Why is a CTO Talking Human-Centered Design?

By Lisa Helminiak

November 30, 2015

Healthagen CTO Brian Garcia had a “light bulb moment” when he recognized the power of becoming a design-first organization. That realization revolutionized the company’s culture.

In large corporations design is often dismissed as “making things pretty” rather than valued for what it truly is—a methodology for innovation and problem solving. But one exception to this rule can be found at Healthagen, an Aetna company and Azul Seven client. In just 18 months the organization has shifted from a traditional technology focus to today, where as Brian Garcia, Chief Technology Officer, puts it, “whether it’s patient engagement, physician experience or care management—we now default to user needs and design first.” We recently sat down with Garcia to talk about how the human-centered design mindset came to be and how it is shifting the Healthagen culture, faster and with more success than anyone could have guessed.

It was in 2012, while preparing for RFP Live Design, an event hosted by Aetna and Rock Health, that Garcia was first introduced to the design process. As he describes it, development and coding had “always been fun and interesting, but there was a problem understanding the purpose and rationale. Why am I building this?” For Garcia, design finally answered the question. “It struck me as filling the missing piece—linking the way I think about technology and the way people want to interact with the world around them. That was the piece that allowed me to connect what I do to something that mattered.”

The Missing Piece

We talked about how his realization expanded even further during the 24 hours of RFP Live Design. At the event Azul Seven competed with nine other design teams to design an app that helps caregivers manage the care of their aging loved ones, while also communicating more easily with family members and other parties involved. A big part of the process, and what helped Azul Seven ultimately win the challenge, was engaging with real users who were available onsite for interviews and testing. Garcia talked about the impact this approach had on his own views, “Listening to end users and working with them made me change the way I looked at technology and building software. Instead of thinking about latest tech, I look at the problem and how to solve it in a way that the end user is going to appreciate.”

He explains that as a result of the event, “Healthagen has been influenced in a more dramatic way than I initially thought. Through RFP Live, our commitment turned to design and infusing Healthagen with a human-first perspective versus technology-first. We made an explicit choice to build our design team, and build relationships with firms like Azul Seven. I thought it would take 12-18 months to get the idea out and change the overall perspective on how tech companies like ours look at [design]. We found it took hold much faster than I ever thought it would. It took hold in six months.”

What happened in those six months, and how has Healthagen’s culture changed since adopting a human-centered, design-first approach? As Garcia explains, it’s become less about data and numerators and the consumption of information, and more about enriching the interaction of the end users with Healthagen’s products. “We used to get into analytic- and spreadsheet-driven exercises, focus groups, market research, etc. Now it’s evolved to the point where we don’t start there—instead we think about how to engage our design expertise to tackle this problem. Whether it’s patient engagement, physician experience, care management. It defaults now that it’s design-first.”

The Culture Shift

Human-centered design has not just changed the way they approach day-to-day work, but has shifted the way the Healthagen team thinks about problems in health care overall. “There are a lot of points of friction in health care… Our goal has now become not, how do we navigate users around points of friction, but instead remove those points of friction. Clear the way for them to walk clearly and it’s a much less anxiety-ridden experience. Increase adoption of that experience, increase that behavior.” Garcia has an interesting theory, that “Tech must become invisible to become impactful. We need to understand how to use technology to diffuse friction between the doctor and the patient. How can it manifest in a 15-minute appointment because the doctors are not working on paperwork, it’s all been done for them? They can have a personal, emotional connection with the patient.”

And how does this new approach help differentiate in the very crowded health care tech market? From Garcia’s perspective, “Taking a user-first approach in design is what differentiates companies in this space. If they adopt this methodology and way of thinking, they can really excel beyond where they are today. It’s not just prettying it up, it’s changing the way the end user interacts with your software. We’re not even necessarily doing things differently functionality-wise, we’re just changing the way the user does things. It sounds so simple, but that’s the magic and what makes a compelling user experience, almost emotional. They feel comfortable and at ease interacting with the tech. Most tools don’t work that way, you get anxiety and it intrudes on the way you interact with the world.”

Using Design to Differentiate

In the year and a half since RFP Live Design, Azul Seven has engaged on the design of several Healthagen business unit products. Garcia explained how our relationship has helped further instill the importance of design on the organization, “[Azul Seven] has helped us deliver clear and tangible results. It’s not just us talking about design, it’s actually showing the results, and how different an interface looks by looking from the perspective of the end user. It manifested in the work we’ve done with Medicity…that’s what success looks like, that’s what the end goal is supposed to be. [Azul Seven was] the big driver in our first project in design with a legacy system. I don’t think we would have gotten as much embrace of design without the leadership [Azul Seven] has shown.”

Clear and Tangible Results

Medicity’s web-based clinical application was Azul Seven’s first engagement with Healthagen, begun shortly after RFP Live Design. On that project we were tasked with redesigning the existing health information exchange in a way that is more user-friendly. Garcia cites the Medicity redesign project as one of Healthagen’s biggest successes to date in bringing human-centered design to the forefront, “We succeeded at getting good design as a thought into one of our commercial businesses, using that initial foray to take a legacy product and redesign the interface by focusing on the end user first.”

Ongoing Success

The ongoing success of Garcia’s effort is evident as other initiatives continue to emerge from Healthagen’s young human-centered design practice. One example is WellMatch, a whole new business working to bring more transparency to health care around costs and provider performance. “That was a full end-to-end design-first business from start to finish. We talked to end users, brought them through a design workshop. We thought about how people interact with health care and with costs. The early beta product was impressive and we’re having great feedback.” Another initiative that has been well received at Healthagen is the new Slingshop methodology, a design-first approach to product development. “This methodology came from the design team. We now use it as our core launch process for our businesses.”

Don’t go it alone

It sounds simple, and the benefits are clear, but shifting an entire organization to this design-first thinking is not always easy. We asked Garcia what advice he would give to other large corporations trying to adopt human-centered design. “Accept that it’s a way of thinking. Understand what it means culturally before you try to figure out how to integrate it mechanically. What Azul Seven has taught me is that design thinking isn’t so much a written down methodology or set of tools, but it’s a way of approaching a problem. And don’t go it alone. Don’t read a book and try to implement it. If you’ve never climbed Mt. Everest, you shouldn’t do it alone the first time. Go with someone who can show you the way but not hold your hand.”

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