Companies like Starbucks, Chick-fil-A, and Culver’s consistently rank highest on guest satisfaction not simply because of the quality of their product, but because of the overall experience they provide. If health systems work with only the “product” in mind (i.e., the care they provide), important as it may be, they may unintentionally create a cold, sterile environment in which a patient receives sufficient medical attention, but is left anxious and confused throughout the process. By designing a healthcare experience for real humans from the ground up, not only will providers’ care be better received, but patients will be more likely to adopt healthy practices and engage with their health provider on a more regular basis.
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 chat with Denise Worrell, vice president of consumerism at Memorial Hermann Health System. Denise shares her background in marketing and human-centered design, what it means to have a master’s in “foresight,” and how she ended up at Memorial Hermann. She also discusses how designing for experiences can drastically improve healthcare, the difference between wayfinding and way-knowing, and how new developments like generative AI will change how healthcare is delivered.
Listen here:
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Show Notes:
[00:00] Intros
[01:03] Denise’s background in human-centered design and innovation
[08:53] Finding the “better” problem to solve
[12:33] The difference between predicting the future and studying foresight
[15:12] Designing for multiple possible future states
[17:54] Denise’s recent work at Memorial Hermann
[27:06] Designing innovations for banal features, such as parking
[32:40] Wayfinding vs. way-knowing
[33:50] Working with the Disney Institute
[36:13] How AI will change how healthcare is delivered
[40:41] Things so well designed, they bring Denise joy
Transcript:
Dr. Craig Joseph: Well, welcome, Denise, to the podcast.
Denise Worrell: Thank you. I’m glad to be here.
Dr. Craig Joseph: Now, you are currently the vice president of consumerism at Memorial Hermann Health System in Houston. Is that correct?
Denise Worrell: I sure am.
Dr. Craig Joseph: And that means you’re in charge of buying things as I understand what a consumer is. Is that also correct?
Denise Worrell: Man, that would be great. Like if they just gave me a big shoe allowance, I could really do something with that. But nope, not quite. Definitely in charge of really making better, seamless consumer experiences for our patients and their families.
Dr. Craig Joseph: Well, that’s different than what I thought. So, I’m glad that you clarified that. We’re going to get into more detail about what exactly that means. But explain to me how someone gets an advertising degree and then ends up working for a big healthcare system trying to figure out how to design a better future. How does that happen?
Denise Worrell: Yeah, definitely a little bit of a windy path, but it all kind of came together in the end, I think, to build on some skills. So yeah, I have a Bachelor of Science in advertising and, you know, thought for sure I was going to be on Madison Avenue just working in advertising for my whole career. So, you know, 22-year-old me would be really shocked to find out I work for a health system now, I’m sure. But yeah, I went and worked in advertising for the first several years of my career at different ad agencies, and I was on the creative side. So I worked as an art director, you know, making billboards, making ads, making commercials. But I found myself being the really annoying person in the room, constantly asking, “Why?” So why is the client even trying to sell this product or service that clearly is kind of, you know, not even strategically fit to be in the marketplace anymore? Like people don’t even have a need for this anymore. Why are we selling this? So over time, you know, I really started picking up more work and kind of the strategy and innovation space versus just making ads. And I actually worked as a freelance talent for quite a while, had my own sort of mini agency, I guess. And, you know, again, over time transitioned from purely just doing kind of the creative work to helping businesses, helping my clients think about what they could be doing or bringing to market instead based on what people wanted and needed, which later I learned was called human-centered design. As I kind of matured in my role. And as much as I loved doing the creative work, I really found that I was able to carry it over into the strategy and innovation space because instead of just handing a, you know, a binder, the typical consultant binder of written words for strategy, I really had the extra ability to bring things to life, to really be able to tell a story and help the client kind of have a, you know, kind of remove some of that cognitive load of trying to figure out how all this might look in the future. So that was really kind of an easy transition, actually, looking back on it. And I’m one of those people that never can turn down a juicy project. You know, what I found was over time I was working 24/7. I was, there was no vacations, there was no holidays. I always had my laptop glued to me. I was that weird, crazy lady in, you know, in the hospital trying to deliver a baby who was also trying to send that last email out. And so one of my clients at the time happened to say, Hey, what if you just came to work for us full time? And I thought, maybe that’s a good idea. Maybe I need to try disconnecting myself from my laptop, like on the weekends. I don’t know, maybe a novel idea. It turns out that’s, you know, not in my blood. I’ve learned later. I just really like, apparently, being attached to my laptop. But I went to work for Langrand, which is a creative think tank here in Houston that does really smart marketing consulting work. And they also happen to have several large national healthcare clients, both in the payer and the provider space. So I really got hooked on solving these complex healthcare system problems