When it comes to human-centered design, we aren’t left guessing what might or might not work for the end user. The field of cognitive psychology offers rich insights into the way people think, feel, interact with, and make decisions within the environments in which they move. This research, combined with real-world observations, gives healthcare organizations insights into how to design experiences for caregivers and patients, as well as streamlining operations.
On today’s episode of In Network's Designing for Health podcast feature, Nordic Chief Medical Officer Dr. Craig Joseph and Head of Thought Leadership Dr. Jerome Pagani are joined by Dr. John Whalen, founder of Brilliant Experience and author of Design for How People Think. He shares about his background in cognitive science and working on projects such as healthcare.gov, and how designing with the brain in mind and using “radical common sense” can create a better healthcare system for patients and clinicians alike.
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Show notes:
[00:00] Intros
[02:27] Dr. John Whalen’s background
[06:23] Working on healthcare.gov
[08:23] How to decide whether or not to proceed with a project
[09:39] Writing Design for How People Think
[11:12] Why you have to observe users, not just ask them questions
[13:55] The importance of language, words, and educational level in communication
[20:22] Designing with “radical common sense”
[21:43] Breaking down the “six minds”
[28:01] Wayfinding and problem solving in design
[31:30] The interplay between the six information processing systems
[34:47] Designing for multiple education levels at once
[38:27] Three things so well designed, they bring Dr. Whalen joy
Transcript:
Dr. Jerome Pagani: John, thanks so much for being here with us today.
Dr. John Whalen: Of course, I'm happy to be here.
Dr. Jerome Pagani: It's great to connect again, just so everyone knows, John and I go back a ways. He was actually my advisor for my master's thesis, and we've kind of kept in touch through the years.
Dr. John Whalen: Yes. Well, and I'm delighted to be here and see where you've wound up. It's awesome.
Dr. Craig Joseph: I feel like the fix is in. I feel like John might not have deserved to be on the pod and normally wouldn't have met our criteria. But because he controlled your future at some point, I feel like, John, you want to defend yourself at this point?
Dr. John Whalen: Right? Well, actually, I might say the reverse, that despite being an overlord to Jerome, nonetheless, he was willing to talk to me now. And so that suggests that maybe there is something that was fair, equitable, and reasonable that made him want to continue to talk to me where that might not be the case for all dissertation advisors or masters advisors.
Dr. Jerome Pagani: And I'll sort of split the middle and say it was actually the continued wise counsel from then through now that made me really interested and sort of the careful thinking that you first applied to science and now are applying to sort of the practical problems around human-centered design and healthcare specifically that really made me want to be able to have you here to speak with us today.
Dr. John Whalen: Great. Well, it's a privilege.
Dr. Craig Joseph: So, John, in preparing for this episode, I learned two things, and I just want you to confirm them. One, when you were a very young child, you decided that you wanted to be a psychologist who actually does product design and works as a consultant. And two, the website called healthcare.gov was all your fault. Did I get both of those correct?
Dr. John Whalen: You're so close. You're just on the edge. So actually, in grade three, I remember looking over at Valda, who I thought was quite swell and wondering, what is that girl thinking? And knowing that I didn't know and knowing how fascinating it was to think about what other, was in other people's heads and how they construct the world and so on. And so, yes, for a long time I was interested in psychology and learning more about that and what's in people's brains. How does that work? As for healthcare.gov, I was part of the rescue team, so almost, and actually just for clarity, I helped to design the informational site, which was the one part of healthcare.gov that didn't crash. That wasn't a newsworthy part. So I’ll just let that go.
Dr. Craig Joseph: Alright. So my apologies for slightly misrepresenting both of those pieces. So let's, more seriously, kind of looking at how you got to where you are. So you went to school to get, ultimately, to get your PhD? My understanding is you were in academia for a bit and then decided to kind of expand out. Can you fill in that story a little bit?
