Artefact

Perspectives

A call for cultural humility in care

An abstract composition featuring various green, yellow, blue, and purple shapes, with two sets of shapes resembling human forms merging together in the center of the composition.
Whitney Easton
Whitney Easton
Rachael Cicero
Rachael Cicero





Sitting in the waiting room, a Hmong woman feared an experience like her last, when a doctor dictated a blood draw as the only next step…

But instead, a nurse sat down with the woman and asked some questions about her symptoms, treatments she had already tried, and her hopes and fears. The woman was glad to have the chance to share her preference to avoid blood testing, which the nurse noted without judgment.

A doctor entered and warmly greeted the woman, inviting her to discuss her health condition and what might be causing it, actively listening while providing space for her to talk. The doctor suspected mild anemia and explained the condition but reaffirmed that the woman preferred to avoid blood testing. Instead, the doctor laid out a few other options, talking over the pros and cons of each.

After discussing with the doctor and agreeing on a plan, the woman left the office confident she’d feel better soon or comfortable scheduling another appointment if necessary. Later that day, the doctor reflected on her reliance on blood tests, but not all patients take them for granted, and maybe she shouldn’t, either.



The above vignette shows “cultural humility” in action. This approach fosters cultural understanding through respect, empathy, and critical self-reflection to build partnerships between providers and the diverse individuals they serve. Cultural humility has become a hallmark pathway for realizing health care that responds to the needs of diverse patient populations and reduces the extreme health disparities they often face. 

Cultural humility is needed now more than ever. If current trends continue, immigrants and their descendants will account for around 88% of the U.S. population growth in 2065. Alongside this, diversity will also grow within healthcare professions. But the current care model in the U.S. rests on a culture of biomedicine that is largely inhospitable to diverse health-related beliefs and practices. Instead, we call for ways to work with our increasingly pluralistic society to uplift the benefits of biomedicine while embracing diverse perspectives on health and healing. 

Centering lived experiences in healthcare

Within any cultural or identity group, each person’s lived experience is intricate and varied, and what is necessary to live a healthy and fulfilling life is equally individualistic. To recognize diverse needs in health care, medical training and practice have come to focus on “cultural competence,” “a set of congruent behaviors, knowledge, attitudes, and policies that come together in a system, organization, or among professionals that enables effective work in cross-cultural situations.” But even with cultural competence, lived experience is often overlooked, causing providers to make assumptions about a specific patient based on learned facts about the broader racial/ethnic groups to which they may belong. This can lead to care decisions based on generalizations, resulting in inappropriate recommendations for a patient’s unique circumstances.

On the other hand, “cultural humility” is a much stronger formation for realizing culturally responsive care that honors each patient’s lived experience. It is grounded in rigorous self-reflection and a willingness to listen to, learn about, and adapt to patients’ diverse cultural values and practices. Crucially, exercising cultural humility reduces unconscious bias and stereotyping toward diverse patient populations based on many identity factors, from cultural background, race, and age to socioeconomic status, religion, and gender identity. Bias has been shown to negatively impact patient care, including poor patient-provider communication, low patient satisfaction, and mistrust of the healthcare system. A culturally humble approach to care achieves the nuanced understanding of patients’ lived experiences and unique backgrounds necessary to truly embrace cultural differences and work toward dismantling the structural vulnerabilities that result in unequal health outcomes.

Practicing cultural humility during moments of care

We see an opportunity to intervene at the most intimate level of care during face-to-face interactions between patients and providers, making cultural dimensions more accessible and the hidden barriers to care faced by multicultural communities more visible. 

Isolated tools exist that make inroads into providing clinicians with what they would need to realize culturally appropriate care. The tools fall into three focus areas:

  1. Improving communication between patients and providers 
    The Eight Questions and the Cultural Formulation Interview can be used to elicit patients’ understanding of their illnesses in the clinic. And the Vital Talk app trains providers to communicate with their patients about sensitive topics, which could be especially relevant for providers who did not have “narrative medicine” as part of their training. But cultural dimensions of care are still not a focus of the app. Moreover, with these tools, providers are still left without guidance on implementing them in practice or pragmatic ways to support their uptake in clinical settings within the time and logistical constraints of appointments.

  2. Equipping providers with cultural information
    Existing provider-focused databases like Ethnomed and CultureVision can help contextualize culturally specific beliefs about health and illness that might surface during a visit while suggesting pointers for culturally appropriate care. But accessing these tools during a visit may take up valuable time and could detract from the provider’s ability to listen and respond to the patient’s needs. The focus on the information at the level of cultural groups may also be problematic, resulting in a lack of nuanced context around each patient’s needs and preferences. Lastly, these tools provide a fixed set of information that does not change, for example, based on community member input or adapt to the needs of individual patients. They do not allow cultural tailoring or adaptations to happen in real-time during patient-provider interactions, such as through in-the-moment personalized recommendations based on information elicited by the patient during clinical visits.

  3. Engaging patients in after-care and ensuring data transparency
    Lastly, some tools provide patients with notes, information, and resources following their appointments. OurNotes is a platform that makes care notes accessible to patients, allowing them to engage with their providers during after-care and express concerns before their next visit. It encourages providers to voice record reflections, which helps them relay insights about patients to other team members while also developing their self-awareness skills. OurNotes also works to mitigate power imbalances through transparency of any data collected during a visit. While a promising development, OurNotes does not target improving interactions during moments of care.

While they have their merits, all these solutions are only piecemeal, standalone tools that imperfectly address a sliver of the patient and provider experience.

We believe a better approach is one making valuable resources less cumbersome for providers to access in real-time, least disruptive to critical face time with patients, and genuinely representative of cultural and individual diversity. This approach includes digital tools and experiences that enhance provider capacity and support them in facilitating more flexible and adaptive patient care. Recognizing that digital products tend to be one-off solutions to complex problems, we see an opportunity to capitalize on their ability to seamlessly integrate with current workflows and software, automate repetitive tasks while offering guidance on those more complex, and customize interactions tailored to individual needs and preferences. At their core, aspirational digital products would enable the practice of cultural humility during patient-provider interactions through experiences that capitalize on its foundational components: fostering cultural understanding through respect, empathy, and critical self-reflection.

