Service design, behavioral design and iterative pilot testing are critical methods for creating digital health products and services that drive positive health outcomes.

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Checking Up on Digital Health

Digital health solutions are poised to transform our paradigms of care for the better. People are demanding healthcare that’s more conveniently integrated into their lives, delivered by the brands they trust. A <a href="https://www.cvshealth.com/news/innovation/consumers-want-a-more-connected-personal-health-care-experience.html" target="_blank" rel="noopener">CVS Health survey</a> revealed that consumers want to receive medical care on their own terms—with ideal experiences being ones that are convenient, accessible and affordable. The shift toward hybrid care models, accelerated by tech advancements and the pandemic among other factors, creates an opportunity to improve health outcomes and reduce costs through delivery of more streamlined, multichannel and equitable products and services.  
The opportunity to lead the market in the delivery of digital health services is ripe, and the competition is rising. Big Tech companies have been <a href="https://medicalfuturist.com/the-first-database-of-tech-giants-collaborating-with-healthcare-what-can-we-learn/" target="_blank" rel="noopener">increasingly open to collaboration</a> (e.g., Alphabet’s Verily and Mayo Clinic), building in-house and growing through acquisitions (e.g., <a href="https://www.aboutamazon.com/news/retail/what-is-amazon-clinic" target="_blank" rel="noopener">Amazon Clinic</a> and <a href="https://press.aboutamazon.com/2022/7/amazon-and-one-medical-sign-an-agreement-for-amazon-to-acquire-one-medical" target="_blank" rel="noopener">One Medical</a>). 
From a patient or care provider’s point of view, healthcare products and services are often intertwined. But from a development standpoint, they differ significantly. Healthcare products are tangible goods (e.g., monitors, surgical tools, medicine and other consumables). In contrast, services are the interactions between products, people and their environment. The key differentiating factor is people—products are the things we use, and healthcare services involve the people we need.  
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<h2>Overcoming barriers </h2>
Through our experience working with <a href="https://www.frog.co/sector/healthcare-service-strategy" target="_blank" rel="noopener">life sciences (LS) companies and healthcare delivery networks</a>, we at frog understand the barriers to deploying digital health products and services swiftly and effectively. Challenges include integration with healthcare systems, overcoming tech complexities and adopting new ways of working. Also, building a digital solution targeted to treat a single disease is often difficult, given the complexity and nuance of managing co-morbidities. Yet, to effectively service today’s growing population of discerning patients, healthcare providers must attend to their demands and deliver services to them with intention.  
LS companies and healthcare delivery networks must embrace three core methods to deliver successful digital health offerings. The first method uses <a href="https://www.frog.co/services/service-design" target="_blank" rel="noopener">service design</a> and system thinking to orchestrate holistic ecosystems that enable critical value exchanges among service providers, end users and organizational stakeholders. A second tactic is designing for behavioral change to drive positive health outcomes and achieve problem-solution fit. A third approach executes agile learning experiments to test and iterate the end user experience in real-time, de-risking product and service development.

When designing a new service, especially in complex healthcare systems, it’s necessary to design the environment and connections among users and touchpoints. It can be tempting to build a digital solution rapidly without a clear plan. Instead, teams need to define the transformative value the new service should achieve across the entire ecosystem.  
There are inspiring examples of well-executed connected health ecosystems. <a href="https://asktia.com/" target="_blank" rel="noopener">Tia</a>, a women’s healthcare solution that unites digital and physical touchpoints (such as virtual care and in-person appointments), operates in a way that responds to patient needs more holistically.  
To create solutions that truly address people’s health and well-being, we recommend approaching ecosystem design through the following steps: 
Map the current-state ecosystem. First, define the primary roles that influence end users and organizations (e.g., patients, caregivers, clinicians). Map out the key nodes (e.g., clinics, patient digital portals) and cluster them by categories (e.g., digital tools, home health services) to help organize elements logically.  
Draw and label lines that indicate the type and direction of value exchanged among players. Value flows may include exchanges of material, data, information, money or labor. The goal is to clarify complex relationships, identify gaps and opportunities in the current ecosystem and make strategic decisions about connections to build or strengthen the intended value.  
Design the future-state service system. When identifying the solution, use inputs from surveys, ethnographic interviews and other human-centered design methods to map out the future-state ecosystem using the same method outlined above. This method can help to remove friction and add value in a service by redirecting a value flow or identifying a need for a new node or role in the ecosystem.

