Designing for Health: Interview with Joyce Lee, MD [Podcast]

A course on information technology is not a prerequisite to graduate from medical school, yet so much of a physician’s day-to-day interactions occur in a digital environment. From a doctor’s perspective, understanding the basics of how and why a software program was designed can greatly enhance their experience with the digital tools at their disposal. Conversely, designers with an open ear to feedback from clinical stakeholders can make significant impacts on the workflow and experience of physicians, lowering burnout and ultimately improving patient care and outcomes.

On today’s episode of In Network's Designing for Health podcast feature, Nordic Chief Medical Officer Craig Joseph, MD, talks with Joyce Lee, MD, MPH, associate chief medical information officer for pediatric research at Michigan Medicine. They discuss how a sabbatical spent in Silicon Valley shaped Dr. Lee’s thoughts on the intersection of design and medicine, the value of a physician-builder program for health systems, and her experiences running patient-centered design workshops.

Listen here:



In Network's Designing for Health podcast feature is available on all major podcasting platforms, including Apple PodcastsAmazon MusicGoogleiHeartPandoraSpotify, and more. Search for 'In Network' and subscribe for updates on future episodes. Like what you hear? Make sure to leave a 5-star rating and write a review to help others find the podcast.

Want to hear more from Dr. Joseph? Order a copy of his book, Designing for Health.

Show Notes:

[00:00] Intros

[01:47] Dr. Lee’s background and sabbatical research

[07:45] What systems design means

[11:40] The parallels between quality improvement and design

[15:43] Physician-builder programs

[24:12] Patient-centered design workshops

[29:11] Dr. Joseph’s background in design thinking

[37:29] Well-designed things that bring Dr. Lee joy

Links to Dr. Lee’s thoughts on EpiPens:

Link to more information on diabetemojis:


Dr. Craig Joseph: Joyce Lee, welcome to the pod. Excited to have you.

Dr. Joyce Lee: Thanks for having me. Excited to be here.

Dr. Craig Joseph: You are the first person who I thought of when we were talking about creating a podcast like this because you own a website called

Dr. Joyce Lee: Yeah.

Dr. Craig Joseph: And there aren't a lot of folks that have a website like that combining, specifically talking about combining design and healthcare in that way. So, I was intrigued from the beginning. Can you tell us how did you come to the, how did it come to a place where you actually created that website? What were you thinking when you were in college that you were going to be doing now? And is it exactly the same or did you go off track and become a doctor and designer?

Dr. Joyce Lee: Yeah. So, I guess I would sort of identify originally as an academic. So, I'm a pediatric endocrinologist. Did, you know, Residency Fellowship joined as an attending and was doing, I would say, identified as something called Health Services researcher. Right. So, someone who was doing a lot of health outcomes research in diabetes and obesity. But I had been at University of Michigan since 2006 as a faculty member, and I actually had the chance to go on sabbatical in 2012 for a year, spent time at Stanford, and their child health policy unit and had a chance to just really explore new frontiers. So, I was really getting interested in digital technology. But I think if you're interested in technology, you really have to think about the importance of design when thinking about the users adopting it. And so, I had a chance to just kind of mix, intermix with a bunch of really interesting individuals in the Valley. It was kind of an exciting time because it was 2012. Twitter was kind of on the rise as quantified self-meetings were happening in the Valley and there were just a lot of fascinating players who were doing work both inside and outside of industry but did meet up with some designers and started learning about the methods and just became super fascinated by it because it's really something that I think we in healthcare are not familiar with. I mean, it's a really, it's a foreign concept to the average healthcare user, but it just made a lot of sense to me in terms of it being an important way to solve problems and then also an important way to think about the patient perspective as we're designing healthcare. I will say that, you know, MedX is a conference that I don't think exists anymore, but it was founded by Larry Chu, he’s an anesthesiologist at Stanford had gone for a couple of years. And I think that's also sort of one of the areas that really sparked my interest, because they always had a very patient focused approach to the conference and then really embraced design thinking, I think as part of the ethos of innovation.

