'The Wall'

Have you seen ‘the wall?’ 

We see the wall frequently.

It’s a common moment on our visits to clinics and hospitals and other sites of care. On our research visits, Helpfully often begins our field work with a tour around healthcare facilities and we observe key moments in how patients and professionals navigate the spaces and get things done. What happens when? Where does a person go next? What’s ‘on stage’ and ‘behind the scenes’? Sometimes, we already know some of the pain points or a breakpoint in the patient journey. In other cases we get more latitude to explore and discover breakpoints.

So let us show you a typical ‘wall’. It’s from a recent walkthrough at a birthing center.

“The Wall” at The  Atlanta Birth Center , Atlanta’s only midwife-staffed birthing facility.

“The Wall” at The Atlanta Birth Center, Atlanta’s only midwife-staffed birthing facility.

The wall is the collection and display case for all kinds of collateral to help patients beyond the visit. They’re often a happy mess — support options, Follow-on healthcare or wellness opportunities, disease management tools, holistic health practitioners, startups trying trying disrupt some part of health or healthcare, foundations providing assistance, patient advocacy orgs, government programs, public health posters.

For an increasing set of health conditions, patients want to be in control of their own care. The attitude of empowerment is growing in prevalence in the U.S. and beyond [see more]. Patients want to direct their medical or wellness path, and collaborate with their doctors or others who can help them. Dare we say they even want to design their own care. They are seeking out help and resources, online and off. They’re asking friends and family, and others who’ve gone through a similar set of options.

As a researcher, the wall is a great conversation starter. We ask patients and the professionals who work in the facility to walk us through some of the options. To explain why those materials are there, how they refresh / add / remove items, and who’s responsible. The wall can serve proxy measure for patient interest and even tell us something about staff engagement as well. When we see a healthy, even overflowing, wall we know the professionals who work there are highly engaged in supporting patients. When we’ve seen sparse or neglected walls, there’s often a lack of support. 

The next time you’re in a medical facility or just visiting your local doctor or dentist’s office, look for the wall. You might learn something, find a flyer or card of interest, and walk away with more knowledge about health and healthcare too.

Improving Healthcare Productivity

McKinsey’s 2019 Healthcare research report highlights how much “low hanging fruit” there is in the healthcare delivery system in the U.S. The report emphasizes why and how hospital operators should focus efforts on improving the team’s productivity rather than making large-scale financial investments in cutting-edge technologies or new operating models. 

The economics of the U.S. healthcare system are complex. U.S. hospitals only earn 1-3% profit. When you compare them to the rest of the world, U.S. hospitals have considerable over-capacity in certain areas, especially total in-patient beds and imaging services. And of course, they require an army of billing experts and the information systems to authorize (and argue for, and appeal, and re-appeal) procedures. 

The authors — and McKinsey in general — deliver a financially and economic analysis, instead of attempting to uncover the human dimensions of this equation. Individuals and teams that work in hospitals exhibit complex behaviors and some of the problems will require rethinking organizational dynamics and designing better. 

As a quick excerpt, here are a few operational improvements which could bring considerable savings and better satisfaction from patients, caregivers, and hospital/system workers:  

“Hospital operators should focus efforts on improving the team’s productivity.”

“Hospital operators should focus efforts on improving the team’s productivity.”

  • Many healthcare providers and systems don’t currently fully utilize clinical staff or physicians. They should consider revisiting preference rules that limit the types of patients clinicians will see at certain times. 

  • Provider systems could encourage all clinical staff members to maximize the amount of time they spend on the highest-complexity activities commensurate with their training and experience. The report calls this working at the “top of an individual’s license.” Fieldwork analysis shows that 36% of activities performed by nurses could be done by other staff, freeing up nurses to do their best work instead of busy work. 

  • A costly challenge is coordinating patient care across facilities and system boundaries — Adding more automatic reminder systems should reduce the number of patients who fail to show up for appointments. 