because, man, there’s just it’s just ripe with opportunity. So I worked at Langrand for a few years as the executive creative director and also helped kind of start up a strategy and innovation practice that really leveraged human-centered design at its core to solve challenges. And one of our clients happened to be MD Anderson, who had just founded an innovation center, and they were looking for somebody to come in and start up and lead a human-centered design function within the innovation center. And as any consultant can relate, you know, I thought maybe it’d be interesting to see what happens on the other side, what happens when the consultants leave and, you know, the binder gets hand-off. How do projects live and die? So I kind of took that leap of faith and went, you know, client side, I say in air quotes, as they say, and became the director of human-centered design. And then later the executive director of innovation at MD Anderson, which really just deepened my love for solving complex healthcare problems. And at the time I was doing a lot of “future of” work. So Clinic of the future network of the future. And I started thinking, I’ve heard of these people called futurists, you know, what is that all about? Is that what I’m doing here? So I started searching and I found this niche futurist community. And turns out there’s just a handful of academic programs sprinkled across the globe. And the oldest, most established one was actually in my backyard here in Houston at the University of Houston. So I jumped in, I got my master’s in foresight and really fell in love with the discipline, realized I’ve kind of been doing futurist work for quite a while, maybe futurist-lite, because I didn’t have all that academic rigor and frameworks and methodologies, which I certainly use now all the time. So got my master’s and then I transitioned to my current role as VP of Consumerism at Memorial Hermann, and I lead a team of human-centered designers and implementation experts, again, to really remove the friction from consumer experiences.
Dr. Craig Joseph: That is a lot. I’m fascinated by the overlap between innovation and design, because I’m not sure those necessarily have to be connected, but they seem to be in a lot of places. So you were brought on at MD Anderson to kind of bring some human-centered design thought to innovation that they were doing. How does that start? Like, what kind of projects are you working on?
Denise Worrell: Yeah, so, I mean, there’s so many flavors of innovation, right? That word means different things to different people and different organizations. A lot of places it’s bringing in new technology, can mean, kind of, you know, investing in new companies. But the model that MD Anderson took was really leading with human-centered design. So we would get asked to do projects to figure out kind of a big problem that the organization might have. And in our human-centered design research, we were able to really reframe problems and figure out what is the actual thing that people want and need, because it was almost never the problem that was brought to us. You know, the problems that were brought to us were real problems for the organization, real issues. But the way that you framed it, you know, to really solve it in a different way, led to the innovation. So we would go out, do all of this work, come back and say, yes, we have a problem with, I’m going to make this up. Yes, we have a problem with getting people out of the infusion suites quicker for chemotherapy. But what does that look like? How do we reframe that problem to solve it in a different way? And then once we really had that knowledge, we were able to then say, well, what’s on the market? Maybe Is there a technology solution, is there a communication solution we need? Is there a culture change or an organization change solution to bring things in? So, you know, really, at least to MD Anderson, I think this is this way at some organizations, but not everywhere. Human-centered design was the impetus for innovation.
Dr. Jerome Pagani: And how often did you find that the problem that was coming to you was not really the problem that your internal clients had?
Denise Worrell: Well, you know, maybe I should say it a little bit differently because it’s not necessarily in my mind finding the right problem. It’s finding a better problem to solve, like one that I can think of in particular is we were tasked at MD Anderson with, let’s figure out how to make an access center. Let’s build a separate building that we can bring new patients in. We can get them in quicker. The goal was really how do we get patients in quicker? And so we went out and did our design research. And what we actually found is we don’t need an access center, we need a survivorship center, because what was happening, if you build an access center, then you have a building that new patients go to. They’re super anxious. They’ve got to learn where to park, where to go, find their way through the space. And then we’re asking them to come back the next day or the next week to a completely different area. At the same time, we’ve got more and more survivors, right, which is fantastic because the treatments are getting better. But you’ve got all these survivors sitting in the same waiting rooms as people just starting their journey. So all of these survivors are sitting there with survivorship guilt, which was a big problem. And so really what we came back and said, there’s, that’s a complex problem. There’s not one answer. There are actually like six big things that we needed to do. But one of them was build a survivorship center. If we’re able to get people out and home and to a different kind of graduated space, the shining light of the survivorship on the hill, that’s our goal. It’s not bringing people to a new place to, yes, we want to get them in faster, but let’s bring them into their home immediately. Let’s not add another stop on their journey. So that’s kind of one example of how we would reframe some of the problems that were brought to us.
