LIFT founder and CEO David McDonald recently appeared on thew Wexford Science & Technology‘s podcast, The Commons, to talk about his book and explore how innovation and human-centricity in healthcare can persevere in a post-pandemic climate. Listen to the episode or read the full transcript below.

The Commons Podcast Episode 3: Design Thinking for Healthcare – An Interview with David McDonald

Tom Osha: Welcome to the Commons Podcast, featuring researchers, innovators, artists, entrepreneurs and community builders who are improving the human condition in your own backyard and around the globe. I’m your host Tom Osha. 

One of the trends says it’s been accelerated by the upending of the health care system by COVID-19. A greater focus on the patient experience, the promise of telemedicine that had been just over the horizon for the past 30 years has suddenly come into focus as patients and their health care professionals have been forcibly separated. 

While the need for support and consultation has never been greater, more over the patient centered care, population outcomes and equitable access are being heavily pursued by health care systems, determined to use this catalytic moment to rethink their business models and reorient the relationship between doctor and patient Innovation Districts around the globe are looking for ways to infuse the health care system, particularly the patient experience, with the same kind of creative thinking and diverse innovation solutions that have brought us a dizzying array of medical breakthroughs over the past several decades. 

Many have realized that scientific progress and patient experience are not always in alignment with the danger being that patients who are confused, intimidated or just plain frustrated often give up before receiving the proper diagnosis, treatment or medication. As former Surgeon General C. Everett Koop said, “Drugs don’t work in patients who don’t take them.” The good news is that several innovation districts are beginning to apply the same design thinking principles that have been at the forefront of leading product design and are applying them to the patient experience and the delivery of care. In leading medical centers around the country. 

My guest today has been at the forefront of human centered innovation and stakeholder advocacy for over 30 years. David McDonald is a health care anthropologist and entrepreneur and the CEO and founder of LIFT, a research and design agency focused on patient engagement and empowerment. His firm helps health care and life science companies better understand the people they seek to serve. By approaching product marketing and patient education and empowerment through a human-centered lands. 

I first met David when he founded Project LIFT, an early stage health care innovation and business incubator operated out of Wexford Converge Miami project with the University of Miami, and I’ve been following his thought leadership ever since. In June, he published his first book, “What’s Their Story? Anthropology, Design, Thinking and the Rebirth of Healthcare Marketing,” a fascinating read and he joins me today from his home in Jupiter, Florida, to share some of his perspective and lessons from the book. David, welcome to the Commons.

David McDonald Thanks for having me. Hey, everybody. 

Tom Osha I’m doing well, and it’s so good to have you on. Congratulations on your book. What’s their story? Give me a little bit of background. Why the title in. And what’s the book’s central thesis? 

David McDonald The book was written for healthcare professionals, period. You know, we’ve come to a point now in health care where we know the health care space is the most overregulated and under designed industry in the world. And so leveraging design, bringing the tools and protocols of design thinking into the health care conversation is becoming very common. It’s becoming increasingly more appealing to people who might not have done that. So I wrote the book to sort of appeal to a broader audience in the healthcare space. 

We work with pharma and life sciences and we work in a lot of clinical trials and we work in the consumer healthcare delivery space. So the idea was to provide some of our knowledge as a design group and as anthropology to the broader community so that we might see the table stakes of anthropology to design as useful tools and understand how to use those tools. 

So there’s it’s foundational book. It’s fundamental in terms of how it speaks to or presents the tools and protocols of design thinking. And it also covers some of great ground on the usefulness of ethnography and the value of anthropology in the healthcare space. And it’s done very well. We’ve had we have had some great responses. We are, my colleagues of course, excited by that. And I’m excited to start talking about that here with you. 

Tom Osha Well, thank you, David. In one of the things that came through in the book as a result of the ethnography and the design thinking tools was really a focus on creating empathy. And one of the examples that really came through was the example of the Haitian women that you found. Can you can you tuck into that a little bit and some of the lessons learned? 

David McDonald Yeah. So the University of Miami, when we first arrived in Miami the health system they had identified a surge in cervical cancer in certain community, a patient community, and they were interested in understanding why. A surge in cervical cancers. And so clearly they were testing at some point in diagnosing. But they couldn’t understand why these screenings weren’t happening sooner and why they weren’t catching these diseases of this particular disease sooner. 