Visualize the entire ecosystem

Designing for behavioral change is critical to driving positive health outcomes. frog has worked with pharmaceutical companies and healthcare delivery networks to successfully design and pilot behavioral interventions in applications ranging from preventative health to chronic condition management, and from hybrid service models to digital medicines and therapeutics.  
We recommend taking these two approaches from frog’s behavioral science and innovation methods: 
Determine the best way to influence behavior change. Health outcomes are influenced by a complex web of factors—everything from our individual actions to the <a href="https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1" target="_blank" rel="noopener">social determinants of health</a>. To drive change in this complex space, frog employs iterative mixed methods research. This involves mapping the factors (promoting and inhibiting pressures) that make a person more or less likely to act, and then designing behavioral interventions that incorporate the strongest combination of these pressures to increase the likelihood and magnitude of change.  
Design and run behavioral intervention pilots. These experiments test and measure whether the intervention changes people’s behaviors in the intended ways. Given that the purpose of the experiment is to test the core behavioral mechanism, they can be run before and/or in parallel with product development to maximize learnings and reduce costs. Behavioral mechanism refers to the process, technique or system designed to encourage people to think and act differently. For example, one could design an experiment in which people with a heart disease have weekly honest conversations about care plan compliance (e.g., maintaining a medically recommended diet) to see if this new activity translates to them reducing other behaviors that are counterproductive to their health (e.g. eating foods their doctors recommend avoiding.) In this case, the behavioral mechanism is the weekly honest conversations. <span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335551550&quot;:1,&quot;335551620&quot;:1,&quot;335559685&quot;:0,&quot;335559737&quot;:0,&quot;335559738&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}"> 
Pilot experiments are used to assess and iterate interventions across three key dimensions: (1) Validation: Did we identify the right pressure? (2) Effectiveness: Did our interventions change the pressures? (3) Impact: Did we create enough behavioral change? Teams should iterate and incorporate the behavioral interventions into the digital health product and service. 
To learn more about using behavioral science in product and service design, check out two of frog’s Design Mind frogcasts: <a href="https://www.frog.co/designmind/design-mind-frogcast-ep-23-the-science-of-behavior-change" target="_blank" rel="noopener">The Science of Behavior Change</a>, featuring Matt Wallaert, former frog Head of Behavioral Science and <a href="https://www.frog.co/designmind/design-mind-frogcast-ep-27-bayer-project-story" target="_blank" rel="noopener">How We Venture: Bayer Consumer Health</a>, featuring insights from the Bayer Consumer Health and frog teams on shaping a behavior-driven platform.

Design for behavioral change

Bringing new digital health products and services to life requires real-time testing of the product and service delivery model in conjunction. We recommend running these two activities to improve the effectiveness of digital health solutions, de-risk the process and reduce development costs:  
Shift the mindset and advocate for experimentation. In working with top 10 global pharmaceutical companies and premier academic health systems, we’ve observed that organizations often struggle with the most critical step in bringing digital health solutions to market—experimentation.  
For LS companies, a key challenge is obtaining organizational buy-in for experimentation methods outside the traditional drug discovery, development and clinical research paradigm. For healthcare delivery networks, a key challenge is rallying a team of clinicians willing to try new tools in their workflows and to coordinate with product development teams to share feedback and iterate in real time. In either case, piloting requires teaching stakeholders to embrace uncertain outcomes as valuable learning experiences. To build a compelling business case for investment, create an experimentation roadmap that sequences experiments in a way that maximizes learnings and reduces development costs.
Launch iterative service experiments. Before investing in a full product development cycle, consider running service experiments that test for product and service-solution fit. Unlike other assessment methods such as clinical trials or usability tests that test aspects of the experience in silos, service experiments aim to test the end-to-end experience for key users which integrates not only the digital product, but also the roles, systems, processes, data points and technology that tie the service all together. It’s also important to design a process that enables the ongoing collection of user feedback.