Dr. Craig Joseph: Well, it's great. You planned well to be in the right place at the right time and, you know, to be in Silicon Valley ten, 15 years ago was a good time with respect to healthcare and Stanford. They know a little bit about design at that institution. I think I like your point about healthcare and those of us in healthcare not really understanding design. It's one of those things we all do. We all design things for ourselves or for others. But most of us don't really think about it when we're doing it right. We design a workflow. We design a form by telling someone these are the pieces of information that we need, and all of those things happen every day. But we don't we're not very intentional about kind of doing this in an organized way. So, it is important and I thank you for kind of calling this out and being one of the early folks to kind of notice that we're not so good in healthcare. We can't do AB tests, right? We can't do some of the things that they do in the software world.

Dr. Joyce Lee: Yeah. So, I mean, I think it was you know, when I came back, I think it was kind of interesting because I came back to University of Michigan. I was trying to think about partners. So, to think about its application in healthcare, where I was actually working right, as opposed to it being a sabbatical. And I got to partner a lot with School of Information, School of Art and Design, patient experience, right? So, I think there's a lot of interested stakeholders in the field, but definitely still have a lot of opportunity to sort of operationalize the method in the system. And I will always say that I'm actually not formally trained in design, right? Like I don't have any formal training, but I think it's about learning about the method, learning about the mindset, right? And then thinking about how we can spread that. So, with all of our, you know, we did a lot of patient centered design workshops when, when I came back and, you know, they were very multidisciplinary and they involved healthcare stakeholders, patient representatives, you know, individuals with a lot of technology and design skills. But I think, you know, for everyone to sort of say I'm a designer is probably a really important and empowering philosophy, right? Like, you don't have to be special. You don't have to go to an art and design school. You just have to be intentional about thinking broadly about how you're going to solve problems.

Dr. Craig Joseph: I love that. A while ago I took a class about a class. I was doing one of those couch to 5K, you know, kind of learning how to run and I kept telling the folks around me from the running store, I'm not a runner, you know. And they all said actually you're running, so you are a runner. You may not be a world class runner, but you're a runner because you run. And I think that's great. All of us are designers and whether we want to be or not and the differences, are we thinking it through clearly and being intentional about it. So that is awesome advice. One thing that I think you said was systems design, and I think that's an important distinction. So, what is that what's systems design mean to you?

Dr. Joyce Lee: You know, I think that the method of design is really important to adopt, but I want to acknowledge that healthcare is a super complex system, right? So, as I was looking for collaborators and for sustainable collaborations, I think one of the biggest barriers I felt like I faced is that everyone's currency is a little bit different, right? So, if you talk to the individuals in the School of Information, School of Engineering, School of Art and Design, well, you know, their currency is in terms of classes and course releases and how they can develop new curricula. Right? I live in the academic medicine world, right. So, you know, there are two things that I do or maybe three things. One, clinic two, you know, perhaps administration, right? And then three, like, how do you leverage your time doing research? Right? And so, it's really hard to integrate true collaboration in healthcare and design, because those structures are so different, the incentives are so different, right? And how do you find traction as a multidisciplinary group? So, you know, I started thinking a little bit more about, okay, beyond education, but beyond sort of spreading knowledge and familiarity with the process, how do you get some more fundamental change inside the system? And, you know, learning health systems is I mean, we can talk about systems design, we can talk about learning health systems there’s many monikers, right? But the bottom line is, you know, I guess learning health systems is a model that's really been advocated by Institute of Medicine, and then many leading leaders in the field around trying to make sure that we have operational players and our clinical delivery system working in tandem and in collaboration with our quality folks. Working in tandem, in collaboration with our research with our researchers, and the ability to sort of innovate inside the delivery system. So, I think I've I sort of latched onto this notion that design is a piece of the puzzle, but it's not the only puzzle we have to think more broadly about the structures in the system, the methods we can use to change them. And so, in addition to design, in addition to sort of patient-centeredness, I really wanted to learn more about Epic and health IT which you're very familiar with. Right? But you know, what is the tool inside the system that really controls the behaviors and the actions of everyone, every stakeholder in the system? It really is the electronic health record. But then also, what are the methods that you use to initiate change inside the system? And I think quality, quality improvement, you know, the methods that come from AI or other areas like Six Sigma, right? Like those methods of trying to innovate in the system using rigorous methods is also part of, part of the opportunity. So, I got training in sort of both of those areas, and I do more leadership and administrative roles now that involve IT and operations and research, right? So my goal is always to bring those things together because we often live in silos and I will say that because most health systems don't know what design is, you have to use the language that they're familiar with. And there's a lot of parallels between design thinking and quality improvements, right? So I think that using the language of health systems or learning health systems is really important for bringing the perspective of design there. Even if you're using a different language or a different terminology to do the same kind of work.