So they deployed an anthropological ethnographic study into the community. They spoke with the Haitian community. They spoke with the women, the family members and other people in the communities about cervical cancer. And they learned a lot. They learned about being a Haitian woman. They learned about body regions that are taboo in Haitian culture or that they’re sort of uncomfortable to talk about. And ultimately, they realized that Haitian women were not interested in coming to a stranger’s office to have a diagnostic procedure performed by a stranger for a lot of obvious reasons, I would presume. And so ultimately, they determined that the best way to address this was to set up clinics or small screening areas in local homes and even in the church environment. And they did that. And ultimately they were able to drop down the incidence of cervical cancer in that community. 

And they figured all this out using ethnography, which is a form of anthropology that studies the lived environment of patients. It seeks to understand the burden of disease, the burden of treatment, the intellectual cultural burden and understanding of health and well-being, and in deploying that tool into that community there in Miami they were able to come up with a pretty novel idea or, I should say, a novel solution to address the problem without a lot of friction from the community because they address the needs of the community to address the cultural beliefs of the community. And they developed a win-win situation where they’ve seen incidences of cervical cancer decline now in their community. 

Tom Osha It’s a fascinating example. And I think one of the words that came out most clearly to me was just the word context, right. Giving context to a person’s experience and being with them in that it is. You’re saying that lived experience within their daily life. So how does context and relate to the larger, more complex academic medical center or teaching hospital that you might find in an innovation community in Miami or Philadelphia or one of the other knowledge communities around the country? 

David McDonald So context is everything. If you don’t understand the context of a stakeholder, you’re missing an opportunity to help your product succeed. And I’ll give you a more tactile example of that that we’ve worked on. You and I, again, at the University of Miami, where you and I met, I believe, you know, Eric Stone and the Velano Vascular folks, but I met them through your life science and Technology Park there. 

They were at the time developing a new device. It is a blood draw device, a needleless blood drop device. I won’t get into the technology too much, but the point is it was a very powerful device potentially in terms of patient experience. Also in terms of caregiver experience, because blood draws are the most common medical procedure ever, more blood draws are done on a daily basis than any other medical procedure. And Eric was interested in understanding the lived reality of the phlebotomists or the nurses who take blood, the lived reality of the parents or the caregivers sitting beside or standing beside a patient who’s having blood drawn and certainly the lived reality of understanding the patient in those circumstances. And I don’t have to tell you and our listeners that given that blood draws are so common, they can be traumatic. Oftentimes in the pediatric environment or in an elderly environment is tough. 

Tom Osha It isn’t just pediatrics. I’m not a big fan of them myself. 

David McDonald Yeah, for sure. For any of us. And so what we sought to do, first and foremost is the product business. This device was going through regulatory review and approval. Eric deployed us out to really understand the lived experiences around these stakeholders, and that gave us the ability to do two things. It gave us the ability to craft a branded a message when he finally got across that sort of valley of death and into advanced commercial activities. 

It gave us the ability to build a great story for the brand. But it also gave us stories that served him well in terms of fundraising. And so it was a win-win across the board for him. But mostly it really shed light on the value of such a simple change in the clinical environment. And now that the company is seeking to commercialize it at scale, it’s really about changing the way hospitals do business. But that little change creates much positive impact. And I think Eric knew early on we understand the stakeholder emotions and the drivers of stakeholder reality, if you will. He would have an advantage when it came to the commercial part of his strategy. 

Tom Osha It’s fascinating because you also explain it’s not just a transaction. I’m getting blood drawn. I’m having an intervention. But you talk a lot about mapping. Right. And in the mapping of a journey. And so talk a little bit about it’s also experience over time to be able to affect behavior and figure out the right moments along that journey in which to do more effective interventions. 

David McDonald So this is there is a journey every interaction, every encounter in health care. And I would say to anyone in last night’s innovation space, you know, if you’re developing a product or an asset, if it’s pharmaceutical or a procedure, there’s there’s humans involved in understanding those human journeys is important. And there’s and it’s not just about the patient journey. It’s about the clinician journey. There’s two sides to every healthcare transaction – the delivery side and the reception of care in terms of delivery of care. 

So journey mapping is important. Understanding the journey of the stakeholders, understanding where they interact, understanding what their expectations are. There’s a thing called expectation mapping. So understanding the expectations that are embedded in a particular journey, understanding the linguistic components of that in terms of language, cultural beliefs, literacy, so they can do what we call language mapping and then context. What’s the context of the particular area of focus and how to count? Can we understand that better and how these maps sort of can start to interact and create good groundwork for better ways of delivering care, better ways of talking about our product or better ways of advancing our idea or our technology through the pipeline in terms of getting to market or getting some traction in market and successfully doing that within the context of empathy, which is the cornerstone of design thinking and certainly ethnography. It’s extreme stakeholder empathy, to say the least. 