We see an opportunity for the development of digital products that afford culturally responsive experiences and focus on the following elements: 


Culturally responsive patient-centered care
Patient-centered care focusing on culture involves treating patients holistically and respecting their unique health needs and desired health outcomes as the driving force behind their healthcare decisions. Digital products prioritizing patient-centered care consider patients’ needs, preferences, and values in the context of their lived experiences. They help facilitate communication between healthcare providers and patients, allowing patients to share their concerns and providers to respond accordingly, enabling patients to engage in and adapt their care plans and collaborate with providers to make more informed decisions. A key but sometimes neglected facet of genuinely patient-centered care involves understanding and appropriately responding to patients’ cultural and individual identity contexts.


Empathy and active listening
Digital products should encourage healthcare providers to engage in more empathetic practices towards their patients, actively listening to them, understanding their perspectives, and validating their emotions and experiences. Providers need tools to help them prepare for cross-cultural patient interactions to elicit relevant information during clinical encounters and respond compassionately. These products would afford a more culturally appropriate and inclusive care experience by prepping the provider with language that respects the patient’s preferences (e.g., preferred name and pronouns) and is non-judgmental.


Respectful and collaborative decision-making
Respectful and collaborative decision-making elevates patient agency to allow for mutual understanding and agreement between them and providers. Digital products can support patient agency through tools that afford them control over their healthcare decisions and will enable them to own and tailor personal data, deeply understand vital medical details concerning their diagnosis and treatment – often missed during care visits – and empower them with the necessary information to communicate and collaborate more effectively with their providers on their care plans.


Continuous learning and self-reflection
To learn and be knowledgeable of the many existing cultural and identity backgrounds is a complex and seemingly infinite task. It is pertinent that providers have the tools to continuously listen and learn from the specific and diverse patient communities they serve. While speaking directly to patients and their families is critical to learning, digital products can provide automated tools that coach providers through moments of cultural misunderstanding to reflect on biases, assumptions, and beliefs about other cultures, traditional practices, and worldviews. These tools should seamlessly integrate into existing provider workflows, making it easier for them to engage in learnings during and beyond direct patient interactions.

Closing Thoughts

We believe many benefits will flow from adopting a culturally humble approach to healthcare delivery, especially by implementing appropriate digital technologies to enhance moments of care:

  • Patients can more easily find care more aligned to their needs and identities that make them feel welcome in the healthcare system

  • Patients will approach care with greater trust, as fear or drop-off due to unexpected clinical activities, tense interactions, and conflicting treatment expectations get reduced

  • Patients will engage more in their healthcare as they feel a greater sense of connection and belonging with their provider and healthcare system

  • Quality of care is improved as providers gain an understanding of diverse patient lifeworlds and are prompted to self-reflect on their own beliefs and practices, ultimately approaching all patients with more empathy

  • A cycle of learning and improvement will be embedded in the healthcare system as providers become more self-aware and reflective, inspiring these attributes in their trainees

  • Patients will experience better outcomes and health disparities will be reduced as patients are more engaged with and better served by the healthcare system

Actualizing a positive future healthcare experience for our rapidly diversifying population requires building cultural humility into the fabric of healthcare training and practice. Explore one way we envision doing this: Traverse — a vision for culturally responsive healthcare.





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Perspectives


Has corporate America broken up with design?


Illustration by Marine Au Yeung

Recently, an article on Fast Company made the announcement that corporate America broke up with design, citing that companies who were once green with Apple-envy and hungry for transformation are now jaded after realizing that “design is rarely the thing that determines whether something succeeds in the market.” Add in the recent corporate silence on the topic of design, and rumors abound – apparently design and corporate America are in trouble.

But does this really mean the relationship has fizzled out? Or could it instead be a time for reflection, re-evaluation, and evolution? Three of our Design and Strategy Directors respond to these questions and more –

Corporate America didn’t break up with design. It broke up with the mythological promise design firms sold them.

Jeff Turkelson, Strategy Director

‘Design will allow you to disrupt, transform, create and lead industries. Just do some research, run some workshops with sticky notes, prototype, and you’ll be onto  something that no one else could dream of!’

These are the false promises that corporate America has broken up with. But, there were always dissenters, Don Norman himself said it:

“Design research is great when it comes to improving existing product categories but essentially useless when it comes to new, innovative breakthroughs.”

Flash forward to today, and the hype around being a design-led organization is pretty much dead. But corporate America has embraced design in a more traditional sense—significantly expanding internal design teams—not to think of radical breakthroughs but to create good user experiences that are usable and delightful.

It’s in many ways a reversion back to the decades-old paradigm of user-centered design (though often twisted by profit incentives, e.g. designing to maximize engagement or conversion rates rather than truly serve the user).

However, the spirit of human-centered design (HCD) is not lost. It has evolved. While the idea of being a “design-led” organization has lost its allure and most in-house practitioners are focused on traditional craft, design’s value to business was always secondary to the value designers sought to bring to humans. And for perhaps largely external reasons, many corporations have begun to embrace HCD’s value-based themes: designing for accessibility, inclusion, equity, etc.

Here we see design intersect with the responsible technology movement— designers, technologists, activists, and more, seeking to create positive outcomes or at least mitigate harms. Designers don’t get to say they own this broader movement but they do play an important role in its evolution.

What goes in comes out: amplify design’s value by doing these four things.

Chad Hall, Design Director

Companies green with “Apple envy” may have invested billions of dollars in design, but few did it well, and most in a way vastly different from the design-centric companies they looked up to. Here are four easy to overlook things they could do to better gain value from design.

