Why Healthcare Design Starts with Stories, Not Solutions

Welcome to Episode 8 of the Ardexia Podcast where we speak to leaders, clinicians and advocates for better healthcare. This week, we talk to Dr. Resa E. Lewiss, a Harvard-trained emergency medicine physician with expertise in healthcare design and technology integration who has designed point-of-care ultrasound programs across six continents.

Healthcare organizations design new emergency departments, implement new EHRs, and roll out new workflows without meaningfully involving the people who will actually use them. Then they're surprised when adoption fails.

Dr. Resa E. Lewiss has designed POCUS programs with EHR integration across multiple healthcare systems, worked on ICU redesign at Beth Israel in Boston, built infection control units in Malawi, and pioneered POCUS integration in emergency medicine. She integrates principles of human-centered design to optimize built environments, workflow devices, and patient care spaces.

The conversation revealed what separates successful implementations from expensive failures: whether you design solutions before understanding problems, whether you involve end users at the table, and whether you plan for sustainability from the beginning.

The Patient on Stage

Resa's design origin story started at Stanford X. "They had a patient on stage speaking about their experience through a moderated conversation. And this perspective of the patient, the end user, the end recipient, it seemed like rocket science, but it's so simple."

That observation sounds obvious until you consider how rarely it actually happens. A pediatric hospital in Chicago was seeing asthma patients return repeatedly with exacerbations. The assumption was blaming caregivers for not filling prescriptions or giving medications properly.

When they actually involved caregivers, they discovered the real barriers. The prescribed regimen didn't fit how people actually lived their lives.

There's a famous experiment called the jelly bean test. People were tasked with taking four jelly beans a day at different times. They couldn't do it. Everyone abandoned the project after a few days.

It's hard to take medicine four times a day. That's not patient failure but a design failure.

Everything Is Designed

"The scrubs that I wore when I was coming up in med school and residency, those scrubs weren't cut or made for me. I mean, they certainly weren't in my size. I walked on my scrub pants a lot because they were so long."

Everything is designed. We just don't always recognize it as design because we've adapted to poorly designed solutions for so long. Scrubs weren't designed for women. Computer terminals are placed at heights that cause repetitive strain injuries. Emergency department layouts create collision points. EHR interfaces require ten clicks for tasks that should take two.

Clinicians adapt. But adaptation has costs: inefficiency, injuries, cognitive burden, and sometimes patient safety risks.

Getting Everyone at the Table

When designing an ultrasound probe, you need the clinician who will use it, the patient who will have it placed on their body, the engineer, the materials scientist, the ultrasound companies, the IT team managing software solutions, the people handling EHR integration, and the coders and billers.

"If you have everybody at the table early on in the process, your ultimate product may not be perfect. It won't be perfect. But it'll be a much better device than had you not had those brainstorming sessions, those iterations going back to brainstorm, iterations going back, and then ultimately the product."

This is what's missing in most digital health implementations. Companies build solutions in isolation, then try to force them into clinical workflows.

Change Fatigue Is Real

"The more frequently you change a process and a workflow, the more you're at risk of losing people. And people are like, I don't even remember all these changes. What you think is a small pivot or a small step change can be overwhelming, and it can be enough for people to abandon the technology."

Organizations underestimate change fatigue. They think each individual change is small and manageable. They don't account for the cumulative cognitive burden of constant adaptation.

Successful rollouts include education components, dress rehearsal before going live, having coaches available during implementation, and ongoing evaluation and training.

"I think one of the most successful rollouts I've seen is when the announcements start six months ahead of time and there's a reminder at every faculty meeting. And then there's a demonstration. And then there's maybe an online tutorial, and then there's the online quiz you have to take, the reinforcement and the repetition, because people are busy."

This is the operational reality most digital health companies want to skip. But it's what determines whether adoption succeeds or fails.

The Accessibility Gap

Resa and I collaborated on a proof of concept study exploring whether patients with no ultrasound experience could be teleguided to obtain interpretable images. The study worked as proof of concept.

But the limitations matter: "There are a lot of assumptions about able-bodied, able in terms of eyes, in terms of comprehension and hearing, in terms of manual dexterity. And I've seen this a lot with my in their 80s parents, their ability to navigate technology."

