Nadyne Richmond [00:00:00]:
When I think about healthcare, healthcare has changed tremendously just in the years that I've been doing it. We talk much more about ensuring that we get quality care to people. Healthcare has the concept of concordant care, which is getting care from someone who is similar to you in background, whether that is someone who's of the same ethnoracial identity as you, the same gender identity as you, also LGBTQ, someone who is more likely to understand you, because we know that when someone gets care from someone who is culturally similar to them, they get better healthcare, they have better healthcare outcomes.

Erin May [00:00:47]:
Hey, this is Erin May.

Carol Guest [00:00:48]:
And this is Carol guest.

Erin May [00:00:50]:
And this is awkward silences.

Nadyne Richmond [00:00:54]:
Awkward silences is brought to you by.

Erin May [00:00:56]:
User interviews, the fastest way to recruit targeted, high quality participants for any kind of research.

Erin May [00:01:07]:
All right, so it was awesome to have Nadine on to talk about healthcare and research.

Erin May [00:01:12]:
You know, we've talked about healthcare a little bit over the years, but really just doing a deep dive on, you know, post COVID.

Erin May [00:01:19]:
With the advent of telehealth, what's it.

Erin May [00:01:21]:
Like to do healthcare research across a variety of methods and contexts? So great to have an expert talk about something so relevant to us as consumers and as researchers.

Carol Guest [00:01:32]:
Yeah, I loved hearing Nadine talk about how both challenging and also rewarding healthcare is. I think we know that healthcare is sensitive topics. You have to be very careful about user information, compliance, regulation, all that, but also just such important work. So, yeah, I really enjoyed the conversation.

Erin May [00:01:56]:
Hello, everybody, and welcome back to silences. Today we're here with Nadine Richmond. She's a design advisor with executive experience at Babylon Health Genentech and included health. So we're going to be talking about healthcare today. I'm very excited to do it by popular demand, really get into what are some of the specific things that come up when we're doing research within a healthcare context. So, Nadeet, thanks so much for joining us today.

Nadyne Richmond [00:02:21]:
Erin, thank you so much for having me here. It's really exciting to be here.

Erin May [00:02:24]:
Awesome.

Erin May [00:02:24]:
We got Carol here, too.

Carol Guest [00:02:25]:
Hey, everyone. Excited to be here. I think of healthcare research as sort of research on hard mode. So excited to get into it.

Erin May [00:02:32]:
Yes.

Nadyne Richmond [00:02:33]:
That's a fair way of looking at it. Healthcare research is really complicated. We often think about healthcare research. There's the obvious side of it, of patients. What is the patient going through at any step in this? But there are dozens of people behind the scenes doing things. I mean, of course, even in front of stage, if you think about a classic service design model, there's the doctors and nurses and other people that you interact with. But then behind the scenes, there's layers and layers and layers of complexity. There's in the US, there's health insurance providers, there's all of the people who do billing and administration and all of that.

Nadyne Richmond [00:03:18]:
There's healthcare researchers trying to extract out population health insights, there's pharmaceutical companies. The list goes on and on. So it is kind of healthcare, it is kind of research on hard mode for that perspective, and then also from the legal and ethical perspective of making sure you're maintaining privacy for everyone as appropriate.

Erin May [00:03:40]:
Yeah, yeah.

Erin May [00:03:41]:
It's in that high effort, high impact of our two x two.

Nadyne Richmond [00:03:45]:
Yes, exactly.

Erin May [00:03:46]:
Awesome. Well, excited to get into it. Maybe we should start with a little bit of background on how you got here and how you kind of developed all this experience over the years in healthcare research.

Nadyne Richmond [00:03:56]:
Yeah, I started off my career as a researcher in big tech companies, IBM, Microsoft, VMware. Got a great grounding in design in research there, and then pivoted into healthcare about ten years ago. Personally, one of the things that I'm just motivated by is solving really hard problems. Healthcare is full of really hard problems. And so being able to use my skills as a researcher to help people get to better healthcare outcomes, that's something I'd never even thought about when I was getting my degrees or when I was working earlier in my career. So I got super fortunate and was offered a role at Genentech, a pharmaceutical company, to help fix their patient assistance programs. And from there, that moved into health tech startups like included health in Babylon, providing healthcare. Able to do much more hands on work, both with patients and with their healthcare providers like doctors and nurses.

Erin May [00:04:55]:
Amazing.

Erin May [00:04:56]:
Maybe you can tell us a little bit about what are the variety of types of research that you've done over the years.