1. Understand the complexity of problem spaces

“Simplicity and complexity need each other,” (John Maeda), a.k.a. there can be no simplicity without complexity. Designers work hard to obfuscate the complexity that exists in the products, services, strategies, and processes we work on. Understanding and allowing time and space to work through these complexities is paramount. If designers or companies don’t understand the complexities of what they work on and invest the time and resources to make sense of it, they’ll never be able to simplify anything down into a ‘magical solution.’

2. Foster seamless interdisciplinary collaboration

Design works best when not in a vacuum. Too often, I see these situations that prevent seamless experiences: A product team separated from key decision makers; A care team that doesn’t have good insight into their patient’s experience; An education board that is far removed from the students and communities it aims to impact.

Seamless customer experiences are a product of seamless interdisciplinary collaboration. Working alongside an interdisciplinary team with deep understandings of different industries, domains, processes, or organizations at hand, designers become experts in not only crafting forms, but leveraging their knowledge to become experts in facilitating processes. 

3. Align power and incentives with desired outcomes

If companies want transformation, they need to examine their internal power and incentives structures. It’s not enough to have a vision. Fragmented teams and inequitable power in decision making yield products with poor outcomes.

To make seamless experiences, the customer experience must be singular above internal organizational divisions, product categories, and even earnings reports in some cases. The organization and culture must support this collaboration; allowing, motivating, and empowering employees to make decisions that work toward the shared goal of a seamless customer experience. Rather we often see internal competition, tailoring outcomes to please a HiPPO (Highest Paid Person’s Opinion), or misaligned performance measurements that incentivize personal decisions over preferable product outcomes. While most organizations might have the vision, they don’t align the distribution of power and incentives to get the outcomes they seek.


4. Be curious about the unknown

Many companies have implemented design in a risk-averse way. Expecting transformation without accepting a level of risk leads to disappointment. To curb risk, we’ve turned a designer’s intuition and mastery of skills into a scalable and repeatable process built upon the scientific method. Design Thinking and Human-Centered Design have proliferated. These are great at identifying existing pain points and undiscovered needs, but lend toward refining existing solutions through incremental improvements. This has merit and need in products today. But, it’s not going to rock the boat.

To make large leaps, we must allow imagination and intuition back into the process. Designer’s, through years of mastery, are primed to make unexpected connections that can lead to new innovations. But, this process is nearly impossible to evaluate and scale. It pushes us into the unknown future and to rely somewhat on intuition. In our data-driven world, this is uncomfortable! It’s an inherent risk. But, a risk that could lead to a potential big win.

Design is expanding and evolving — we’re counting on corporate America to do the same

Joan Stoeckle, Design Director

Design is baked into countless experiences we encounter on a daily basis – ordering ahead for curbside pickup, communicating with our healthcare providers through patient portals, and of course in the devices we use for hours each day. We’ve become so accustomed to frictionless, carefully-designed experiences that the occasional encounter with an outdated tool can feel downright grating by contrast. Were corporations truly to break up with design, as customers and consumers we would definitely notice. Perhaps their common understanding of design was too narrow from the start.

Although design was historically associated with the creation of beautiful objects and innovative products, today we also interact with invisible forms of design in the services and systems we use and are a part of. Not only was our home’s smart speaker designed, but so was the AI and the specific phrases used to communicate with it, and we are as much components of that system as the speaker itself. The expansion of design into different contexts and ways of interacting with people and systems certainly represents new and exciting frontiers for innovation, but many designers and organizations are also exploring novel and alternative approaches to the processes and practice of design – not just its outputs. 

User-centered design established a baseline of orienting around the needs of end-users. Human-centered design helps foster a more holistic view of people as more than just ‘users’ of a product, anchored in understanding motivations, behaviors, values, and more. Elements of each are central to the design thinking process that was adopted by many companies. But there are concerns that focusing only on the needs of target users results in a myopic view of challenges and opportunities and can lead to unintended consequences (ex. worker injuries in warehouses that are struggling to meet consumer demand for rapid shipping). In response, designers and organizations are questioning and reframing the process of design to foster equity and inclusion, design for diverse and complex needs, and create more sustainable futures.

The practice of design is expanding and evolving in response to social, economic, and environmental realities. Will corporations also take informed action by evolving how and with whom they create products, services, and systems? Or will many of them, as the article suggests, walk away from a narrow and outdated notion of design?

At Artefact we continue to evolve our methods in support of our mission to create better futures: taking a more holistic view through stakeholder mapping, establishing best practices for trauma-informed design research, reflecting diversity of needs and mindsets through persona spectra, guiding participatory and co-design processes, reflecting on possible unintended consequences, and more.





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Research + Strategy

Gen Z and their demands for the digital future

Rachael Cicero
Rachael Cicero
Neeti Sanyal
Neeti Sanyal

Partnership Highlight

This year, Artefact had two opportunities to partner with mission-driven organizations to understand young people’s relationship with digital technology and how they can support their efforts to shape a better future. In celebration of those partnerships with Omidyar Network and Hopelab, we highlight our approach to centering young people’s perspectives as we implemented our research and structured our recommendations.

“Our partnership with Artefact has helped us clarify how we can take action and support youth who are creating opportunities for inclusion and well-being in the next digital era. We appreciate the team’s depth of research, and their responsiveness to emergent opportunities in the work.”

Jaspal Sandhu

Executive Vice President at Hopelab

Young people and the hope for a new digital future

Youth are growing up in a vast digital system with a level of complexity that we haven’t seen before. Many features on today’s major tech platforms keep youth online by design, depleting their energy and consuming their attention. Combined with the short life cycle of pop culture and the fear of missing out, young people – especially Gen Z – are aggressively pulled online, affecting their productivity, mental health, and overall wellness. These effects will likely persist with emerging technologies such as the metaverse and web3. Still, young people are capitalizing on this ‘new tech’ to have a role in shaping a more accountable, equitable, and inclusive internet for themselves and future generations.

