We were sitting in a market research room in the midst of a long day of customer interviews. Across from us, a young mother was telling us about her experience bringing her daughter into the ER during a severe asthma attack. We had been interviewing people about their healthcare journeys for a large hospital group, but we’d been running into a few problems.
First, the end-goal of the interviews was to develop a strategy for the hospital group’s website. But what we’d discovered, within the first morning of interviews aimed at creating a customer journey map, was that hospital websites were part of no one’s journey. This wasn’t wildly surprising to us—in fact it was part of the reason we’d recommended doing customer journey mapping in the first place. The hospital had a lot of disease content on their site, and we wanted to see whether people ever thought to access that content in the course of researching a condition. The answer had been a resounding no. Some people said things like, “Hmm, I’d never think to go to a hospital website. That’s an interesting idea.” Others didn’t even know that hospitals had websites. And even though we’d anticipated this response, the overwhelming consistency on this point was starting to freak out our client a little—in particular it started to freak out the person whose job it was to redesign the site.
The second issue was that our interviews were falling a little flat. People were answering our questions but there was no passion behind their responses, which made it difficult to determine where their interactions with the hospital fell short of expectations. Some of this was to be expected. Not every customer journey is a thrill ride, after all. Some people’s stories were about mundane conditions. I had this weird thing on my hand, and my wife was bugging me to get it checked out, so I did. The doctor gave me cream, and it went away, was one story. Another was from someone with strep throat. We didn’t expect much excitement from a story about strep throat, and we didn’t get it. But mixed in with the mundane experiences were people who had chronic conditions, or were caregivers for children, spouses, or parents with debilitating diseases, or people who had been diagnosed with cancer. And these people had been fairly flat as well.
We were struggling with two problems that we needed to solve simultaneously. First: what to do with the three remaining days of interviews we had lined up, when we’d already discovered on the morning of day one that no one went to hospital websites. And second: how to get information that our client could really use. We thought that if we could just dig a little deeper underneath people’s individual stories, we could produce something truly meaningful for not only our client, but the people sitting with us in the interview rooms.
We’d been following the standard protocol for journey mapping: prompting users to tell us about a specific healthcare experience they’d had recently, and then asking them at each step what they did, how they were feeling and what they were thinking. But the young mother telling us about her daughter’s chronic asthma made us change our approach.
“How were you feeling when you got to the ER?” we asked.
“I was terrified,” she said. “I thought my daughter was going to die.” And then, she began to cry. As user experience professionals we’re constantly reminding ourselves that we are not our users; but we are both parents and in that moment, we knew exactly what the woman in front of us meant. The entire chemistry of the room shifted. The interview subject in front of us was no longer an interview subject. She was a mother telling us about the worst day of her entire life. We all grabbed for the tissue box, and the three of us dabbed at our eyes together.
And from that point on, she didn’t just tell us her story as though we were three people sitting in front of a two-way mirror. She told us her story the way she might tell her best friend.
We realized, in that interview, that this was not just another project. We’ve both had long careers in user research and user experience, but we’d never worked on a project that involved the worst day of people’s lives. There might be emotion involved in using a frustrating tool at work or shopping for the perfect gift, but nothing compares to the day you find yourself rushing to the emergency room with your child.
So we decided to throw out the focus on the hospital website, concentrate on where emotion was taking us, and trust that we would be able to reconcile our findings with our client’s needs. We, as human beings, wanted to hear other human beings tell us about the difficulties of caring for a mother with Alzheimer’s disease. We wanted to know what it felt like to receive a cancer diagnosis after a long journey to many doctors across a spectrum of specialties. We wanted to understand what we could do, in any small way, to help make these Worst Days minutely less horrible, less terrifying, and less out-of-control. We knew that the client was behind the two-way mirror, concerned about the website navigation, but we also knew that we were going to get to someplace much more important and meaningful by following wherever these stories took us.
We also realized that not all customer journeys are equal. We still wanted to understand what people’s journeys with strep throat and weird hand rashes looked like, because those were important too. Those journeys told us about the routine issues that we all experience whenever we come into contact with the medical establishment—the frustration of waiting endlessly at urgent care, the annoyance of finding someone who can see you at a time when you can take off from work, the importance of a doctor who listens. But we also wanted to get to the impassioned stories where the stakes and emotions were much higher, so we adjusted our questioning style accordingly. We stuck to our standard protocol for the routine medical stories. And for the high-stakes journeys, the ones that could leave us near tears or taking deep breaths at the end of the interview, we proceeded more slowly. We gave our interview subjects room to pause, sigh, and cry. We let there be silence in the room. We tried to make it not feel weird for people to share their most painful moments with two strangers.
When we completed our interviews at the end of the week, we had an incredibly rich number of stories to draw from—so many, in fact, that we were able to craft a digital strategy that went far beyond what the hospital website would do. (Website? We kept saying to ourselves. Who cares about the website?) We realized that in many ways, we were limiting ourselves by thinking about a website strategy, or even a digital strategy. By connecting with the emotional content of the conversations, we started to think about a customer strategy—one that would be medium-agnostic.
In Designing for Emotion, Aarron Walter encourages us to “think of our designs not as a façade for interaction, but as people with whom our audience can have an inspired conversation.” As we moved into making strategic recommendations, we thought a lot about how the hospital (like most hospitals) interacted with their patients as a bureaucratic, depersonalized entity. It was as though patients were spilling over with a hundred different needs, and the hospital group was simply silent. We also thought about what a helpful human would do at various stages of the journey, and found that there were multiple points where pushing information out to customers could make a world of difference.
