Health post: Permobil wheelchairs

Last week I had a Skype call with Permobil, a wheelchair-manufacturing company that started in Sweden in the 1960s. While still headquartered in northern Sweden, Permobil now has offices in multiple countries around the world. According to Vinnova, the Swedish government’s innovation agency, Permobil is the largest company “developing assistive products for people with disability” in Sweden (Vinnova 2011). Though my main purpose was to interview them about the attitudes towards electric wheelchairs that they’ve encountered, I ended up learning more about what types of questions I should be asking for my project.

First, I asked about Permobil’s process for developing new products. They have product managers that try to find gaps in the industry, but for the most part they build on what they already have. Permobil has been selling electronic wheelchairs successfully for decades, so their process focuses on fine-tuning and upgrading products that have already been on the market for 5-10 years. They also respond to government requests when building new products. The Swedish government will occasionally announce a competition to build a new product that meets certain standards, like price and comfort, and then various companies can compete to meet that request. Permobil enters these competitions when the product is a wheelchair.

Even fine-tuning an already successful product, though, requires some research. I asked if Permobil used questionnaires to do this, but that method doesn’t work for them because their users have very different disabilities that cause their need for a wheelchair. To use questionnaires, Permobil would have to isolate these groups and then develop a certain set of questions for each group. It is too much work to create so many individualized questionnaires, and then the sample size would be too small for the results to be useful. Also, Permobil does not have access to individual customers – because of the same privacy laws that prevent Giraff Technologies from reaching out to customers, Permobil cannot get contact information for its users.

As I mentioned, there are many reasons why someone might need a wheelchair. Permobil often designs many functionalities for a wheelchair beyond its most basic and necessary function: to transport from one point to another.For example, comfort and angle of the chair could come into play. Permobil had one test case with a patient who had a muscular disease that limited his movement. He would slide forward in his wheelchair throughout the day, so he had an assistant that would readjust his position 8-10 times a day. Permobil designed a wheelchair that was better shaped to hold him in place, and now the assistant only moves him once or twice a day. I can imagine this has many benefits, not just for the patient’s physical wellbeing but for his happiness and dignity as well.

But I wasn’t reaching the heart of my research question: what are the cultural attitudes to wheelchairs in Sweden? What factors influence success? As the Permobil people reminded me, wheelchairs are quite present in Sweden. They said that people in Sweden are very accepting both of wheelchairs and the diseases that require them (such as ALS, MS, and cerebral palsy). Also, every new Permobil employee must spend their first workday in a wheelchair. They often struggle, giving them an insight into the main challenges and needs of their target user population. While one day is not enough to know what it’s like to use a wheelchair for life, Permobil clearly makes an effort to be connected to the user. It’s crucial to understand the specific situation, they said. Their least successful design, in fact, failed because it had too many complicated “tech-y” features. It was too expensive and difficult to use. Sometimes it’s valid to make a simple design and have control over the costs of that design.

By the end of the interview, the men I was speaking with could see that I was struggling to narrow down my questions and get the answers I was seeking. I finally asked them for help, wondering if they might see what I was trying to achieve. They had some great ideas for approaches I can take in future interviews. They suggested that I focus more specifically on the process of selecting a new product to develop and then validating that product. New medical solutions emerge either because they are based on a new technology or because a patient need is newly identified. When I meet with various companies, I can ask which reason influenced their beginning. Then, how do they validate their product? After the product is validated – meaning that it has been proven to have the desired functionality – how is it verified? That is, how does the company make sure that it actually has a positive effect on the medical status of the user? What is the medical outcome, and how do they measure it? How do they make sure that there is a direct link between an added feature and the user’s health, rather than simply increasing the “cool factor” with such features? and so on. I think asking companies to distinguish between their validation and verification processes could be really valuable for my interviews.

I’ve been wondering why I had such trouble asking the “right questions” of Permobil (always a journalist’s challenge). I think it is because wheelchairs are such fundamental assistive devices. They have been around for so long – apparently since the 6th century! – that we accept them without question (https://www.wired.com/2012/05/wheelchair/). Clearly, they serve their purpose, as the wheelchair hasn’t been displaced in 1500 years. Yes, they’ve become electric, more comfortable, faster, and self-drivable – all important upgrades on the original idea. But the idea itself has persisted, which makes the wheelchair different from a smartphone app that reminds you to check your blood sugar levels, for example. I’ll have to work on my question set for medical solutions that have stood the test of time.

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