An inclusive, systems approach to understanding youth beliefs and behaviors

Omidyar Network and Hopelab each needed actionable insights to develop a holistic strategy and prioritize actions aimed at influencing and activating technology as a force for good in supporting young people. However, the focus of each organization’s effort was slightly different. Omidyar Network focused on identifying the core issues that animate digital native activism and organizing as it relates to technology. These issues ranged from digital rights to social justice to tech worker activism. In contrast, Hopelab concentrated on understanding how emerging technologies can uplift or detract from youth mental health and well-being.

Throughout each project, we took inspiration from well-established fields such as inclusive design and human-centered design, incorporating equitable methods affording continuous participation for internal and external stakeholders.

Participatory methods to engage internal and external stakeholders included:

  • Using simple tools like Dovetail to convey research insights and allow stakeholders to view secondary research and highlight reels of key topics discussed during 1:1 interviews
  • Hosting multiple workshops to review research insights, co-create opportunity areas, and develop critical actions
  • Hosting office hours for youth and key internal stakeholders to give feedback, check assumptions, and develop actionable priorities
  • Sharing research insights and project outcomes with internal and external stakeholders to keep participants informed, give transparency to our processes, and solicit feedback to ensure data points were representative of their voices

In addition, we took a systems approach in selecting research participants to holistically understand how youth are affected by the internet and what they are doing to take control of their future. This approach helped us understand the nuances and complexity of this problem space through various perspectives.

An overview of who we spoke to:

  • BIPOC + Youth Digital Creators
  • Digital Rights Youth Activists
  • Web3 Designers
  • Mental Health Product Innovators
  • Psychology + Digital Technology Academics
  • Metaverse Academics
  • Feminist Technologists
  • Data & Security Researchers
  • Youth Mental Health Experts

Engaging diverse youth perspectives

Whether engaging digital natives to comment on our preliminary research insights or inviting them to attend key workshops and presentations, we continuously sought to ensure youth voices remained centered. Why? Because of their diverse lived experiences growing up digital and their drive to design, create, and advocate for what they want to see in the world.

Our approach to centering young people’s lived experiences online included the following methods:

  • Conducting outreach on popular web2 platforms (e.g., Twitter, Instagram, TikTok) where digital natives are active and currently participating in conversations around technology
  • Bringing in youth advisors as co-researchers to help shape insights and outcomes
  • Creating video highlight reels with direct quotes from youth participants to better represent their words and attitudes in our research
  • Developing youth-centered design principles taken directly from one-on-one and group discussions to guide future action
  • Developing youth-centered areas of focus that steered strategies toward the issues that matter most to GenZ

Supporting young people in their pursuit of better digital futures

The landscape of digital experiences and emerging technology is rapidly changing, allowing youth to shape the development of these technologies before they are entrenched. And young people are activated, ready, and willing to be the catalysts for change. They need a platform to be heard and supported that amplifies their needs and values. We are excited about Omidyar Network and Hopelab’s work to provide young people with this platform and support. Putting youth at the center is critical if we want the internet of tomorrow to be a place where future generations can thrive.

Want to learn more?

To learn more about the Omidyar Network project, check out the case study: A Youth-Led Agenda for the Responsible Tech Movement.

To learn about the insights and outcomes from the Hopelab project, attend a talk by Neeti Sanyal, Artefact’s Executive Creative Director, at the HLTH 2022 Conference Gen Z & Web3: How a Mental Health Crisis among Digital Natives is Shaping Our Virtual Future. This panel discussion is scheduled for Tuesday, November 15th, 4:20 PM—4:55 PM PST.





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News


Fast Company honors Artefact with three Innovation by Design awards


Image source: Fast Company

Fast Company honors Artefact with three Innovation by Design awards

A version of this press release first appeared on PR Newswire


Fast Company has honored Artefact, a design and strategy firm with a mission to create better futures, as a winner and honorable mention across three categories of the 2022 Innovation by Design Awards: Rapid Response, Healthcare, and Experimental.

Fast Company’s October 2022 issue celebrates visionary design that solves the most crucial problems of today and anticipates the pressing issues of tomorrow. Celebrating more than a decade of Innovation by Design, this year’s honorees feature a range of finalists from Fortune 500 to small, impactful firms. Entries are judged on the key ingredients of innovation: functionality, originality, beauty, sustainability, user insight, cultural impact, and business impact.

“We are honored to have our work in emergency preparedness, healthcare, and retail recognized. We believe that thinking about unintended consequences and all stakeholders is critical to bringing positive change in the world. Artefact is proud to work with individuals, communities, and organizations to create a better future, by design.”

Sabrina Boler, COO of Artefact


Artefact was recognized across three categories for the following work —

Navis: Emergency preparedness

Winner for Rapid Response

Navis is a conceptual emergency preparedness system that guides people in planning for, and responding to, crisis scenarios. The concept uses conversational UI and augmented reality to help people create a personalized emergency plan on their preferred devices. A durable home hub helps people stay connected during an emergency and translate plans into action.


AdaptDX Pro: Diagnosing macular degeneration

Honorable Mention for Healthcare

Artefact partnered with MacuLogix to help create AdaptDX Pro, the first portable, wearable, and AI-integrated ophthalmic screening system for age-related macular degeneration on the market. The AdaptDx Pro overcame the challenges of traditional ophthalmic devices by rethinking the patient and technician experience, and led to earlier, more accurate diagnosis and disease management. The AdaptDX Pro first shipped in June 2020, and over the past several years has performed over 1 million tests across 1200 eyecare practices. Today, AdaptDx Pro is owned by LumiThera.


Future of shopping and food retail

Honorable Mention for Experimental

We imagined three ways that emerging technology might help customers shop with more confidence during the pandemic, while ensuring businesses efficiently manage guest volume, protect employees, and sustain revenue by guiding safe customer behavior, forecasting risk, and bringing the best of in-store shopping, online.






About Artefact
Artefact is a visionary design and strategy firm with a mission to create better futures. By partnering with leaders and approaching the toughest challenges with equal parts creativity and pragmatism, we deliver lasting change. Headquartered in Seattle, our award-winning team includes researchers, strategists, and designers with a passion for excellence and impact. Connect with us today.

