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Full Episode Transcript

Jennifer: Mike Avery, what makes you optimistic about the future of the legal profession?

Mike: I teach a course on health and architecture. And years ago, when I would present this course to the students, I felt like I really needed to convince them that this was a topic worth studying. So my presentation was about, “Hey, you might think it’s this, but it’s actually this.” And this year, what I realized was, that case no longer needs to be made. Whether it’s because of the pandemic, because it’s the equity issues that have really come to the surface in the last two years, and everyone is very much aware of now, they’re realizing that they don’t just want to be a quote-unquote “designer”. I’m assuming you’re getting law students who don’t just want to be a lawyer, but they want to be the agent that can actually make the change around them. And they see design or law that this is an opportunity, this is a time when change can occur and they want to be argued.

Jennifer: Hi everyone. I’m Jennifer Leonard, Chief Innovation Officer at the University of Pennsylvania Carey Law School. As an alum at the Law School who practiced law for a decade in private sector and government practices, I realized there are so many ways we lawyers can better serve our clients. And now, through the Future of the Profession Initiative, my colleagues and I focus all our energy on thinking about how to do just that. Our profession is full of bright, engaged lawyers, working at the highest levels. But we frustrate many of those we want to serve because of the way we’ve structured the practice of law and our legal systems. And students coming to law school today need new skills that turbocharge their legal education so that they can navigate the dynamic landscape that lies ahead. To develop fresh approaches to the way we educate lawyers and serve our clients, we need to open up the conversation.

So on this podcast, we’ll hear from experts working to change the legal profession, and leaders who’ve developed creative solutions to complex problems in other fields. We’ll also discuss how the Law School is producing the next generation of lawyers, a generation that will create new ways to put the people they serve at the center of everything they do. There’s so much to do, so let’s get started.

Today, I’m excited to welcome Mike Avery. Mike teaches Digital Fabrication courses at Penn’s Weitzman School of Design. He founded and operates Draft Works, a design studio and fabrication lab focused on bridging the divide between the field of design and the act of fabrication. Mike has deep experience in applying human-centered design to the field of healthcare. He joins us today to explain the concept of human-centered design, to compare healthcare redesign with legal services redesign, and to share why he’s optimistic about the future of higher education. Here’s my conversation with Mike Avery.

Welcome Mike, to the Law 2030 podcast.

Mike: Thank you very much for having me.

Jennifer: You have a really interesting background. You have a Bachelor’s of Science in Landscape Architecture, a Master’s in Architecture from Penn, and also a Master of Science in Occupational Therapy. So how did you move from architecture into healthcare? I understand that you actually went through the training to become an occupational therapist to do that. Can you explain a little bit more about why you made that decision?

Mike: Yeah. So after graduating and spending about two-and-a-half years doing digital fabrication work in a shop, designing, making, I realized that this wasn’t necessarily the path for me. And I wanted my design work to have more of an impact on people and not just making fancy things, which was fun and enjoyable. But I didn’t really see the long term trajectory in my own career around that. So when looking at what other areas needed, some love, some design, may be influenced, it seemed like health care jumped out at me, it jumped out at my wife as I was speaking to her about what transition I could make.

And to really become a content expert, I felt that the best way to really be embracing this new path, as well as earn some credibility when I’m talking about it, was to actually become a practitioner of it.

Jennifer: So you actually worked as an occupational therapist?

Mike: Yeah, as a part time occupational therapist while I continue to teach.

Book learning was not going to get me there. I needed to be able to look at myself in the mirror and look at individuals across the table and say, no, I’ve actually done the work. I’ve seen that patient, I’ve had that conversation. I know what you’re talking about. I didn’t want to just say, I read it in a book.

Jennifer: That strikes me as such a deep commitment to understanding what the humans who are receiving the services go through. Is that common in the field of design where people actually take a pivot in their career to better understand the person who’s consuming the services or for whom the services are designed?

Mike: At the time, it made sense for me to broaden my career trajectory in the event that potentially I did fall in love with it and wanting to do that full time. I was open to the possibility. So I don’t think that’s a common thing for designers to do. But I would say that what I think is common amongst a lot of, especially service designers and architects and industrial designers, the people that I talk to on a regular basis, is the love for learning the topic they’re doing.

So there is a moment when a service designer, let’s say, decides to work in healthcare, and they just love … When I speak to them, they love learning about the conditions people are facing, the conditions in a hospital. It’s that passion for learning more, which I think does impact all good designers. If you’re not really interested in curious about what you don’t know, then I think it might be hard to be interested and curious in what you produce.