Test products and services in new ways

<h2>Moving forward<span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335551550&quot;:1,&quot;335551620&quot;:1,&quot;335559685&quot;:0,&quot;335559737&quot;:0,&quot;335559738&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}"> </h2>
In a changing healthcare landscape, it’s vital for healthcare and LS organizations to embrace new ways of working, business models, organizational structures and skillsets. When we employ these three methods—service and behavioral design and testing—to launch new digital products and services, we not only create new business value streams, but also and most importantly, we all benefit as communities and individuals. We improve the healthcare system through more accessible and affordable channels for care. We equip healthcare providers with more effective tools to deliver personalized care and make their jobs more manageable. We give our family and friends more comfortable ways of caring for themselves and their loved ones to improve quality of life.  
frog has a unique team at the intersection of its practices in <a href="https://www.frog.co/services/service-design" target="_blank" rel="noopener">Service Design,</a> <a href="https://www.frog.co/sector/healthcare-service-strategy" target="_blank" rel="noopener">Healthcare</a>, <a href="https://www.frog.co/designmind/design-mind-frogcast-ep-23-the-science-of-behavior-change" target="_blank" rel="noopener">Behavioral Science,</a> and <a href="https://www.frog.co/services/product-service-design" target="_blank" rel="noopener">Product Strategy, Design and Delivery</a> ready to take on new digital health challenges. <a href="https://www.frog.co/contact" target="_blank" rel="noopener">Connect with us</a> to discuss your needs around developing digital health solutions and the potential opportunities for your organization.

Jess Leitch

Sara  Manzini

Lauren Ianni

Carissa Lim

Authors

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Ianni, Lauren_crop (5)

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Women are the ‘Chief Healthcare Officers’ of the home, so why does healthcare design exclude them—and how can we enact positive change? 

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3 Approaches to Women’s Healthcare Design

Women hold significant decision-making power for household expenditure, typically taking the role of ‘Chief Health Officer’ of their households. In the U.S., women make <a href="https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/women-and-job-based-health.pdf" target="_blank" rel="noopener">80% of all healthcare spending decisions</a>. Furthermore, women are <a href="https://www.frost.com/frost-perspectives/femtechtime-digital-revolution-womens-health-market/" target="_blank" rel="noopener">75% more likely</a> than men to use digital tools for healthcare. Despite women’s influence over healthcare spending and use of health technology, they continue to be overlooked in design and suffer as a result of this <a href="https://carolinecriadoperez.com/book/invisible-women/" target="_blank" rel="noopener">gender data gap</a>.
The market for healthcare products and services for women is fertile yet underdeveloped. Recently &#8220;femtech” has gained momentum with companies such as <a href="https://www.mavenclinic.com/" target="_blank" rel="noopener">Maven Clinic</a>, <a href="https://www.instagram.com/modernfertility/?hl=en" target="_blank" rel="noopener">Modern Fertility</a> and <a href="https://www.instagram.com/flotracker/?hl=en" target="_blank" rel="noopener">Flo Health</a> among those leading the charge. However, there is not only a significant need for increased investment, but also an equally important need to change the way in which we approach product design and development. At frog, we have designed products and services for a range of women&#8217;s healthcare experiences from <a href="https://www.frog.co/work/yona-humanizing-the-medical-pelvic-exam" target="_blank" rel="noopener">reimagining the pelvic exam</a> to improving the journey of those with <a href="https://www.frog.co/work/a-biopharmaceutical-company-that-puts-the-patient-first" target="_blank" rel="noopener">triple negative breast cancer.</a> Most recently, we worked with a major U.S. healthcare provider to design a digital application and in-person service offering to navigate the maternity experience, including postpartum support.
From our experience, creating human-centered healthcare products and services for women requires embracing three critical paradigm shifts in approach to design: normalize “taboo” women’s health topics, focus on intersectionality and co-create with the community.