  • Developing a standard set of reporting requirements and incentives offered through alternative payment models will help reduce costs. As a first step, they could aggregate claims processing and adjudication and further automate their billing insurance and reporting (BIR) processes. McKinsey estimates that if payers were to collaborate to develop a clearinghouse for billing and insurance data (similar to the financial services industry), overall administrative spending could be reduced by up to 30%.

  • Over the longer-term, provider systems should consider renovations and changing the idea that the hospital bed is the center of all care. They can rethink service distribution based on modern care pathways. For example, provider systems would benefit from delivering some patient services in the community or at home.

The healthcare delivery system in the U.S. provides some of the best care available worldwide, though it’s pretty clear that the return on health spending is not always positive — the U.S. lags many developed countries in health outcomes, longevity, and quality of life achieved. Optimizing the operations and finding the right levers can be a boon for us all  

For all the details, here’s the McKinsey Report.




3 Startups Innovating in Primary Care Experiences

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Helpfully’s consulting teams have engaged the healthcare system from multiple client vantage points — from researching hospital patient flows, design for doctor’s office IT systems, consulting on peer-to-peer support networks for people suffering from serious conditions and working with organizations to influence health policy experts.

But no matter our health, we all share one experience: getting checkups and care at a primary care doctor’s office.

We all face it, so everyone — including VCs — knows the frustrating and disjointed and poorly designed experience from the consumer’s perspective. And when you ask doctors, they wholeheartedly agree running a doctor’s office today is full of challenges: patient volumes are high, insurance companies can be a bear to deal with, and there’s considerable IT and operational “administrivia” gumming up the works.

The trends driving change are easy to spot. First, consumer choice and consumer expectations are rising fast, even in health. People want to be in charge. People value carefully designed and delightful experiences. Second, the tech is ready, with things like video visits, text based answers, or predictive care paths. Lastly, changes to how insurance works and care gets paid for. The US system is hungry for a move from insurers paying for the service — a procedure — to paying for the outcome we all seek — good health.

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Helpfully is tracking many companies innovating inside clinical care settings and each has a slightly different perspective on what’s broken and how to fix it. So this article will dig into the following startups:

  • Forward

  • 98point6

  • HIPnation

(A quick note of disclosure: Helpfully has personal and professional friends at each of these companies.)

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Forward is a startup based in San Francisco (SF) and they’re building the care a somewhat SF-centric on primary care. Forward’s team has created an experience that is tightly orchestrated and beautifully designed.

The first visit is 2-3 hours (yes, really!) and consists of the patient and doctor taking 60+ minutes to get to know one another and explore every medical and lifestyle attribute. Genetic testing and blood work is done on-site so results can be immediately brought to bear. The Forward experience focuses on a spa-like environment, some high tech elements (including a custom-designed stethoscope!), and gorgeous apps.

Forward’s business model is ‘concierge medicine,’ so their clinics have far fewer patients, but patients pay a membership fee ($149/ month) on top of their monthly insurance premiums.

Biggest differentiator: Amazing experience!

Some details:


98point6 is a primary care clinic where most of the care experience is ‘in the cloud’ and delivered anywhere a member is via their web and mobile apps. They have their own clinic locations and all of the staff are employees of 98point6 (so it’s not a franchise). The team did research with consumers and the service follows a research insight into Millennial and generation Z consumers. Younger people prefer messaging and chat interactions for solving problems, even in health. They like it even more than video messaging.

Compared to some concierge medical concepts, 98point6 seems to skew towards the episodic users. It’s great for when you’re sick with something relatively minor or things for which a patient already has a hunch and they just need a professional decision and treatment course. They market the service as an urgent care replacement. Also note that they’re now shifting their marketing focus towards corporate / enterprise partners. Surely, adding members by the thousands will in some cases be easier than adding members one at a time.

Biggest differentiator: Text-based messaging (with photos and video as needed) and AI make the magic.

Some details:

  • Founded in 2015, Seattle HQ

  • Total clinics open: NA, since care is virtual (but available in all 50 states + DC!)

  • Cost is $20 for the year and then a per-visit fee.