Nadyne Richmond [00:05:01]:
Oh goodness. Sometimes I feel like I've touched everything and other times I feel like I've barely begun to peel back that onion. Some really interesting things that I've done include research with pregnant people whose babies were admitted to the neonatal intensive care unit. So, a big scary time for parents. How can we help make that better? How can we help give the parents the right information? Ensure everyone is getting the right care? I've also done research with unhoused people. I've done research with people of various ethnoracial identities to better understand the disparities in healthcare. And I've also spent a ton of time in doctors offices and hospitals of varying stripes, learning more about what it takes to deliver healthcare. Being a doctor is a really complicated job just on the healthcare side of it, let alone the healthcare administrative side of it.

Nadyne Richmond [00:05:58]:
So have spent hundreds of hours shadowing doctors, nurses and other folks to learn about how they do their job and how to make it better for them.

Erin May [00:06:07]:
Amazing. So again, back to the hard mode. Lots of sensitive populations, lots of things you want to be really careful with and treat delicately and get right. But then when you do get it right, what impact you can make for people when it really matters.

Erin May [00:06:22]:
Yeah.

Nadyne Richmond [00:06:22]:
You know, that point about getting it right, I mean, that's something that I personally take to heart, is when you're in a setting like that, one thing that I've found with the participants in research like this is that they are so willing to be vulnerable and to open up, usually with an eye towards helping someone else. And so when they give you that kind of access and share with you their experiences, both great and others very much not. So it's really important to take that information and do a great job with the collection and the analysis and working with your teams to ensure that something happens with it that moves the needle, that makes things better for people.

Carol Guest [00:07:05]:
I'd love to go deeper on this topic of sensitive topics and populations. If someone is approaching what they know is going to be a challenging study. Given the sensitivity, how do you think about, are there things that you might do differently than a different type of study in terms of volume of participants or approach?

Nadyne Richmond [00:07:23]:
Anything like that? Yeah, great question. A couple of things that I think about here are, first of all, what does that sensitivity look like? Is that merely about the healthcare itself, or is it about everything that surrounds it? For example, I once did research on people with cancer, people with metastatic cancer, so very sensitive, not only in terms of the healthcare that they're receiving, but also, I mean, this impacts everything in your life. This impacts your ability to work. This impacts how you think about life and death, even this impacts your finances. All of these kinds of topics come up as part of these conversations. And so being, first of all, being prepared for that, and then secondly, knowing how to handle that when it comes up in the conversation, and then finally, knowing how to manage yourself through it. These can be some pretty deep conversations sometimes. And so making sure to give the research team the space that they need to not only analyze the data, but also process what they've heard so that they're able to show up for that participant and then show up for the next one, too.

Nadyne Richmond [00:08:40]:
Those are some of the things that I spend a lot of time really thinking about. And that's, of course, on top of, I'm going to say, all of the usual things like protecting patient privacy, protecting. Protecting that really sensitive information that you're being given custody over in an interesting way.

Carol Guest [00:08:57]:
And is there anything different that you, or do you have any examples of things that you do that are different in either how you approach the person or open up the research session? Anything like that in the case of a sensitive topic?

Erin May [00:09:08]:
Yeah.

Nadyne Richmond [00:09:10]:
So first of all, I just like giving voice to it as we are going to talk about sensitive topics today and you're in control of this. So if there is anything that you don't want to answer from me, please say so. And of course, if you want to end this at any point, we will. I'm not here to make this uncomfortable. I'm here to learn from you. And I'm here specifically to help to gather information from you and people like you so that we can make it better for others who come afterwards. By setting the stage to be clear about I care about the information that we gather and about making it better for people, that usually helps participants be more open. I also, in terms for my team, something that I do for myself and for others, especially if we know that this is going to be a sensitive topic, is I don't book those sessions back to back.

Nadyne Richmond [00:10:07]:
I have certainly done the research where I have just gotten smushed as many participants as I could into a single day so that I could do all my data collection at once for really sensitive topics, especially if there may be some overlap between the researcher themselves and the topics that they're doing some research on. I make sure that we don't book those back to back, that we give ourselves some time and sometimes explicitly call out, we are going to discuss this session afterwards so that we can process it together for really sensitive topics. I'll even ensure that on our side, we have access to a mental health professional to be able to discuss what we've learned through that or what we experienced through that, to ensure that the team has the right option to take care of themselves so that they can go do the research that they need to do.

Erin May [00:11:00]:
Got it.

Carol Guest [00:11:00]:
There's a piece of this that's preparing the participant and giving them a space to have an out if they need it and then also preparing the team.

Erin May [00:11:07]:
It sounds like it is, you know.

Nadyne Richmond [00:11:09]:
Because, you know, it's funny because as a researcher, I don't know about you, but sometimes, like, I can talk to anyone about anything and so, and I can collect data about anything and I sometimes can incorrectly view myself as like, outside the process. I am a blank page. We're going to write onto this blank page. But of course, I'm not. Of course, I'm a human being who has my own experiences with healthcare, my family's experiences with healthcare. And so I can't pretend that we are just that blank page all the time, certainly not in the same way that I could when I was working in enterprise software.