About Fast Company

Fast Company is the only media brand fully dedicated to the vital intersection of business, innovation, and design, engaging the most influential leaders, companies, and thinkers on the future of business. Winners, finalists, and honorable mentions of Fast Company’s sought-after Innovation by Design Awards can be found online and in the October issue of the print magazine, on newsstands September 27, 2022.












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Event

Design Methods and Mindsets in Global Health: A Conversation with Leaders from World Bank and Bill & Melinda Gates Foundation

Neeti Sanyal
Neeti Sanyal

There is a greater need than ever to provide essential, affordable health services to everyone, regardless of where they live. Achieving this goal requires resilient, functional, and inclusive health systems. Human-centered design, and other creative disciplines such as systems thinking and strategic foresight, are well suited to formulate and strengthen such systems by providing a deep understanding of people and their needs, by actively engaging stakeholders throughout the development process, and by using a holistic approach to address the various factors that affect health and health related behaviors.

In this webinar, Artefact sits down with Tracy Johnson, Senior Program Officer at The Bill & Melinda Gates Foundation and Jumana Qamruddin, Senior Health Specialist with the World Bank’s Health Nutrition and Population Global Practice, to discuss how they are using various design and creative approaches to reframe challenges and refocus efforts to better ensure primary health care works for all.

We explore:

  • What are the factors that affect health and healthcare and how can we account for them when designing interventions?
  • What are some ways to operationalize design as a mindset and practice into an organization’s culture, structure, and processes?
  • How can we “right-size” efforts to integrate design to achieve the specific needs and goals of an intervention?





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Design

UX 2030:
Expanding food access
through IoT farming


Holger Kuehnle
Holger Kuehnle

The UX 2030 Series

As emerging technology becomes an increasingly ubiquitous part of our lives, the design decisions we make today will shape how these technologies impact the world over the decade to come.

This series envisions how we might apply emerging technology in specific industries to create positive impact. We’ll explore what might accelerate or hinder these realities and the key risk areas and unintended consequences to consider.

Illustration by Laura Carr

A version of this article was first published in IoT Now.

Access to healthy food is a staggering problem in the U.S. Some 19 million Americans live in food deserts, while up to 40% of food produced in the U.S. goes to waste. Moreover, the production, transportation, and distribution of food is the fifth-highest contributor to greenhouse gas emissions in the country. It’s clear that the existing food system faces an overwhelming efficiency problem.

Growing food is a reasonably well-understood science that humans have iterated on for thousands of years. Yet despite advancements in technology, agriculture is still one of the least digitized of all major industries, according to McKinsey. There is enormous opportunity to combine agricultural technology with the proliferation of the Internet of Things (IoT) to improve access to food in underserved communities.

We imagine a 2030 where IoT-enabled circular food production democratizes agricultural skills, improves efficiency, and can be personalized to meet community needs. These community solutions would augment – not replace – the existing agricultural system, providing supplementary access to healthy foods to those most in need.

So how do we get there – and what risks will we face along the way?

More accessible, efficient, and personalized food production

IoT has the unique ability to integrate and automate tasks that would require significant expertise or time, greatly improving efficiencies and offering novel ways to personalize experiences. As IoT evolves over the next decade, how might this technology help improve access to food?

Democratizing skills

While existing personal and community gardens have an important role to play in food access and urban development, they can be unrealistic to scale. The knowledge and work required to sow, tend, and harvest food at the right time and in the right way every day is a daunting task for anyone, especially those living in food deserts or underserved communities.

An automated IoT system could address this challenge by bringing specialized farming knowledge to laypeople. Imagine a communal rooftop garden on an apartment or commercial building where healthy produce can grow throughout the year. Yet rather than the people living or working in the building tending to the crops, the garden would be managed by a web of sensors, automated watering systems, and robotics for tasks such as sowing, pruning, and harvesting.

Specialized sensors could take on specific tasks of measuring watering levels, soil nutrition, as well as plant ripeness and health. With IoT sensors and fully connected system-on-a-chip (SoC) devices continuously becoming cheaper, a monitoring device could be deployed for nearly every plant on a rooftop garden. This means the time-consuming task of tending to plants can be carried out by inexpensive electronics rather than humans, reducing barriers to access and allowing more people to participate in, and reap the benefits of, urban farming.

Improving efficiencies

Humans are increasingly developing novel and more sustainable ways to farm that involve less – or better managed – water, light, and soil. Combined with the possibilities of machine learning to identify the best time and manner to tend to and harvest plants, by 2030 we could establish robust farming operations in almost any location.

As systems of IoT-enabled devices and sensors work together in harmony to measure water and nutrient levels for each plant and communicate with connected pumps and other delivery systems, machine learning can aggregate these vast amounts of data and drive inputs which ensure ideal growth conditions. Rainwater collection systems, coupled with weather prediction models, could determine optimal watering schedules. Devices might direct the sun throughout the day to plants that need it most, or capture sunlight itself and store its energy for cloudy days.

An IoT-enabled system layer can manage the individual technologies used to grow food and organize which gardens might be best suited for which plants based on growing conditions inherent to its location and predictions for the needs of the people living in that community.

Community personalization

The connected and automated nature of IoT is well-placed to help determine a community’s real-time food needs and provide personalized distribution.

Just as the IoT system in aggregate could predict climate and resulting crop yields, it could also determine consumption patterns based on daily habits and anticipate the irregularities of a family and community’s schedules. Machine learning could detect patterns and anticipate food supply needs across a community, in order to allocate space to the produce in highest demand and efficiently distribute available produce within the community. A fully automated, communal garden could also be connected with other automated gardens, allowing for win-win sharing of crops and eliminating surplus that might otherwise go to waste.

Multiple communities could together make up a large system of interdependencies that can optimize the use of technology while distributing up-front costs across different investing areas. Even greater impact could come from partnering with existing local organizations such as food banks and community centers.