We heard from people diagnosed with cancer who said, “After I heard the word ‘cancer’ I didn’t hear anything else, so then I went home and Googled it and completely panicked.” So we recommended that the day after someone gets a devastating diagnosis like that, there is a follow-up email with more information, reliable information resources, and videos of other people who experienced the same thing and what it was like for them.
We heard from people who spent the entire day waiting for their loved ones to get out of surgery, not knowing how much longer it would take, and worried that if they stepped out for a coffee, they would miss the crucial announcement over the loudspeaker. As a result, we proposed that relatives receive text message updates such as, “Your daughter is just starting her surgery. We expect that it will take about an hour and a half. We will text you again when she is moved to the recovery room.”
The stories were so strong that we believed they would help our client refocus their attention away from the website and toward the million other touchpoints and opportunities we saw to help make the worst day of people’s lives a little less horrible.
And for the most part, that is what happened. We picked a few journeys that we thought provided a window on the range of stories we’d been hearing. As we talked through some of the more heart-rending journeys there were audible gasps in the room: the story of a doctor who had refused to see a patient after she’d brought in her own research on her daughter’s condition; a woman with a worsening disease who had visited multiple doctors to try to get a diagnosis; a man who was caring for his mother-in-law, who was so debilitated by Alzheimer’s that she routinely tried to climb out the second floor bedroom window.
In Design for Real Life, Sarah Wachter-Boettcher and Eric Meyer note that “the more users have opened up to you in the research phase” the more realistic your personas can be. More realistic personas, in turn, make it easier to imagine crisis points. And this was exactly what began to unfold as we shared our user journeys. As we told these stories, we felt a shift in the room. The clients started to share their own unforgettable healthcare experiences. One woman pulled out her phone and showed us pictures of her tiny premature infant, wearing her husband’s wedding ring around her wrist as she lay there in an incubator, surrounded by tubes and wires. When we took a break we overheard a number of people on the client side talking over the details of these stories and coming up with ideas for how they could help that went so beyond the hospital website it was hard to believe that had been our starting point. One person pointed out that a number of journeys started in Urgent Care and suggested that perhaps the company should look at expanding into urgent care facilities.
In the end, the research changed the company’s approach to the site.
“We talked about the stories throughout the course of the project,” one of our client contacts told me. “There was so much raw humanity to them.” A year after the project wrapped up (even though due to organizational changes at the hospital group our strategy recommendations have yet to be implemented), our client quickly rattled off the names of a few of our customer types. It is worth noting, too, that while our recommendations went much farther than the original scope of the project, the client appreciated being able to make informed strategic decisions about the path forward. Their immediate need was a revamped website, but once they understood that this need paled in comparison to all of the other places they could have an impact on their customers’ lives, they began talking excitedly about how to make this vision a reality down the road.
For us, this project changed the way we conceptualize projects, and illustrated that the framework of a website strategy or even “digital” strategy isn’t always meaningful. Because as the digital world increasingly melds with the IRL world, as customers spend their days shifting between websites, apps, texting, and face-to-face interactions, it becomes increasingly important for designers and researchers to drop the distinctions we’ve drawn around where an interaction happens, or where emotion spikes.
Before jumping in however, it is important to prep the team about how, and most importantly, why your interview questions probe into how customers are feeling. When you get into the interview room, coaxing out these emotional stories requires establishing emotional rapport quickly, and making it a safe place for participants to express themselves.
Being able to establish this rapport has changed our approach to other projects as well—we’ve seen that emotion can play into customer journeys in the unlikeliest of places. On a recent project for a client who sells enterprise software, we interviewed a customer who had recently gone through a system upgrade experience which affected tens of thousands of users. It did not go well and he was shaken by the experience. “The pressure on our team was incredible. I am never doing that ever again,” he said. Even for this highly technical product, fear, frustration, anger, and trust were significant elements of the customer journey. This is a journey where a customer has ten thousand people angry at him if the product he bought does not perform well, and he could even be out of a job if it gets bad enough. So while the enterprise software industry doesn’t exactly scream “worst day of my life” in the same way that hospitals do, emotion can run high there as well.
We sometimes forget that customers are human beings and human beings are driven by emotion, especially during critical life events. Prior to walking into the interview room we’d thought we might unearth some hidden problems around parking at the ER, navigating the hospital, and, of course, issues with the website content. But those issues were so eclipsed by all of the emotions surrounding a hospital visit that they came to seem irrelevant. Not being able to find parking at the ER is annoying, but more important was not knowing what you were supposed to do next because you’d just been told you have cancer, or because you feared for your child’s life. By digging deeper into this core insight, we were able to provide recommendations that went beyond websites, and instead took the entire human experience into account.
For researchers and designers tasked with improving experiences, it is essential to have an understanding of the customer journey in its full, messy, emotional agglomeration. Regardless of the touchpoint your customer is interacting with, the emotional ride is often what ties it all together, particularly in high-stakes subject matter. Are your client’s customers likely to be frustrated, or are they likely to be having the worst day of their lives? In the latter types of situations, recognize that you will get much more impactful insights when you address the emotions head-on.
And when appropriate, don’t be afraid to cry.