Erin May [00:11:48]:
Right, right. And I imagine there's a balance to strike there, too, where when you're, you know, you're trying to get great insights and real human insights from the people you're engaging with, where it's important they view you as human, too.

Nadyne Richmond [00:12:00]:
Right.

Erin May [00:12:01]:
But at the same time, objective enough there to judge them and all the bad things that go with being a real person. Right. So I'm objective. I'm here to listen to you, but I am also a person.

Erin May [00:12:14]:
Yeah.

Nadyne Richmond [00:12:14]:
And something that I've actually found really interesting in a lot of the healthcare research that I've done is that I'm not a doctor myself. I'm not a nurse. I have absolutely no clinical training, but I do know a lot about healthcare, and I know a lot about various conditions now, much more than I wish I did, quite honestly, in many cases. But so by being an outsider to that individual who knows a lot about healthcare and the healthcare system and specific diagnoses, oftentimes the questions that I'm asking as part of the research are reflective questions that they may not have even had an opportunity to consider for themselves. In fact, in that cancer research that I mentioned earlier, we actually had participants reach out to us after they had completed their sessions with us and ask if they could have a recording, a copy of our recording, because they'd never talked about their conditions from that perspective. They'd only ever talked about it in terms of getting the initial diagnosis or with a doctor or nurse as they were going through a particular treatment or a checkup or something. But they'd never actually looked back over their history to think about how the diagnosis impacted them. What were the ups and downs of that diagnosis and treatment?

Erin May [00:13:28]:
Yeah, so we've talked a little bit about what it's like to work with sensitive topics and populations. You talked about working with patients and working back with your team and making sure you're taking care of the team as well. What about the differences between working with the medical staff and these different kinds of population, doctors, nurses, insurance, other stakeholders that might get involved there, as well as the patients and the different approaches there?

Nadyne Richmond [00:13:56]:
Yeah, I mean, researching with professionals is always a little bit complicated and trying to get the time of someone who is extremely busy, and especially in the case of medical professionals, understaffed, under resourced, under everything. That said, spending time with that staff is really rewarding and gives an opportunity to see all of the things that happen behind the scenes that they have to do. I'm sure if you've been in a doctor's office where they spent the entire time taking notes so they don't have to do it later or so that they can do some of it now and then do enough to complete it later. Actually being able to observe what that entire workflow is like and why they do that is really instructive because you'll see how many touch points they have with others, how many points of friction they have, how much ridiculous work that they have to do, even in the easiest of appointments. I had a cold a few weeks ago, and I went into my doctor to make sure it wasn't COVID, and so did the test, did the thing, but just watching my own doctor and realizing that not only is he trying to talk to me, keep the notes up, get the test ordered, get a prescription ordered, get a follow up appointment ordered, each of those, I know this, of course, outside of working with him, those are each different systems that he's interacting with. There's very little integration in many hospital systems in those kinds of things. And so he is constantly switching from task to task to task to try to manage that, not to mention all of the staff that are supporting him.

Erin May [00:15:34]:
Right. And to your point, back to the patient side, we're all dealing with different systems on our side, too. So there is that shared struggle at times, you know, in the healthcare process.

Nadyne Richmond [00:15:44]:
Absolutely.

Erin May [00:15:45]:
Between the patient and the doctor.

Nadyne Richmond [00:15:47]:
Absolutely. Because your poor doctor is most likely dealing. Speaking specifically, in the US, your doctor probably sees patients who have 50 to 100 different insurances every single day. So, of course, they don't know the specifics of yours. They're trying to look it up to do, you know, to get some kind of understanding to help you along and to better understand what administrative burden they're going to have, whether they need to do something with the insurance company to get a test approved, whether there's limitations on what they can prescribe. There's so much complication there that's happening mostly invisibly to the patient when it works, and very, very painfully, visibly to the patient when it doesn't work.

Carol Guest [00:16:33]:
So you mentioned doing research with patients and medical staff, and then also that there are a number of other players, insurance providers, et cetera?

Erin May [00:16:41]:
I don't know.

Carol Guest [00:16:41]:
In your experience, have you worked with those other players as well?