Addressing risk areas

Implementing such a complex, interconnected solution requires not only an understanding of human needs and technological constraints, but also the broader economic and social impact.

Cost

While the cost of IoT technology is continuously decreasing, the overall costs of establishing such a system are still significant. There unfortunately aren’t many examples of new technology adopted by underserved communities first – typically, those who can afford it create the economies of scale that make the technology accessible to a wider audience. Depending on population and density, a system such as this might not make financial sense for every food desert or underserved community – for example, distributing infrastructure costs may work for thousands of apartment dwellers but not for a hundred small-town inhabitants.

However, we have to look beyond the short-term investment costs and consider the long-term benefits of this system that other industries and stakeholders might find valuable. Start-ups like AeroFarms and Vertical Harvest are already leveraging technology to bring vertical farming to urban communities in the U.S., and governments are taking note as well: Singapore aims to triple domestic food production by 2030 through the use of technology-backed systems like multi-story urban LED farms and recirculating aquaculture systems. Industries from retail to healthcare could see a case for pursuing the positive long-term health outcomes of providing people with access to healthier food options. 

Privacy

Any system that relies on tremendous data collection in order to fuel machine learning models needs to be fortified against misuse of data and have a clear perspective on who retains control of it.

A highly interconnected system of IoT devices, robots, and machine learning models raises concerns about how privacy and user consent would be managed. Would people or communities be comfortable sharing their food consumption habits? Who else would have access to that information?

Privacy concerns may also be more significant for some communities than others. Lack of trust in government and centralized organizational bodies may be a barrier to adoption of a system that assumes people would be comfortable letting something as personal as food be handled by robots that are invisibly managed. Care must be taken to co-design such as system with members of the community, educate them on how it works, what data is collected, and how community members are empowered to control it.

Behavior Change

Access to healthier foods alone does not ensure that people will use them. What we eat is a very personal decision with social, cultural, and educational impacts. How might systems like this change the relationships people and communities have with food? Could these systems support existing community organizations and resources that have a strong understanding of their communities’ unique needs? At the individual level, could they help people live and eat healthier?

Providing healthy produce is only one aspect of systemic change that helps people build new, sustainable eating habits. There will be a need for instruction and guidance in terms of nutrition, recipes, and motivation in order to encourage behavior change for those with busy schedules or no awareness or interest in adapting their lifestyle habits.

Designing with, not for

IoT represents a unique opportunity to solve some of the inefficiencies of food production and distribution, and with that, the ability to address inequities in food access.

Nevertheless, there are important challenges involved in creating an infrastructure that impacts such an important aspect of what we as humans need to survive. As designers, it’s critical to engage with communities of use when considering such systems, elevating their needs and lived experiences, and ensuring that we design with, not for, them. Moreover, we need to approach such problems with a systems-thinking mindset that considers all people and groups potentially affected by the change, whether they ever come in direct contact with it or not.

It’s a difficult challenge, but an imperative to avoid unforeseen consequences and design for preferable outcomes. In leveraging this responsible design approach, we might imagine a future where IoT is used not only to bring healthy food closer to underserved areas, but bring people closer to each other, as a community.





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Event

Driving Health Equity
Through Evolving Care Models


The pandemic has demonstrated the healthcare industry’s ability and appetite to adopt models of care that meet patients where they are – whether online, at home, or in the community.

In this webinar, Artefact sits down with Sara Vaezy, Chief Digital and Growth Strategy Officer at Providence and Dr. Shantanu Nundy, physician and Chief Medical Officer at Accolade, to explore the innovative and accelerated models of care here in the U.S. that are impacting not only patients today but also the patient experience in the years to come.

We explore:

  • Opportunities and risks in distributed care models such as hospitalization at home; digital models such as telemedicine for behavioral health; and decentralized models such as subscription-based care
  • What these evolving models of care mean for the patient experience, their relationship with care providers, and greater health outcomes
  • How evolving care models that center the patient might support greater inclusion and equity, creating new opportunities to reach underserved populations





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Inclusion in Healthcare



Tech

3 lessons for EdTech from
the healthcare industry


The pandemic has upended education as we know it. School districts and universities across the country were overwhelmingly unprepared for the overnight shift to long-term distance learning and its resulting consequences around equity, relationships, and alignment. 

While schools and teachers have shown great courage and ingenuity in rapidly adopting technology that was not designed to address these challenges, this very technology can contribute to exacerbating inequity, weakened student-teacher relationships, and fragmented systems. There is ample opportunity for EdTech to better support teachers, students, and families in the current remote learning context and beyond. 

As the education sector looks to evolve the use of technology in the face of the ongoing pandemic and gradual return to in-person schooling, it can learn from another industry at the very heart of the pandemic: healthcare. 

Not only are education and healthcare two industries experiencing rapid, technology-driven change as a result of the pandemic, but they also share essential characteristics: a focus on human outcomes (students and patients), a foundation of relationships (between students and teachers, and patients and healthcare providers), and a complex system of stakeholders (from administrators to service providers to government regulators).

Through our experience working with organizations in both the education and healthcare industries, we’ve surfaced three areas where EdTech companies might take inspiration from healthcare’s use of technology to help accelerate positive outcomes in student equity, student-teacher relationships, and systemic alignment.


Understand students more holistically

Distance learning has surfaced the staggering disparities in each student’s home environment, from quiet spaces to study and parent/guardian support to access to technology and connectivity. While this has highlighted the unique circumstances of each learner in new ways, there are many factors beyond environment alone that determine how students learn. These include VARK learning styles (visual, auditory, reading/writing, and kinesthetic), executive function (how learners cognitively process tasks), social/emotional learning (how students collaborate and relate to each other), and individual histories and experiences. Understanding the unique context of each student can help teachers and administrators recognize roadblocks or opportunities to help learners achieve their best.

Education has typically leveraged technology to streamline specific tasks – whether it’s to deliver or disseminate information, or to conduct formative or summative assessments. Yet there is great opportunity for EdTech companies to help teachers and administrators gain a more holistic understanding of students as human beings, and what support they need to succeed. 

