thelastmile

I have now permanently moved this blog to http://blog.vialogix.com/. Thank you

For the past 12 years we have worked on web site development projects designing online applications and tools that make complex information easy to understand. No where is that more needed today than in healthcare.

The complexity of individual data alone is staggering. Claims information, deductibles, in-network vs. out-of-pocket, prescription vs. generic, health savings accounts and flexible spending accounts all confuse the average consumer.

The dollars and cents part of the equation is maybe even harder to fathom. Costs are rising at rates 2-5 times the cost of living. Small business can’t afford to face 20+% increases each year for their health care. U.S. health care costs have risen from 4.4 percent of Gross Domestic Product (GDP) in 1950, to 9 percent in 1980, to 12.4 percent in 1990 and to 15.4 in 2005.

In this country we spend more money on health care than any other in the world and yet the result is many are forced into bankruptcy (Health Affairs article) We have a much higher obesity rate that any other of the 30 countries in the Organization for Economic Cooperation and Development and rank in the lowest third in life expectancy and per capita number of physicians (2006 OECD Health Data) in that group. Are we getting what we pay for?

Fortune 1000 companies are removing the lifetime health care benefits that our parents assumed because it is bankrupting them. The Ford Motor Company unbelievable announcement of early retirement packages for 75,000 employees is now being criticized as maybe not enough. In a Detroit Free Press editorial one of the concerns raised of the cuts is that unless the company gets major concessions from the unions largely on health care and retirement costs, Ford may need to make even deeper cuts in 3 years. (Free Press Editiorial article)

Demand is the third leg of the stool. With the first of the baby boomer generation turning 60, their tremendous numbers will stretch health care in the US for the next few decades. Even now the industry has become perhaps the most influential one in our economy. Michael Mandel quotes in a recent BusinessWeek article “Healthcare Economy” that 1.7 million jobs have been created in the health care industry since 2001. The rest of the private sector have created none in comparison (BusinessWeek article).

So its easy to agree that it is a big problem. What better way to make a big problem smaller than to make it easier to understand?

Many more Americans are opting to work on their own and will face the task of insuring themselves. Health care needs to become like retirement plans - something we all take charge of.

Enter - Consumer Driven health care and the chance to all of us to more firmly understand that each trip to the doctor’s office doesn’t just cost the $20 copay.

Consumer driven plans and tools are giving consumers more information and the chance to shop for services. Quality care, risk assessment, personalized health info like claims data and rx prescriptions gives average user the chance to save money by making intelligent health care choices. In a PricewaterhouseCoopers (press) release, the summary is that the “Current health plan trends to promote provider pay-for-performance, transparency, consumer engagement, and healthy lifestyles have the potential to mitigate future cost increases and address some root cost drivers.” In other words, if consumers treat health care like they treat every other major purchase they make maybe the costs can be managed to a more acceptable curve. And the only logical choice for making that “research” function really rich is online.

Consumers for health care information come from all walks of life. In user tests that we conducted for hospital systems, we found at least 11 different types of online user for health care information. They range from people nervous about delivering their first child to those who need nutritional information (ie diabetes) to folks worried about a loved one going into surgery. They have various levels of internet savvy. They all have a need to find the information that will lesson their anxiety.

A collection of links to third parties doesn’t do that. It is more confusing. An entry screen designed by the back-end data base team probably doesn’t get it either. An enterprise solution has far too little customization in most cases. What we have found it boils down to is design that is simple to use - for everyone - and easily understandable.

Consumers want choice in everything else they purchase. And the internet has been a boom to informational gathering on consumer products from books to music to automobiles to homes. It is about time we all think about health care the same way.

While on vacation this summer I listened to my wife and started each day with more stretching. On the floor each morning I reminded my muscles that they have been spending too muchtime in an office chair. Stretching hamstrings and hip flexors before I windsurfed and kayaked and swam and jumped off the rocks with my kids made me feel younger and stronger. It also brought tightness I hadn’t had in my legs since high school sports. But I am slowly feeling stronger and more agile. And the hurt is the good kind.