Dr. John Whalen: Sure. You're exactly right. So I got my PhD in cognitive science, and so I did things like work with brain damaged patients, with doing what was then considered like artificial neural networks, so was really the precursor to all of our machine learning and also working with just ordinary adults and looking at how they learn actually, in this case, artificial mathematics. So I could see how that works in their heads as well. So putting that all together, was using converging lines of evidence to really deeply understand a process, which is something we still do today. And really after that was a post-doc UCLA psychology professor. And as you might have guessed, I love doing the research and I was not as interested in publishing and so publish or perish. And so I became a consultant after that. And so I immediately had a job as soon as I left and really, really enjoyed it. And it actually, for someone who gets their PhD and is a world expert in one thing or that's our goal, being able to actually solve concrete problems in months and then move on to a new topic and do the same was incredibly rewarding and so satisfying. So I just I got addicted and here I am.
Dr. Craig Joseph: So you mentioned publish or perish, and you went the latter, from your academic endeavors, and, so what are you up to right now?
Dr. John Whalen: Yeah, actually that moment was terrible because my pay doubled. But anyway, yeah. So right now I actually, after working for a few different companies, went out on my own as my dad had his own little company. So we do consulting for new product discovery. So digital products or services. So essentially my little company called Brilliant Experience tends to work with very large ones. And we generally are either deeply understanding the potential audience and their needs that are out there, and understanding the segments that are out there and so on, helping a group to decide is this actually a scalable problem that they want to solve? Is it something that they're really good at? Could they compete in the competition? So that's our strategy side. And then thirdly, if they still have just a twinkle in their eye and want to know what this service or product might be like, we have to do the sort of ideation or early concepts of that thing and testing it to do that sort of build, test, learn, classic design thinking kind of process.
Dr. Craig Joseph: That's great. So getting back to that, since someone brought it up, oh wait, that was me, the healthcare.gov website. Can we just dig a little deeper into that? So you were involved with the informational part, which didn't crash. What does that mean? What is the informational part and what was your involvement?
Dr. John Whalen: Sure. So the fundamental challenge actually, with that entire project was, you know, at one point I asked, like, so who's really in charge of this project? And no one could answer. So there was no single, as they say, throat to joke. So different people had different pieces, but they hadn't really put it all together and been responsible for doing so. So we dove in. I did more all-nighters than I've ever done in my life and was able to design. So I'm not a programmer. I did things like wireframing and testing these possibilities with both ordinary folks, folks with lower educational profiles, accessibility, and so on, making sure that the core, you know, is this right for me, kind of information was available. And then secondarily that would launch you to pick a plan kind of things, which was the other side that it didn't work quite as well. Well, actually, to continue with “why didn't that work” just for a moment, we really did learn that one of the key challenges was the law said you need to get this information from another vertical within the government in order to decide, “does this person qualify for plan one or plan two or plan three?” That group didn't really have a reason to really dive in and make a really fast API to make it all work as a service design because there wasn't a higher-order person in charge. So it's just a, you know, knowing the organizational structure to building a great experience is actually really relevant, in addition to the psychology I'm happy to talk about.
Dr. Jerome Pagani: So John, we know from our experience working with clients that there are a lot of smart folks out there who are really invested in what they're doing, and there's no shortage of really good ideas. How do you help people to think about whether or not to proceed with a project or not?
Dr. John Whalen: Absolutely. So, I mean, one of the big things here is that, you can imagine that, if you think of your Googles and Facebooks and folks like that, who we work with, that they have a plethora of engineers and an inclination for almost any group is like, wow, we need an X, let's go start building. And so actually, I think one of the steps here to start is actually the more pragmatic go/no-go decision and really being well informed with that. So is there really a need for what you imagine folks need? Is there really, you know, a large enough audience for that? And so on. So actually deeply understanding the problem and really making sure you're addressing what really is the problem and linking that to what your business specialty is to make sure that this is great for your business, great for that. And target customer is crucial if you know and folks are investing millions of dollars in this thing, let's make sure it's going to work before we do that.
Dr. Jerome Pagani: You formalize this into three big chunks that folks can use to think about the design process as they, as applied to their own businesses, and wrote a book about it. Can you tell us a little bit about, just at a high level, of what the book is about?
