New Day had a blast with the series. Check out what they had to say!
Telemedicine--the ability to conduct remote clinical visits through videoconference--is a rapidly growing industry. HealthcareITNews reported that, “The global market for telemedicine is expected to be worth more than $34 billion by the end of 2020.”
One of my clients, the non-profit health insurance fund UniteHere! Health, contracted with a telemedicine provider to help keep their ten thousand New York and New Jersey members away from unnecessary emergency room visits and hospitalizations. The problem was that very few members were taking advantage of the service. With low utilization, UniteHere! Health would end up with little return on their investment.
I got called in to help UniteHere! Health increase utilization of telemedicine among its members because I had worked with them on a project to drive down costs by connecting their membership to primary care doctors and chronic conditions management.
I went straight into the field to test the mobile app, focusing on UniteHere! leaders who I knew would spread the word about telemedicine across the organization--that is, if they liked it. I sat down 1-1 with each member and watched him or her navigate the service on their phones, from downloading the app all the way to having a videoconference with a doctor.
Here are my two major findings that I think will be valuable to all telemedicine or health IT providers who want to get more people engaged with their technology.
To reach the broadest base of potential clients possible, cater to language.
The majority of UniteHere! Health members that I tested the telemedicine technology with did not speak English as a first language. To navigate a website or a mobile app that is written entirely in English is a barrier for immigrant communities. It’s a high hurdle to jump. Equally important, there have to be doctors available who speak the same language as the patients. UniteHere! members who speak Chinese or Haitain Creole would have to be comfortable enough in English to navigate to the menu option that allows them to choose a doctor that speaks their language. And then, radio silence. There wouldn’t be any doctors available.
If telemedicine wants to serve a global population, it can’t be shortsighted about language. Language is essential. In New York City, half of the population does not speak English as home.
2. Scaling the Digital Divide
Invest resources/staff into underserved communities and reap the rewards.
About 50 percent of the UniteHere! members I tested the telemedicine app with were confident tech users. These were the type of people to whom you could say, “Download this app and let me know what you think.” Typically, this is the person that tech developers are designing for. The other 50 percent of UniteHere! members I tested the technology with had never downloaded an application on their smartphones. They needed step-by-step assistance to help them learn how to use it. Once they learned however, they were up and running.
A lot has been written lately about the lack of gender and racial diversity in tech. As CNN Money writes, “After all, engineers build gadgets and software for men, women and people of every color—and a diverse workforce means a more expansive understanding of what customers want.” In this instance, increased diversity would contribute to designing better gadgets and software, and work to get that technology into the hands of “unlikely” customers.
The Opportunity: How might we bring the benefits of telemedicine to underserved communities?
Here is the good news: The UniteHere! members I tested the telemedicine app with uniformly LOVED the service. They loved that if their child got sick in the middle of the night they could see a doctor from home for the cost of a primary care visit, instead of going to the emergency room and paying a much bigger bill. They loved that telemedicine gave them the option of getting a doctor’s opinion on that pesky rash, and even receive a needed prescription, without having to miss a day of work. One UniteHere! member who suffers with chronic conditions said, “I’m a fan of this, and I’m not a fan of ANYTHING.” Another said, “This is like having a doctor in your pocket.”
On top of that, the UniteHere! members who struggled with the technology were completely undeterred from trying to learn it, and were still very enthusiastic about what it could do for them. Some members sat with me for over an hour working to set their mobile accounts up. What should have been a 5-minute registration process took longer. They didn’t have an email address. Or they couldn’t remember the password to their email address. Or they were confused about how to enter their insurance information. At no point did they say, “This app is not worth it. I’m out of here.” They wanted what the technology could provide for them.
The Value of Community Engagement
Telemedicine, health IT, and the tech world in general, would benefit from a strong investment in community engagement. And underserved communities will benefit from technology that they are currently being overlooked for.