Nadyne Richmond [00:16:44]:
And how does that differ? I have. I think one thing that I found that is common across all of them is that they want to help people. They're in healthcare for a reason, and you can lose sight of that when you're in the middle of a mess with an insurance company, for example, or when your doctor's office has made a mistake in billing. Human errors creep into the system, whether we like it or not. I think that some of the biggest differences are how much information that other party has access to and what they're trying to do with. Are they trying to move you through their system as quickly and efficiently as possible, like a pharmacy? They don't want to hold you for a long time. They want to get you in, get you your medicine, get you out the door, get you whatever information that you need. Others, your health insurance company, have a really different relationship with you because their incentives are entirely different and they're trying to do more to manage not only this particular instance of you in seeing your doctor getting medicine, whatever, but also overall, are you getting better? Are you having a better health care outcome? Because generally speaking, better health means spending less money.

Erin May [00:17:59]:
Right. Makes sense.

Erin May [00:18:01]:
You know, you were talking a bit about what it's like to observe doctors taking notes in, you know, 15 minutes appointment context with a patient, which makes me think about access. How on earth are you doing this? And so I'd love to hear if you have any stories or advice for folks who are trying to get access to do difficult to do research, how to approach that and make it happen.

Nadyne Richmond [00:18:27]:
Yeah, absolutely. Certainly. Actually, being in a healthcare setting is extremely complicated from a legal perspective, from a regulatory perspective. And so in a case like this, first of all, you have to have a very clear, crisp and clear story about what it is that you're researching and what the outcome will be for them. The second thing that you have to do is show that you're going to comply with all of the legal, whatever legal rules are in place. So in the US, things like HIPAA, in Europe, things like GDPR, all sorts of other regulations to ensure that you are doing the right legal thing in whatever country you're operating in. And then thirdly, showing them that there is a path for going from what you are collecting here to a real world outcome for them. So showing them exactly what you plan to do with this in as much as you can guess.

Nadyne Richmond [00:19:25]:
I mean, we all know that research doesn't always go in exactly the direction that we anticipate it going. But at least being able to say, these are the goals of our research and we plan to do this with what we learn from this usually goes a long way. I've had to learn to have an amazing relationship with my legal team. Sometimes in corporate settings, it can be really easy to view the legal team as a blocker or a barrier, and I can't treat my legal team that way. I have to treat them as my equals. As someone who is helping me and my team ensure that we are staying on the right side of the laws and regulations that apply to us to make it possible for us to do the work that we do. And I make sure that I talk to my legal team and say, I understand that we are a risk, we are introducing legal risk to the company by doing this. Here are the ways that we are minimizing that as much as possible.

Erin May [00:20:24]:
And when it comes to actually getting access to just going back to that example of the doctor in the patient's office, but there are many, many other contexts, remote in person and otherwise. Do you get access to the participant directly? Do you go through the medical offices? How do you broker those kind of.

Nadyne Richmond [00:20:42]:
I've done both, yeah, certainly. So if I want to do something in a medical practice, it is absolutely brokered through the medical practice. If I want access to a patient outside of that, I go through to patients directly. Usually. Sometimes I'll partner with a medical practice or something like that. If it's a particularly rare patient population, a rare disease, or a really difficult to recruit population, sometimes I'll partner with a medical practice to ask them to help get access to that patient population again, so long as you can talk about what the outcomes are and how they will benefit from it, they can be willing to do that.

Carol Guest [00:21:22]:
When you said go to the patients directly, what channels are you using to actually find the participants?

Nadyne Richmond [00:21:27]:
Is it forums or groups you already.

Carol Guest [00:21:28]:
Know about, people who can reference other people? How are you doing?

Nadyne Richmond [00:21:32]:
Yes, absolutely. So again, of course, depending on what you're looking for, sometimes these are really easy recruits. You can often use a general purpose solution, like all of the various recruiting platforms out there, to find people with anyone who has experienced the flu in the past year. I don't need to go any. That's not a difficult one. Someone who has a rare cancer that only one in 100,000 people get, that's probably somewhere where I need to do a little bit more digging. You're absolutely right that there's lots of forums online forums where patients find other patients like themselves and are swapping tips and tricks and treatment options and doctor recommendations and insurance information. I have a whole laundry list of resources that I keep at the ready for whenever I'm going to need something like that.

Erin May [00:22:27]:
Makes sense.

Erin May [00:22:28]:
Finding the harder to find conditions is harder to do. And you've got your long list of kind of ways you can go about finding folks.

Erin May [00:22:36]:
I do.

Nadyne Richmond [00:22:37]:
You know, one thing that I found is that when you found one of those patients, you will find ten of those patients very easily. The patients, especially with rare conditions network like you wouldn't believe.

Erin May [00:22:50]:
Is that the approach? Is that what they call that?

Nadyne Richmond [00:22:53]:
Absolutely.

Erin May [00:22:54]:
Recruiting. Yeah. Because I imagine especially when you get into some of these very rare conditions, there's a. A desire to talk about it for some folks, and certainly, as you were.

