When you think of empathy, you may think of commiserating with a friend when they receive bad news or helping a neighbor who is going through a similar challenge that you’ve experienced. But in human-centered design (HCD), empathy is a critical step in the design process.

In HCD, empathy is how you get to the core of what people think about a certain topic. The empathy phase helps fill in the blanks of our understanding so we can co-create SBC solutions that reach into the heart of different issues.

We recently sat down with design gurus Cal Bruns and Cristin Marona to talk to us about HCD and the use of humility and empathy as a critical step in the design process.

A&T: To start us off Cal, we’d love to know what brought you from the advertising world to the public health space. How did you end up here?

Cal: My wife comes out of the public health world, and I'd sit at these dinner parties and listen to these really interesting challenges that people were wrestling with, and their approaches to trying to solve the problems and I thought, "Gee you know I've never sat in a group of smarter people in my whole life who are less in touch with those that they're really trying to help." And I thought that there must be some role in adapting what I'd learned in marketing and communications over a 20-year career to kind of change how modern public health approached some of these really difficult challenges.

A&T: So, what is that change? What is different about how you approach things?

Cal: That's really simple. It's actually letting people participate in solving their own problems and it's so intuitive and so obvious and yet in practice it doesn't happen. We're all so desperate to help people that sometimes we forget to have the humility to just listen to people—and give them a voice in the process. It took us a while to kind of happen upon a process that later on we discovered had a fancy name—human centered design.

A&T: Could you explain a bit more about why the emphasis on humility and empathy?

Cal: I think that it's really difficult when you're an incredibly smart scientist not to, kind of feel like you’ve got a solution and you just need people to understand how to implement it. But often the barriers aren't your solution. They're very human barriers that exist in the group of people you're trying to help. You're speaking different languages so no matter how smart your idea is it may never actually work in practice because you haven't taken into account the reality of those individuals. Also, I think that there are great ideas out there that are never discovered because we just don't ask. So, it's that objectivity combined with a little bit of creative spark and listening to people that gives the ideas on how to solve their own challenges. Ninety-nine percent of those ideas they give you may seem completely useless, but it's that tiny nugget, that 1% that you're mining for. They give you a completely different way of looking at the challenge, something that even though you've been looking at it a thousand times before, you never saw. And often we find those are the nuggets that really unlock interesting and innovative solutions that do create impact.

A&T: I’ve heard you say before that the focus on empathy is about putting yourself in another person’s shoes, that the empathy phase is what often sets apart an HCD approach from other methods. Can you tell us more about this step in the process?

Cal: Our empathy phase is very much ecosystem-based—it takes into account what is happening all around people. So, we have over time learned that the motivations and attitudes and triggers and rewards of implementing partners or government officials are just as important in addressing an outcome as finding out what mothers think for example or other players within a family, or a mother-in-law. I think that's somehow often forgotten in bigger programs. People are so concerned with the actual stakeholder, the one under the microscope, that they forget all the other forces that actually dictate success or failure of a program. So, we really try and bring that into the equation during the empathy phase by talking to a lot of people in situ, where they are. This empathy phase is very much like Oprah in interviewing.

A&T: So, what makes Oprah so good at building empathy?

Cal: Oprah is amazing. And she is my hero. She just has this absolute magical ability to pull the best stuff out of people very efficiently. And I think that that's kind of where we aspire to get to in building and actually harvesting empathy, understanding, and then being able to translate that to others. Oprah does her homework. She knows who's going to come sit next to her and she's naturally an amazingly curious person. It shows in the way that she talks to people. When she has an interview, you get a sense that you never know the next question she's going to ask because she's listening to the answers that that people are feeding her.

Then, she establishes trust. I think trust is one of the most important elements of what contributes to the effectiveness of human-centered design. That ability to create trust between two human beings—there's a bit of science behind it, but more importantly there's a certain art to it. Some people are just naturally great at it and others are racing to get answers, as we’ve seen in some traditional public health information dives. They don't take the time to just sit and listen and chat. I think for us, empathy is about that.

A&T: So, it’s clear that the empathy phase is critical. And I think that most SBC practitioners recognize the need for a quality formative research phase. But you know, it can be challenging to convince policymakers or donors to invest in and take seriously the insights that come out of these smaller-scale ethnographic methods. They prefer “scientific research results.” How might HCD learning be made convincing to policy makers and donors?

Cal: I think the one challenge that we've discovered is that nothing stays the same, yet public health kind of drives by looking in the rearview mirror; so, you know, when we conduct these massive randomized control trials and we wait for the results of those, it's often years past when the fieldwork has been done before the results are released. The world has changed in the time it takes to do all that amazing analysis. You have to look at those results, but also combine it with what's been happening around you to be able to apply them. And I think that, this sense of rapid knowledge application and iteration is and answer, and one that public health is getting better at. But, it's not intuitive and it's certainly not historical. So that's another I think major philosophical element or contribution that human centered design brings to the table.

A&T: That makes sense. Do you have other thoughts on how we might deal with a community that defers to the scientific method for evidence-based decision making?

Cal: There's no easy answer to it but there are two things that we've had some luck with. The first is: show them the stories from the people themselves. So there's a technique in the work that we use called video ethnography, I'm sure you guys use it as well. When you bring films to people and let them actually walk in someone else's shoes for a bit. You’d be surprised at how compelling and strong that evidence is weighed versus a PowerPoint presentation. We're hardwired to react to stories. The second way is to get them involved in the collective problem solving. We've found great luck in South Africa with some fairly obstinate government officials—when they actually come into a collective problem-solving workshop as participants. They get a degree of humility when working with ordinary people. It's a challenge to get them to come but once they do, they walk away changed people. So those are two techniques that we've tried. It doesn't always work—I mean we still run into plenty of people who are, you know, “Show me the randomized control trial or I'm not listening to you.”

A&T: That was great! Thanks very much. We look forward to talking to you again soon.

From the standpoint of HCD, the ability to develop ways to positively affect other people’s behavior rests understanding their situations—empathizing with them. HCD helps experts marry their knowledge to the lived experiences of the people they are trying to help.

But putting empathy first often means we have to let go of expert knowledge, at least temporarily, to appreciate and understand the experiences that affect people’s behavior. We have to build trust and connect with people, like Oprah does so effectively. It isn’t easy—but it’s essential for creating sustained social and behavior change.

Share your experiences with us in the comments below. Learn more about Cal Bruns and Cristin Marona.