Flexibility is the key to success in business today. The Internet gave consumers flexibility of when and where they find information. IT infrastructure gives companies, of all sizes, the flexibility to transact business from any location. Software services have given us the flexibility to scale that technology backend without the cost exorbidence of previous business models. Companies can no longer just “throw bodies” at projects. Large companies have realized that the game has changed and flexibility is key to their success.

Fortune magazine dug into the problems in a recent article entitled “Tearing up the Jack Welch Playbook.” By making fixed costs more variable (ie outsourcing, partnering, and focusing on core strengths), corporate success stories now come from agile companies with streamlined business models that do not require scale but with technology that can (Fortune article)

Software tools that allow instant publishing of opinions, news and information are totally changing the political landscape. Politicians are abusing the flexibility of this new medium by editing their opponents pages as well as enhancing their own (Charlotte Observer article) as covered in this recent article. Flexibility is not a license to cheat however and those indiscretions had to be monitored and made less flexible (try editing President Bush’s wiki entry for instance).

Apply flexibility to your business life. Get down on the floor and stretch. Get your employees and co-workers and clients to do it with you. Try to gain back some of the mobility you had when you were younger. Use it as you go about business today. It may bring a little tightness tomorrow, but you will start to see the results almost immediately in other aspects of strength and agility.

I remember a grad school course in Mass Communications research that made me think it would be hard to ‘measure’ advertising results (Grady Course Listing). 15 years in a creative service business have help prove that in more detail. Don’t get me wrong, I believe that the UI work we do definitely effects results in a measurable way. I just think that companies and service firms struggle with the need to Quantify results that are probably more Qualitative.

We are starting to see the frothiness of web hype (Web 2.0 BS Generator) again with mergers, venture money and hyperbole from consultants, but many of the old adages still apply. The Journal of Marketing has only been around since 1936 and has published a ton of research on effectiveness. One of the articles I remember most came from a 1961 quarterly publication. It was by Robert Lavidge and Gary Steiner and we used it in class at Georgia when we discussed measurement. It took users through the 6 step process from Awareness to Knowledge to Liking to Preference to Conviction to Purchase. Advertising programs have been teaching kids to write copy to get people across that spectrum ever since. Bill Bernbach exemplified the skills starting with the 1959 Volkswagon Think Small campaign and held our attention for decades.

How does that age old ’selling’ translate to the web? Where are we on Lavidge and Steiner’s continuum? Seth Godin has important opinions in his book “All Marketers are Liars” highlights which can be seen in a fantastic video of a talk he gave at Google’s offices (Godin Video). He believes that people “poke around” on a site until they can find meaning. And Meaning is the only thing that leads to Action (purchase in the old model).

His premise is is that you don’t have to invest millions in advertising (like the push model of old) if you can make a story worth telling by your customers. Engage your site visitors with a story? Have you been to a sales training session of any type where they didn’t tell you that? Story telling as a sales process works and it has been since the beginning of advertising. Getting customers to tell them is another story altogether.

So - how can a company cause those conversations to take place? That may be the most qualitative measure I have ever studied.

Innovation and creative thought are the foundation of the next generation business ideas. As more and more ‘thinking’ jobs Business Week article move to less expensive labor around the globe, design will become more central to successful business operations.

Cultural differences and varying tastes around the world give us all the opportunity to keep those creative positions in-house. The result is that “Design” can be your business differentiator.

New York Times economics columnist, Virgina Postrel believes we are just at the beginning of a time when ‘design’ and form factor will prove beneficial. Her book The Substance of Style gives case after case of style influencing the purchase decision. In sexy technology toys like laptops and game cubes as well as everyday items like a toilet brush - design matters for sales.

Consumers are expecting smart design in their purchases. They are expecting to see it in products from vacuum cleaners Dyson to MP3 players iPod to automobiles BMW.

Obviously this applies online. Web applications that make sense and are easy on the eyes have higher success metrics. Jakob Nielsen included one of our own case studies 3 years ago in his ROI for Usability Whitepaper. His metrics were for sales and conversion rates as well as user performance or productivity. Granted, gathering a true mathmatical measurement of design improvements is squishy, the underlying results of our examples are that online sales can improve dramatically if design is appreciated.

There are still only a handful of hugely successful online sales stories (Amazon, Cisco, Dell, Apple, GAP) but more and more evidence that the Internet is being used for research and comparison shopping.