Erin May [00:23:06]:
Speaking about, to do something to make.

Erin May [00:23:08]:
It better for others.

Nadyne Richmond [00:23:10]:
Yes, exactly. And I found that to be really common across every condition I've ever talked to people about, every demographic group I've ever talked to people in.

Erin May [00:23:21]:
Yeah, so that's a great tip to find the one, and then it gets easier from there.

Carol Guest [00:23:26]:
Do incentives look any different with patient populations than anyone else? I'm partly imagining that it's clearly a different message than here's $25 to talk about your travel experience.

Nadyne Richmond [00:23:37]:
Right.

Carol Guest [00:23:37]:
It's much more sensitive. I just wonder what it looks like, how that conversation looks.

Nadyne Richmond [00:23:41]:
You know, it's funny because it often does look exactly like that. To participate in this diary study for the next two weeks, we'll give you dollar 200 if you do. If you meet these four milestones, that's actually really common. And so something that I often do when recruiting for something like this, again, especially if it's a more sensitive topic, is to offer for just a straight incentive or a donation to a leading charity for that condition to give people the option. And again, to underscore that, I know enough about this condition to know that there are charities like this out there that are doing work with patients, with researchers to help make lives better.

Erin May [00:24:30]:
Awkward interruption this episode of awkward silences, like every episode of Awkward Silences is brought to you by user interviews.

Carol Guest [00:24:38]:
We know that finding participants for research is hard. User interviews is the fastest way to recruit targeted, high quality participants for any kind of research. We're not a testing platform. Instead, we're fully focused on making sure you, you can get just in time insights for your product development, business strategy, marketing and more.

Erin May [00:24:55]:
Go to userinterviews.com.

Nadyne Richmond [00:24:58]:
Awkward.

Erin May [00:24:58]:
To get your first three participants free.

Erin May [00:25:02]:
So Nadine, you've had many years of experience working in and around healthcare research. You're a good hire for someone who wants. You probably bring just so much knowledge with you. We don't need to research. I know something about this. What's changed over the years, particularly in thinking, obviously about COVID about technology, about AI, is now on the scene. You know, have your methods changed a lot because of those things or not?

Nadyne Richmond [00:25:27]:
I would say that the methods themselves haven't changed terribly much. I'm definitely seeing more remote research and doing more remote research, both because it gives, I'm not going to say better access. It gives different access. There's certainly still lots of great reasons to do in person research, but doing remote research is more prevalent and lowers costs oftentimes. When I think about healthcare, healthcare has changed tremendously just in the years that I've been doing it. We talk much more about ensuring that we get quality care to people. Healthcare has the concept of concordant care, which is getting care from someone who is similar to you and background, whether that is someone who's of the same ethnoracial identity as you, the same gender identity as you, also LGBTQ, someone who is more likely to understand you, because we know that when someone gets care from someone who is culturally similar to them, they get better healthcare. They have better healthcare outcomes.

Nadyne Richmond [00:26:40]:
You can see this most directly in the maternal mortality rate for black women in the US. Our maternal mortality rate is atrocious by the standards of other developed countries. When you look at it by ethnoracial identity, it is even worse for people of color, and black women in particular, have the worst maternal mortality rates. The number one way to fix that is for that black woman to have a black clinician somewhere in her care team.

Erin May [00:27:08]:
Yeah, that's exactly where my head went when you mentioned that. I imagine representation is a challenge there, too, finding enough providers to provide that care. But technology can assume health care, too, with the matchmaking and finding people that are going to provide the care that you're comfortable with.

Nadyne Richmond [00:27:26]:
And that's exactly it. I mean, that's one of the things that we've really seen with telehealth just taking off in COVID. Of course, it existed before that, but then everyone on the planet experienced a stoppage of healthcare except for the most important emergencies and an overnight transition into telehealth. And so that made it easier for people to get care that looked more like them. On the flip side, it also drastically increased the workload and the stress load on those doctors and nurses who suddenly have a long, long waiting list of patients who they very much want to treat. They know the statistics that these patients will also get better care, and they're doctors, they want to give better care. So that is definitely something that we've seen, both good and bad.

Erin May [00:28:19]:
Yeah.

Erin May [00:28:20]:
Interesting. So we've talked a bit about some methods that you've done. You mentioned diary studies, you mentioned going into the field. Are there some go to methods that you tend to use or that you would say that the healthcare research sort of space is more reliant on? Are you doing usability testing? What are your user interviews? What are your kind of go to ways of getting insights in the healthcare context?