  • More information on the experience: Inc profile

  • 98point6’s official site


HIPnation is a primary care health clinic experience that uses membership to change the operations of providing care. HIPnation does a great job of balancing consumer desires with doctor / clinician wish lists and finding a win-win between the two. It’s a membership service that includes unlimited visits and referrals to well-regarded specialists in a kind of custom ‘narrow network.’ HIPnation takes health insurance totally out of each patient’s  primary care visit. “Right now, insurance is in every aspect of healthcare, but it should be used for low frequency, high cost things,” Hall said. “You need it for a heart attack, but not for poison ivy.” HIPnation is more like car insurance — a consumer uses it for major accidents, not an oil change.

Patient loads at a traditional practice that takes insurance can be 2000 individuals or more. HIPnation clinics get by on 500-600 patients. That’s mostly because without the burden of insurance, the practice can be run with far fewer staff (no big teams doing claims, coding, billing, appealing denials, collections, etc. etc.). Which means patient appointments are 30+ minutes instead of less than 10.

Biggest differentiator: Business model innovation to deliver full health plan with a membership model for primary care, but still getting access to specialists and hospital or large-scale treatments (via a health insurance product).  

Some details:


How Do You Innovate?

When we think about what it means to be innovative, the one thing that is certain is that anything is possible. So, when everything can be done, there can be a paradox of choice for the products you have, the experiences you deliver and the business models you have.  The real issue is how to make decisions.

The Paradox of Choice

Because there are so many options, how do you decide what to do? When you move an idea one more level, one more step towards tangible realization, you must decide everything about that idea.  What does it touch? What business model is it part of? How can it actually be used in the lives of customers and clients it touches? You’ve got to have more voices in the room to actually help you make those decisions. You can’t innovate in a vacuum.  


That’s why there is so much value in getting outside of the four walls and moving the conversation about innovation out into the world.

That doesn’t have to be expensive or require a Ph.D. in Anthropology or Ethnographic Research. At the most simple, It requires having a better set of eyes. You just a better perspective and the deeper inputs to your innovation process both from the idea side as well as from the constraints side.  Those good perspective moments or nuggets, those influences, aren’t going to automatically give you better ideas, but they will give you better sets of constraints to apply to your problems.

Research with Low-Cost Ethnographic Tools

One thing that can be especially valuable in today’s world is to find some Gorilla digitally-centric or digital ethnographic tools.  Gigwalk and Fiverr are two really nice little platforms or little communities where people can post jobs to do.  You can pay a nominal fee to help you do research. Fiverr has a $5 model and Gigwalk is between $5 and $20. You are able to use those platforms as virtual ethnographic research ‘shopalongs’ which will give you access into people’s real lives. Your team can say “Hey, take me with you to your corner convenience store...” Or “Let me tag along during the day...” Or “I’d like to see the inside of your dishwasher. Let me see your pantry where you put your groceries. Show me your refrigerator.” Can you tell Helpfully has done research for a large grocery chain?!

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Gathering Inexpensive Customer Insights

Try this: “Show me the five apps that you use the most.”  Take screenshots of them on the customer’s or user’s phone. Then ask “Show me how you use them / why you use them…”.  Take more screenshots. Take a picture of the home screen on their phone. For research, I’ll pay you a dollar for that. There are a lot of insights  that we can glean from a soccer’s mom’s phone and from an executive’s phone. There will be a lot of differences. They will be very telling for your business model.

Pick an Idea to Investigate

An innovation funnel is always being fed so there is always a big stream of ideas.  What we like to do is to turn the funnel on its head and pick the single product, the single idea that is at the top of the funnel and really investigate it.  We call it the innovation rocket.

We take the single idea and ideate inside and then use some of the evaluation criteria sets. Some will be quantitative or financial. Others need to be much more focused on the human need or the desire of people to accomplish some tasks.  We flesh these ideas out. We often make low or high-fidelity prototypes to better understand the core needs.

Test Early and Often

The ability to test your innovations out on the world is a critical component of a well functioning innovation program.  