Dr. Craig Joseph: Sure. So that's interesting. Kind of the overlap between quality improvement processes or programs and design. So, let's dig a little deeper on that idea of the parallels between quality improvement and design. I think you said that hospitals understand quality. They've been forced to understand that to practice quality healthcare, but a lot of them don't understand design. And so, what are some of those parallels or how have they developed together?

Dr. Joyce Lee: Well, I mean, I think they're both about solving problems, right? And they both have a process that sort of design and development. But what I like about both of the processes is that it's about iterative development, right? So, you know, in design they just talk about the Double Diamond method or like the ability to go back and redo and rebuild. As part of the design process, it’s not a linear process. It's not something that happens immediately and then you just get to final product, right? And I think quality is the same way, right? We use PDCA cycles or PDSA cycles, right, to iteratively improve on what we're trying to achieve, right? I will say that quality tends to be a little bit more metrics oriented, right? So usually there's measurement built into the system and you're able to see whether there's improvement in the system. I don't know that design has sort of rigorously applied this right across the board. I think the other thing is that quality perhaps tends to focus more on small tests of change or iterative improvement or perhaps like optimize a system that exists in a particular way. Whereas I feel like design perhaps allows you to think about reimagining the system or changing up or eliminating pieces of a system, right? So, I feel like both of those methods are both very beneficial to designing better healthcare experiences, better healthcare products, you name it. So, I like the idea of applying them at the same time to achieve, I think, a better result for like the user, for the system. So, but I will say that again, like most hospital measures, they don't know what design is. There aren't a bunch of designers, right, to be hired on the payroll, right? I think those individuals live in various pockets of the health system. You know, they might be project managers, they might be quality improvement specialists. They might be located in, I don't know, innovation centers. But to the extent that you can, in truth, introduce, to the extent that you can introduce the method or the ideas and or the innovative spirit into sort of the standing that sort of healthcare delivery system, I think it's super helpful because it is otherwise really hard to gain traction to achieve the kind of important goals that you have.

Dr. Craig Joseph: Sure. So a little bit ago you used that three letter word EHR, which I believe stands for electronic health record. And it's basically, the EHR is the tool that clinicians use all day long. You know, they're not in their outlook, they're not they're not doing email most of the day. They're there in that EHR for patient care. And actually, often for non-patient care activities as well. How do you see or maybe how have you seen folks be successful and kind of leveraging some of these principles of design as it comes to IT and the EHR specifically, how does the University of Michigan and I know I'm not asking the right person, but here you are. How does the University of Michigan leverage design and, and their use of technology for clinicians?

Dr. Joyce Lee: Well, I mean, I think that participatory design, right? So, if you think about users of the technology, stakeholders in the system, making sure that they're part of the design process is one important piece of designing better technology and or better experiences. And so, you know, something as simple as a physician builder program, right? As we have, like for example, with Epic I think is an example, right? Because like, clinicians are seeing patients, they're going through the workflows, they're documenting. Right? And so how the tools have been designed or badly designed such that it really impedes their ability to do it efficiently, effectively and learn from the data. Right? So just, you know, so I want to acknowledge that we've done some work with this in type one diabetes, right? Where, you know, we were creating structured items that capture really specific clinical variables that are actually really important for understanding how to improve the system as it relates to glucose management and our glycemic outcomes, right? So, it’s the content, right? But then it's also delivery, right? How do you embed it in the workflow, how do you get it to be user friendly? It’s really kind of fascinating to me because I didn't feel like when I went to do my courses at Epic to become a physician builder, I felt like before, before you would ask for things and then people would tell you, no, you can't do that. No, you can't do this. No, you can't do that, right? But then you go to a builder class, and you’d be like, oh, you actually can do this, and you actually can do that and you can actually do these things too, right? So, you know, just want to acknowledge that. I think sometimes there's a lot of value in having the stakeholders using the system actually design the system so that they can make it user friendly so that completing your note is like a five-minute exercise or endeavor instead of a 20 minute one. And how do you make it yield meaningful and actionable results that we can learn from in analytics so that we can understand where our deficits are, understand where we're really performing well, and design opportunities or interventions to improve on some of those outcomes.