A commitment to community engagement would mean that tech companies equip skilled cultural workers to introduce technology in neighborhoods and regions beyond the middle-class tech-savvy markets. This engagement is an excellent opportunity to get product feedback from a diverse range of potential users and get new people onto platforms that they would never know about otherwise. Many community leaders simply need the initial training about the technology and then they are up and running and ready to tell their family, their neighbors, their co-workers, the people they go to church with, the people at the YMCA, and the people who hang out at the local bar or coffeeshop. That is how an intensive community engagement practice becomes scalable.
Something as valuable as telemedicine should be accessible to everyone. Catering to a more diverse clientele is a great way for the health IT industry to bring in more valuable business. It’s a win-win. And I would love to work to make it happen.
Contact me if you are interested in learning more.
This summer I’ve been exploring the whole wide world of social innovation and human-centered design and talking with studios that are leading this work —like Ideo.org, Greater Good Studio, Public Policy Lab, and Design Impact. When I tell my friends and colleagues that I’m interested in social innovation, they usually respond with, “what does that mean?” When I mention human-centered design their reaction is something like, “huh?”
Let me explain. The way I understand it, big global design firms like Ideo popularized human-centered design as a core method to create innovative products and services for clients like Apple and Nike. The principle is that the best way to design stuff that is really transformative for people’s daily lives is to deeply understand the person you are designing for. You need to watch that person go about their day, understand what they are motivated by, see their biggest frustrations first-hand. Then you can prototype a product or service directly based on their needs, and even better, involve that person in helping to improve your prototype by getting their feedback and watching them use it. What you end up with is a product or service that directly caters to the person you are designing for. And as a result, what you design is not just more effective, but can actually be transformative in a person’s life. Human-centered design is definitely not rocket science. It’s a common sense approach. But in the design industry, it seems like it was fairly revolutionary to move away from thinking about consumers as “users” and designing for them from a distance.
THEN (this is the part that’s exciting for me) a number of people from the design industry who had been using this human-centered practice with corporate clients started to say, “Hey, this technique is super effective for coming up with incredibly innovative and powerful solutions that change people’s lives. What if we applied this design approach to social issues? What if we used design to create transformative products or services or systems for vulnerable communities?” And that’s how you get solutions like Greater Good’s work to empower Chicago citizens to help design a better public transportation app that encourages more people to get out of their cars. Or Ideo.org’s work designing a high quality and affordable solar light for families in Kenya and India living on less than $1.25 a day. Or Design Impact’s work to strengthen programs helping low-income women in Northern Kentucky get and maintain good paying jobs in advanced manufacturing.
Now, I LOVE this stuff. My entire career has been focused on working with local communities to find innovative solutions to complex problems. Like fundamentally changing the way police and social services were interacting with the community in Oakland, California, so those systems could proactively prevent the homicide and gun violence that was devastating the city. Or working with the Center for Medicare and Medicaid Innovation in Washington DC to pilot new healthcare delivery systems across the United States that would better serve high need patients. I’ve been practicing human-centered design my whole professional life!
And I’m really excited to learn even better ways of doing it. That’s why I’m currently participating in Ideo.org’s Design Kit: The Course for Human-Centered Design. As a change agent and practitioner, as someone who loves to connect with people, create new systems, design new experiences, find interesting solutions and take action to implement them, human-centered design is an awesome addition to my toolkit. It’s a super systematic and fun way of collecting insights, discovering design opportunities, brainstorming and testing innovative solutions, and implementing new ideas. It’s a powerful approach for staying true to the community you are creating with. And ultimately, human-centered design is a method that allows truly transformative and revolutionary ideas to break through, come to life, and have incredible impact in the lives of the people I care about. This motivates me more than anything.
I can’t wait to share the solution I’ve been working on with my ideo.org team this last month. My next addition on human-centered design: coming soon!
To actualize a dream, you have to know what it is.