Tom Osha So now that we’ve come back around to empathy, we’ve talked a bit about mapping and context. Let’s apply that to a topic that is foremost on everyone’s minds today, and that really is creating an environment of racial equity, of social and economic mobility. Many of this nation’s and North America’s, to be quite honest, academic medical centers and universities are in or near or adjacent to typically disenfranchised or under invested in communities. And there’s a large focus in how do you engage these communities in the prosperity, the jobs, the opportunity that an academic medical center and its jobs and innovation district and its jobs and opportunities can represent? And so help me think a little bit about how design thinking, anthropology tools like ethnography can really help us create an environment that is more diverse and inclusive. 

David McDonald Yes. So inclusive ecosystems are crucial. We know that we’re interacting with people. We’re trying to move people’s behavior. We’re trying to improve their lives. We’re trying to do something good for other people. 

The little nugget of importance here is that people do things for a reason. Healthcare consumers do things for a reason, each individual. And oftentimes we tend to give up on them or or to shrug our shoulders and be frustrated when they don’t do what we think they should do. As a scientist or care delivery expert or whatever the case may be, this is where empathy comes in. And there are three types of empathy. There’s cognitive empathy, there’s emotional empathy, and there’s what’s called empathic concern.

And cognitive empathy is the ability to understand the stakeholders perspective. It’s the ability to understand the patient perspective where the care delivery staff’s perspective about putting yourself in their shoes, if you will. We all have some ability of cognition and empathy. We have children, spouses, significant, others parents. We tend to want to put ourselves in their shoes and understand them. If at all possible, many times, or at least we should. So that’s cognitive empathy. Emotional empathy is the ability to sort of sense or feel what someone else is feeling to be a little more emotionally connected. So those of us who have significant others or children might. Since that type of empathy from time to time and then empathic concern is the third type of empathy, and that’s the ability to sense what another person needs. And in that triad of empathy has to be practiced in equal balance at all times, if possible. 

Tom Osha Let’s go back to my conversation earlier in my comments earlier about empathy and the three dimensions of empathy. They had to be present and they are present in design thinking. How does that encourage diversity? 

David McDonald Well, it gave us a common language to speak. Design provides a framework for a common language. It’s something that we can all do together. You know, the tools and protocols of design thinking. Again, I go back to the fundamentals of what I called extreme stakeholder empathy. And you can’t do good design without a diverse multi-stakeholder approach. And so we were very fortunate in Miami. And I saw this in St. Louis and I’ve seen this also in Philadelphia. The community of stakeholders was as diverse as it could be. 

David McDonald But what we what we were able to do and what design is able to do is provide a framework where everybody can get involved and explore and problem seek and problem solved in a in a common language. So, you know, back then we said that we wanted collisions. I remember you using the term collisions. I heard it from you at the last science parks. And I believe you were in Chattanooga talking to some folks there at the time. But I heard that word “collision,” which I thought was beautiful because it gives it gives these environments that you’re building. Basically full of collisions like that among stakeholders, and it feels important conversations and important traction in terms of the success of the Life Science Center, but also in terms of the contribution that success it makes in the community. 

So design provides that framework. Once all those stakeholders in the room speaking so many different languages, how can you get them focused on one language and design thinking does that. And of course, a fundamental tool of design we think it’s the most important to is ethnography. And in any instance where you’re setting up a science park or in any health care district, ethnography is often overlooked. But it’s certainly valuable tool and understanding. There’s a difference between knowing and understanding stakeholders. And so you can start to understand those various stakeholders if you sort of take that empirical lens and fold that into the design process as well. 

Tom Osha That’s a fascinating perspective and great advice in how we’re really thinking to better and more authentically engage with communities that are adjacent to universities and their academic medical centers in the knowledge communities that are coming up around them. So so let me move to another thing I thought was kind of fascinating about the book. And this is probably a basic for you, but goes kind of eye-opening for me was this I thought about elements of design, thinking, empathize, you know, define or redefine eight prototype tests and iterate and reiterate in a lot of ways. And it follows what happens in a university research lab or a clinical research environment. And so research is all about improving the human condition. So can you give me examples of design thinking or ethnography and action as kind of a component of the research enterprise itself? 