Dr. Craig Joseph: So yeah, now that's perfect. And so, you mentioned the physician builder program, and I think a lot of electronic health record vendors have these kinds of things. Just for the uninitiated, a physician builder is a physician who's using an electronic health record with generally no formal IT background who gets just a taste, just a taste of how it works behind the scenes. Kind of get to look under the hood. And what is it, 8 hours, 10 hours for your typical, you know, your first kind of class something along those lines and you were just describing how it was kind of an eye-opening experience, right? Because you would ask questions of your IT folks and they told you either frankly, incorrect information or maybe they didn't understand exactly what you were asking for. So they were responding as best they knew how or they were responding to the way the system was five years ago when they were trained. And they haven't kept up on what's available now. But under any circumstance, I think this is actually this really ties back nicely to that idea of you don't have to be a professional designer with a master's degree in art to actually leverage some of these ideas and really be able to leapfrog over your peers and much in the same way a physician builder with, let's just say, ten or 20 hours of training, can they go and create these tools from scratch? No, but that's not what they're I mean, basic ones. Yes, but complicated ones, no. So physicians who have ten, 20 hours of training, a small amount compared to the analysts that they're talking with can still have much better conversations and ask for things in a way that that more understandable and be able to pose a question in a much more formal way to move the process along. And I think it's amazing what a little bit just a little bit of intentionality and a little bit of kind of knowing the lingo really makes you go a long way or helps you go a long way with respect to, you know, to improving the tool that we all use. So one thing that you had mentioned in passing was a learning health system. So, what is a learning health system? How do I sign up for one do or do I want to go with one that doesn't learn? I don't think I do, but maybe give me some clue here. Point me in the right direction.

Dr. Joyce Lee: Yeah. So, I think it's really just trying to connect the silos. I think in most health systems, right? You have a lot of clinicians and operational folks actually delivering the clinical care. You have quality improvement folks. Who're actually trying to look at safety and patient outcomes. Right? And then you have researchers, right, who are at it for interesting, interesting clinical questions, perhaps, or maybe even more biomedical questions. And they're sort of lost in that world of the biomedical. So, I think, as you know, I think many of us I mean, I think I've sort of seen this push to medicine, but I think, you know, many of us, at academic institutions across the country, have noted that we all work in silos. And perhaps that's because we have expertise. We have partners, right? We have sort of in-depth and in-depth sort of approach to achieving excellence in what we do. But the question is, how do you actually break down the silos? How do you get individuals, you know, the improvers, the doers and the researchers to talk to each other? And how do you get those systems? Who are all actually trying to learn or learn from data. How do you get them to speak the same language so that we can collectively sort of synergize our learning, right? So, there may be like discoveries that we kind of understand through better measurement of the care that we execute, right? And then there may be things that we want the researchers to study, but we have to generate those insights through data and learning and metrics to share that and sort of see if those are opportunities to like to go more in depth. But then at the same time, I feel like the researchers have some really great, you know, trials or behavioral trials or other discoveries that we have yet to integrate into the delivery system, right? Because there's something like a 15 to 20 year delay in translation, right? Like perfect example, type one diabetes, diabetes control and complications trial, right? If you do intensive management and lower A1C in this population of type one patients, you will delay the onset and progression of complications. But it's been almost 30 years and we are still struggling as clinicians across the country to really achieve those goals or the majority of our patients. So I think again, it's a systems approach to improving patient care when one patient at a time.

Dr. Craig Joseph: Yeah, yeah. And I think that oftentimes that that systems approach is missing. We still blame, it's the patient's fault. Why didn't they, you know read the information the voluminous college freshman level treatise that that I sent them because if they would have read that then clearly this this problem wouldn't have happened, or we blame the nurse who mistakenly connected two tubes that probably should never have been connected. But we the system allowed those two tubes to be connected and hence it's probably not from a systems perspective, it's probably a system-wide problem, not a human problem, because we want to make things that are mistake proof, and we don't do that. One thing that you had mentioned when we were preparing for this episode was some patient-centered design workshops that you had done and one that I found particularly interesting was adolescents who had diabetes and how their results were communicated to them. And so can you tell us that story and what happened? What was the problem and how did you ultimately try to improve it?

