Book Excerpt

Empathy: Standing in the Shoes
(or Lying on the Gurneys) of Others


Editor’s Note: In his new book, Change by Design, Tim Brown, CEO of the celebrated innovation and design firm IDEO, steps back from focusing on creating elegant objects and beautifying the world around us, to examining design thinking itself. The best designers, he says, match necessity to utility, constraint to possibility and need to demand. Most people are “ingenious at adapting to inconvenient situations that they are often not even aware that they are doing so,” Brown claims. “Traditional research techniques such as focus groups and surveys, which in most case simply ask people what they want, rarely yield important insights…Henry Ford understood this when he remarked, ‘If I’d asked my customers what they wanted, they’d have said a faster horse.’” This is an excerpt from the chapter where Brown talks about three mutually reinforcing elements of any successful design program – insight, observation and empathy. We asked to present the section on empathy.

It’s possible to spend days, weeks, or months conducting [ethnographic and behavorial] research, but at the end of it all we will have little more than stacks of field notes, videotapes, and photographs unless we can connect with the people we are observing at a fundamental level. We call this “empathy,” and it is perhaps the most important distinction between academic thinking and design thinking. We are not trying to generate new knowledge, test a theory, or validate a scientific hypothesis—that’s the work of our university colleagues and an indispensable part of our shared intellectual landscape. The mission of design thinking is to translate observations into insights and insights into products and services that will improve lives.

Empathy is the mental habit that moves us beyond thinking of people as laboratory rats or standard deviations. If we are to “borrow” the lives of other people to inspire new ideas, we need to begin by recognizing that their seemingly inexplicable behaviors represent different strategies for coping with the confusing, complex, and contradictory world in which they live. The computer mouse developed at Xerox PARC in the 1970s was an intricate technical apparatus invented by engineers and intended for engineers. To them it made perfect sense that it should be taken apart and cleaned at the end of the day. But when the fledgling Apple Computer asked us to help it create a computer “for the rest of us,” we gained our first lesson in the value of empathy.

A designer, no less than an engineer or marketing executive, who simply generalizes from his own standards and expectations will limit the field of opportunity. A thirty-year-old man does not have the same life experiences as a sixty-year-old woman. An affluent Californian has little in common with a tenant farmer living on the outskirts of Nairobi. A talented, conscientious industrial designer, settling down at her desk after an invigorating ride on her mountain bike, may be ill prepared to design a simple kitchen gadget for her grandmother who is suffering from rheumatoid arthritis.

We build these bridges of insight through empathy, the effort to see the world through the eyes of others, understand the world through their experiences, and feel the world through their emotions. In 2000, Robert Porter, the president and CEO of the SSM DePaul Health Center in Saint Louis, approached IDEO with a vision. Porter had seen the episode of ABC’s Nightline in which Ted Koppel had challenged us to redesign the American shopping cart in one week and wanted to discuss the implications of our process for a new wing of the hospital. But we had a vision too, and we saw an opportunity for a new and radical “codesign” process that would join designers and health care professionals in a common effort. We challenged ourselves by starting with what is perhaps the most demanding of all hospital environments: the emergency room.

Drawing upon his highly specialized expertise in the ethnographic study of technology and complex systems, Kristian Simsarian, one of the core team members, set out to capture the patient experience. What better way to do so than to check into the hospital and go through the emergency room experience, from admission to examination, as if he were a patient? Feigning a foot injury, Kristian placed himself into the shoes—and in fact, onto the gurney—of the average emergency room patient. He saw firsthand how disorienting the check-in process could be. He experienced the frustration of being asked to wait, without ever being told what he was waiting for or why. He endured the anxiety of being wheeled by an unidentified staffer down an anonymous corridor through a pair of intimidating double doors and into the glare and the din of the emergency room.

We have all had those kinds of first-person, first-time experiences—buying our first car, stepping out of the airport in a city we have never visited, evaluating assisted living facilities for an aging parent. In these situations we look at everything with a much higher level of acuity because nothing is familiar and we have not fallen into the routines that make daily life manageable. With a video camera tucked discreetly beneath his hospital gown, Kristian captured a patient’s experience in a way that no surgeon, nurse, or ambulance driver could possibly have done.

When Kristian returned from his undercover mission, the team reviewed the unedited video and spotted numerous opportunities for improving the patient experience. But there was a larger discovery. As they sat through minute after tedious minute of acoustic ceiling tiles, look-alike hallways, and featureless waiting areas, it became increasingly evident that these details, not the efficiency of the staff or the quality of the facilities, were key to the new story they wanted to tell. The crushing tedium of the video thrust the design team into Kristian’s—and, by extension, the patient’s—experience of the opacity of the hospital process. It triggered in each of them the mix of boredom and anxiety that comes with being in a situation in which one feels lost, uninformed, and not in control.

