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In the 90’s the US government proclaimed that unsaturated fat was what made people gain weight. The low-fat category, packed with sugar-laden treats, was launched to help dieters looking for a healthy snack.

All of the research led to a greater variety of low-fat foods being needed because consumers wanted to eat healthy, easily and lose weight. The key underlying assumption was wrong, but everyone took it for granted as a fact. The spiral of research was only looking for answers within the bias i.e. every problem that came up (people are gaining weight) was looked at against the solution of — make more sugary low-fat foods.

A less obvious element, however, is the impact on the entire field of dieting. Diets became hard (or harder). You were eating the right low-fat foods but getting fatter. People became demotivated, the concept of “easy fix” was touted even more, before you know it you have a multi-billion dollar industry that is doing exactly the opposite of what it wasn’t meant to do.

This is the bubble that assumptions cause, they blinker you to the proof around you as you strive forward, researching based on your assumptions versus the outcomes of your actions.

Pragmatically, this doesn’t mean that going against the grain would have been useful. To sell high-fat, low-sugar (which is what occurs today) you need a broader system of belief that supports your product can build on. It does raise the question of what you aren’t asking or taking for granted. What are you assuming to be a given because that is your context that may actually not be true?

For us this came up in a recent study looking at improving the medical care experience for a new healthcare company, SUSU, launching in France & West Africa. The service focuses on delivering better care for patients by improving their medical experience and structuring their treatments more effectively.

One of the common themes was that doctors visits were generally avoided as they were difficult, making treatment more complicated when they did finally occur. On mapping the experience in-country we could see how much friction around payments and general appointment management existed for patients.

Our biased assumption was that western style appointments would work and that arriving at a clinic and waiting for a whole day at the doctor was unnecessary (which is what the current experience is). However, when we dug under the surface we found that many patients found the idea of scheduling an appointment complex and undesirable. In an environment where getting across the city can be complicated (irregular public transport, no consistent street addresses, bad traffic etc) making an appointment that you (or the people before you) may miss is frustrating, as you will just end up waiting anyway. Not making an appointment and arriving to wait your turn seems easier and less stressful.

Just like low-fat diets, we assume the scheduled event is better because that is what we know and have been told. Appointments assume that everyone in the system keeps to them or they fail quickly. Solving the problem becomes choosing between a systemic design challenge (change everyone’s behavior), a transactional design challenge (change behavior just for our clients) or a situational design challenge(change the situation for our clients). Our guiding principle at SUSU is care — which means our solutions were to make the process as comfortable and efficient for the customers as possible.

While we have opted for a situational solution as the best initial approach, the key component is putting in place the benchmarks that test not only the positive feedback i.e. was this a “better” experience, but the actual outcome of the system by looking at the number of doctors visits and attendance. Real metrics that point to success or failure of a solution vs assumptions (number of appointments made).