Dr. Jerome Pagani: And what I love about that example is that you’re thinking through the patient journey. And then on the other end, obviously, the clinical care team’s experience of caring for them in a very specific way, and that meets that sort of larger need that you’ve identified but is slightly different than maybe sort of the surface problem presented itself as.
Denise Worrell: I think what I’ve really found doing human-centered design over the years is that it’s not just about one side, right? So I do my hand in a triangle a lot because there’s really three things that we have to balance. We have to balance the needs of the patient with the needs of the staff and the providers and the needs of the organization for it to still be, I don’t want to say profitable, because a lot of times we’re talking about nonprofits, but no mission, no margin, right? You have to put all three of those things in balance. And no, really, we have 100 hundred year old health systems a lot of times that were really built around the needs of the provider, but the world has shifted. So now how do we get all of those things in balance? In fact, that’s one of the things I say a lot of times. The first time I come into rooms and meet new people and introduce myself as the VP of Consumerism now in my current job, because I think the initial thought is, Oh man, here comes somebody who’s only going to try to make things better for the patient and doesn’t understand what we do, doesn’t understand business, doesn’t understand all of our needs. Most of the time I’m actually solving for the needs of the providers and the staff because they’re the ones providing the care at the end of the day. So it’s kind of interesting that a lot of times the problems are really internal systems, problems that we need to solve more than anything.
Dr. Craig Joseph: So your master’s degree is in foresight.
Denise Worrell: Yes.
Dr. Craig Joseph: And that’s from one of the preeminent programs in the world. And so I’m kind of fascinated that one can get a master’s degree in foresight. And I’m curious as to, you know, what is that? What is the difference between kind of predicting the future or being a futurist and studying foresight and how does that all come together?
Denise Worrell: Yeah, absolutely. Well, I have to say kind of the first rule of foresight is to tell everybody that we don’t predict the future. So no crystal balls. It’s absolutely kind of, you know, I wish, I wish I had a crystal ball. That would be fun, but not for foresight. So the whole goal of foresight is really to understand the possible, probable, and eventually the preferred future that we want ahead too, so that we can make decisions in the present in order to get us on the trajectory of where we want to go. So foresight, it’s really a, you know, a strategic discipline with a lot of rigor around it to understand and extrapolate out what are the drivers that are likely to change the world in the future and really beyond just a domain that you’re looking at. So a lot of time you’ll hear people talk about the future or the future of something, and they’re really focused on just the future of that object or that service without really contemplating, well, what’s happening in politics, what’s happening in the environment and the economy and all these other factors that start to come in and really shape things maybe in a different way than you might have considered if you hadn’t thought about it in a systematic way. So in foresight, we go understand all the trend drivers that are kind of moving and shaping the world. Then we build scenarios and from those scenarios the goal is really to, there’s, I should say too, there’s, there’s different archetypes or how the future often unfolds. So we’ll build different archetypes looking at what are the different ways the future might unfold based on what we know about the trends that are coming. And from there, it’s really about understanding the implications of those scenarios. So how do we kind of look out ahead and say, Well, if this happens, if we go down this path, what do we need to be prepared for as an organization or as a society that we can start planning for now? Or a lot of it’s kind of risk mitigation, quite honestly, because you can say, man, this terrible thing might happen if we don’t change our ways. So what do we need to do to change our ways so we don’t end up in a really rough situation?
Dr. Jerome Pagani: I like that you said that it’s not the tea leaf reading or prognostication. It’s, that reminds me of that William Gibson quote about, the future is already here, it’s just not evenly distributed. So you’re really picking up sort of those seeds and kernels of things that are going to turn into something else. And, you know, when you’re doing that, you have to really be thinking about those sort of first, second, third order effects and how they play out and rank order them in terms of importance. How do you handle that complexity when you’re thinking about designing for those future states?