Learning from healthcare

The medical community recognizes that chronic health conditions are often impacted by non-clinical factors known as social determinants of health. This includes everything from zip code and financial stability, to education level and social support, to past experiences in the healthcare system. The healthcare industry is working to identify and utilize this information on patient context in order to provide better care. In Artefact’s work in diabetes care, there is emerging interest from healthcare providers to integrate Patient-Reported Outcomes surveys into diabetes care tools. These surveys help healthcare providers gain more nuanced insights about a patient and more effectively target interventions – which are more often related to connecting patients to the right resources and services rather than increasing an insulin dosage, for example.

Education might similarly use technology to improve understanding of student performance and engagement. A more holistic picture of students that moves beyond the standard scope of assessments could help educators and administrators connect the dots between student performance and behavioral, environmental, or other psychosocial factors. While this can help schools meet immediate student needs like access to technology, the long-term implication is the potential toward a more proactive and expansive approach to supporting students and their learning.

Create space to build relationships

We’ve all experienced disruptions to our relationships as a result of physical distancing due to the pandemic, and telecommunication has introduced unique challenges in maintaining authentic connections. This is even more relevant in the context of education, where quality of interaction between teachers and students (as well as among students) lead to better engagement in the classroom, and subsequently better learning outcomes.

As teachers experience myriad challenges to translate in-person classroom activities over teleconferencing or e-mail, we are recognizing that the role of technology is to augment, not replace, critical interactions and relationships in education. Beyond simply translating in-person interactions to virtual ones, technology can help create additional touch points to support learners of different types, for example, by leveraging both synchronous and asynchronous modes of communication, interaction, and instruction. Employing a combination of these approaches can help educators amplify the relational aspects of teaching to achieve better student outcomes.

Learning from healthcare

Adoption of telehealth services has seen steady growth in the last few years and especially during the pandemic. Beyond improved access to care, telehealth can improve patient outcomes in areas like chronic condition management and mental health. Instead of having to schedule an appointment weeks ahead only to get a limited window of time, telehealth introduces new flexibility that allows patients to reach their providers through different modalities based on their situation and preference. Synchronous solutions like audio/video sessions can support real-time care and consultations much like in-person appointments but without the need to factor in time for intake and administrative work, while asynchronous solutions using AI chat bots for triage and instant messaging for patient-provider communication can facilitate non-emergent and ongoing care outside of the limitations of what could be accomplished during a traditional appointment. Telehealth subsequently gives patients more agency to manage their own health by broadening their choices and affords providers the ability to attend to patient needs without having to be in the same space at the same time.

As educators continue to innovate strategies to engage learners in front of a screen or through increasingly flipped and blended learning environments, teachers can use synchronous and asynchronous technologies in concert to reach and empower different kinds of learners more effectively. Moreover, leveraging technology to take some of the rote tasks of teaching off an educator’s plate so that they can focus on higher-order relational outcomes, creates new opportunities for educators and learners to connect and interact both within and outside of the “classroom” – the boundaries of which are surely changing as a result of the pandemic.  


Bridge systems by reducing fragmentation

The piecemeal adoption of technology over time has created a fragmentation problem in education. This has further accelerated during the pandemic, as remote learning forces classrooms, schools, and the education system at large to digitize at an unprecedented pace. Products designed to address specific needs for different stakeholders – learners, educators, administrators, or parents – introduce silos of information that lead to inefficiencies and redundancies. 

It’s not uncommon to see teachers relying on one tool to access curriculum and class materials, another to distribute said materials, and yet another to capture assessment and student information. In this process, teachers themselves become the bridge across the system: manually organizing, transferring, and entering information to ensure that information is propagated across platforms. There is opportunity to create alignment and reduce teacher burdens with “agnostic technology.” This means creating a unified standard or architecture to ensure digital products are interoperable – in other words, able to “speak” with each other. 

Learning from healthcare

The healthcare industry has adopted Fast Healthcare Interoperability Resources (FHIR) – an electronic health records data standard – that has unlocked innovation across the industry. For example, the SMART apps platform built on FHIR allows medical apps to run across different healthcare IT systems and communicate with one another more seamlessly. The consumer-facing Apple Health app is also built on FHIR standards, and can synchronize with various health IT systems, giving patients more access to electronic health records and more agency in managing their own health. Interoperability improves efficiency by allowing data to be shared more easily across supporting systems and between different stakeholders. Reducing fragmentation also provides a more comprehensive view of the system and insights at different altitudes, enabling the industry to tackle more complex challenges.

In EdTech, an interoperable system might enable more coordination among educators, parents, and administrators in the same way digital health solutions help clinicians, home care aides, and visiting nurses provide more coordinated care. Interoperability standards could ease the burden on teachers and administrators, help them surface better insights across data sets, and more effectively allocate resources.

Inspiration and innovation

While the accelerated adoption of technology in education has surfaced many challenges, it also presents opportunities for EdTech to help education evolve during and after the pandemic. By looking to the use of technology in industries like healthcare, EdTech can help propel and improve student equity, student-teacher engagement, and systemic alignment in education – all central to helping every student achieve their best.





Read Next:

Align, Build, Contextualize:
The ABCs of EdTech Inclusivity



Event

Align, Build, Contextualize:
The ABCs of EdTech Inclusivity


As part of SxSW EDU Online 2021, we sat down with Elyse Eidman-Aadahl, Executive Director of the National Writing Project (NWP), and Lukas Wenrick, Assistant Director of the Learning Enterprise at Arizona State University, to discuss inclusion in EdTech.

Discover the “ABC”s of EdTech inclusivity – Align, Build, and Contextualize – as we share an approach to developing inclusive, flexible, and human learning pathways and programs at any organization.

We explore strategies and lessons learned creating curriculum, programs, and delivery models for greater access, equity, and inclusion, and identify ways your organization can develop tech-enabled learning experiences that serve every student’s unique needs.