Last week, I led a team of New Day members to imagine the future of their church. They imagined walking through the doors of New Day in 5 years. They visualized the people, the worship space, the activity, the smells, the sounds, the sense of touch, and how they felt emotionally.
When they opened their eyes, New Day members got busy using magazines and glue to create individual illustrations of this future church, the church they most want to be.
Then New Day worked together to fashion these individual dreams into a DREAM MOSAIC.
The Dream Mosaic is a powerful tool to align the vision of a team. Using this technique unified New Day members around their common desire to expand and innovate. It showed them ideas and goals with tremendous collective energy. The Dream Mosaic is a strong catalyst, motivating New Day to be accountable to themselves and each other in the work of building their future church.
If you want to leverage the power of your organization and create the deep impact you desire, you have to harness the vision and creativity of your members.
This last weekend, I led New Day in creating an exciting collective vision for their church. More to come!
Tuesday night at New Day Church was AWESOME!
I’m consulting with New Day, a young and vibrant church community, on an overarching strategy to strengthen their ministries and develop deeper leadership within the congregation.
On Tuesday night, I led 30+ congregation members in making a social map for their church. Together, they charted the talents and passions of their fellows and worked collaboratively to group people based on what they love to do.
Now New Day has the prototype for an organizational Treasure Map-- "For where your treasure is, there your heart will be also” (Matt 6:21).
Treasure Mapping is not only a super fun team-building exercise, it gives New Day a dynamic tool to better leverage the creativity of their members and make strategic decisions to grow their ministries.
On Saturday, I’ll return to New Day for a collective visioning session. I’m looking forward to more time with this passionate and joyful congregation!
This summer I consulted with New Day Church in the Bronx on three things I love: organizational strategy, leadership development, and creative empowerment.
Over the next couple weeks, I’ll be leading New Day in a series of workshops that help members celebrate their gifts and talents, illustrate their visions for the congregation, and guide members towards a deeper level of participation in church ministries.
I’m excited to see what happens!
Role-plays are one of the most valuable training tools there is, especially in peer-to-peer learning environments.
Role-plays easily transmit nuanced and complex information and are essential for teaching behavioral techniques.
I used role-play as the primary tool to model for UniteHere! members how to get respect in the hospital. Studies have shown that patients who STAND OUT to their doctors when hospitalized receive a higher quality of care. Patients who play a more proactive role get their doctors to pay more attention to their treatment, and are at less risk for costly and fatal mistakes.
But respect is a tricky thing to teach. It’s nuanced and complex, and it’s grounded in behavior. Perfect for a role-play!
I designed a short skit, to be played by UNITEHERE! members, modeling behaviors to help them stand out with hospital staff and receive a higher quality of care. The role-play is not only a great interactive learning technique, but it allows everyone in the training to witness what respect looks like, and what people just like them did to get it.
The peer facilitator can sum up learning like this:
What did the couple do well to make sure the doctor and staff respected them? (let group answer, write down responses)
- They asked the nurse when the doctor was coming so they could plan
- They asked the nurse to coordinate the medicine
- They made a plan of their questions and wrote them down in advance
- They asked the doctor questions; they had their own agenda
- They helped each other in the interaction with the doctor
- They wrote down what the doctor said
- They followed up when they didn’t understand something
- They asked the doctor to be connected to an “inside” helper so they could get more support.
Using role-play as a tool in peer-to-peer learning is the best way to transmit complex information. A facilitator could tell their peers, “These are the things we should do in the hospital to make sure we get good care,” but without the role-play, it’s hard to understand how to implement those techniques. Role-play lets everyone in the room SEE it.
Even better, role-play is a chance for participants to immediately practice the skills they are going to need if they are ever hospitalized. How often in life do we get a dress-rehearsal for hard situations? By role-playing these techniques, there is a higher chance that UNITEHERE! members will be able to remember and DO what they learned if they are ever hospitalized.
