The carrot & the stick in design in health: A conversation with Lindsey Mosby
Healthcare as we know it is a messy, complex system marked by conflicting value and cash flows between stakeholders. As designers, one of our roles is to bring these stakeholders together in order to realize a people-first health system by fiercely advocating for their needs. Few embody this ethos better than seasoned healthcare leader Lindsey Mosby, whose ambition for meaningful innovation has led her from design consultancy frog to large healthcare companies — and, most recently, all the way to the Netherlands.
In her current role as Head of Strategic Design at Philips, she inspires, envisions, and delivers human-centered, healing experiences that make life better. And as an Advisory Council member for the Design in Health program, she generously shares her wealth of knowledge with a new generation of leaders bent on creating improved systems of health and care.
I had the honor of (virtually) sitting down with Lindsey to get her take on the outlook of design in health, the differences between working at a design consultancy versus a larger healthcare player, and what she considers to be a carrot and stick philosophy in an out-of-date industry to either “put up or shut up.”
Note: this interview has been lightly edited for brevity and clarity.
Danielle McGuinness: As someone who has witnessed a lot of the evolution in the field, how do you think about or define design in health?
Lindsey Mosby: For me, it’s really simple. At the root of it, design is the art and science of complex problem solving. It is pulling apart all of the different pieces, understanding what your end goal is, and then figuring out how to get there. It’s not just what you’re capable of from a technology standpoint, but also what somebody wants, and making sure that real connections happen. So to me, a designer is equally someone who does visual, UX, or interaction design as it is a strategist, a technologist, or an engineer. All of these people have their hands in the work of design. At the risk of oversimplifying, design in health is doing the same work, trying to get to the same really user-centric, valuable, people-oriented goods and services like we would do in hospitality, financial services, retail, or elsewhere.
I think for a long time, healthcare has had the dubious benefit of being able to act as though their audience is a captive as opposed to a consumer, and that really has hampered how healthcare has evolved. There are great studies around how different industries rank in customer service and value. Not unsurprisingly, retail, hospitality, even parcel delivery score really high. We in healthcare rank right near the bottom among insurance, telco, and cable companies. And if you think about why, it’s because healthcare has been a contractual event. “Consumers” have to sign on the dotted line to be treated at X, Y, or Z hospital and you can’t go over here, and you have to pay this insurance, and you can’t go over there, we’re not going to tell you how much this costs. Right from the start, we’re automatically in a defensive “I don’t trust this” stance because we’ve been forced to agree to something with no clarity in the fine print.
Design in health has been a long time coming, but I’d say for the past ten years, it has become a much more future-forward and active conversation. Still, in a lot of ways, healthcare continues to play catch up in the design industry. Hospital administrators and insurers finally realize, “Oh, we can’t do this anymore — we’re going to have to actually be competitive.”
DM: You built frog’s health practice from the ground up and now you lead strategic design at Philips. What are some of the differences between working at a design consultancy and a large healthcare player?
LM: For so much of my career in an agency role or at a consultancy of some kind, it was all about speed and innovation. Nobody’s going to come spend a ton of money with a design consultancy to tweak something. They’re all asking, what’s the next next? What are we gonna be doing ten years from now? That type of work can be really exciting. But one of the things that can be frustrating at the end of the day is that a lot of stuff ends up on the shelf. It’s hard to get innovation actually to market. It’s really tough and it’s a percentage game for sure. The flip side is, in a large organization like Philips, the clout that they have, the power and influence they wield on the global healthcare stage, is amazing. They’ve got the ear of every hospital, every government. They have massive impact, but as a very large, multi-businessed, global player, “rapid” is hard.
Another pro to a big company like Philips is the depth of expertise that you find. At frog, I was often the expert in the room because we didn’t have a ton of healthcare expertise — we were building that. Whereas at Philips, I’m put to shame constantly, which is humbling and also really wonderful. I love learning from my colleagues. I was on a call the other day listening to things being explored in cancer treatment and management. There’s so much going on, and that is just incredibly interesting. It’s about marrying pace with scale. I swear, I think they hired me because I’m American and I’m like this *snaps fingers rapidly* all the time.
DM: What has it been like living abroad and designing for health and healthcare in another environment?