Dr. John Whalen: Sure. So the book is called Design for How People Think, which I'd like to think is radical common sense, but in fact, you know, is often overlooked. So fundamentally, the book has three steps. One is to really dive into a little bit of what Jerome is an expert at, and I seek to have his knowledge, and that's really deeply understanding cognitive psychology. And so things like attention and memory and decision making, problem solving, how emotion factors into that, what draws our attention. And so how we represent information, lots of pieces to that. So the first part is simply knowing what it is I should be looking for beyond simply asking someone. We should watch their behavior. We should watch how they interact with something, how their expectations with the, with the tool that they're working with now. The second part is actually how to do interviews better. So rather than say so, would you like a blah, blah, blah? Because that would be great for me. We want to make sure they have got unbiased kind of science that they're doing and also that they can catch some of these subtleties like: what words was that person using, and what does that suggest about their sophistication of knowledge about the subject matter, for example? And that would really help you with design. And the third part is really, if you have that knowledge, how should that be actually used to help better your designs?
Dr. Jerome Pagani: John, you said something which is one of the things that always fascinated me about people. Why can't you just ask them, Why do you have to watch what they're doing?
Dr. John Whalen: You know, this is one of these things where I like to a little joke here. So just think about when you were at the dentist and what I wonder, what is my tongue doing? And I'm terribly embarrassed and I don't know because there's so many automatic processes that we all have. And so whether it's reading words or making snap decisions or actually even just what comes into our head in terms of the frame of reference we have. So when someone thinks of happy hour, they think of beers on a patio or they could think fancy umbrella drinks in summer with high heels and a fancy dress. So it could be a hugely different representation in their head and we want to tease that out. So simply asking them isn't enough.
Dr. Jerome Pagani: And whether or not we engage automatic processes or step back into a more reflective phase is heavily influenced by the environment and some of the factors in it, right?
Dr. John Whalen: Absolutely. So another thing actually I'd really encourage everyone to do is the, the more you can simulate the situation in which the person might be and the more likely they are to have that frame of reference, maybe those emotional qualities, even be attending to certain things in comparison. So often someone says, Hey, would you like to meet with me? Yeah, that's great in person. Yes, now we can. And then they're like, Great, here's a conference room. And I say, No, no, no. I want to crowd behind your desk and see what Post-it notes you have around your, your monitor and what books are there and what's gathering dust and how many times you get called and so on. If you’ll, if you’ll bear with me, one little story. We met with folks at UBC who are, who are helping people with investments. The folks that we were working with initially said, yes, I think this should be, you know, really complex. These are really sophisticated investors. And when we got there, we found that they had, you know, a sort of a glass wall in front of them. And beyond that was their assistant. And within the room they had the squawk box on, “the Dow Jones is down by 5%.” And they had a TV on in addition to that sound. And their phone was, like, lighting up like a Christmas tree. And they had seven monitors up at all the same time. And how would they typically ask for help from their assistant? They could hit a button on their phone or they would do what everyone else did, which was like “BOB!” and screamed through the window. So I would, like, duck and cover. And, and so the point is, knowing what the reality is on the ground is so helpful in your design. So simply asking in that boardroom weeks before wouldn't have sufficed, you know, wouldn't have been satisfactory.
Dr. Jerome Pagani: So we've heard that from some of the other folks that we've talked to. The importance of this kind of ethnographic research where you're not only interviewing people in the context in which they live and work, but you're also spending time observing them, taking photographs, making videos. And this really informs well the sort of model of the actual situation and the workflow and the environment in which the process or product you're designing for will live and the way people will interact with it.
Dr. John Whalen: Absolutely. So in that case, you know, the amount of attention they could dedicate to the thing we were giving them was small, so they needed an easy button, not a complex sort of thing. So it's something you can all relate to. So. Except for the Squawk box.
Dr. Jerome Pagani: Do those even exist anymore? I mean, I don't know, I guess it's all Slack or Teams or something now.
Dr. John Whalen: Well, it's, yeah, it's broadcast through a stream, but nonetheless it still exists.
Dr. Craig Joseph: So, John, you'd mentioned a little bit earlier the importance of language and words and your educational level. And I don't think that just means what grade did you go to, but are you in healthcare? Are you a banking expert? And sometimes we use the same words to mean something completely different and people are not talking to each other, but in fact are talking at each other. Could you comment on that? Could you make that real for us with any specific examples?