How do you write a peer-to-peer adult education curriculum that guides participants to find answers for themselves?
It’s much more interesting to learn something through investigation than to be told the answer upfront. Plus, something you discover yourself is easier to remember in the long-run.
Discovery can happen any time someone has to look for an answer.
For example, to teach participants about the danger of taking too much pain medication, the peer facilitator can use this exercise.
“Partner up with the person next to you and look at this label of a common over-the-counter medicine. Answer these questions together and be prepared to report back to the group."
What is the recommended dose? Hint: It’s under DIRECTIONS (ask group to respond)
- 20 mL every 4 hours
- only use with dosing cup provided
What warnings does it give you? (ask group to respond)
- Don’t take more than 6 doses in in 24 hours
- Don’t take with other drugs that have Tylenol (acetaminophen)
- Severe liver damage can occur if you take too much, or combine with another drug that has Tylenol (acetaminophen)
- Ask doctor of pharmacist before use if you are taking blood thinners
- Ask a doctor before use if you have diabetes, high blood pressure, liver disease, heart disease, thyroid disease, trouble urinating, persistent cough (such as asthma).
- Do not use if taking prescription MAOI (certain drugs for depression, psychiatric or emotional conditions, or Parkinson’s disease). If you do not know if your prescription drug contains MAOI, ask your doctor or pharmacist.
Based on these warnings, what actions would you take next time you need to take an over-the-counter medicine? (ask group to respond)
- Read the label!
- Ask the pharmacist or my doctor before taking!
Is this information still dry and dense? SO. VERY. YES. But the act of DISCOVERING the answers and sharing with others is empowering. And it gives participants practice in a critical real-life skill (reading labels) to protect their health.
Using discovery as a tool of peer-to-peer learning takes the pressure off the facilitator to be the expert, is much more interactive than talking AT people, and makes participants contributors in their learning.
This style of learning lasts; people can actually implement and sustain it in their lives. Here is Deliverance, talking about how the skill of reading labels has helped his family.
How do you write a training manual that helps a peer facilitator guide their co-workers towards learning new behaviors, without having them read a script of Do’s and Don’ts AT people?
Crowdsourcing is a great teaching tool to create a peer-to-peer learning environment. First, the person facilitating doesn’t get stuck in the role of “expert.” Second, people participating in the workshop have a chance to share their own knowledge and experience, and learn from others. Crowdsourcing creates an atmosphere where everyone can feel empowered.
For example, in a session where the key learning outcome is for members to recognize the danger of taking too many over-the-counter and pharmaceutical pain meds, the facilitator can begin by asking questions.
- How many of us have pain from repetitive physical stress on the job? (Ask for show of hands)
- How many of us take pain medicine regularly? (Ask for a show of hands)
- How many of us take pain medicine on a daily basis? (Ask for show of hands)
- Can you give some examples of what kinds of pain you have? (Allow members to share)
- What kinds of pain medicines do you usually take? (Allow members to share)
- How many of us know someone, and it could be ourselves, that has taken pain medicine every day for years? (Ask for show of hands)
Crowdsourcing member experience on pain medication does a few things simultaneously.
1. It includes the facilitator in the discussion, illustrating that they are not separate from the other participants.
2. It lays the foundation for explaining the problem. The facilitator COULD begin with an opening such as, “Pain medicine is a big problem in our society. 30% percent of people report taking pain medicine every day.” But that style would not be as authentic for the facilitator, and it wouldn’t be as engaging for the participants. It’s UNITEHERE! members, not “people in society,” that this training is for.
3. It fluidly positions the training to move forward into discussing the risks. Once everyone in the room has shared about their pain medicine usage, there is a natural opening to explore precautions.
Simple techniques like crowdsourcing allow a written curriculum to be led by anyone! And it’s a great way to involve members in their own learning.
Here are a couple UNITEHERE! members sharing the big-picture benefits of learning through crowdsourcing.