Nadyne Richmond [00:28:45]:
So I will tell you a story about a usability test, since you brought that up first. When I was working for a pharmaceutical company, they'd never done usability testing before. They'd let their marketing company, that they were outsourcing marketing, do that kind of thing, but they'd never actually done it themselves. And so we wanted to do usability testing for what we were just building. And my poor lawyer had never gone, had never even heard of usability testing, let alone understand what we were trying to learn from it. It took more than four months to get my discussion guide approved, and then in the research, because she had never experienced it before and had no internal experience within the company on it, we weren't allowed to deviate from the discussion guide at all. It was an amazing experience. I've never done that buttoned up of a usability study in my life, but it was a really great reminder of what happens when someone whose job it is to reduce risk to the company encounters something brand new that they've never heard of, that they don't know what to do, and that they look at it and they only see risk.

Nadyne Richmond [00:29:54]:
But, so by working through that first usability study, we were then able to show the legal team, here's the outcomes of this. Here's how I would normally do this, which I think will give us more of the goodness that we're going for here and in the long run, reduce our risk.

Erin May [00:30:12]:
Well, so.

Nadyne Richmond [00:30:12]:
And that actually, I mean, that, you know, that gets into one of the things that sometimes we do have to do in healthcare research, which is double blinding our research, you know, ensuring that the participants don't know who is sponsoring the research and that we, as the company or the entity who is sponsoring the research, also never knows who the participants in it are. Sometimes we do that to ensure that we are absolutely meeting all legal and regulatory requirements to give us that degree of separation so that we are not influencing the results in any way or that there's no concerns about us doing something inappropriate with it. That can be a ton of fun to actually go out and get the research set up and work with an agency to let them go do it and then come back with the results and analyze the results with them. But so that sometimes adds some complexity and of course, expense to doing research like that. When I think about the research that methods that we rely on, I feel like it's a really good mix of qual and quant, you know? So definitely do lots of ethnographically informed studies, lots of field visits, lots of, you know, as much in person as I can to soak things up. Lots of interviews, but also lots of surveys to validate results or to go out to a wider audience. Certainly one of the challenges that we've kind of touched on are difficult audiences to reach. And so being able to go out and do some qual work at first to get an understanding of what's happening, and then do some confirmatory surveying afterwards to make sure that it holds up against different demographic groups, different areas of the country or the world.

Nadyne Richmond [00:31:58]:
I do that a lot of times to make sure that I've really got solid backing for everything that we're saying here.

Carol Guest [00:32:05]:
You also mentioned diary studies. Do you find those come up quite a bit as well in healthcare research?

Nadyne Richmond [00:32:11]:
Sometimes I think, again, of course, I am legally required to say this. It depends on what research method we're doing. So apologies for that, but I like doing diary studies in healthcare, especially because what happens in the moment, whether you are in a doctor's office, getting a diagnosis, at the pharmacy, trying to get a prescription, any of those, it's only the tip of the iceberg of how you think about your healthcare experience and what you understand about it. A diary study can help you gather all of that information that happens around it. If you talk to somebody who's just received a major diagnosis, one of the most common things that they'll say is the doctor said cancer, and the patient heard nothing for the next hour. And so a diary study helps get past that initial moment of that initial emotional moment of fear, foreboding, all of the things that come up in a moment like this, and then gives the patient some time to reflect and better understand what they've experienced and a little more distance from it to be able to share what they learned.

Erin May [00:33:24]:
I imagine across every method, every type of study, it just feels like you probably have a pretty high level of rigor that you're applying given the compliance and the sensitivity and the expense of doing this kind of research. As you were talking about with the usability study, which can be kind of a quick and loose thing in a, you know, right b, two B SaaS product, you know, it's just talk to five participants and onto the next thing and we'll iterate as we go. So you're probably doing, I imagine, a lot of upfront work and really planning this out so that it's worth the time and you're going to make an impact with what you're learning.

Nadyne Richmond [00:34:02]:
Yeah, that's a great point. I mean, something that I always believe about research is that we should know what decisions we're impacting, why are we gathering this information and how will it impact whatever it is that we're building, products, service, whatever, including helping us choose not to make something. Sometimes that's a great outcome of research. In healthcare research in particular, I think that it's helpful to be very crisp up front about what the research goals are and where the information that comes out of this will go, so that you know that you are investing your time in the right place and that you're investing the time of all of these sometimes really difficult to reach groups for the right things. Getting that prioritization right across projects is especially important if I can only, if I have ten doctors on staff and I can only get 1 hour per month with each of those ten doctors, but I've got eight researchers on twelve different projects. What do we do? So being really clear about what the anticipated outcomes are helps us make better decisions and use that limited resource more effectively.

Carol Guest [00:35:12]:
Is there anything distinct that you do in synthesis? The final steps of research synthesis, information sharing, all of that, I imagine. Of course privacy is top of mind, but anything unique that comes up there.