David McDonald One example. So the process of design thinking, you talked about that circular empathize. Define. Ideate. Prototype. Test it or go back to the circle again. This is nothing. I mean, in design, thinking is certainly not something that I hold the corner in the market. It’s a very important tool. It’s been around since the 60s or so and it’s becoming more and more valuable in the healthcare space, even in drug development or clinical trials. And so the first example I would give you would be a project we did called Limit JIA. We did it with juvenile idiopathic arthritis, pediatric arthritis, if you will. And so we were asked to help them do a better job understanding the complexity of emotion when a child is diagnosed with at first joint, we call it understand the emotion of the parent, because in a pediatric situation generally you have the parents or the carers and they make most of the decisions. And so the idea was to understand what is it that they’re feeling? What is it that are thinking? 

And how can we take that and build a language that’s impaired toward their needs, but that also empowers them and cultivates a higher level of ownership in their decisions about their clinical path. And thereby elevate the competency and account accountability of the parent to a level where they are bought into and they own the decisions they make in in they’re more involved and therefore their commitment to a clinical trial if they were to take on a clinical trial. That project gave us a great opportunity to understand not only what clinical trials look like and drug development, but also what the stakeholders especially. The patient stakeholder looks like within the context of a clinical trial at a very emotional point in time. And so we were able to seek this understanding of the lived experience by interviewing parents once immediately after their child had been diagnosed. Translating that understanding into language that facilitated a better clinical counter clinical journey. 

We talked about journeys a minute ago for the patient and also gave the clinical trials and the pharmaceutical company the tools they needed to build a better brand or a better product. Once regulatory approval was achieved and the drug was ready to go to market. And so that’s an example of design and anthropology informing the early stages of drug development, as well as the critical functionality of a clinical trial. 

Tom Osha So this goes way beyond patient centricity, right? I found the chart of the Rogers Innovation Adoption. Yeah. Very interesting because we’ve heard about patient centric health care for probably two decades at least. But this is kind of a new and far more powerful way of adopting thinking with results and benefits that would go much broader than just a single patient around which previous solutions have been centered. 

David McDonald So if you think of the adoption of design and then the adoption of anthropology into sort of the ethos of health care practice at any level of practice, asset development, research, patient communication, whatever the case may be, it’s relatively new. In a sense that not everybody’s doing it. But I think that soon it will be. 

You brought up Rogers curve, and we all know about the innovators and early adopters take up about the first 50 percent. And you have to get across this chasm where we call that in life sciences, “the valley of death.” Sometimes ideas and products kind of fall down that chasm because they’re just not useful. And I think we’re getting across that chasm now. And I think we’re going to soon see ourselves as the early majority. And that’s the people who are really wanting to champion this added to the broader health care community audience, if you will. And I’d say that the path we’ve traveled over the past five years or 50 years as it relates to patient centricity, I think that makes us the innovators and the early adopters. 

Even your organization, I’ve seen you leverage design thinking into many of the facilities that you have. And so I think we’re now at a point where we’re ready to sort of be the Sherpas that carry us across that chasm and get this adopted into the mainstream of health care thinking and strategy. And I don’t think we can do it. We can do anything productive in health care without it. You talked about equality earlier and we talked about drug development or asset development. Product development. Device development. Patient experience, design, whatever the case may be. Communication, education, marketing. You can do it with an empathic point of view and empathic lens. And you can’t take what you learned through empathy. You can’t take empirical data and just let it sit on a shelf. You have to organize and get thematically, put it to work. And the best way to do that is through the lens of design thinking.

And in those environments will come human-centered, truly human-centered solutions for healthcare. Consumers and healthcare providers and within the context of that is the opportunity for innovators, researchers and whatever the case may be to change the way they do the work they do, sort of to match up with that global imperative of equality and understanding the patient or the stakeholder voice, truly understanding. There’s a difference, as I said earlier, between knowing someone and understanding someone. And that’s what these tools can do. 

Tom Osha That’s amazing. It’s a wonderful book. It is a great read. And I encourage everybody to go to Amazon and pick up a copy. My guest today has been David McDonald. He is the CEO and founder of LIFT. And his new book is What’s Their Story? Anthropology, Design, Thinking and the Rebirth of Healthcare. I’m Tom Osha. And this has been the The Commons, a production of Wexford Science and Technology LLC. The views and  opinions expressed are solely those of the host and guests to view additional material about today’s episode, submit questions or story ideas, or learn more about Wexford science and technology. Please visit www.WexfordSciTech.com/thecommons. I’m your host, Tom Osha. Thanks for Listening 

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