In Your Users and Oneself
This is an honest story about losing one’s own confidence as a designer.
When I worked for Aetna, in an industry we tend to loath but pay for monthly, our big digital-team tried to always be Good. Growing up in a medical family made it clear; patient care and education are the highest standards of practice. And at Aetna, I noticed two things.
More than ever, understanding the complexity of the system patients are in, changes their ability to act or react to good medicine. Thus, creating bad patients which returns higher costs for all.
Learning to build confidence as a designer made patients confident in managing their own healthcare. Making healthier patient outcomes and lowering costs for all. (Don’t worry. I’m not saying patients can manage their care all alone without their care team or individual doctors. I’m not reckless 😊).
I finally noticed that first lesson spans across design experiences — 8 years later! 🙄 Let’s look at commerce-customers, not patients. Say hello to Dan Lewis. You may not know you know his work, but every single person reading this has experienced his work. Amazon reviews and star ratings are his ubiquitous gift to the commerce world. Copycatted and used as a gold standard to measure product quality and user sentiment….but it shouldn’t be. Dan says so. Back then, Dan thought he solved for one thing, while he actually created another. That was Social Influence (letting the world tell you it’s a good idea) as a game mechanic to justify buying now. Here’s his quick story.
Dan Lewis spoke about how he started five star reviews to solve the problem that customers can’t touch smell taste products before they buy. So, how does one gain the confidence to buy? Peer Reviews were the start. But they held too close to their solution rather than solving the problem with better technology over time.
Amazon’s Dan Lewis, now Convoy’s founder and CEO, discovered this upset from his pioneering days of our ubiquitous 5-star reviews. And now uses that redefined focus as a value of Convoy's.
Biases Exist Everywhere. Learn Which Ones Rule Your Behaviors.
Now, let’s look at patients. There’s a big ol’ study (actually lots of them) that show what drives better behaviors of patients — see the likes of Kahneman and Tversky’s Thinking Fast and Slow. Patients’ prospective outcomes don’t drive their behavior, usually. Meaning, every patient knows what will make them better. “Take two pills and call me in the morning.” But patients have a difficult time doing the smallest things.
This big ol’ study showed us a few things (which I will over-simplify here). One, what causes the behavior. Two, that it’s common and repeatable. Third, we can do something about it. One solution is generating patient scores that predicts the likelihood of good patient outcomes based on the confidence level patients feel about managing their care. The Patient Activation Measure (PAM) measures a patient’s confidence. If one measures high, not only do they feel confident, they are more likely to act like a good patient and take those two pills.
Part of that confidence journey started at Aetna as a question we all have, “what’s wrong with me?” Typically, until something is real bad, we don’t seek out care, because the answer is time consuming, expensive, and part of the scary unknown. Luckily(?), the gift of the internet provided us with private companies that created services to help find our way, and mostly for free. See Google and WebMD. From there, Aetna knew the general public had difficulty sussing out accurate and trustworthy results. Though I’m sure information coming from a private insurance company can easily feel suspect, Aetna is afraid of being sued. Sounds amoral, but that’s the only motivation. And it’s a good one. A great one. The outcome is good information for patients! Aetna must provide us with quality medical content, period.
How’d Patients Get Here?
Back to figuring out what’s wrong with you. One can Google or try the old WebMD site to dive down rabbit holes all day, ending in sometimes scary results. Another time, look up something similar and get non-scary results. That inconsistency is terrible. Why does it exist? How does that affect users’ trust? Unfortunately, people will stop learning when they confirm for themselves. Stopping when they find answers most comfortable with. Which can be at best, a false positive and at worst, a false negative. Yikes!
Those scary results easily perpetuate the ideal that medicine is scary, unknown, and medical practices are predatory. So you stop being a good, informed patient. At Aetna, we wanted to know if and how we could make you feel confident in what you were learning. To make better, rationale, healthier decisions. We knew, measuring your level of confidence over time determines good patients from bad ones. If we knew which, we’d provide each with a differentiated experience! Because no two patients are the same. Just ask your doctor.
So we started with a patient’s first step — asking the question, “what’s wrong them me?” This is the well known and well used, Symptom Checker. Try it. Try something simple. Like “Cough”. You’ll get 100s of results. The running joke was all things led to brain cancer. 😬 Not a good reputation.
