By Brenda Reginatto, Research Lead, Care Team, ARCH

patient centred design blog

Thoughts on patient-centred design, Steve Jobs and faster horses


Last week I was talking to a friend about a challenge they are facing in his company. This is more or less how the conversation went:

Friend: “… it is super exciting. We have built a product that has the potential to revolutionize the way patients manage disease X. What is frustrating is that, after years working on this, we are still finding very hard to get market traction and our investors are not very happy about that…”

Me: “Oh, really? That must be frustrating. Why do you think that is?”

Friend: “I don’t think the patients understand how much the product can help them. It is so much better than the one they currently use. But they don’t get it. People are just stuck in their ways…”

Me: “Interesting…” – at this point alarm bells start going off in my head – “Did you talk to any patients to understand why they prefer the product they have when your one is so much better?”

Friend: “Not really. There is no point asking people. It is like Steve Jobs said, people don’t know what they want until you show it to them…”

At that point I thought to myself “oh, here we go again”.

You are probably familiar with this famous quote from Steve Jobs where he said “It’s really hard to design products by focus groups. A lot of times, people don’t know what they want until you show it to them.” I lost count of how many times this quote has been used in conversations I had as a reason for not involving patients in the design of connected health solutions. It is either this or the alleged quote from Henry Ford: “If I had asked people what they wanted, they would have said faster horses”. The basic assumption underpinning the argument being that patients are not necessarily aware of what technology is capable of. In other words, they don’t know what the possibilities are.

I find this debate fascinating. If you know me, you know that I firmly believe in the value of patient-centred design as an approach to develop solutions that are meaningful to real patients in the real world. Of course, I also understand that innovation can come from within and a company may come up with a product first and then try to find market fit. I’ve seen both being done successfully. This is not the point.

The point I think many people are missing is that patient-centred design is not about going around asking patients what they want. It is not about companies asking patients to tell them what they should build. That would be mad! Patients shouldn’t be telling companies what to build, in the same way companies shouldn’t be telling patients what their problem is.

Patients are experts in their lives. They know better than anyone what they get up to everyday. They know what challenges they face. They know what brings them joy. They know what matters most to them.

Patient-centred design is all about that. It is about engaging with patients to understand how they currently go about their lives and what the ups and downs are. It is about understanding what makes them tick. It is about making sense of these insights in order to identify gaps and opportunities for improvement. It is about creating great, relevant solutions as a result of this process. In Rob Fitzpatrick’s words “They (customers) own the problem, you (entrepreneur) own the solution”. I think that is a nice compromise.

In fact, I agree with Jobs and Ford. Asking patients what they want is probably not the most effective approach to designing highly innovative solutions (which are desperately needed in healthcare). You have to go way beyond that. You need to understand why they want this and what this will enable them to achieve that they can’t achieve with the tools that already exist.

If you want to design a product that not only patients need but also want (and do I dare say love?), getting to know the people you are designing for is essential and should be a constant effort throughout your product development life cycle. If after all that your product is still not flying off the shelves, at least then you should be able to figure out why, learn from this and move on.