In Silicon Valley there is a concept referred to as friction. It’s the idea that you’ve got to remove every bit of inconvenience or work that gets in the way of a digital interaction. It’s about making things as easy as possible to get done. Reducing friction leads to higher conversion which means it gets you to do what the app wants you to do. I’ve been thinking about friction in healthcare.
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Of course, reducing friction makes sense if you’re a part in a machine. Because grease make everything run better. But the idea of friction in technology equates humans (scratch that, users) to mechanical parts. And in a world of algorithms designed to understand what you want and, in turn, lower the threshold to subscribe, buy or commit, you are very much a cog in a machine.
And for the technologist, there’s nothing more terrifying than the idea of friction.
Kevin Roose warns about what friction potentially does to us in his new book, Futureproof:
The biggest problem with frictionless systems, though, is what they do to our autonomy. Just like recommendation algorithms, they pull us into the middle of the bell curve—training us to pick the most popular option, the most probable outcome, the path of least resistance. They rarely prod us to do the hard, counterintuitive thing, or pause to scrutinize our own impulses. And by reinforcing what the technology critic Tim Wu calls “the tyranny of convenience”—the idea that the best solution is always the easiest one—they can cause us to overlook things we might value more in the long term, like trying new experiences, or overcoming tough obstacles.
I experienced this last month.
My son goes to college in Fort Worth, Texas. When traveling to visit him my mapping software does a great job helping me find the most frictionless route.
Coming home from a visit last month I had missed my morning coffee and half way home decided to go a few miles off the algorithmic route to find a small coffee shop I had seen on the map. When I was done I decided to make my own trail south through some of the smaller towns of central Texas. I was by myself and I had the whole day to get home if I wanted. And as it turns out my detour was an unexpected surprise.
Peaceful and removed, the new route offered a trip back in time with old farms and early 20th century homes. I had the time to pull over and take pictures and just look around. Best of all, it was March which is peak season for the Texas bluebonnets — And on that day I had never seen so many bluebonnets. And there were none of the crowds trampling the flowers like you usually find at the side of the road on the main routes. While many times I had made my frictionless trip in record time, this diversion added almost two hours to my trip. But it’s one I don’t think I’ll ever forget and it allows me to see part of our state that I never even knew existed.
The speed paradox
Friction can fit in with other parts of our lives. Like thinking and writing.
I always have a paper notebook with me. My friends give me a hard time because I write alot about digital tools but I carry around this medieval piece of technology. Now nearly all the writing for this email was done on my MacBook Pro. But like every writer I sometimes get stuck with ideas or concepts and so I turn to paper. Scribbling and outlining on a piece of silky smooth paper with my bold, 1mm Uni Ball Signo allows me to uncover some things that I can’t make happen on my laptop or iPad. I find the same thing happens with the big whiteboard in my office. Sometimes scribbling and doodling opens me up to new connections and ideas.
Why is that?
Corbin Cunningham, a user experience researcher at Google, has identified that it may be the slowness of paper that allows me to see and create new things. Paper provides instantaneous feedback where people can capture an idea and begin to instantaneously work with it. Paper allows you to think about your ideas. And studies show that individuals who take longhand notes, compared to computer notetakers, perform better on follow-up tests with conceptual questions.
Cunningham refers to it as the speed paradox. When we write we are forced to process what we’re writing and scribbling. Creating on paper creates a level of constructive friction that gets us more involved in the information we are trying to get down, process or create. It seems that the artifacts that we can touch and hold force us to see and experience our ideas differently.
The magic of friction in healthcare
This whole idea of better, faster and frictionless has made its way in to healthcare. It seems every application and platform is working to create the seamless experience of moving from sick to healthy with the push of a button. Virtual first healthcare wants to shape care as an end-to-end online experience where you don’t have to leave your sofa. Text-based communication allows us to access professional input at the speed of now.
But it isn’t that simple. The format or platform that we use for engagement with patients should depend on the kind of care they need. And this is where Silicon Valley has missed how medicine works at the ground level. I’ll follow-up on the different kinds of encounters we have in healthcare. But to make it simple, we have transactional encounters and those that involve deeper, perhaps more critical conversation.
While refilling a medication should be as frictionless as possible, an encounter around the new diagnosis of Crohn’s disease is far more involved. So minimizing friction in the Silicon Valley sense should be the furthest thing from our mind in this second case.
Of course many of these new transactional tools offer a channels of communication and access to care that wasn’t available before. But sometimes a careful connection and a little bit of friction trumps convenience.
The idea of intentional friction in healthcare and taking more time in clinical encounters has spawned the slow medicine movement. More of a rally cry to humanize the decay of the traditional office visit, slow medicine is a vision for visit design that prioritizes the needs of humans. The idea and spirit slow medicine sits in stark relief against Silicon Valley’s drive to shape a homogenized Uber-like healthcare experience.
I’m just raising the idea that we need to consider the way human care should happen rather than how we can make it look like a consumer transaction.
A few things to think about
- Think about where friction needs to be designed in to the healthcare encounter.
- What transactions really should be deeper experiences, be it in healthcare or other parts of our lives?
- In your own life how can you intentionally look for ways to add friction to our lives? When did you take the long route or ‘lose’ your map?
Friction can be good. Friction in healthcare can be good. It can keep us connected and thinking. It lets us be part of the process we’re involved with, whether it be coming home from a college visit, using paper to outline a newsletter or connecting with a patient.