For us, this is a way to distinguish innovation work from R&D work. If it’s innovation, it has to get in the hands of a customer or user. If it’s R&D, the full benefit might be in the lab, the proof-of-concept, or the technology. Innovation requires business viability and customer desireability, in addition to tech feasibility.

Ideal Team Structure — Forming Teams

New problems require us to develop new modes of working together.

Startups and innovators of all kinds attempt to solve problems that span disciplines and require teammates to collaborate across disciplinary boundaries.

The big problems startups endeavor to solve today span field. You want to solve a problem today? Great, just hop into business / design / technology / psychology / sociology / brand / marketing / management science. No big deal, right?! Many of today’s projects even grow to include elements of the broader social implications beyond the stakeholders of “company” and “customer,” things like the ethical implications of your invention, adversarial users, and  product end-of-life.

But how should we handle the rise of multidisciplinary teams solving today’s complex problems?

What’s the right way to structure teams to collaborate better and solve these problems more fully?

Quickly, let’s define some terms around disciplines, the depth skills that team members study and hone. A project can be:

  • Disciplinary — A project that is directed inside of a single discipline. If two disciplines are needed, they’re added as components (making a project multidisciplinary).

  • Interdisciplinary — A project that blends perspectives and methods from two or more fields. The back and forth creates learning about each discipline’s underlying assumptions. The project team’s work starts to develop concepts that cross boundaries.

  • Transdisciplinary — A project which strongly overlaps each contributor’s perspectives to create a new discipline (or at least explore creating one). Transdisciplinary teams also often consider the impact of the project on broad stakeholders and “the public.”

I’ve been searching the space, and I wanted to look beyond the usual teamwork and team design bookshelf — Creativity, Inc., Designing Together, Redesigning Leadership (and this new one which is coming out at the end of October, Turning People into Teams).

But then I found something super interesting buried in a student’s unattributed presentation. Scarlet Atkins (a student of some sort - ?) created a guide to ‘mechatronic product development’. What?! Uh, okay. Mechatronics concerns the design of household or industry-specific electronics, such as computers, phones, appliances, and hospital systems like MRI machines and heart-rate monitors.

In this kind of a project, the team will create a product. But doing so requires deep engineering skills to make the product work, UX design for the controls, industrial design for the enclosure, and mechanical perspectives for manufacturing the item. So companies in this space have spent a lot of time designing — and managing and evaluating — teams. And using each team member’s unique perspectives to harmoniously collaborate, navigate constraints and not just your discipline’s constraints), and ultimately delivering amazing solutions.

Here are three models for interactive product development.

  • Cooperative Specialists
    Each person on a team works as a trained specialist, with deep but narrow knowledge. The team members desire to cooperate and collaborate and so they establish a zone of cooperation between their areas. The project at hand is in the middle, between the designers and so it will include a bit of each disciplinary specialty, but with limited interdisciplinary work to blend the team’s perspectives.

  • ‘T-type’ Generalists - Japanese Model
    The Japanese model is quite different. Teammates are selected for their “T” shapes. They are all a team of generalists. While each team member has her own skills, disciplinary background, and department affiliation “developer,” she at the very least possesses passing knowledge of the vocabulary and methods from other domains. Others might have relatively deep skills in other domains, and their titles can be built to match —  companies sometimes explicitly name a “creative technologist” Other companies use the “slash,” where a single team member might be the “ux-slash-dev” or “ux-slash-designer” player on a team.

    Because of the influence of IDEO in design thinking — and perhaps the 1990s management buzzword for cross-training — the T-type generalist model is popular at many companies and agencies today.

  • Generalist Facilitator - The Finnish Model
    This hybrid teaming model was popularized by Finnish companies, especially Nokia, during heyday in the 1990s, but might be less popular in U.S. companies. The model anoints an interdisciplinary facilitator, who usually also serves as the team leader, as the single team member with the broadest and most overlapping skills. This facilitator servers as the orchestrator of the collaborative project, having deep skills and knowledge in many domains. He or she works with specialists who don’t have as much interdisciplinary knowledge.

