The Next Step for Human-Centered Design in Global Public Health

(Illustration by Miho Kitagawa Pedroso)

“How do we select the right design partner?” “Where can I find evidence that design really works?” “Can design have any impact beyond products?” These are real questions that we’ve been asked by our public health colleagues who have been exposed to human-centered design. This deeper curiosity indicates a shift in the conversation around human-centered design, compared with common perceptions as recently as five years ago.

The past decade has seen a rapid increase in organizations that use human-centered design for innovation and improvement in health care. However, there have been challenges in determining how to best integrate design into current ways of working. Unfortunately, these challenges have been met with an all-or-nothing response.

In reality, anyone thinking of applying design concepts must first decide how deeply they want design to be integrated into a project. The DesignforHealth community—launched by the Bill & Melinda Gates Foundation and Center for Innovation and Impact at USAID—defines three types of design integration: spark, ingredient, or end-to-end.

As a spark, design can be the catalyst for teams to work creatively and unlock innovation.

Design can be an ingredient that helps improve an existing product. Using design end-to-end in the development process can address a complex concept such as social vulnerability.

As the field of design in health matures, the next phase will require support for “design consumers.” These are non-designers who take part in a design approach, whether as an inspiring spark, a key ingredient in an established process, or an end-to-end approach.

Here are three important considerations that will help design consumers make the critical decisions that are needed before embarking on their next design journey.

1. Identify the Kind of Design Skills You Need

Human-centered design is a systematic process that uses diverse skills to analyze problems in context and to pursue innovation while placing the real experiences of people at the forefront. When applying design, the first step is to understand the challenge that your organization is facing. Are you trying to improve a service, such as delivering health care to rural communities? Have you set out to improve a medical device, such as a pulse oximeter, so that it functions more reliably? Or are you attempting to streamline the paper forms that providers and beneficiaries use to track health information?

In 2016, the Gates Foundation began partnering with an international public health institute in a project called the Paper-Based Health Information System in Comprehensive Care (PHISSIC). The project’s theory was that by improving the design of paper-based health information tools and processes, the health system would improve its decision-making. That, in turn, would ultimately lead to better health outcomes.

The team explored every step in how paper-based health data were generated, stored, and transferred in Côte d’Ivoire, Nigeria, and Mozambique, to discover four types of design problems: creative problem solving, visual thinking, prototyping, and interaction.

The team found that various points in the process required different types of design capabilities. In the initial phase, when exploring the root causes of the problem, the team relied heavily on a strategic and visual design partner who was able to capture existing behaviors through journeys and systems mapping. That helped in collaborating with key partners and brought greater clarity to defining the problem. When the focus subsequently shifted to how to redesign health forms to more effectively transmit key and correct data across the health system, the team’s design needs changed to include greater capability in interaction and systems design. 

(Illustration by Miho Kitagawa Pedroso)

The PHISSIC team learned that not all design is the same, and partners differ not just by quality, but also by their relevant design expertise. Just as health care professionals can implement shared understandings of patient care with individual clinical specialties, designers possess common skills in creative problem solving and visual thinking, alongside specific technical specialties. The team ultimately realized that there is no need for individual design partners at different points in the process. Instead, it is preferable to invest more time defining a problem to understand the phases that solving the problem might go through. This will allow you to understand the design skillsets you will need, enabling you to pick a design partner with expertise in those specific areas.

2. Pair Design With Other Disciplines to Amplify Its Value

Pairing design—with its questioning mindset, inclusive philosophy, iterative process, and varied skill set—with other disciplines unlocks the greatest value. Global health offers deep expertise, much of it rooted in research literature, and this accumulated knowledge should be a starting point for all health-focused design efforts. Integrating design with complementary disciplines—such as anthropology, behavioral economics, and developmental psychology—amplifies the impact of design, providing a new lens into how the field of global health has traditionally designed solutions to some of its most intractable problems. However, this requires openness to new lessons from all the participants, and they must be prepared to build on them.

In a portfolio of projects, started in 2015 and now called Pathways, the Gates Foundation and its design partners sought to extend global health’s view into social vulnerability. The intent was to move beyond a clinical and biological understanding to one that includes social and environmental factors. This multi-disciplinary, human-centered design work provided a new type of evidence demonstrating that not all people experience the same risks, barriers, and access when seeking improved health. The resulting framework has served as a catalyst for internal strategies at the foundation that address maternal and child health. For instance, program interventions are now being designed with a distinct focus on social and environmental vulnerabilities identified at family and individual levels. It also looks at the different pathways that young girls and women take to receive care. 

Developing this view of social vulnerability is human-centered design at its best. It reframes questions from a human-centered view. It marries anthropological and qualitative explanations of a person’s life with the deep wealth of quantifiable lessons in biological and clinical vulnerability. A program officer from the Gates Foundation stated, “This work gave us a framework to organize data that we know brings great insight, but often gets dismissed as anecdotal.” Thanks to the collective empathy of the design lens, the different stakeholders within the health system can tailor their engagement with families in a way that lets them achieve health goals on their own terms.

3. Decide on Your Role in the Design Process

We increasingly encounter design consumers that want to do more with design beyond a single project. They can get started on bigger initiatives by answering some questions. Are you an outcomes-focused design consumer, who looks at insights and innovations only as an input toward delivering results? Are you trying to better understand how design is being used in your context? Are you looking to go all-in and learn design by doing it?

CompleteCare Health Network in southern New Jersey opted for this last path. They were able to successfully execute a design project, even though they were new to the approach. As part of a 2015 initiative sponsored by the Center for Care Innovations (CCI) and The Nicholson Foundation, the Gobee Group provided human-centered design training and project coaching to the CompleteCare team of executives, managers, and frontline staff.

CompleteCare decided to improve its breast cancer screening processes for the 25,000 women the network serves annually. Ten percent of those women are migrant and seasonal farm workers. Their circumstances pose unique challenges to providing effective, ongoing prevention and care. The design team identified system inefficiencies that resulted in delays in care for patients, as well as potential to improve cancer diagnoses, and they used design as a way of addressing these delays.

The project team enlisted a range of patients and staff to better understand the patient perspective. Engaging patients and frontline staff as the experts who know most about the screening experience was a step that was new to the organization and led to the team undertaking a comprehensive overhaul of all aspects of their existing mammography process. The new system, called Pathways to Wellness, reduced the time between the discovery of a breast cancer screening abnormality and a definitive diagnosis from 26 days to 15 days. The team has applied the Pathways approach to cervical and colorectal cancer screening. Richie Elwell, CompleteCare Network’s executive vice president of business and operations, said, “The patient impact was big, but the impact was much bigger for our organization. It taught us the importance of designing a process around the customer, and not designing a process around the organization. It's one of our checks in our checks and balances.”

Intention Yields Better Design Consumers

Good human-centered design practitioners don’t claim that design is a magic bullet. But they believe design can play an important role in helping non-designers in health understand the “why” behind people’s behavior.

As the practice evolves, the human-centered design approach can help the health community shift from prescribing solutions according to a perception of people’s needs, to identifying solutions that actually meet their needs. The more these ideas address people where they are, not where we think they are, the better chance we will have in dealing with complex global challenges in health and health care.

Read more stories by Tracy Johnson, Nikki Tyler & Jaspal S. Sandhu.