While technology based innovation in healthcare is not new, the growing diversity of US (and Global) populations combined with the significant lack of diversity in the tech sector, represent both a problem with potentially far reaching consequences and an opportunity with transformative potential.

One critical key to improving health in America, is to provide consumers with much better “user experiences” in healthcare. It does not matter whether healthcare happens in hospitals and is provided by professionals or at home and is provided by parents, loved ones or other caregivers, the experiences of patients and consumers who are struggling with health concerns can and should be significantly improved. “Who continues to engage in activities that are unappealing, boring and inconvenient”, they ask. “In our current system, you only need a hospital when you hurt or there is a problem”. “When you go there, they are cold places where doctors always wear white coats, there are long waiting periods, odd odors and yet the healthcare system want us to get more engaged?!” While there are some good reasons for the way things are currently being done in the healthcare system, there is much room for improvement.

Health goals will not likely be realized without creating a healthcare delivery system that is more patient and consumer centered and therefore more responsive to cultural differences that exist in an increasingly diverse US population.  The Institute of Medicine has highlighted this need by calling for initiatives to enhance the cultural appropriateness of the healthcare delivery system. In addition, noted anthropologist Diana Forsythe has done studies which show that computer based solutions are embedded with “hidden cultural assumptions,” that are inevitably made by innovators and designers. Designers often believe their creations to be culturally neutral. In reality though, the cultural assumptions that have been made, may not be appropriate for all consumers or patients. Other authors have called, for deeper understanding of how health information should be tailored for diverse cultural groups, how cultural factors affect the use of health technologies, and how health technology may be used to mitigate intractable health gaps. Finally, computer engineers have long understood that designers must design for the physical, cognitive and cultural realities in which consumers live, in order for digital solutions to be valued, usable and provide patients and consumers the best user experiences. Cultural difference manifest in a range of technological system elements – from keyboard layout to attitudes toward privacy – each of which have important design implications. Indeed some experts suggest that design factors such as culture can no longer be dismissed nor can a design be considered truly user-centered if it does not address cultural factors.

The lack of diversity will inevitably lead to the development of health solutions that are most appropriate for users whose demographics, behaviors, mental models and cultural norms are similar to those of the creators. As these solutions proliferate and the US population continues to become increasingly diverse, it is inevitable that usability and utilization gaps will appear across users from different backgrounds. In the healthcare sector, these gaps may translate into poor health outcomes for certain users and may eventually lead to widening health disparities between patient groups.

It is possible though, to close health technology usability and utilization gaps and in turn reduce or eliminate intractable health problems. The first step is to disrupt the traditional innovation process itself. In the traditional design thinking processes of innovation, ethnographic studies support innovation for a particular market. However we propose an alternate  “Collaborative innovation” model which is not about innovation for a market, but innovation with a market.” While traditional innovation formulates a ‘user’ who must be studied and for whom innovation is done. Collaborative innovation, involves the community that is the target of innovation, in every aspect of the design, innovation, and startup processes. It’s about empowering communities to articulate their own problems and innovate for themselves, in collaboration with stakeholders who bring needed expertise to the development process. Shifting the traditional innovation model will not be easy nor will it come quickly.  This is primarily because most people are reluctant to embrace change, especially in areas they don’t understand or in which they have little knowledge, experience or expertise. This is completely reasonable, logical and safe they say.  But is also precisely the reason that most diversity strategies will continue to yield very slow progress.

It is really imperative that we go beyond creating more “traditional” incubators & accelerators. This is because new entrepreneurs from multicultural backgrounds often (though not always) need more mentorship than more traditional innovators and entrepreneurs. Because in general, they lack the exposures and informal mentoring that is often available to more traditional innovators, it becomes difficult for many of them to even believe that an opportunity, is a possibility, if no one that they know, or that looks like them, has ever done it before.

In closing, most children are taught in preschool, the Arnold Munk story entitled The Little Engine that Could. In the story, a long train needed to be pulled over a high mountain. Large train engines, were asked to pull the train, but for various reasons they refused. The request is sent to a small engine, who agrees to try. Ultimately, the engine succeeds in pulling the train over the mountain while repeating the phrase “I-think-I-can”, “I-think-I-can.  While most children, in the US have heard the story, for some children it becomes a metaphor for hard work and success, while for others it remains a cute children’s story. The reason this happens has little to do with intelligence or aptitude but everything to do with early life experiences, opportunity and societal norms. Can these things ever be changed? If the little engine could do it, why can’t we!