Dr. John Whalen: Yeah, let me give you two different things. So one's a little more serious and one isn’t. So the first thing is just that in many cases that, you know, especially in medicine, there are hugely different representations of the same idea. So the example I give from NINDS, the National Institute of Neurological Disorders and Stroke, is someone who might have had a brief, so they might call it a mini stroke if we're just our local folks and Jerome might call it a transient ischemic attack, and we need to make sure we connect those two together. So actually, one of the beautiful things that NIH has done on their website, and we tried to encourage this and they really did so, was to, so if I search for mini stroke, I get to transient ischemic attack. So the point is that we're connecting the very sophisticated folks and the less so all at once and just to be clear, in your organization, your newer employees are probably like those novices. And so we often, even within our own organizations, have like two levels to work with, just to think of it that way. And just sort of very concretely for myself, in my experience, I remember, you know, I'm a small business owner. I met with my broker for yearly review. He said, So John, how's your plup? And I said, My plup? My plup? And I was looking like, Do I have something in my shirt? Don't look at my plup. How dare you talk about my plup in public! And anyway, I finally learned that, and of course that was what's going through my head. I finally learned that he was talking about your umbrella policy, and I was like, Oh, that's what you were talking about. And so it's a great example of us insiders have our insider baseball, often, it's so unhelpful with the customers. And so we always have to remember that they don't speak our internal baseball language.
Dr. Craig Joseph: Yeah, that's great. As you're talking, I was just thinking of abbreviations as well. The same abbreviation can have remarkably different meanings in I'm a pediatrician and when someone says ROM to me, I think of only one thing, right? Otitis media. That's an ear infection on the right side. I've always just used that word, those letters in that way. But when talking with an orthopedic surgeon, ROM talks about range of motion and has absolutely nothing to do with ear infections, which was shocking to me.
Dr. John Whalen: I heard rough order of magnitude.
Dr. Craig Joseph: Love it. That's a, so ROM is, and there's probably a few others in healthcare that we can come up with those. So oftentimes, yeah, even people with the same type of background can use a word or phrase or an abbreviation and have fully different expectations as to what information their communicating to one another.
Dr. John Whalen: And you know, real quick, Jerome asked about why do you have to focus on behavior and so on. Imagine if you're in a car dealership and someone says, hey, I think there's a clunk somewhere in the back, or someone else says, you know, I really think it's the bolts with the Cadillac converter that are loose, probably three, three or four iteration down. You know, one of those folks probably knows a lot more about the car or at least plays one on TV. But no, most likely really does understand more about the mechanics. And so we do need to serve that person in a different way. So you can pick up on that pretty quickly and adapt according.
Dr. Craig Joseph: Yeah, I don't want to do this, but I'm now forced to do this. When we started moving to electronic health records in the hospital, that meant that we needed more computers, terminals, ways of you for you to get information and to send information. And certainly we had those sitting in offices and around the hospital, but we needed some mobility. And what people have found is that laptops, when they're dropped, don't do very well. They don't bounce. And so we put them on carts and we put wheels on those carts. And so you even see today people rolling around. Well, that's a computer on wheels, which can be abbreviated as a C O W, or cow. And this is a classic story that I think a lot of people have probably happened or it's happened too. But a nurse was asking about the cow that was just down the hallway and a patient overheard this and said, That is so rude for you to be talking about patients in that way. And there was a whole, you know, the nurse looking at the patient, What are you talking about? I'm not referring to a patient in any way. But her perception was a cow was you were saying something bad about a patient. And in fact, they were just talking about the cart with the wheels. And yeah, it's just.
Dr. John Whalen: I was hoping they were on the ground floor in the Midwest and, you know, Betsy had, you know, snuck in, you know, on the double doors.
Dr. Craig Joseph: So if we have any listeners who have experience of farm animals in the hospital, I would love for them to reach out to us so that we could feature them in an upcoming podcast.
Dr. Jerome Pagani: I mean, I was going to say this opens up an entirely new genre of cow tipping jokes that I think are relatively untapped.
Dr. John Whalen: Right? And this is why you now use iPads, probably.