    Pushing leaders to have a firm grasp of all of the domains used in the project might be somewhat simpler than hiring a full team of generalists. The idea that one person owns the “magic moment” — the insightful moment of synthesis where it all comes together — could appear undemocratic. But in some of the best product design work we’ve been a part of, this accurately captures how the team functions.

What model do you use? Is it explicitly designed did it implicitly evolve from the team dynamics? Who leads your product team — and what perspective does she have?

Podcast Interview on AI and Human Intelligence - Tech Done Right

What does AI mean for the future of design, development? Can I be replaced by an AI algorithm?

Recently on Tech Done Right, I got a chance to talk with Noel Rappin about what's coming and what it means.

From the description: "Zach thinks a lot about artificial intelligence and how it might impact the future of different knowledge work. It's impossible to talk about AI without talking about the ethics of AI projects and how AI might affect society and culture.

We'll talk about why AI started with chess and moved to facial recognition, what AI might and might not be able to do in the future, how we might deal with it, and how that will change the way you work.

Embed episode and download links below.

Perspectives on Dig South 2018

A couple times a year, Helpfully offers scholarships to deserving young professionals who want to attend industry events like DIG SOUTH. This spring, a panel of esteemed women judges reviewed several dozen applications and selected Farah Rohman and Megan Landau for the DIG SOUTH scholarship. Here’s a peek into their experience.


Farah hails from Birmingham, Alabama where she works in web strategy and implementation at Influence Health. Her work involves building intuitive digital experiences for the healthcare world. Farah tells us that she was inspired by sessions from DIG SOUTH that were about this critical intersection between technology and humans. Specifically, the Anthrotech presentation by Kit Hughes really spoke to her.

Like many DIG SOUTH attendees, Farah took away the feeling that anything is possible in our future.

“I have met an abundance of incredible people with flourishing ideas and motivation who I hope to constantly stay in touch with. I hope to also do a talk someday that will encourage dreamers to push their ideas to the limits of what we know,” she says. 

Farah also told Helpfully that DIG SOUTH definitely sharpened her awareness of the need for ethical boundaries around data collection in the digital age. A very astute observation in this season of GDPR, of course, and this recent news about Amazon’s Echo sharing a couple’s private conversation.

“Throughout the DIG SOUTH conference, lots of diverse ideas were brought up and a wide array of topics were explored ... DIG SOUTH encouraged me to be proactive about pursuing ideas, the importance of keeping updated on innovation, and to strive to continually improve your skills or learning something every day.

Farah Rohman, Helpfully Scholarship Winner

Lisa Wang of SheWorx presents at Dig South on Enoughness.

Lisa Wang of SheWorx presents at Dig South on Enoughness.


Megan Landau recently graduated from the College of Charleston with a B.S. in Computer Science. Over the last few years in school, Megan was very active in computer science clubs, as well as an internship with Blackbaud. She is passionate about her field and has gained a great amount of experience in a short time. After DIG SOUTH, she jetted straight to Los Angeles to start her new role as a software engineer for Disney ABC Television Group. (Congrats, Megan!)

Megan was especially inspired by the Dig South session called “Cracking the Gender Code: How to Stack the Odds in Your Favor”. She recognized the importance of having discussions where women talk about their struggles as an underrepresented group in their workplace, regardless of industry. Megan also felt a strong emotional connection to Lisa Wang’s talk on Enoughness – focusing on how leaders must practice ‘antifragility’ or the ability to bounce back after hardships. For Megan, conferences like Dig South are a perfect opportunity to challenge both personal and societal limitations so that we can reach our best potential.

Both ladies also shared with Helpfully that Jason Feifer’s keynote on Think Like A Journalist was both fascinating and relevant to them. This message about putting yourself into the shoes of the media (and the reader consuming the media) was something they’d carry with them in their respective career paths. 

Scholarship winner Megan Landau with Helpfully's Zach Pousman

Scholarship winner Megan Landau with Helpfully's Zach Pousman