Jennifer: That’s interesting, because it reminds me, actually, of lawyers, and my background is in litigation. But one of the things I really enjoyed about litigating, and there were things I did not enjoy about litigating, but I enjoyed that every new dispute, every new case involved some really unique topic. So you would become a really deep expert pretty quickly on things like I worked on a case about oriented strand board, which is akin to plywood. And I never thought in law school that I would become an expert on plywood or how state agencies set the rates for milk purchases in the state.

Mike: Sure.

Jennifer: So I could see the similarities there between law and design and becoming deeply familiar with the topics at hand. And I’m curious, lawyers frequently compare legal systems to healthcare systems. And I would love to hear from you some of the major takeaways that you had in this experience, unpacking and exploring the patient experience in healthcare delivery systems.

If you were taking the human centered approach of being a consumer of healthcare services or the patient who’s receiving them, what were you seeing patients struggle with the most or the greatest deficiencies in the way that the systems were designed, such that the delivery was less than ideal for the patient?

Mike: I think, and this is more and more … And I’m sure, I’m obviously not the first person to see this, but I think it’s the little things that really impact care. So for instance, having a patient who can’t get to the hospital for their appointment is why Uber or Lyft and these other services are partnering with hospitals. And I think often it’s the little things that get in all of our ways, whether it’s wanting to cut back on what we eat, but yet we are still buying chips, so they’re in the house.

Or whether it’s the little thing about how hard it can be to refill a prescription, let’s say, when it should be one step and it’s actually seven. Or, again, accessing care or providing help for caregivers. So like looking at it from the patient perspective and being in these homes and seeing the stress and burden that caregivers go through in order to provide care and in order to take on a quasi-medical role for the loved ones in their lives.

But understanding that the healthcare system stopped short of fully embracing the whole patient. They’re not always capable of … Because of the fee structures, because of regulations, there’s a lot of reasons why. But really, thinking through what is that full lived experience, like I said, from being well to being in a hospital and then to returning home.

I really do believe it’s those little points. It’s those little things which OT really focuses on, the daily living tasks that we all have to do to be successful as independently as possible.

The idea that human centered design needs to take into consideration the human as a whole person. The goal there is not to … At some point, everyone needs to bracket and define what we’re looking at. You can’t just look at every second of that person’s life, but really understanding the whole person in the moment. If you’re going food shopping, the moment you decide to go and to the moment you put your groceries away and then even to the moment where you cook and serve your family, that is all fair game for understanding what the shopping experience would be, or the packaging of a product, or the design of a grocery store, or a cart. Those are all fair game. And it’s the whole process that needs to be understood.

Jennifer: Because the person is not just spending their entire day putting on a pair of glasses and trying to read a book, they’re living an entire life.

Mike: Exactly.

Jennifer: And you need to figure out how to fit this into that. And that’s the perfect segue, because I would love to talk about the design process and human centered design. And in the legal profession, this is a relatively new area for us. And I would imagine many of the people listening to our conversation might not be familiar with design thinking or what human centered design is. Could you walk us through what the process looks like? How would you try to understand and put yourselves in the shoes of somebody for whom you’re trying to design something in a better way?

Mike: Yeah, I think that’s a good question. Without getting into the minutiae of it, for me, what really is the part of human centered designer and honestly, we can call it whatever we want, just good design, is understanding the person. It’s understanding them. In order to do that, to answer your question, I believe we need to, and this is not just me, this is the field, you need to speak to people. We need to talk to them. It’s not send out 500 questionnaires and get a Likert scale back. That’s not going to give you the nuance. You need to talk to people.

Also observing, right? There’s things that we all do that we do every day just out of habit and we don’t realize that they’re workarounds. The famous IDEO example is that they went to an older woman’s home and she said, “I have no problem taking the cap off my medicine bottle,” and they realized that she was using a meat slicer to chop the cap off from medicine bottle.

That is her thinking that this is normal, that this is okay. It works and it worked for her. But would anyone walk in there and say that’s the safest, best way for her to do it? Definitely not.

So if we’re not going into their spaces, if we’re not talking to them, if we’re not observing them doing the action, we’re going to miss, I don’t know what percentage, but a good percentage of the valuable insights that we can gain from caring about the person doing it

Previously, there was a time, I believe, and I think we’re still living in maybe the tail end of it, where designers would go in, they would do this part of the process, and they would close the book and they’d go away and design. And what we’ve seen is that’s really not a successful way to do it. And the idea of co-design, and actually bringing those people in again throughout the process and saying, hey, did we get it right? Not only did we get it right, but what should we do differently? What is your feedback? Can we actually design this with you?