Dr. Jerome Pagani: John, you said something earlier that I want to come back to because it's such a fascinating idea. What do you mean by radical common sense?
Dr. John Whalen: Yeah. So, you know, why shouldn't we design systems in a way that matches, you know, it should be sort of augmenting your cognition rather than challenging your cognition. So you can, you know, when there was something where you couldn't figure out how to do the two factor authentication or if any of you, you know, and I apologize if you have for the stress I'm going to cause now, but you had to fill out the FAFSA form for your college age child to get financial aid, that is incredibly difficult to do. And, you know, the opposite is thinking about something like TurboTax where they say, well, do you have a lighthouse? Do you have a train? And very concrete things that help someone and make it simpler, that you’re not quite sure why you're asking that, but they don't need to know the law. They need to know the answer to the question in order for this system to draw out the answers for you so you don't have to think about it so hard. So the radical common sense is designing for how people think. So they're more accurate, they're faster, and they trust the system more, which is actually an important component to that.
Dr. Craig Joseph: So, John, in your book Design for How People Think, you talk about something called the six minds, and that that is supposed to help a reader kind of get to the why of human behavior. And so could you, for once and for all, just tell us why people do things, that would be great.
Dr. John Whalen: Sure. So, first of all, you're welcome if you're having trouble sleeping for reading the book. But to summarize here, you know, fundamentally, there are six different major pieces that I wanted designers and product owners and so on to think about. And thank you, Jerome, for having me on, despite simplifying all the sophisticated version of cognitive science. But fundamentally, I would say if you're thinking about it, one of the pieces is literally, what are they looking at or what's attracting their attention? What are they trying to find, is one piece. So that's vision and attention and that's something that's in the occipital lobe, way in the back of your brain, logically as you're navigating in real life. And we know this from university hallways and hospital hallways, how complex that can be. That system is enormous in your brain, and we tend not to think about it very much when we're building digital systems that have a virtual space. And so I still think that's something where you should really think about, Do they know where they are in the process? Do they know how to get to the next step? Do they know how to go back? And so, is the person able to navigate and wayfind, the term I was using. Another thing that we've talked about already, you know, just touch on, is just listening to the words they use. And that suggests the sophistication of their mental representation of the topic that we're covering. And so, and also give you great clues on whether you should do the TurboTax version or something much more complex. And with memory, is the fourth. I would really say that, you know, we really want to understand what their past experiences are. What they're used to. Using a restaurant is a great example in our post-COVID era. Do we expect to be able to sit down? Do we expect to look for a QR code now, or is someone going to hand us a menu? Are we going to talk to a waiter or not? There are all these things. I have these built in assumptions. We want to know what those are for our users. And really ultimately you're trying to solve some problem. And so thinking about their decision making and what they're trying to accomplish versus maybe what they should actually be accomplishing and how do we increase their sophistication along the ride to get them to make the best decisions they can? And within all of this, there's emotions that are tied into this. We know that the stronger the emotions, the more you fall back on default. You know, some people call it satisficing, but making quick decisions that have low working memory loads just to get through the day. So we want to know how kind of stress they are along the way as well. So that's the six.
Dr. Jerome Pagani: So I actually love the way you've kind of chunked these systems, John. You know, in academia, the goal is to get to the next and better question than the one you asked before. And so you, can you can keep sort of subdividing and getting more and more specific. But for those of us who have kind of stepped away and are really interested in the practical application of scientific principles to problems that we're experiencing today, I think this chunking gives us a great way to think about a rubric for thinking about how to how to begin to take action and think about the people who are involved in the things we're designing.