After a certain age, or for people with different abilities regardless of age, integration becomes impossible. "Which means ultimately it's not a human-centered solution. It's not gonna work unless ideally it works for everybody."

Most digital health companies design for young, tech-comfortable, able-bodied users and assume everyone else will figure it out. That's not human-centered design.

Global Implementation Realities

Resa has taught POCUS workshops across six continents. Her approach starts with questions: Who is the audience? What is their most common patient presentation? What applications do they seek to learn based on actual patient complaints?

"Outside of the US in general, people haven't been as interested in an aorta ultrasound. The concept of AAA, it's a lot of non-communicable diseases that aren't always the main disease presentations at other countries where I've visited."

You can't export workflows designed for US patient populations and assume they'll work elsewhere.

Resource realities matter. "There may not be a CT scanner, there may not be an MRI. There's almost always an ultrasound machine, usually in the corner, usually not plugged in, usually hasn't been turned on for years."

But empowerment requires thinking through practical barriers. Electricity reliability and surge protection. Maintenance and troubleshooting. Quality assessment workflows when you don't have EHR integration.

"The most successful experiences I've had is when the sustainability plan has been talked about, designed with the people that are going to be the one to kind of own ultrasound when we leave and to make sure there's ongoing communication once we leave."

The one-and-done approach fails. You need local ownership, ongoing support, and sustainability planning from the beginning.

The C-Spine Lecture Lesson

Resa's story about her first global health experience captures everything wrong with assumptions-based implementation. She was assigned to lecture about C-spine injuries and immobilization.

"It was such a bizarre experience because the lecture sort of didn't at all take the temperature of where we were going. To advise in a healthcare talk, like you should just put on a C-collar. They didn't have C-collars. And in fact, they had sandbags with tape."

Advice that assumes resources you don't have isn't helpful. It's insulting. The healthcare professionals already knew what ideal treatment looked like. What they needed was practical solutions for their actual context with their actual resources.

This is exactly what happens when digital health companies export solutions without understanding context.

Stories Reveal Truth

Resa gave a TEDMed talk in 2014 on technological disruption in medicine. When asked how her thinking has evolved:

"What that experience taught me is storytelling. And I completely changed the way I presented from that experience forward. And what I love is storytelling is 100% a part of healthcare design. In fact, that's often how we get people's attention. It's how the companies understand why the technology doesn't work, why it does work. Having the patient tell their story on stage, it just conveys so much more. It's always about the stories. It's really gonna be about the stories."

Data shows what happens. But Stories show why. Both matter for understanding whether your solution actually fits the problem you're trying to solve.

The Bottom Line for Healthcare Design

Several principles emerge:

Design starts with understanding problems, not building solutions. Get everyone at the table early. Include end users, not just decision-makers. Iterate based on actual feedback, not assumptions.

Adaptation has costs. Just because clinicians can adapt doesn't mean they should. Change fatigue is real. Successful implementations include structured support.

Context determines whether solutions work. What works in US healthcare systems may not work elsewhere. What works for tech-comfortable populations may not work for everyone.

Sustainability requires local ownership. The one-and-done approach fails. You need ongoing support, maintenance planning, and quality improvement workflows.

Stories reveal truth. Data and stories both matter for understanding whether your solution fits the problem.

"We have to walk humbly because of the iteration process of the design process. But part of that is bringing those people to the table."

That humility, that willingness to actually listen to end users rather than assuming you know best, separates successful implementations from expensive failures.

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Learn more about Dr. Resa E. Lewiss's work: LinkedIn | TEDMed Talk | Her book: Microskills | Visible Voices Podcast

Watch the full conversation on Youtube.

Listen on Spotify or Apple Podcast.

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Ready to transform your healthcare innovation approach? Contact Ardexia to discuss how we can help you move from pilot to sustainable adoption.

Related Resources

Episode 7: Why Every Healthcare Technology Has Trade-Offs

Article: Why Clinical Adoption Fails and its Economic Effect

Dr. Aditi Joshi is the CEO of Ardexia and host of the Ardexia podcast. She's an emergency physician who has built multiple digital health programs across three continents and specializes in turning failed digital health implementations into measurable clinical and financial success.