Jennifer: Yeah, that makes sense. I’ve been reading Design Justice by Sasha Costanza-Chock, and they talk about how everybody really is a designer. Some people are trained in design, but moving from this idea of the designer on high who takes the information and then create something to the concept of the designer as facilitator and understanding, and then going back to the human who needs to use it and getting the feedback.

I think it’s so important for lawyers to understand for the legal profession to understand because our profession and our industry and the way that we serve clients has been developed almost exclusively by lawyers. And there’s virtually no client or user or human insertion into that process or feedback into how we deliver things. And I don’t think it’s any secret to anybody in the legal community or otherwise, that we use a lot of jargon, we use a lot of Latin, we enjoy having complicated ways to say things that maybe we could say the more simply that would be more helpful for humans who are using them.

And I could go on and on. But I’m wondering you and I’ve been working on a few projects now to teach our students about how to integrate these approaches to legal service re-design and thinking about some other things we could do in the future. What have you seen in our time working together that you see as similarities between the healthcare system and things that maybe are different as comparing healthcare and legal?

Mike: So I think your first point about the jargon is present in any, I guess, profession that has created a system around itself because those indoctrinated into the system, understand things. And I think the other point you brought up, which is important, is that while you’re learning them and you’re struggling to learn the Latin or the abbreviations, there is something rewarding about when your notes as a medical professional have the right abbreviations in them, even though with epic, they’re trying to remove as many abbreviations as possible.

But that idea that now I’m part of the fold, I get it in a certain way that I didn’t before.

The thing we all have to remember is that everyone outside of that doesn’t necessarily understand it. So making a 10 by 10 square and showing it to someone on Zoom and saying this is going to be your new kid’s bedroom, most people are not able to just shut their eyes and think about what 10 by 10 looks like.

So we need to do a better job everyone, I think, again, law, healthcare design of helping the people who come to us for our assistance to really understand what we’re doing. And I do believe that part of that is removing whenever possible as much jargon as we can and providing, say, in design as many physical objects as we can. Because people understand physical objects. People understand renderings way better than they can just understand plan and section.

So really, thinking about what … Again, as famous people have always said like, if you can’t explain it to your grandmother, grandfather, someone completely outside of your profession, then either partly you might not understand that as well as you think, but also what is really the point of doing it if you can’t get the information out to the general public? So I think that really, it falls in all of us to do our best to convey that information in a way that actually makes sense to someone who doesn’t have 5, 3 to what, 10, 12, 15 years of training in a discipline.

Jennifer: So speaking of jargon, Mike, you just used some jargon I’m not familiar with. What is Epic?

Mike: Yeah, my apologies. Epic is one company that provides electronic medical record for hospital systems. There are many others as well.

Jennifer: And I love the example of asking your grandmother to look at something and see if she understands, because it seems to me to be a relatively simple way to understand how close or how far from the mark you are when you’re designing something for a person to use. And I think in the legal context, the place where I’ve seen it used is for litigators or trial lawyers who argue in front of a jury. They try to argue in front of their middle school or high school child and see whether the concepts makes sense, and would make sense to a jury.

But that’s such a limited part of what lawyers do. And I think one exercise you and I had been working on for law students is just having them take a form from a municipal or a trial court that a regular person would use and show it to their roommate and ask their roommate to walk through it and explain which words are really confusing and could be simplified. Do you see that in healthcare? Do they take approaches like that with medicine, where they’re trying to break down some of these jargon approaches?

Mike: Yeah, so in the consulting work that I have done, and I’ve spoken to a fair share of patients, there’s always … Or again, people, but patients in this case, they have often spoken very highly of the physician who has called them after hours to break down a complicated topic for them, or has spent the time with their spouse to really make sure they understand because they know that the individual seeking the treatment is either not in the right mindset at the time that conversation is happening or just overwhelmed by a new diagnosis.

And those who are taking the time to really break it down and convey in a way that is meaningful and digestible are always individuals where they will say, I would recommend Dr. X to every one of my friends.

And maybe this is getting to another topic that we’ve discussed in the past, but the idea of the billable hour and how these services are compensated really does curtail the amount of time that individuals can spend with a patient or family in that room before they need to move on to the next person.

So finding creative ways to follow up, maybe using technology, I believe that assuming that we can’t change all of these structural limitations, really finding ways to either work within them, around them, in tandem with them is going to be really important moving forward. For example, there’s at home monitoring. So you can send someone home from the hospital and you ask them to continuously monitor their weight and their blood pressure for a certain amount of weeks to make sure things are going well. And that’s great, because it’s real time.