Dr. John Whalen: Can I give you just two quick stories that are related to that? So one, I have a lovely daughter and, and she's a, you know, I think, you know, maybe a little bit shy or a little more reserved maybe, is a good word. And she came in after school one day and was stomping her feet back and forth and so mad. And I was like, you know, did someone do something terrible? And, you know, she said, I can't believe it. And I was like, wow, what happened? And it's like, Snapchat changed their interface. And so this was the moment they went from Snapchat 1 to 2, that the CEO thought would be great and would be helpful for, you know, other generations to work with. What they did is they tore apart her ability to wayfind because the virtual space had changed, that had changed her expectations. Suddenly she couldn't accomplish what she wanted to. It was taxing for her memory, broke apart her, you know, representation of this thing. And so ultimately, you know, as they slowly unwound what the CEO had done and had they tested it with their target audiences more carefully, they would have seen the red that was within my mild mannered daughter. So that's one and a very different one. Just to make sure you remember your users are not you. We work a lot with one of the largest technology companies in the world that does search and you'll never guess who they are. But one of the things they want to know is when aren't they being used. And so we had one person where we interviewed and she said, Yeah, you know, I live in Atlanta and I'm going to Phoenix and I wanted to find a good restaurant, so of course I used… Pinterest. And we're like, Oh, okay. And she's like, Yeah, because you know, what I did is I went and looked at pictures of restaurants in Phoenix, and those were my friends. And I know if this friend likes hot sauce or not, and I can see if the restaurant's fancy or not or what kind of things they were serving or fun drinks. And so I knew exactly where to go based on that. And so the simple point here is you almost are always surprised by what happens when you start to interview real users who are not you. And it makes you understand, oh, they have a different way of solving the problem or they have a different way. But we also see the components that person needed to solve the problem and therefore could design a system that's consistent with what they're seeking. And actually they use Pinterest as a kluge in that case.
Dr. Craig Joseph: I was totally going to say Pinterest, but I couldn't get off mute. So I just want, I'm hoping that I can get credit for that because I of course. No, actually I was going to go, I was going to go with Yelp, but. Well, that's interesting. I'd like to pick apart one of the six minds, the wayfinding, because in my experience, that's such a huge problem. And I think when most of us think about wayfinding, where either we're talking about how do I get to the doctor's office in the big medical complex, and are there signs that, that helped me. When, you know, tech designers are thinking about wayfinding, they're thinking about looking through the screen, you know, looking at the screen and, and how do I get to the next place that I want to go? I think about it as the process of a referral. So a patient is in the doctor's office and they say, I want to go see this specialist. And how does that happen? And it's I think it's a huge opportunity because there's lots of different folks involved and they all have different understanding about the complexity and, and what's in, you know, what's really needed from the patient's perspective. Sometimes it's as simple as here's the phone number, call them up. However, that's how it I think it was when I started practicing. But it's changed now. Many insurance companies require prior authorization and, and, you know, you need permission to go see the specialist. And if you don't get it, whose fault is that? And so oftentimes there's a whole process that sometimes the referring doctor knows about, sometimes the specialists staff knows about it. It's so complicated and it seems to be different every single place I go, that's a form of wayfinding. Can you fix that for us?
Dr. John Whalen: Yeah, and actually, I would say two things here. One is that your, your parietal lobes that are really focused on, you know, really designed for physical space, obviously really aren't involved in what you're describing. And let me let me tell you why. So you're really talking about problem solving and actually there's a notion of problem space. So take a chessboard, for example. We know that there are legal moves in, in with different types of chess pieces and so on, or even when you're in one of those escape rooms and you know, they lock you in and then you assume you can't just unlock that lock, you've got to find, there's another layer to it, and then there's a layer to that. I know there's a glass cabinet and that has a lock on it, and maybe there's another problem. So my point is that your problem space representation changes here. So your initial problem space was, I have to find a telephone dial, the rotary thing and pick up the receiver and talk to the person. And so at that's evolved to a cell phone, perhaps your, your watch. But my point is that actually in many cases, the novice in this situation doesn't understand the complexity of the healthcare navigation and so on. So yours is a good example where there might be prior authorization. Why do I have to do that? And you might actually go ahead and then I get an enormous bill and have to unwind it, you know, in reverse. And so, yeah, these, helping folks in your design to understand or even catch them with the simplistic notion and help to say, by the way, did you know at that moment, in some cases there's a more complex situation? And that's just like in TurboTax. Well, do you do you have a lighthouse? Do you have a train? You know, these very funny, you know, 18th century laws in the tax code. But I think the point is the same that, we're trying to catch people at the moment where they're thinking one thing and help to encourage them to really, this behavior change, to really help them have better decision making.