As trust in online security increases that awareness and knowledge of a product or service will continue over the vintage advertising continuum toward prefernce, conviction and ultimately purchase. Those final purchase decisions will be guided by preferred “Design” that doesn’t stand in the way of commerce.

Customer-focused design and development works. It works for web development as we have learned that if people understand your graphical interface, your application is far superior to many competitors.

Customer-focused also works for products. One of our favorites books on the topic is The Design of Everyday Things. Mercedes-Benz created seat adjustment controls shaped in the L of a seat to allow intuitive adjustment without taking your eyes off of the road.

Another auto example is how things don’t work - like the fuel door on my 2004 Honda Odyssey being in the way of the drivers side sliding door when refueling. Toyota rode 100,000 miles with Mom’s before they redesigned the Sienna and the result is new leader in the mini-van category. Customer inputs made that redesign a huge succes for the auto maker.

Customer-focused works for physical space too. Architects have gotten into the groove using charettes - a combination of town hall meeting, brainstorming and old-fashion teamwork to design solutions that solve customer needs. How Buildings Learn by Stewart Brand has some great examples of space changing over time becasue of customer needs. Who among us hasn’t edited our own homes with personal decisions based on our lives?

More importantly, customer focused works for organizations. Nordstrom is famous for their customer service, but it stems from their organizational chart - an inverted pyramid with the Board of Directors at the bottom and Customers at the top. Building customer-focused organizations starts with just that type bent. In The Roaring 2000’s Harry Dent described a little different tact on customer-focused organizations by having the sales people empowered to make decisions and recommendations to help customers more. His perfect company of the future was only seen in the background (like so many eBay entrepreneurs) while creating customized service for each buyer.

Customer-focused seems like common sense. After all - without any customers, you don’t have a business. But in a recent Inc. Magazine survey, CEOs of the fastest growing companies listed their top concerns as: competitive strategies, managing people, keeping up with technology, managing growth and finances. Nary a “customer” focus among them.

Going forward we can all improve on our customer focus. Try adding customer inputs to your next project whether that be home improvements or product development or application design. Chances are you will find a better solution based on the improved inputs.

Have you seen the new IBM marketing campaign? Simple Drive-through Whole page spreads in national newsprint. Outstanding creative behind a classic American brand. And the message? SIMPLE - from a company with more complex solutions than most of us can imagine.

SIMPLE is not new. It is common sense. And it has been around since the beginning of business. Peter Drucker wrote about Simple in the 1950’s. I listened to Bill Jenson (Simplicity - The New Competitive Advantage ) at a Fast Company Real Time conference. His whole approach seemed right about stripping away the complex to focus on what was important in business - any business. Clarity of purpose is Simple. Very hard - but Simple nonetheless.

Simple is stripping away the old (200 channels and nothing on) with personalized info (Tivo). Simple is not spending 2 years writing requirements for an application, but using faster tools and processes to deliver an application that just does one thing well (iPod, Palm, Basecamp, Blinksale examples). Simple is applying the right people to a task and focusing only on core competencies. For individuals and companies alike.

In today’s web development world, simple is more like the Hollywood movie studio model. Bring in the best talent for lighting, editing, acting etc. and then release them when project is done. Simplify down to what you do well and focus on it. Common sense.

In Jack Trout’s book The Power of Simplicity , he quotes Alfred P. Sloan, Jr. as the CEO of General Motors in 1944 telling Peter Drucker to only put down “what you think is right” in his consulting report on the great company. Simple guidance for any consultant. We should all strive for this simple target.

“Nothing is more simple than greatness; indeed, to be simple is to be great.”
Ralph Waldo Emerson

According to a recent Pew Internet & American Life report 42% of US homes now have broadband access and over 73% of respondents (147 million adults) use the internet. The vast majority of those users shop. They shop for health care, or new consumer electronics or filter information feeds about their hobbies - but they shop.

Corporations large and small have put their wares online in the hopes of selling products and services through the inexpensive medium. They have spent millions of dollars to ‘promote’ and market through search engine optimization and keyword buys. The larger players have gone to great pains to ensure their marketing message is on key and logo perfect.