Dr. Joyce Lee: Yeah. So, I think what I love about design is it helps you think about what problem you want to solve, right? And we sort of designed these workshops. We invited patients as experts to the table. We had multidisciplinary stakeholders at the table. But the bottom line is we sort of like put them, put the individuals at the table through the exercise of design, right? So they had to define a problem, right? They had to ideate, they had to prototype, they had to test. And then they had to go back and go through that process again, right? But the idea was to come up with sort of like a paper prototype of demonstrating that they could sort of walk through the design process. So again, we had sort of teenagers with type one diabetes who served as the stakeholders. They were our very brave stakeholders, right? But they knew more about diabetes than the rest of us. I mean, I'm an endocrinologist, right? And I and I'm a pediatric endocrinologist so I treat patients right? But I just want to acknowledge that, like as a physician, I don't understand the lived experience. You know, I think like as clinicians, we tend to focus on A1C as our primary outcome, right? So, we're always looking for glucose control. What tools can help improve glucose, right? And so what I think what I think was really fascinating about the process is that when we let the experts speak, you know, they weren't complaining about their blood sugar levels, they weren't complaining about their hemoglobin A1C levels. But what they cared about was the fact that their parents were texting them all the time about blood sugar management during school. And it was really annoying to them. So, you know, and there's a lot of acknowledged like family-child conflict as it relates to chronic disease management. But I think that's where, you know, you have to define the right problem. And if you if you left the problem to the doctors, they would pick the wrong problem to solve in the first place. It would be the problem but didn't actually need to be solved. So we went through a series of like, you know, they went there was sort of a series of ideas that were created. There were some, you know, paper prototypes that were created. But one of the things that came out of it was something called diabetemoji, right? Which was this idea of like, could we find a more fun and interactive way to one ease the tension between patient and child or parent and child and then two, you know, put it in the language of the teenagers, right? So we went through a couple of iterations that actually existed as an app on the App Store, but had trouble keeping that alive because we lost our engineering talent through the undergraduates who were working for us. So it actually exists right now as stickers in the App Store. So I have to acknowledge the Omer family. They are patients with type one diabetes that we've collaborated with quite a bit on design activities. And it was really their girls who sort of created the genesis for this like little mini product. But, but again, I just think it's a great example of talking to the right people and meaning like in healthcare, we really have to talk to patients to really understand sort of the nature and the importance of the problems that we're going to sell.

Dr. Craig Joseph: Diabetemojis is first of all, if I start a band, that might be my band name, ladies and gentlemen, Diabetemojis. And it wouldn't be The Diabetemojis, it would just be Diabetemojis. That's amazing. And everything you said really resonates with me, that is not the problem, that I would choose to focus on. But after it's one of those things where it's obvious it's been in front of your face the whole time, but it's not something that you think about until someone points it out. And that's someone where we're, you know, some teenagers with diabetes mellitus, type one. And so kind of absolutely knowing who your audience is or should be, right, is an important part of design because otherwise you're doing all this amazing intentional design for the wrong person, for the wrong group. And then when you try to put it in a chart in front of that entire group, it fails and you wonder why. In the same way, when we asked the chief of cardiology how she wants us to configure this particular module, this particular screen, and then you're shocked when the vast majority of cardiologists who really use the system every day and don't have a team of people underneath them are like, no, this is not no, this is not working. It works great for the chief of cardiology, but that's one person out of 40. So, you know, we had the, we hit the design thing, right? But we got the wrong audience. And so it all failed. So, yeah.

Dr. Joyce Lee: Could I ask you a question?

Dr. Craig Joseph: No, this is a one way this is a one-way podcast interview Joyce, no one talked to you about this apparently in the past. All right. I will allow it, but I just want any future guests to know that this is not a regular feature of this podcast.

Dr. Joyce Lee: So what got you interested in design?