The team realized that two competing narratives were in play: The hospital saw the “patient journey” in terms of insurance verification, medical prioritization, and bed allocation. The patient experienced it as a stressful situation made worse. From this set of observations the team concluded that the hospital needed to balance its legitimate concerns with medical and administrative tasks with an empathic concern for the human side of the equation. This insight became the basis of a far-reaching program of “codesign” in which IDEO’s designers worked with DePaul’s hospital staff to explore hundreds of opportunities to improve the patient experience.
Kristian’s visit to the emergency room exposed a layered picture of a patient’s experience. At the most obvious level, we learned about his physical environment: we can see what he sees and touch what he touches; we observe the emergency room as an intense, crowded place that provides patients with few cues as to what is going on; we feel the cramped spaces and the narrow hallways and note both the structured and improvised interactions that take place within them. We may infer that the emergency room facilities—not unreasonably, perhaps—are designed around the requirements of the professional staff rather than the comfort of the patient. Insights lead to new insights as seemingly insignificant physical details accumulate.

A second layer of understanding is less physical than cognitive. By experiencing the patient journey firsthand, the team gained important clues that might help it to translate insight into opportunity. How does a patient make sense out of the situation? How do new arrivals navigate the physical and social space? What are they likely to find confusing? These questions are essential to identifying what we call latent needs, needs that may be acute but that people may not be able to articulate. By achieving a state of empathy with anxious patients checking into an emergency room (or weary travelers checking into a Marriott hotel or frustrated passengers checking in at an Amtrak ticket counter), we can better imagine how the experience might be improved. Sometimes we use these insights to emphasize the new. At other times it makes sense to do just the opposite, to reference the ordinary and the familiar.

Cognitive understanding of the ordinary and the familiar was at work when Tim Mott and Larry Tesler, working on the original graphical user interface at Xerox PARC in the 1970s, proposed the metaphor of the desktop. This concept helped move the computer from a forbidding new technology of value only to scientists to a tool that could be applied to office and even household tasks. It was still in evidence three decades later, when the start-up Juniper Financial asked IDEO to help it think about whether banks still needed buildings, vaults, and tellers.

In approaching the uncharted territory of online banking, we began by trying to get a better understanding of how people thought about their money. This exercise proved to be challenging in the extreme since we can’t watch the cognitive process of someone thinking about money in the way we can watch the behavioral process of someone paying a bill or withdrawing cash from an ATM. The team settled on the technique of asking selected participants to “draw their money”—not the credit cards in their wallets or the checkbooks in their purses but the way in which money played a part in their lives. One participant—we called her “The Pathfinder”—drew little Monopoly-style houses representing her family, her 401(k) retirement plan, and some rental properties, since her focus was on long-term security. Another participant—designated “The Onlooker”—drew a picture with a pile of money on one side and a pile of goods on the other. With disarming candor, she explained to the team, “I get money and I buy stuff.” The Onlooker was completely focused on her day-to-day financial situation and did almost no planning for the future. Beginning from cognitive experiments like these, the team of researchers, strategists, and designers developed a subtle market analysis that helped Juniper refine its target market and build an effective service in the emerging world of online banking.

A third layer—beyond the functional and the cognitive—comes into play when we begin working with ideas that matter to people at an emotional level. Emotional understanding becomes essential here. What do the people in your target population feel? What touches them? What motivates them? Political parties and advertising agencies have been exploiting people’s emotional vulnerabilities for ages, but “emotional understanding” can help companies turn their customers not into adversaries but into advocates.

The Palm Pilot was an indisputably clever invention, and it has, deservedly, won widespread acclaim. Jeff Hawkins, its creator, began with the insight that the competition for a small, mobile device was not the omnifunctional laptop computer but the simple paper diary that many of us still slip into and out of our shirt pockets or purses a hundred times a day. When he began to work on the Palm in the mid-1990s, Jeff decided to buck the conventional wisdom and create a product that did less than was technically possible. That his software engineers could have stuffed spreadsheet capabilities, colorful graphics, and a garage-door opener into the Palm didn’t matter. Better to do a few things well, so long as they were the right things: a contact list, a calendar, and a to-do list. Period.

The first version of the Palm PDA was a hit among tech-savvy early adopters, but there was nothing about its chunky gray plastic form that fired the imaginations of the larger public. In search of this elusive quality, Jeff teamed up with Dennis Boyle at IDEO, and together they began to work on a redesign that would appeal not just at a functional but also at an emotional level. The interface was left largely unchanged, but the physical quality of the device—designers call it the “form factor”—was reimagined. First, it was to be thin enough that it would slide smoothly into a pocket or purse—if it didn’t disappear, Dennis sent his team back to the drawing boards. Second, it was to have a feel that was sleek, elegant, and sophisticated. The team sought out an aluminum-stamping technique used by Japanese camera manufacturers and found a rechargeable power supply that even the battery suppliers doubted would work. The added development was worth the effort. The Palm V went on sale in 1999, and sales rocketed to more than 6 million. It opened up the market for the handheld PDA not because of a lower price point, added functionality, or technical innovation. The elegant Palm V did everything it promised to do, but its sophisticated look and professional feel appealed, at an emotional level, to a whole new set of consumers.

From the book CHANGE BY DESIGN. Copyright C 2009 by Tim Brown. All rights reserved. Published by arrangement with HarperBusiness, an imprint of HarperCollinsPublishers.