estonia as being a great place to do business.

[00:22:00] If you think about it, with a lot of functioning in the cloud, does a country really have to have geographical boundaries? When we spoke earlier on about displaced people, we currently have 65 million people worldwide, set to rise to 320 million in 25, 30 years. When you start thinking about how you define a country and a society, this is an interesting concept.

[00:22:26] The other thing about the e-residency programme is their programme director, and this is Kaspar Korjus, and I think he's definitely less than 30. Estonia have a policy of grassroots development in technology and innovation, and they know that education in ICT is key. As part of their Tiger Leap programme, they have an initiative to teach kids in school as young as first grade the principles of programming. It's not really intended to churn out the next generation of app developers or anything like that. It's more to give them a smarter and healthier relationship with technology, not only to help them create careers in cyber, but also looking at lives in cyber.

What we can learn

[00:23:11] What can we learn from this example? To be effective, UX design and design thinking need to be core to an organisation's culture and strategic direction. Human beings need to be central. You have to think of those who consume products and services, so involve them in the process. But you also have to invest in tomorrow's innovators, so nurture tomorrow's talent, both in our businesses and in our educational systems. Ease of use is very important, but you also have to consider things like trust, fear, fulfilment, pride, all of these emotions that influence the success of a product or service.

[00:23:56] Delivering effective solutions is core. It's often helpful to break it down into small, meaningful, manageable chunks, but make sure that they address the real needs of users. Delivering an effective solution can also build confidence within an organisation and encourage a culture of innovation. But most of all, good design makes good business sense, particularly on a project of this scale.

[00:24:27] A very quick example closer to home where good UX design has helped is milkmen, Milkmen.ie. You might ask, do milkmen still exist? Essentially what we did was we created an end-to-end business ecosystem for them, and it allowed milkmen to grow their businesses mostly by more than 20%, but in some cases more than 50%. This has a significant impact for milkmen, who were essentially self-employed small businesses. The project won multiple awards.

[00:25:00] But I think the most memorable was the IxDA in 2015 in San Francisco, where we found ourselves in Silicon Valley, a small UX design agency, up against the likes of Nike, Skype, Lego, Volkswagen, and there were thousands of people in the audience from the UX world globally. Not only did we win our category, but we also won best in show, and we were amazed. It was a great coup for us. But I think it's also great for Irish design and development, and it was developed by an Irish company as well, that we can contend and we can succeed on an international stage.

[00:25:39] It also illustrates that you don't have to be a large organisation like IOM or a country like Estonia to change the lives of a small group of people in a big way. The most important thing is just to do it right. So if I was to ask, will UX change the world? I think, based on the examples that I've shown, maybe bit by bit, maybe it can. But more importantly, as Cameron Sinclair might say, design like you give a damn. Thank you.