Back in the day WebMD didn’t ask to clarify very important information that drastically changes results. Simple questions like age or sex. Aetna had an advantage. We could essentially “know” our patients and use their health data for Good. We could cater results to your medical history, current meds, etc — which is THE gold standard for practitioners. But how does a patient know how good those results are? Effectively, how do we raise their confidence as they search?
We made 4 Googles. I showed users a Google search bar because it’s the go-to mental model of searching anything. Then I showed users more and more granular search result categories that group answers together. The hypothesis was, “Oopf! More granularity looks like more work/clicks/reading, Ben!” And by most UX accounts, that rule of thumb is accurate. But it was not in this case. Patients trusted the results of the specifics (far right)! So I went a step farther. I wondered if patients would do A LOT of work to find better answers.
A Way to Grow Confidence.
So I made a new symptom checker. I called it Guided Search (I think, it was implemented years later, YAY!). It allow one to continuously refine a search as results are found. We used a series of qualifiers every diagnostician (nurse or doctor) asks. Any symptom or condition one looks up, Guided Search ask four qualifiers (all optional). First, are you currently experiencing it? If so, how often (frequency), how long you’ve experience it (duration), and how bad is it (severity)? After each added qualifier, the results could go from 100s of results, to only 5! The patients watched that number get smaller and smaller, making it obvious why “doing more work” was worth their precious time.
Lesson Number Two.
Guided Search lead me to my second realization. As a designer, working on any important, life-changing designs (dramatic flare intended), requires knowing if you’re on the right path. I required a confidence that allowed for a growing sensibility or intuition so others could say, “Hey Ben, you’re a designer and I’m not. So, I’m gonna trust you.” What a great feeling to be needed.
Today, I noticed this in all my use cases, but I’m losing it, myself. The necessary user confidence at Apple, was knowing if you (sales people) were truly teaching a customer how to solve their problems with Apple products. At Riot, it wasn’t just to make a game fun, it was making sure users feel good spending money on objects that brought them joy. At Amazon, users needed Alexa’s voice to provide accurate answers and perform tasks correctly. At Mattel, children needed to feel in control of their play and imaginations without shame or judgement.
Back to Dan
So I’ve noticed through just about all my experience since Aetna, that the product or process was static. And this causes problems for myself because I cannot stop trying to find something better. A better way. Better thinking. Better file structure. Better communication. Better strategy. Etc. All that could be considered “solutions” at a place of business and particularly at places of business that are long standing. Which is why Aetna was such an anomaly. Our little design team did all that work at a 169 year old company!
Stepping away from being in love with the last solution they created frees people up to disrupt themselves instead of protecting what they’ve built. — Dan Lewis
What’s interesting, looking back at Aetna where most would think any good thinking goes to die, we were actually able to practice Dan Lewis’ value before we knew to preach it. (We’ve all been wrong about Aetna!) And ever since, I’ve yet to work somewhere that allows one to practice and preach said value. I rarely feel the freedom to build confidence in my design journey.
I cannot tell if I’m making an impact anymore. I’m at this place of feeling too old, whiplash hurts more. Being treated like a new energetic, tableau rasa designer focuses on the wrong skills set. I’ve worked at so many companies, I’m exhausted from needed to re-learn their status quo when the same outcomes can be produced. Or worse, to conform to a process that cares about short term outputs more so!
In fact, I care more about the people I working with than the products I’m creating with them. We all have skills. I don’t need more fancy resume gems and sparkles. I’m losing confidence because micromanagement of the status quo makes me feel like a robot. It has me missing that feeling when we changed patients’ lives for the better. All with ugly prototypes. All while adapting how we could get work done. Because the outcome was always patient confidence.
Conclusion
This might be my own pep talk. By the end of this article, I’m giving advice I have a hard time practicing. But still, think about the times you felt like you just nailed it. How’d that happen? How come it’s not always happening? Don’t stick around some place that doesn’t build up your design confidence. At Aetna, patients were king. Of your career, you rule. Any place that says otherwise is uncaring and likewise lying about how they care for you. They are either there to teach you to be better or they are not.
If you’re unhappy, leave. It’s a great-scary feeling. That freedom of your own power. I want to figure out my own PAM score again. Because my confidence got lost in the years of shining up a resume that’s not built on as much happiness as one might suspect.
Trust yourself.