My first project meeting here in Stockholm was with Veryday, a design consultancy firm that does ergonomic, or user-centered, design for client companies (similar to IDEO). I talked to Tara, who is a Designer/Design Researcher on Veryday’s Healthcare team and has done her PhD in human-centered research on the cancer patient experience of radiotherapy.
Veryday, which was called Ergonomidesign until 2012, has focused on “user-driven innovation” for over 40 years, working on products to improve people’s lives day to day. In 1969, Veryday’s first year, the company consulted with Permobil to design a battery-powered wheelchair. Healthcare has always been an important sector for Veryday’s work; they have since designed operating rooms, clothing for disabled people, ambulance stretchers, crutches, asthma monitors, and more (http://veryday.com/history/).
Tara is from the U.S. and moved to Sweden about 6 years ago, so I had a unique opportunity to ask her to compare the two countries’ approaches to human-centered design. “There is a human-centeredness that is embedded within almost every aspect of Scandinavian culture,” she said. “You don’t have to fight for it.” She said that everyone in Sweden wants to improve patient experience; in the U.S., while companies would certainly be open to having that discussion, nothing would move forward without monetary incentives.
Tara said that when hospitals in the U.S. do focus on patient experience, they usually do it to differentiate themselves from other hospitals, competing to be the best. However, Sweden’s nationalized healthcare system makes competition between the hospitals unnecessary. The result is not nationalized mediocrity but rather a nationwide discussion of how all the hospitals can be better for all Swedish citizens. If a patient experience is improved in one hospital, how can that be extended to the whole nation? Tara was speaking from her experience working on the Swedish Testbed for Innovative Radiotherapy, a joint effort by university hospitals, companies, and regional cancer clinics to improve the radiotherapy experience for all cancer patients.
The tough aspect of this is that, while designing for the patient is an obviously good thing, it’s hard to measure the effect on the patient’s medical outcome. A few days ago, the UK medical journal The Lancet published a study ranking nearly all the world’s countries according to 33 health indicators such as under-5 mortality rates, death rates due to disaster, rate of HIV infections, and alcohol use. It’s a hugely comprehensive study funded by the Bill & Melinda Gates Foundation, and it’s far better than the “10 Healthiest Countries” list from USA Today that I was perusing when I formed my Watson itinerary. I’ll probably reference this study, called “Measuring the health-related Sustainable Development Goals in 188 countries,” many more times, but today I want to say it ranks Sweden as the third-healthiest country in the world, and none of the 33 factors that put Sweden so high on the list relate to human-centered design or a patient-focused approach (as I said, these things are hard to put into numbers).
I asked Tara about this, who replied, “All I can say is that healthcare in Scandinavia is top in the world, but I don’t know if that specifically has to do with them putting patients first, or if it just has to do with some of the interesting dynamics that happen with nationalized healthcare where everyone has access. There’s no disparity of rich and poor.” I think she’s right: from my experience in the past couple months, I would say that the two most important factors contributing to Sweden’s high health standard – both in practice and in the eyes of the Swedish – are 1) the nationalized, nearly-free healthcare for everyone, and 2) the user-centered approach to design and patient care. I think only the latter factor affects success and adoption of medical devices, though (to tie it back to the main focus of my project).
Also, the concept of eHealth (electronic health) simply seems more widespread in Sweden. Tara showed me the 1177.se website, which is Sweden’s national online healthcare service. I couldn’t believe I hadn’t heard of it before. It has lots of healthcare information for many different diseases, illnesses, and conditions, as well as personalized advice based on various symptoms. Users can also log onto the site and book appointments or call the number “1177” to get advice about your symptoms and book from there.
This way of booking appointments contributes to one of the differences between the Swedish and American healthcare systems. If you have a medical issue in Sweden, you book an appointment via 1177 and end up with a doctor you’ve never seen before and will probably never see again. In the U.S., you call the office of your family doctor or general practitioner to book an appointment. There’s a greater emphasis in the U.S. on staying “in the system” and meeting with someone who knows your family history. In Sweden, Tara said that it is considered to be beneficial to see a doctor with whom you have no previous relationship. I thought she would say that it is for a medical reason, so that the doctor isn’t biased when making a decision, but she said that it is a privacy issue. The Swedish “want that separation between the patient and the doctor,” she said, “with no blurring.”
Finally, I asked Tara what the biggest medical issue in Sweden is, or what disease Veryday seems to be working with the most. Since Veryday’s work is project- and client-based, however, their portfolio doesn’t necessarily form a comprehensive picture of Sweden’s most pressing diseases. Tara said that she has noticed a demand not for solutions tailored to a specific condition, but rather for connecting physical devices with digital cloud-based services. For example, pairing an insulin pump with a cellphone app is a specific solution for diabetes patients, but it’s an example of an overall trend of merging platforms to make daily life easier for someone with a chronic illness. It’s about supporting individual patients more fully in their conditions and integrating the services around those individuals, rather than focusing on one specific disease.
I really liked talking to Tara, and there’s far more I could add from our conversation, but I’ll leave it here for now. Tara helped me think about my project, noting that designers like her would have a hard time answering my questions about the medical outcome resulting from user-centered design. Also, since Veryday is a design consultancy, companies come to them for help with projects and ideas. So while Veryday is all about working closely with users to develop the right device for the right problem, I can’t strictly say that all companies in Sweden care about patient-focused design of medical products. Companies still have to make their own effort, whether that’s conducting user research themselves or deciding to work with a company like Veryday.