Normalization and destigmatization of historically “taboo” women’s health challenges is a critical first step in effectively designing for women’s healthcare experiences. It is necessary to destigmatize first as we cannot begin to create solutions for challenges that we do not openly talk about, acknowledge as valid or invest in as priorities. It is a significant opportunity for healthcare systems and digital health product and service providers alike to change perceptions across three life-changing health journeys experienced by many women: maternity, postpartum and menopause. In particular, in postpartum care, there is a need to normalize the challenges of postpartum depression (PPD), body image and sexual health. This need is growing as prenatal and postpartum anxiety has <a style="text-decoration: underline; font-weight: bold;" href="https://www.hsph.harvard.edu/news/press-releases/pregnant-postpartum-covid19-post-traumatic-stress/" target="_blank" rel="noopener">risen by 31%</a> during the COVID-19 pandemic.
In our work designing postpartum products and services, we observed that lack of normalization is associated with lack of care resources and psychological barriers to seeking support. We heard through interviews with women that they have been conditioned to dismiss their feelings and question the possible abnormality of their mental and physical health. This results in their hesitation to seek support or even to recognize the need for support. We spoke with healthcare providers who identified that there is a lack of services that cater to women’s mental health support. For example, there is a need to better support women through postpartum depression through benefits such as paid parental leave for miscarriages, which are unfortunately <a style="text-decoration: underline; font-weight: bold;" href="https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298#:~:text=Miscarriage%20is%20the%20spontaneous%20loss,even%20know%20about%20a%20pregnancy." target="_blank" rel="noopener">not uncommon experiences</a>.
In this context, normalization and destigmatization not only mean increasing the sheer amount of dialogue on these topics in the public domain, but also—and more importantly—reframing the conversations around these topics so that they are validating and drive change. These conversations should enable women to perceive their challenging health experiences as not uncommon, shared by others in similar circumstances and acceptable to discuss. For healthcare solutions providers and employers, this means recognizing the significance of these three health experiences in women’s lives. Furthermore, incorporate behavioral research into the design process to understand what factors drive and inhibit behaviors. Solutions should incorporate behavioral interventions to reduce frictions to seeking support. Solutions should also include mechanisms to directly connect individuals to mental and physical health resources that are tailored to their unique health journeys.
Action points:
<ul>
<li>Create a safe space for women to speak frankly about their health challenges.</li>
<li>Design interventions that reduce frictions to seeking support.</li>
<li>Tailor resources to women’s specific psychological and physical needs (rather than of the <a style="text-decoration: underline; font-weight: bold;" href="https://www.youtube.com/watch?v=CVdn-2KE2bs" target="_blank" rel="noopener">Reference Man</a>.)</li>
</ul>

Normalize “taboo” women’s health topics 

Many products that are designed for women cater to a narrow idea of womanhood. In order to truly design for all women, we must be inclusive of all those who identify as women, such as those of different ethnicities, sexual orientations and gender identities. A lack of consideration for these differences has led to negative healthcare experiences and outcomes such as <a style="text-decoration: underline; font-weight: bold;" href="https://www.liebertpub.com/doi/10.1089/trgh.2020.0017" target="_blank" rel="noopener">feelings of discrimination</a> and <a style="text-decoration: underline; font-weight: bold;" href="https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm?s_cid=mm6835a3_w#T1_down" target="_blank" rel="noopener">unequal treatment</a>. We have seen <a style="text-decoration: underline; font-weight: bold;" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182298/" target="_blank" rel="noopener">too many products </a>assume that their users are cisgender women in heterosexual relationships, thereby alienating and excluding people who may not fit into these categories.
When starting to design an experience “for women”, make sure to use a broad and inclusive definition of womanhood. During research, intentionally find participants that represent a diverse range of women—making the time and effort to capture their varied perspectives and lived experiences to inform and inspire more comprehensive solutions.
As you define the experience, avoid making assumptions about the user’s gender, family dynamics and cultural norms—especially when building a product specific for maternity and family care experiences. Instead, allow your users to self-identify and avoid any gender-specific or heteronormative terminology throughout the product. Additionally, when adding any visual representations in your products, ensure you depict different women in the <a style="text-decoration: underline; font-weight: bold;" href="https://createherstock.com/" target="_blank" rel="noopener">stock photography</a> and <a style="text-decoration: underline; font-weight: bold;" href="https://www.blackillustrations.com/" target="_blank" rel="noopener">illustrations</a>, showcasing a range of cultures and ethnicities, physical conditions and ages.
Actions points:
<ul>
<li data-stringify-indent="0" data-stringify-border="0">Keep the definition of womanhood broad and inclusive. For example, make sure it includes those of different ethnicities, socioeconomic status and sexual orientations.</li>
<li>Capture historically underrepresented perspectives when conducting research.</li>
<li>Avoid making assumptions of the user’s gender, family dynamics and cultural norms.</li>
<li>Include a diverse range of women in any visual representations in the experience.</li>
</ul>