Denise Worrell: Well, I have to say, first of all, that quote is so very true, because one of the things in foresight that we talk about a lot is that there are pockets of the future that are in the present, which you just have to know where to look. And it’s not where you would expect. You know, people might look at something on the front page of The New York Times that’s new or that new things probably been here for ten, 15 years if you were paying attention. And, you know, you might think it’s in academic journals. Sometimes it is. Sometimes there are academics and researchers within a particular domain that are thinking just radically different from everyone else in that domain. But what we tend to find is that usually the kind of these pockets of the future in the present are someone who’s absolutely not constrained or influenced by the limitations within a current system. It’s people who are free to think and experiment, free to fail. And they’re on the fringes, experimenting. And so one of the skills that we learned kind of early on as futurists is how do you learn which rocks to look under, which bunny trails to follow, to kind of find these pockets of the future and extrapolate them out? Because, you know, it’s like anything where it’s easy to project maybe tomorrow if you’re a weather forecaster, it’s hard to project ten days out. Well in foresight we’re usually looking really for a longer-term future. We’re really looking more like ten years out, typically. It depends. There’s some other, I know University of Houston’s done some work with the forestry program in the United States and they’re looking at 100 years out because that’s a typical horizon if you’re trying to, you know, reforest something. So yeah, you have to really learn, Where do you find these people experimenting on the fringes and understand which ones are likely to really become the future? And then how do you make that transition from today to that future? Because there’s kind of this messy middle point where a lot of things can happen. You have to make sense of that. So we have a lot of frameworks and a lot of systems, maps and frameworks that that we use to synthesize and make sense of that future. And I’d probably put everyone to sleep if I started talking about them. So I’ll spare you that.
Dr. Craig Joseph: We love the gory details, but it is kind of difficult with an audio-only format. So I’m going to let you bypass that. So why don’t we talk a little bit about what you’re doing now. So we established that as VP of Consumerism, you’re not buying shoes, although we also established that that would be really cool. And if anyone from leadership is listening, you’re not against that kind of a job description. And so can you tell us about, hey, what have you been up to at Memorial Hermann since you started? And, you know, what are the major things you’re working on now?
Denise Worrell: Yeah, absolutely. So my team and I kind of over time, we’ve developed a and are using a moments that matter strategy. And of course, we’re not the ones who invented moments that matter. There’s some brilliant Harvard business professors who came up with this concept of moments that matter, but we have come up with seven moments that matter for our healthcare consumers, and it really serves as a way for us to prioritize efforts around improving the most impactful parts of the consumer journey in the most scalable way possible. So, you know, when we started, the concept was let’s go out and build journeys, right? So let’s go out and build the best cancer patient journey. Let’s go out and build the best, you know, having a baby journey. But reality is there’s no one journey for any of those things. You know, if it’s cancer patient well, what stage are they? What kind of treatment are they having? Are they having chemo, radiation, surgery, all the above? You know, there’s just so many variables that really every single patient journey and healthcare is unique. So that makes it really hard to design the perfect anything journey in healthcare if you’re just thinking end-to-end journey. So what we really did instead is we’ve kind of broken it down into these moments that matter, and instead of sort of looking horizontally across a single patient journey, we’re looking vertically at what are the common pain points and common moments that every patient, no matter if you broke your leg or having a baby, you know, experience and we’re working on those. So of our seven, we’re starting with three. And I can tell you a little bit about the three we’re working on. The first is called Feel Comfortable. And this is really about providing comfort in every space where we interact with our patients and their families. So that’s physical and virtual. And really the idea is to ensure that when people are in our care, that one, they feel safe and not just safe from harm, but safe from people coughing or sneezing, you know, germs and psychologically safe, too. That’s a big one. The second part of that is alleviating discomfort. Again, that’s not just pain management. Nobody wants a designer to be messing around with what doctors do with managing pain. But what about alleviating discomfort when it comes to things like lighting or noise, when it comes to furniture or even going into a hospital room and there’s a phone that the patient has to use to order food, but it’s 20 feet behind them out of their reach. You know, how do we alleviate that kind of discomfort? Or discomfort for people who may have disabilities are a little bit different than how the building was designed and then helping just reassure people to alleviate anxiety versus adding to it. So a lot of things in that space of feeling comfortable. One in particular that I think is really interesting and we’re just starting to kind of play with is again around this idea of