As far as it’s every day, they’re not waiting three weeks to go back to see their physician

So I think there’s creative solutions to provide this wraparound care and get away from the limitations of a 15 or 20-minute session.

Jennifer: And one other thing you mentioned about healthcare isregulation, and of course, the healthcare system is very heavily regulated, the legal system is very heavily regulated as well in ways. Some would argue, myself included, are designed for the protection of the client or the person consuming the services extensively, but it can actually result in them not getting any legal counsel at all because the regulations are so onerous. So I’m wondering in the healthcare system, it seems as though they have been able to make strides. I’m thinking of telehealth as an example.

Have you seen examples in healthcare where you might think at the outset that the regulations would prevent change, but in fact, there are ways to be creative and work within those constraints?

Mike: One example could be that, maybe not necessarily regulations, but the billable part of it, that I’ve worked with healthcare institutions to help them roll out 3D printing services and for customizing products, for rehabilitation. And the issue is always the time for the individual to get trained on the software or the devices or the printers. Because really, there isn’t a mechanism in place if you’re not billing insurance for rehab. That is how a therapist is going to make their pay, their salary. That’s how the institution gets paid.

So being able to think about that differently means that the healthcare institution needs to actually support that, and they might need to support it as non-billable time. And in doing so, they’re going to expand in my mind the services they can offer, which potentially attracts more patients, which also potentially gives better outcomes and happier individuals when they go home.

And by putting some upfront time into it for training and to be able to access the machines and to troubleshoot, and so on and so forth, you’re able to actually change healthcare without worrying about regulation, really just thinking about the fact that we need to support these with money that isn’t necessarily billable.

And in that case, my hope would be long term, is that they end up having the financial benefit. Because now all of a sudden, they’re seeing certain amount of their patients who are getting custom products made for them are now able to leave earlier, or they’re able to have better scores of satisfaction when they leave, whatever that might look like to actually improve top line numbers for those institutions.

Jennifer: Yeah, that’s really interesting. Because that’s very different, I think, from the legal profession and the way that we’re able to innovate. Because even though I hear the point that insurance companies won’t support you spending inordinate amounts of time doing these things, you do have this third-party payer who is pressuring the system to become more efficient, to develop innovations that will be quicker, less expensive, and reach the patient and get better health outcomes. And you don’t have that in legal, and you have a billable hour.

That means you can never hit stop and think about any of these things or how you might make them better, especially among the timekeepers in law firms who tend to be the lawyers. So it strikes me as a challenge that we have in even trying to step back and figure out how we make change. And I don’t really have a question there for you. It just strikes me as something that we’ve really struggled with, how can you possibly make change in an industry where you can never stop billing for something or your business model breaks?

Mike: I can see what you’re getting at. And I think similarly, actually, to the example I just outlined, it’s the person or the people at the top saying, you know what, it’s worth giving that individual one hour of protected time a week to just think and innovate. I mean, this is not a novel idea. Google, like the tech companies, they do this. They make sure that their employees who are working very hard are actually given the time to think about new ways of doing things.

But because of the treadmill, because of your billable hour, or because of healthcare’s payment structure, there isn’t necessarily an opportunity for us to evaluate what we’re doing, and actually question it deeply enough to make that change. But it’s clear to everyone, I have to imagine that there are problems that universally could be improved upon.

Jennifer: Yeah. Or the people coming into the profession. I’m very struck by the way design and architecture students learn how to receive feedback and make their product better. In legal education, sometimes it’s challenging, especially in the first year of law school. You don’t get a tremendous amount of feedback, especially in Socratic classes other than more questions. So could you walk us through a little bit about how design and architecture students learn how to improve, and also psychologically how they adjust to receiving pretty extensive feedback?

Mike: Yeah. So really, the cornerstone of any design, education is studio class. So studio class is depending on where you are in your education or what school you’re at going to, you’re looking at potentially a minimum of, say, five to six hours a week of a studio course, to maybe … What is it? 15 hours a week of studio. And with studios, it is what it sounds like. It’s a room where everyone meets and the professor or instructor will walk around and meet with individual students. Sometimes they are group critiques. Sometimes there’s invited critics.

It’s not a classroom in any traditional sense. And what that really does for students is it means that every time you show up, probably similar to a law student, you’re thinking about, does this make sense?

Is the argument I’m making for this product, space, service makes sense? And if you can’t define it or defend it to yourself and therefore then defend it to your instructor, then clearly, that conversation is going to go in very different way, which is a question and answer. And for most part, it’s good humored and it’s meant about building up. It’s not necessarily meant about tearing down in any way, shape, or form. But what it does is it forces you to be very critical of your own thought process. Because you know that you’re going to have to talk about it.