LM: It’s interesting for me, not only having moved from a design consultancy to a large healthcare behemoth, but also to living in another country and seeing how healthcare is done here. I’m not going to be a Pollyanna about it and say that everything is so much better in the Netherlands from a healthcare standpoint. But I will say, on a regular basis, we’ll get a mail notice from the Health Ministry that says, “there’s a colon cancer screening for men 50+, do you want a self-test kit at home that you can mail in,” or “there’s a breast cancer screening,” or “there’s a cervical cancer screening.”
And if you check yes or reply to the email, they’ll send you a little kit so you can do the test at home and simply send it in. They push that ability to us—the consumers! They’re sending that out to the entire Netherlands population. In the States, you’re not going to get that (for all sorts of reasons). The U.S. could learn a lot from some of the methods used in other single-payer or nationalized systems where the government is involved, who have decided that it really benefits the government to have healthier constituents.
DM: In the U.S., everyone supposedly has the same objective — yes, we want people to be healthy and reduce costs! But then behind closed doors, there are a lot of respective and misaligned incentives.
LM: A huge a-ha for me a number of years ago came when I was working for a large pharmaceutical client. We were doing chronic disease research on a few different chronic conditions and had been speaking with plenty of patients — healthcare consumers—their caregivers, and also a bunch of physicians who were caring for these people. I’ll never forget sitting and having a team discussion, when one of my colleagues was like, the business models of the clinician and the insurer are fundamentally opposed. They’re literally at odds.
The doctor wants to get the person on the therapeutic they think is needed as soon as possible, and the insurer is looking to delay expenses for as long as they can. When you think of chronic condition management in particular, if the doctor is like, this person is a type 2 diabetic, I know them. They’re not going to use that insulin pen. They’re not going to do it on time, they’re not going to do it everyday—I just want to get them on the pump. The insurer’s like, nuh-uh, I don’t want to get them on the pump, it’s too expensive. The doctor wants to get them on the pump now because it’ll be cheaper in the long run. These fundamental conversations around business model alignment and people’s health have to be had.
DM: How have you navigated some of those complex and conflicting relationships and values to get stuff done?
LM: When it comes to my healthcare clients, I have a carrot and stick philosophy. My carrot was, and always will be, don’t forget that the healthcare industry is born of inspiration and innovation and practical magic. Healthcare can be an incredibly conservative and risk-averse environment for very obvious reasons — but if we stay in that space, it hampers our ability to look forward and dream big. Healthcare and science are some of the most innovative, outrageous, crazy sci-fi industries ever pioneered, right? We see in people’s bodies! We 3D print tracheas! That’s the DNA of healthcare. So if I can get my client partners to remember that, yes, we have to get the system right, and yes, there are privacy concerns, and yes, there are repercussions, but don’t forget where it all comes from.
So the stick is, if you ask someone who is suffering what they need, deliver it. If you really want to change healthcare and improve the patient experience and be a good partner to someone who is sick, or be a better partner to a clinical person, that’s tremendous and laudable. So, if you then go out there and do design research and you ask, what would make it easier for you if you have this chronic condition? Or if you’re suffering from cancer, how can we help? Then deliver. Do not then go back later — when you know what the answers are — and tell them, yeah but this is hard, or it’s gonna be expensive. Don’t do that. Don’t ask. If you’re not actually going to help, don’t ask people what they need.
I can’t tell you the number of homes, doctor’s officers, clinics, parks, restaurant tables, where I’m interviewing people and they ask, is this really gonna happen? Are they actually going to make this thing? Is this going to be something I’ll be able to have? And then to have that thing sit on the shelf—it’s not good. Don’t do that to them. Life is hard enough. There’s a duty and a sense of responsibility that I think it’s important to remind our clients that they need to put up or shut up, a little bit. There are ways to do it—you put your Southern on and say it in a nice way. But it is important for there to be advocate voices in the room. Whenever we present research, we put audio and video clips of people sharing their stories. Put their voice in there. Get those quotes in. Bring your clients along and let them hear those voices, hear somebody crying. Let them feel it. They need to actually be connected to it. Enforcing that human connection is important in healthcare because we aren’t talking about a new potato chip flavor. Who cares about a phone plan? But people DO care about help—about products and services and experiences—that help us feel better, care better, treat better, live better.
That means everything.