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Designing for Trust + Inclusion
in Digital Education



Design

3 reasons your business
needs a design system


You need a design system. Yes, you. 

As a busy product owner working at a start-up or overseeing an established portfolio of solutions, we know the last thing on your mind might be putting precious time and resources toward another internal tool. 

Yet a design system is not only the single most effective tool to improve the efficiency of how you create, maintain, and innovate experiences, but you don’t need significant in-house design expertise to get started, either. Design systems have proven value for every organization, from start-up to enterprise. 

Having developed and evolved design systems for clients large and small across the tech, finance, and healthcare industries, we at Artefact have seen three consistent benefits that even a basic design system provides: saving time and money, delivering better product experiences and outcomes, and aligning stakeholders on a strategic long-term vision. 

Let’s dig into these three reasons design systems are important to your business and examples of how we’ve help clients leverage them for success.

What’s a design system anyway?

First, let’s take a moment to define what the heck a design system is. A design system is a set of strategic standards and documentation that accompany a collection of reusable UI and visual design assets that can be assembled together to build any number of applications. It is a living system unique to your organization that evolves and adapts alongside your product and business. 

To understand design systems, it’s often just as useful to define what they are not: Design systems are not style guides, they are not plug-and-play UI repositories, and they do not have to be crafted by seasoned in-house design teams. In fact, an external perspective can be a real asset to solving challenging, systemic design problems in unexpected ways by providing new knowledge, a more holistic strategic viewpoint, and an unbiased perspective to your organization.

1. Design systems save serious time and money

In the fast-paced world of digital products and experiences, collaborating on projects or onboarding team members is often chaotic – especially in a remote context. Whether you’re relying on a cloud content management system, a team Sketch symbol library, or a shared Figma file, lacking transparency or a common design language can lead to one-off solutions, inconsistency, and rework that drags out a project timeline – and budget. 

A design system helps your team design better at scale by unifying your brand across all products and platforms, alleviating communication and collaboration challenges, ensuring a smoother design-to-development handoff, and speeding up production to save you time and money.

Case Study: Canadian bank Tangerine partnered with us to create their Forward Banking digital brand, mobile app, and suite of digital banking features. While Tangerine had an established corporate brand, they were just building up their design capacity. We knew that Tangerine planned to create many new digital products in the years to come, and a design system would be essential to scaling efficiently. As an external agency, we brought the necessary skills and insight to help them organize around a cohesive design system and create guidelines and documentation for new feature and product implementation that would support the easy reuse of design components and logic as they continued to build their design practice. This set up the Tangerine team to more efficiently collaborate and scale in the future. 

2. Design systems deliver better product experiences and outcomes

As human-centered designers, our central focus is the experience of the people we design for. A design system helps establish UX deliverables that are rooted in real-world scenarios and tell a story about the people who will use the products we design. By balancing ideas with specific UI, a design system helps your organization create better products and experiences and informs stronger strategy for future projects. We consistently see the power of integrating design systems into UX projects that may not have explicitly outlined it as a deliverable. 

Case Study: We partnered with a software start-up to help identify product focus and improve the experience of their photo, video, and document storage and management tool. With an evolving new product and small but loyal user base, they needed to establish a product architecture that would allow them to add features and build on their product more seamlessly. We worked together to help them develop holistic design system primitives (typography, hierarchy, colors for wayfinding, etc.) and a UI component library that surfaced important questions across their product offerings and business, such as: How can UX improve product learnability as it evolves and expands? How will this selection pattern support globalization efforts? Should we create alternative data color palettes for accessibility? As an external voice, we brought a more holistic lens to developing a design system that helped the client gain focus and plan for the future of their product more strategically.

A design system helps balance the human (scenario-based views) with the technical (a library of components), in order to solve UX problems more proactively and systemically. It maximizes consistency from project to project and across new teams, helps you incorporate best practices around key design factors like accessibility, and can surface opportunities to create more extensible, accessible, and future-proof products and experiences.

3. Design systems align stakeholders on a strategic long-term vision

Design systems empower clients with little design background – or stakeholders outside of the design discipline – with the tools to talk about their product or brand. We’ve seen how design systems can be a powerful socialization piece for stakeholder alignment at both a product team and executive level, helping ensure consistency, reduce friction, increase speed to market, and reduce product risk. 

Case Study: We collaborated with a large, cutting-edge healthcare organization to develop several patient- and provider-facing digital platforms. Despite having a sophisticated portfolio of digital products and a large design team, they often faced pushback from stakeholders in marketing, brand, and industrial design departments, who each had their own product vision. A leader in their field, our client also had ambitious, long-term innovation plans for emerging technologies and multi-modal experiences that would require close stakeholder alignment for success. 

We helped the client develop a vision for a universal design system that serves as a common design language for the organization to align on and use to gain buy-in across their future initiatives. The vision was informed by both external trends and factors that would influence their product development in the coming years (such as multi-modal systems that account for multiple senses in order to better meet the needs of people with a range of cognitive and physical abilities), as well as perspectives from key internal stakeholders on their product priorities and how a design system would serve the needs of their discipline (for example, whether products should have distinct or unified brand experiences). We then developed a foundational design system for immediate implementation that laid the groundwork for bringing this long-term, universal design system to life.

As an unbiased external agency, we were able to transcend internal politics to create a design system that demonstrates how design decisions will impact products and strategy, and encourages thoughtful discussion on their business implications. In this way, a design system helped the client build a design culture with clear, transparent guidelines that not only simplified communication, but helped stakeholders align on a strategic vision and make better long-term decisions. 

Value today, impact tomorrow

Design systems are for every organization and product. You don’t need a large team dedicated to governing and managing it – just establishing a foundational design system that is manageable for your organization can help you create products faster and at lower cost, with better experiences and outcomes, and that are better aligned toward a strategic organizational vision. That’s the promise of a design system: it provides immediate value, while setting a foundation for strategic impact in the future.





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