Consider the needs of all who identify as women 

Designing effective women’s healthcare experiences requires bringing in their voices as decision-makers on the executive level and as co-creators throughout the design and development process. First and foremost, there is an overarching need for more female representation in leadership roles. Women are underrepresented in influential global health leadership roles, accounting for only <a href="https://www.google.com/url?q=https://www.statista.com/statistics/1102621/females-global-health-workforce-by-role/&amp;sa=D&amp;source=docs&amp;ust=1647383213795237&amp;usg=AOvVaw3nH-yho66Gwh226CunkVKn" target="_blank" rel="noopener">3.7% </a> of Fortune 500 Healthcare CEO’s and <a href="https://www.statista.com/statistics/1102621/females-global-health-workforce-by-role/" target="_blank" rel="noopener">25%</a> of heads of global health organizations boards. Gaps in leadership trickle down to lack of investment in women’s healthcare products and oversight in the design and development process, which puts women’s health at risk. Women have been underrepresented in drug and disease treatment studies for years and, as a result, have <a href="https://www.nature.com/articles/550S18a" target="_blank" rel="noopener">suffered disproportionately</a> more side effects and risk of receiving ineffective therapies.
In addition, in order to design and build equitable experiences for a diverse set of women, we must ensure that our design and development teams are diverse. At the start of a project, consider spending time to intentionally consider the identities of those on the project team. How do the members of the team identify themselves and how might those identities influence decision making? If there is a gap, consider leveraging <a href="https://vimeo.com/235081825" target="_blank" rel="noopener">radical empathy exercises</a> to help individuals on the team better understand and relate to different perspectives other than their own. During the design process, make a point of establishing which perspectives might be missing and create opportunities along the process to directly engage with those voices at a regular cadence. Give those voices decision-making power in the design process so they can have a direct impact on the experience itself.
Action points:
<ul>
<li>Take action to reduce biases and consider how the different points of view of team-members influences product design assumptions.</li>
<li>Leverage radical empathy exercises within the project team.</li>
<li>Identify gaps in perspectives and bring those voices directly into the design process.</li>
</ul>
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<h3>Care for those who have cared for you </h3>
Over the past year, we have seen a heightened demand to design for women’s healthcare experiences. In <a href="https://www.frog.co/sector/healthcare-service-strategy">frog’s healthcare practice</a>, we have collaborated on multiple products and services with partners across the healthcare landscape from digital application developers and diagnostic device manufacturers to leading U.S. hospital systems and insurers. Through this experience, we have learned—and urge others—to focus on embracing these three paradigm shifts in approach to design: destigmatization of historically “taboo” women’s health challenges, inclusion of the needs of all women and, most importantly, co-creation with (not just for) the community.
The first step to co-creation is listening. Ask your grandmothers, mothers, sisters, aunts, daughters, teachers and caretakers about their experiences. Then genuinely engage them directly throughout your design process as shared decision-makers. They have cared for you, so care for them.

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Lauren Ianni

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