Nadyne Richmond [00:35:24]:
In healthcare, so definitely a few things unique come up there. First of all, we do an excellent job of scrubbing our data and anything that we share out to ensure that nothing personally identifiable about the patient is shared. So that is definitely a higher barrier than I'm used to in my previous roles. Another thing that I think that we spend a lot more time on is not just understanding the research that we've conducted or what we've learned, but also drawing lines to publicly available research. I now have an amazing library of academic papers about all sorts of things in healthcare that I've used to help both inform my studies as well as inform the analysis and the sharing out of what we've learned. I mentioned Concordant care earlier on, there is a whole body of research about how that impacts patients getting great healthcare. And so when I draw parallels from that and draw from that, not only are our results stronger, but it also makes it easier for the teams that we're partnering with to understand what we're saying, put it in their context, and then take action on it. Doctors are an extremely smart group of people.

Nadyne Richmond [00:36:55]:
That goes without saying. Being able to come in and show that you have some understanding of their field, some understanding of the best practices of current research in their field, and about the current research in patient care really helps them better feel like you are taking healthcare seriously and are not coming in naive with recommendations that can't be applied in their setting.

Erin May [00:37:25]:
Right, Nadine?

Erin May [00:37:27]:
For folks listening this part, they probably have some idea of, geez, thinking about maybe this would be a kind of research I would be interested in doing. You know, after being in house for a while, you're now consulting, and I'm curious, you know, the difference between being in house and in the consulting role and. And who you think might enjoy this kind of work, having shared all this great background on what it's like.

Nadyne Richmond [00:37:50]:
So I think that the kind of person who will enjoy this kind of work is both someone who really enjoys taking on difficult problems and pulling apart those layers of complexity and understanding how they all play together, but who's also a pragmatist. The changes to healthcare are not overnight. And with a system this complex, getting something through really takes a lot of resilience. I mentioned that usability study earlier on. I'll be honest with you, there was one night in the middle of it when I didn't think that the lawyer and I could agree on anything, including whether it was rating or not. That day. My husband and I were having dinner that night, and I remember saying to him at dinner, I think there is a 90% chance that I get fired over this. That wasn't the case, but it certainly felt that way at the time.

Nadyne Richmond [00:38:46]:
And so being able to work your way through a bureaucracy, a multi layered bureaucracy with lots of different people who, as a researcher, I'd never interacted with before. That's a level of problem solving that I'd never had to do before. And so being able to take that on and be resilient in the face of it, when they feel like there are roadblocks that are just being thrown up for no reason, it does take some extra grit to get through that sometimes. And then working in house and doing this, though, actually being able to see the impact of what you're doing, being able to help people improve their processes, improve their applications, improve their services, that is amazingly rewarding. It can be slow going sometimes. Certainly it doesn't work at the same speed that the rest of tech does, but you get some amazing results on the other side. Now, when I think about the difference between doing in house and consultancy, it's interesting. Consultancy is different in that you are doing more advising and that you're all layer removed.

Nadyne Richmond [00:39:54]:
You're like, I'm not responsible for making the decisions as a consultant. I'm not responsible for the final thing that we deliver. And so you're really in a position of doing more coaching and helping people make decisions and supporting them through all of the hard work that they're going to have to do to deliver the final thing. It's a really different way of thinking through it. It's a lot of fun. It's very similar to being an executive and building up your team and helping them grow when you're no longer the one actually in the weeds conducting the research.

Erin May [00:40:29]:
Yeah, you're making me think about these. Whether it's government education, pick your system. These big hairy systems, bureaucratic systems, take time and resilience to improve. But a small positive change and a big system is a big change.

Nadyne Richmond [00:40:48]:
It is. I've definitely had that conversation with folks who work in civic tech and financial tech. Both of those are big places where it takes some time to change course. But when you do change course, the impact just has to be seen to be believed.

Erin May [00:41:04]:
Yeah, that's great.

Erin May [00:41:05]:
Any last thoughts? You want to leave us on the topic of healthcare research, which obviously we could talk about for a very long time.

Nadyne Richmond [00:41:11]:
But yeah, I think that healthcare research is one of the places where we as researchers really get to make an impact in the world. This is a time and a place where you get to touch on something that impacts every aspect of someone's life, not just the healthcare that they receive in that moment, but also their financial well being, their spiritual well being. There's so much that comes that you get to work on as part of this that it is amazingly rewarding to do, even though it is challenging. And being able to understand all of the players in here, how they work together, how they don't work together, gives an unprecedented opportunity for us as researchers to show the value of what we do and to put the value of what we do in really strong business terms, because we get to show that the understanding that we've created, where we have increased business efficiencies where we have reduced costs, where we have increased retention. This is one of the places where, when we talk about showing the RoI of research, healthcare research is one of the easiest places to do that, which is nice to have for a change.