But have they invested in their Experiential Brand? The most important brand trait online is the user experience.

Experiential Brand is what people think of your company. Not if the corporate color chart was used correctly, but if the actual web interface allowed users easy access to the information THEY were seeking. Are you helpful and easy to use (read - do business with) or are you aloof and difficult to understand (and generate less sales as a result)?

Ultimately every company who wants to deliver goods and services online will have the commodity of transactional technology to handle the sale. But the truly successful online ventures will have experiential brand tendancies that make their site the preferred venue for those transactions.

Here is the start of a list we give to clients who ask for user-focused book recommendations and knowledge transfer. Standing on the shoulders of giants…..

Don’t Make Me Think
By Steve Krug

Designing for Web Standards
By Jeffrey Zeldman

The Elements of User Experience: User-Centered Design for the Web
By Jesse James Garrett

The Design of Everyday Things
By Donald Norman

Designing Usability
By Jakob Nielsen

Designing Visual Interfaces
By Kevin Mulley, Darrell Sano

Information Architecture for the World Wide Web: Designing Large-Scale Web Sites
By Louis Rosenfeld, Peter Morville

Homepage Usability: 50 Websites Deconstructed
By Jakob Nielsen, Marie Tahir

Visual Explanations: Images and Quantities, Evidence and Narrative
By Edward Tufte

Archived 2001 Vialogix article originally published in The Charlotte Business Journal

Your VCR madly flashes “12:00.” (Still.)

You watch as the elevator doors rudely close on an approaching rider because you couldn’t find the “Open” button in time.

With a grumble, you abandon your corporate intranet and take 20 minutes to search out an answer from a knowledgeable coworker.

Sound familiar? If so, you’ve suffered poor usability and lack of customer-focused design.

When companies focus on technology rather than customers, and when products aren’t easy to use from the outset, corporate value is burned and consumer goodwill wasted.

Successful developers get customer input before, during and after creation of a technical project. From industrial design to web site restructuring, input improves the purchasing experience, turning browsers into buyers.

That approach is producing sound results.

Timex developed a watch with two large buttons and an uncomplicated display after research determined women are more interested in simply setting the time and less enamored with gadgets for technology’s sake. It quickly became a “Pick of the Month” at female.com.

Saab built its new Viggen car using air force fighter pilot experience to create a cockpit-like interior, giving drivers a more usable environment. “The controls are very logical and easy to use in keeping with Saab’s history of functional aircraft ergonomics,” noted a positive Roadtestonline.com review.

Similarly, web developers must shun the hype and spare the eye candy, beginning instead with customers and the tasks they need to complete.

Customer-focused design is not a step or single element found on a web site or online application. You don’t slap “usability” into your methodology or position statement and have a better model. It is, by definition, a process—one that should affect the creation or redesign of any web project at all stages. The goal of customer-focused design is to enhance the customer experience. It requires the strategic involvement of every area of a company.

When IBM redesigned its web site in 1999, the firm’s User Experience Team gathered input from more than 1,000 users. Using surveys, focus groups, usability testing and e-mail feedback, they consolidated and reengineered the IBM e-commerce initiative into “ShopIBM”.

The result: a 400% increase in online revenue; improved customer feedback, selection as the best corporate website for user experience by Web usability guru Jakob Nielson; and a “Best Business Web Site of 1999″ award from the UK’s Financial Times.

Yet Forrester Research reports Fortune 1000 companies spend an average of $1.5 to $2.5 million on web site redesign without knowing if the efforts will make the site easier to use. Usability specialists agree that every dollar spent on testing before a site goes live will save at least $10 in redesign efforts later.

The multiples can be even higher for intranets. Any usability improvement in-house leads directly to saved employee-hours and increased shareholder value.

GE Capital is building the “e-Deal Room,” which will let its lenders review applications online, reducing processing time by 20%. General Electric spokesman Gary Reiner told Forbes magazine that GE would save $1 billion this year on internal-productivity gains from projects such as an improved intranet. (April 30 issue).

Technology is a great equalizer. It can strengthen your customer relationships or drive a wedge through them. As technology becomes more of a commodity, only companies that use it wisely will thrive.