safety and psychological safety. It’s been all over the news. There’s been a lot of kind of, unfortunately, some active shooter events in healthcare lately. And so I think healthcare as an industry is starting to kind of harden. Starting to think about how do you add more security guards and kind of a different vibe maybe when you’re walking into a healthcare space, which absolutely understand the necessity of doing that. But what does that do to the mindset of the staff? What does that do and say to the patient as they walk in the door? Does it actually make them feel safer or does it make them feel anxious? And, you know, how do we start thinking about security guards as part of the care team, maybe instead of having kind of an intimidating bouncer-like feel when you walk in the door? What if they were your friendly greeter and your human wayfinding while they were kind of scanning the environment? So we’re thinking about a lot of things like that and just really trying to understand how to make all these things more, more human, bringing the humanity back to our patients. The second moment that matters that we’re working on is one called Understand My Health Journey. And this one is all about kind of shifting traditional healthcare thinking around patient education to kind of focus on five other key things. So one is helping patients understand what’s going to happen to my body and what’s going to happen to my emotions? The third thing is kind of helping people understand what are the possible outcomes and when is the path potentially going to change, as well as helping people know when to reach out for help? Because I think a lot of times patients go home after a surgery or after an event and they’re not really sure when they should call back. Some of our research that we found, one of the most asked for, one of the most Googled things from patients after a surgery is, is my incision supposed to look like that? Which, you know, sounds kind of funny, but it’s so true. People are Googling this, and they don’t have a good way of knowing. So how can we provide patients who just had surgery pictures of what their incisions are supposed to look like? Right? How many phone calls could that save? How many people could we help sleep better at night knowing that they may or may not have an issue there? And then the last kind of thing we’re looking at in this moment of understanding my health journey is how do we support the support system? Right. So you have all these caregivers, I mean, by caregivers in this case, I mean family and friends who are supposed to help the patient when they get home, who can be our front line eyes and ears when maybe something’s going wrong. But those support systems don’t usually know what to look for. They may not have been involved in the conversations of what to look for. So how do we include them in that space? And then the last, the third, moment that matters that we’re working on right now is called Navigate My Care Journey. And this is really around, I mean, kind of obvious navigating the healthcare system. And I know healthcare tends to think of navigation just in sort of this expensive manpower nurse navigator kind of way. And that’s certainly a piece of it. But there’s so much opportunity for self-service tools, for automation or wayfinding or way knowing, as I like to call it, to really help people overcome social determinants of health, to get the transportation they need for follow-up care and so forth. So we’re really working out looking at what is the right balance between human and tech intervention to take the burden of, quite honestly, healthcare’s kind of broken systems that a lot of times the patient has to shoulder. How do we take that off of their shoulders to help them navigate the system better? We like to use sort of an analogy of Google Maps here. So you type in your destination of where you want to go in Google Maps, and it starts zoomed out. You can see the whole journey of where you’re starting and where you’re going. But then as you start to move, the map zooms in and it’s only giving you information at the time that you need to turn or hopefully a couple of seconds before. But it’s not giving you all of the information at one time and hoping that you’re going to find your spot at the right place. And that’s really what we think healthcare needs to be doing a better job at. How do we help our patients have just the right information at just the right time? So, yeah, that’s what we’re working on right now.
Dr. Craig Joseph: So that seems like a couple of weeks of work. What are you going to do after that? No, that, well, that’s a lot. And I’m tired just contemplating just those three moments that matter. And, you know, the first thing that really resonated with me was that security guard conversation that you had and I can speak personally, it happened to me as a patient where I was walking into a facility to have a test done, not the emergency room in a big downtown hospital, but just to have a test done. And yeah, there was a security guard, and there was very little explanation as to what was happening. But I was told I needed to empty my pockets. And I kind of. Much like you. Like you said, I got anxious, like, wait, what? What’s going on? I’m. I’m just. I’m here to get a CT study, right? I’m not. What are you doing? How does this machine work? It wasn’t like an airport. And if you were trying to make me feel safe, you absolutely achieve the opposite. And the concept of kind of changing that up and making a security person kind of part of the care team, I think is amazingly brilliant. And in doing that in a smart way, kind of anticipating some of the reactions is easier said than done. But I think it’s a great step forward.
Denise Worrell: Yeah absolutely. And I definitely owe that concept to my team. They’re the bri