Erin May [00:42:27]:
Yeah, 100%. Well, let's move to our rapid fire section. So you've done lots of interviews. What is your favorite interview question to ask folks?

Nadyne Richmond [00:42:36]:
Oh goodness, this feels like cheating, especially since it's not even a question. Tell me more.

Erin May [00:42:42]:
Yeah, that's a good one.

Nadyne Richmond [00:42:43]:
Those three little words, I sometimes think they're magic for how much they unlock. I once was showing some doctors what a user research session looks like, and I warned them in advance that they were going to hear me say tell me more a few times. And I asked them to not roll their eyes when they heard it because on the outside, as you're observing it, it can look a little fake. But when you're in the moment and the participant, you're engaged with the participant and you say something like tell me more, that unlocks another level of thought for them.

Carol Guest [00:43:20]:
I love that I find myself using tell me more.

Nadyne Richmond [00:43:22]:
A lot more.

Erin May [00:43:23]:
In my personal life, I've heard it's a good active listening technique.

Nadyne Richmond [00:43:28]:
It is an excellent active listening technique.

Erin May [00:43:31]:
Yeah, absolutely.

Carol Guest [00:43:32]:
We'd love to hear what are the top two or three resources you recommend most to others? Books, podcasts, anything like that.

Nadyne Richmond [00:43:39]:
So three things that I recommend. First of all, if I could make everyone read the book crucial conversations, I would. That is just such a great book for all of those times in our lives when we have to have a difficult conversation, whether that is with a colleague, your boss, a co worker, a family member, it gives such great frameworks for thinking through how you want to present yourself, how to handle that conversation if it starts to go off the rails, how to handle it when you're having your own emotional reaction is definitely one of the books that I sincerely wish everyone would read. A podcast that I love listening to in healthcare is called an arm and a leg, and it's a show about the cost of health care. And as the podcast host says, why it costs so freaking much. And so it's an amazing primer on how american healthcare works. And if you're deep in the middle of a problem, what you can do to try to get to something better with your doctor, with your health insurance company, so on and so forth, definitely a great, like a great, good listen to better understand things. The third thing that I love is Steve Portugal's book, interviewing users.

Nadyne Richmond [00:44:59]:
He's just released another second edition of it. And he's put so much more work into those questions that we were talking about earlier about what happens when you're done with the research. I love that he's put in that much extra work because I feel like that's one of the places where we as researchers can truly differentiate ourselves and the value that we bring. We're not just here to collect information. We're here to analyze it and share it back out in a way that's meaningful.

Erin May [00:45:25]:
Yeah, we got to get Steve on the podcast. Carol.

Erin May [00:45:27]:
Let's put him.

Erin May [00:45:28]:
He has a good podcast as well.

Nadyne Richmond [00:45:30]:
He does, definitely, which he's just started up again, so I'm excited to listen to that one, too.

Erin May [00:45:36]:
Yeah. And where can folks follow you or connect with you online?

Nadyne Richmond [00:45:40]:
You can find my website, nadinerichman.com. I'm also on bluesky and Instagram as Nadine.

Erin May [00:45:47]:
Awesome.

Erin May [00:45:48]:
Just Nadine. That's a good one.

Nadyne Richmond [00:45:49]:
Trust Nadine. Early adopter.

Erin May [00:45:52]:
Yeah.

Erin May [00:45:52]:
Amazing. Amazing. Well, Nadine, thank you so much for.

Erin May [00:45:55]:
Joining us today and for those great. I have not read this book, so I will definitely read that the crucial conversations. But thanks so much. It was wonderful to hear your expertise and get to know you.

Nadyne Richmond [00:46:06]:
Thank you. This is so much fun. I'm so glad to meet you too as well.

Erin May [00:46:15]:
Thanks for listening to awkward silences brought to you by user interviews theme music by fragile gang hi there, awkward silences listener thanks for listening. If you like what you heard, we always appreciate a rating or review on your podcast app of choice.

Carol Guest [00:46:40]:
We'd also love to hear from you with feedback, guest topics or ideas so that we can improve your podcast listening experience. We're running a quick survey so you can share your thoughts on what you like about the show, which episodes you like best, which subjects you'd like to hear more about, which stuff you're sick of, and more just about you, the fans that have kept us on the air for the past five years.

Erin May [00:46:59]:
We know surveys usually suck. See episode 21 with Erica hall for more on that. But this one's quick and useful, we promise. Thanks for helping us make this the best part. Podcast it can be. You can find the survey link in the episode description of any episode or head on over to userinterviews.com. Awkward survey.