Dr. Craig Joseph: Ah! Okay, awesome. Yeah, I'll tell you, it's Don Norman who wrote a book called The Philosophy, and the original title was, or at least the initial edition was The Philosophy of Everyday Things, and I think it was chapter two or chapter three. He talks about doors. So this just happened to be I just I don't even know how I stumbled upon this book, but several, many years ago, maybe 15, 20 years ago. And it basically this was the take home message I got from his very long chapter on doors. If you need instructions as to how to use a door, it's probably a poorly designed door right. So if I see the words pull or push, someone's probably done something wrong. It should be designed with affordances such that there's only one thing I can do with this door. I can push it or I can pull it, unless it's an odd door that you can push from both sides. But, you know, if I see a door handle, I want to pull it. If I see a flat plate, I want to push it. And I don't need anyone to explain that to me. And no one needs to go to school to understand that. And after, you know, those have been called now, not by Don Norman, but by others, people like me, Norman doors, poorly designed doors. And after you kind of come to that conclusion that there are such things as Norman Doors. A, you see, you see them everywhere you go and it makes you crazy. And then you point it out to other people so that they become crazy. I can't tell you how many people have told me, like, I can't look at a door now because of you. And I'm like, don't blame me, blame Don Norman. But B, I see these things in in healthcare. I see them as a patient, see them as a physician, I see them as an IT person where I'm like, okay, we want people to do the right thing, whether it be open, walk through a door or report their hemo or go get their hemoglobin A1C checked or eat right or do whatever it is that we or you know, for the physician, we want them to order the right labs and ask the right questions. And we make it often difficult to do those things. And then we are shocked when people don't do those things. When you made them jump through a bunch of hoops or do something that they don't want to do or that seems inherently uncomfortable, or just no one understands, why should I ask this question? I don't see any benefit to asking this question. And, you know, to me, part of design is simply that one of the key aspects is transparency. So saying like, okay, well, this question is used for this information or this report or five years from now, we're going to go back and look at this thing and we wouldn't be able to do it if we didn't have that information. And so often, you know, people are like, okay, yeah, that makes sense. So now I understand why I'm going to do that. So, so that's really so it's a great question. No one's really asked me that question. But yeah, that, that's how I got interested in design. Like you, I have actually much less formal training than you do. I never got to spend time at Stanford, but I get to talk to smart people like you and others who do this for a living. And I feel, again, just like your physician builder reference, which I'm going to now, I'm going to now steal from you. And I will tell everyone that I do follow the rule where the first two times I talk to other people about your idea, I give you full credit. But the third time and every time after that I steal it completely and will not remember your name on purpose.

Dr. Joyce Lee: You're the guru of health IT, so you deserve it.

Dr. Craig Joseph: Yeah, I'm that guy. But you know that that idea of, hey, a physician builder with minimal experience I'm sorry, minimal training, but some training but minimal, can't solve the world's problems. But boy oh boy, can now speak much more intelligently to the IT analyst. Can now explain in a more cogent way to their colleagues about how things work or why they don't work or why they have to work this specific way and it changes things from magic to something that's approachable, right? The electronic health record, most technology for most of us is magic. I don't know how it works. I have no idea how my phone works. It just does. I don't know how it does it. And there's lots of things like the doors, you know, I always struggle with it when there's when there's a pull on both sides of the door. Half the time I'm going to get it wrong when I go up to the door to pull it, it's not going to move. And then I'm like, I need to push it. And, you know, I could say like, I don't like this door. I always approach this door the wrong way or gosh, I'm dumb because I always do the wrong thing when I come up to this door. But in fact, it's not true. It's the door. It's not me. So, I just feel like design helps us. And then to kind of make things just a little bit easier. And I've been amazed at how sometimes it's the little, tiny things that really decrease our stress and decrease our perceptions of burnout. You know, I always tell the story where a physician has complained or mentioned that this documentation template of what Epic would call a smart text, you know, I use this thing every day and paragraph two, sentence three has two periods at the end and I have to go in and I have to delete that extra period every single time because I'm an anal retentive physician, as are 99% of us. And it just makes me crazy. And of course, you know that the fix for that takes approximately 3 seconds. It's really quite easy to fix that. So, I might go to someone and say, you know, I know that functionality that we promised you, but it's not ready, it's not calm. And I know it's a big problem for you. And you know, we can't deliver the care that you want to deliver. And often they'll be like, oh no, it's okay because you fixed that other problem. And I'm like, what other problem. You know, the two periods at the end of the sentence and it's like, oh, so that little pebble, I've got a big boulder here, but you're okay with that big boulder because I got rid of that little pebble. So that's the same thing with those doors. So at least in my perception, like, you know, just fix the door. So, then I don't pull it when I'm supposed to push it and vice versa. And life is a little bit better. So that's my soapbox on design and healthcare.