Dr. Jerome Pagani: John, you mentioned a bit about those six information processing systems we have in our brain that you've largely sort of chunked into those different areas. And the interplay between them is very important in decision making. And when you're thinking about design and walking people through a process, does the interplay between those systems begin to change over time?
Dr. John Whalen: Sure, because, you know, so I think a good example is when I start to learn what a plup is and I don't get, I'm not staring at my shirt wondering what I ate for lunch and why it's on my shirt, and rather I'm understanding that's a, you know, some type of umbrella policy. Suddenly I don't have the same emotion attached to that. And I'm actually in the conversation and understanding what that person was hoping to get back. So actually there can be a dramatic shift in the way they represent information, what their expectations are, the words they start to use and so on. So all of these things, you know, even just, we were talking about navigation, that I wouldn't expect to just call up the advanced doctor first. I would check to see, do I need to get some sort of prior authorization? It's a great example. And so we very much in, in cognitive science land, try to think about behavior change and behavior change for good, and making sure they're making, you know, this is not only in things like just navigating the system, but even making sure that they try to go for that walk or take the stairs that one time and what would encourage them. So there's lots of pieces to this we can use for that positive behavior change in addition to simply designing systems for them.
Dr. Jerome Pagani: That's fascinating. And so the interplay between those information processing systems say static across our lifespan, or does it change, and how does that influence the way you begin to design processes for people at different ages?
Dr. John Whalen: I mean, I think a really good example is we've worked with an actually more than one group on things like signing up for health plans and specifically thinking right now about Medicare sign up. And in those cases, actually there's, I just want to say, we can think outside the single human, into the family and so on. So you start off in by not having just turned, you know, 64 and three quarters, and you're eligible for Medicare. And those folks are like, kind of don't have much wrong with me, I'm good. I can, I’ll sign up with the cheap one. And they don't really know what is in that system before they start actually using it more and more. And gradually as they get older and inevitably they have some more things that they're working on, they start to learn more about this. And even further, as you get older, it's in, and actually the complexity of the system because of the governments in the world, becomes increasing in complexity. It's overwhelming for that person to try to represent all this information and they actually really need support from family members and so on. And knowing who to trust in that Medicare sign up processes can be really terrifying for them. And they're overwhelmed with mailings and TV and, and phone calls because somehow they find their number and those can be high pressure and so on. So for the older adults helping to guide them and not have them be so overwhelmed and also making sure that they're essentially safe and making the right choices for them is really important.
Dr. Craig Joseph: John, it's interesting what you're, how you were talking about kind of potentially generational changes and how folks, when they first sign up for Medicare might not be experts, certainly don't think that they need anything. And then they become smarter as things move along. And it reminds me of the idea that all patients are not the same in terms of level of complexity. So certainly folks who are generally fairly healthy, they have very limited interactions with the healthcare system. However, if you get a diagnosis, like something like cancer, you quickly become very knowledgeable about not only how the system works, but about your own medical problem. And now with tools like the internet, I can become a super expert on a particular kind of cancer and start to be able to speak the lingo. And so what I have seen from time to time is designers who kind of are focused on, well, we'll get them their lab results of their annual lab tests and, and that's all they need. And they can wait a little bit for that, to patients who have cancer, who are very knowledgeable and want that information immediately and creating the same type of tool for those two different audiences, even though they're both patients in your healthcare system, really satisfies only one or potentially neither group. Is there a way of thinking about this that can kind of help us as we're, if we're just starting out on, Hey, how do we release these results or how do we think about patients? I'm, I'm worried that we're going to think about the more common one or the one that's closer to us and not the larger group.