Dr. Joyce Lee: Yeah. You know, what I think is so fascinating is signs, signs are everywhere inside healthcare. So, it's fascinating to see the problems that need to be fixed when you, like, walk around the hospital and look and see what signs are put up, right? So, my favorite in a health system was the sign taped on a door that said, “please keep door closed, wandering patients.” And I was like, I feel like this speaks to a more systemic issue or problem in the system. That's an interesting clue and that's an opportunity to design.

Dr. Craig Joseph: I like that. We won't say the name of the hospital, but yeah, that's actually a perfect that's a great metaphor for a system problem. The solution is not lock this door so this patient can't accidentally escape, but in fact like, well, why are patients who are at that kind of risk who are confused, don't know where they are trying to get home? Why are they given the opportunity to even come close to that door? And yeah, that's great. Well, I think we are coming close to the end, and I want to give you a chance to answer the question that we ask all of our guests, which is, are there things in life that are so well-designed that they bring you joy or happiness? Often, they're not related to healthcare, but sometimes they are. So, are there one or two things that you'd like to share with us?

Dr. Joyce Lee: So, I'm a food allergy mom, right? My kids both have like anaphylaxis, to dairy, egg, and peanut. And so, I think growing up, as they were growing up, right, I had a lot of worry about use of the EpiPen right? As we know it. So, I think one of the most innovatively designed products that came out, which I thought was sort of like life changing for me, although unfortunately we can't get it now because of insurance is the AUVI-Q. So I don't know if you've seen sort of traditional EpiPens, right? But traditional EpiPens, they have the cap on one side, but then they have the needle at the other end, right? So, what happens is that if you're using the metaphor of a pen, if you take off the cap, you will assume that the needle would be where you took the cap off. But in fact, it's at the opposite end. And so, there's a ton of people who auto-inject themselves instead of actually injecting the person, having the anaphylaxis. So and then the other thing that I think is really interesting is there's actually a big sign at the bottom that says, like needle here, which I think is fascinating. Right? Because it's sort of like putting a sign on a really bad design. So, what's interesting about AUVI-Q is that it was like it's almost like wallet sized, cap and needle are on the same side. So you pull it off and then it actually like talks to you. So, it's sort of like a Siri. So, it will say like take cap off, like insert into left thigh, wait 10 seconds, right? So, it sort of guides you through that whole process. And then it’s even just sort of like designs that you can actually fit it in a purse or a pocket instead of those big fat Sharpie shaped EpiPens. So that was sort of like one of the coolest, I would say, health products that I encountered as my kids were growing up. It's hard to get that product now just because of insurance and sort of the way all these pharmacy benefit managers allocate those tools. But I still think it was a great example of product and medical product made through design. And I think what's really fascinating is the company that made it, was actually like the product was actually made by two brothers who had allergies, right? So, it was like the user understood what the problem was like, understood what needed to be solved, and actually designed the product that got FDA approval. That actually solved the problem for a lot of families.

Dr. Craig Joseph: That's great. And I have to say, like I have prescribed many an EpiPen and I did not realize some of those design issues that you just mentioned, because I had never, I've certainly I've seen the sample ones, you know, the ones that you get to play with without a needle. But yeah, that that makes complete sense because you're not thinking very clearly when you're either going to administer to yourself or someone else. None of us are going to be thinking clearly about how to use this tool. And if it's not just ridiculously inherently obvious, there's an excellent chance that we're going to get it wrong. And, you know, putting words like you said, you know, “sharp end in this direction,” that is something I will totally read after I accidentally inoculate myself like, yes, I now see my heart is beating very fast, but I now see that I just made a mistake. So, yeah, that's great. That's a great example. Thank you for bringing that to us. Well, this was a great conversation. Thank you so much for explaining some of these things to us, especially learning health systems and systems design and some of the overlap between quality and design. Dr. Joyce Lee, thank you again. Really appreciated it.

Dr. Joyce Lee: Thanks for having me. It was fun to chat.

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