Dr. John Whalen: Yeah. So what we've tried to do in some of our designs is to, even in this healthcare space, for example, of Medicare, is to start with essentially, say, a card size thing. What's the bottom line with this plan? What are the core elements and what, based on a few questions we might have asked you, like, it's really crucial to have this medicine or have this particular ailment or I have this hospital I really want to go to, what's in it for me? So making it relevant to them actually was one piece that was really important. The second was having a quick bottom line so they're not overwhelmed with choices. I think, you know, with choice decision making, that we're much more successful with three than 17. And so actually recommending the top things for them in our systems now can be very good at predicting what would be best for them. But secondarily to your point about the experts who have a very specific question, letting them then have another view that dives into the details. And really so in your case, it's like over time, how did this this metric change, you know, and so you can watch that go up and down. And so, for example, that expert in that type of cancer, unfortunately, would probably know, here are the tolerances for that protein and when it's out of whack. And so even letting them understand that you've gone beyond three standard deviations, you know, whatever the case might be, might be relevant for them. So. But that first person who's just learning about their situation doesn't need to know all that. So finding the right way to present a simple bottom line and then saying, we're not hiding anything, here's all the details if you care to look or you want to share it with someone who is an expert, but not if you show all of that right away. It's like, this is just nonsense. You know, if you get the diagnostics from a car, for example, you can be really good at cars. And just having 72 numbers is not useful. You want four to start and dive in.
Dr. Jerome Pagani: That's fantastic. So, John, we like to ask everybody this, sort of the same question, which is to think about three things that are so well designed, and they could be outside of healthcare, the three things that are so well designed that they bring you joy to interact with.
Dr. John Whalen: Right. Well, I think, I think I have them for you. So, and actually some of this is, in my choices, are that I don't have to interact with it. So one is, so this is reducing my cognitive load, right? How doing things for me. So let me start with, actually, my lights at home. So I have my hue lights set up with the timer. So in the morning, just before my alarm goes off, these gradually come up. It encourages me to have regular sleep. Same at the end of the day, and it goes dimmer and it starts to give me a mental cue that, oh, you know, I might be getting a little sleepy. And so these are just positive. These, I'm trying to do behavior change on myself, to encourage positive behavior. And if you have a teenager, making sure they don't stay up too late. So that's one. And so that's simply where I don't touch those lights. I leave them the way they are and they come up at sundown and they go to bed at the right time and so on. And that solves, its one less thing for me to think about. It's like Steve Jobs wearing his same turtleneck every day, right? It's one less thing to think about. The other one I've got for you is I really like my one password. As a small business owner and wanting to keep things safe, being able to use biometrics and have, you know, 160 different, I actually, I didn't count how many, but probably more like 200 different passwords. Simply not possible for a human to keep all those unless you do some sort of code that would then let the hackers in on your little secret. So first all, I'm looking forward to when passwords are extinct, and I know we’re, that's coming. But still, in this moment in time, this is one way that it just has to know I'm me and we're all good and I don't have to remember that thing. So there's two ways that I actually love for the thing to give me joy by not having to do something. And the third one is actually, I love using Google Maps when I'm walking. And, you know, so for example, I get out of the train and the Amtrak in New York City and I always walk one block and then I can see the change in blocks. So, you know, the sun isn't going to help you. There is a huge building. So did I go up or down? You know, did I change from this avenue to that avenue? Then I understand. And when I'm going somewhere, I know you, of course, Jerome, are always early for everything. But supposing you were just on time or even running just a hint late. You want to make sure you don't take that one wrong turn. So having Google Maps reinforce what I'm doing actually makes me calmer and makes me feel like it's going to be okay. And so, so it's one of those things that just internally you're getting, getting a reinforcement that we're doing the right thing. So all of these relate, actually, to the six minds, interestingly, I think almost everything does. So there you go.
Dr. Jerome Pagani: You know, I, you mentioned the reducing the cognitive load. And I remember how grateful I was when smartphones came along and maps like Google Maps or Apple Maps were a thing you could just take with you. Because before that I had had some jobs where I would travel to interview people. And, you know, I was carrying physical maps and they weren't always updated. Or if there's construction or road closed, you know, it's, it's increasing your cognitive load, which is taking your mind off the driving you're supposed to be doing and inducing anxiety because time pressure. Yeah. So I love that, that idea of just thinking about things that can help you focus on what you want to be focusing on as, as part of the design process. That's fantastic. Elimination rather than, than adding to.
Dr. John Whalen: Right. That's that radical common sense. There you go.
Dr. Jerome Pagani: John, a pleasure to speak with you as always. Thanks so much for joining us for the podcast.
Dr. John Whalen: Oh, it's very much my pleasure. Thank you for having me.