It’s not like you can kick the can down the road. Oh, in six weeks, I have to write a paper and then I’m done. I’ll get a grade and I never have to think about this again. I don’t care. No, because tomorrow, you’re going to have to answer why you made that decision. Why did you create this space? Why do you think that this rendering captures what you’re doing? Why do you think this shape is the correct shape for your object? Or again, when it comes to services, why does this workflow? Why does this layout make sense for you or the person using it?

So really, thinking through that and knowing that the expectation is that you’re going to have that conversation and it’s, again, good hearted and meant to be really rigorous and inquisitive, I think create someone who, for better or for worse in their personal life as well as in their professional life, is always asking questions, is always wants to know more. It’s something that when I’m speaking to my kids, I’m constantly just asking them questions, and really want them to think it through on their own.

Jennifer: Yeah, that’s really interesting. First, I’d like the collaborative nature of the studio time itself. It sounds like it’s very interactive, not only between instructor and students, but among the students themselves, which I can imagine builds up a culture of curiosity and critique.

It also sounds to me like you could create some efficiencies in some ways. You’re not just spinning your wheels trying to solve a problem on your own and somebody else could spark an idea that you just had thought of.

Mike: 100%. 100%. The goal is not that … If your classmate gives you a great idea that becomes your project, it’s not that it’s their idea you took. It’s that through the collaboration, this developed, and it was sparked by whatever you brought to the table and sparked by whatever inspiration they had, and it just moves forward.

Jennifer: Well, I’m really excited for the projects you and I can work on together with law students and design students and helping our students really embrace some of these techniques. I think law students are very curious. We are definitely taught to question all of our positions and our arguments. It’s how we sharpen our skills. I think we’re at an exciting point in the profession where we’re shifting that lens to question the systems themselves, and whether the way they reach individuals make sense, which I don’t think we have done very well in the past.

And that has led to this enormous access to justice chasm we’ve created and these really challenging and complicated systems.

Mike: Where do you see the most change occurring in the next 5 to 10 years?

Jennifer: It’s a great question. I think the most interesting change that the pandemic has really created is what will happen to the way that we conceive of as legal work and legal work environments. I think we were one of the last professions to really be a physically grounded work environment where you had to be in an office all day long. Face time is extremely important in law firm culture. The idea that you’re working all the time, you’re the first one there and the last one to leave means you’re the one working the hardest or the most committed, which creates a lot of problems with diversity and inclusion, particularly around working parents.

And so, now we’ve been forced into this environment where everybody worked remotely for a year-and-a-half and are still working remotely. And I think we’re learning that a lot of legal work can be done remotely. It’s knowledge and intelligence and problem solving. There’s not a whole lot of physical facilities required to do that, but will the culture shift back to what it was before and be so physically grounded? And will new lawyers coming into the profession be interested in a profession that snaps back to a model like that when I would imagine other professions will move even further into a more mobile environment.

Jennifer: Sadly, we are running short on time, Mike. And I just had a few questions I wanted to ask you very quickly if you could concisely answer them as briefly as possible for our listeners. I think they’d really be interested in hearing your thoughts. I know you and I’ve been working together on a syllabus for a course and you helped me understand the difference between the terminology and design of saying user centered and human centered. What is the difference? And why is there a preference in your profession for one over the other?

Mike: Good question. The user centered design puts the person in a passive recipient of a service or a design, and human centered is more about putting the entire person in the center of the design, not just in their one role as using a device or using a service or using a space.

Jennifer: Got it. Thank you. And you have effectively conditioned me against saying user centered. I never say that anymore, so thank you.

Mike: Perfect.

Jennifer: And my other question is we briefly touched on Integrated Product Design or IPD, which is the program at Penn that you teach in. What is Integrated Product Design in a nutshell?

Mike: In a nutshell, it’s bringing together those three disciplines we spoke briefly about, which is business, engineering, and design, and understanding that a successful, again, product design, service design, spatial design is really the culmination of all three of those, and really rooting the program across all three of those schools and bringing together students, all three of those backgrounds.

Jennifer: 100%, and I’m so grateful to be connected with you. I can’t wait to work with you on future projects we’re developing. And I want to thank you for spending time and sharing your expertise with all of our listeners today.

Mike: Thank you. Thank you very much. I really enjoyed it.

Jennifer: What an enlightening conversation with Mike Avery. Here are my key takeaways. First, robust, human-centered design focuses on deeply empathizing with the person for whom the service is intended, which means getting inside her shoes, and experiencing as much as possible from her perspective, to develop responsive adjustments that enhance usability and improve outcomes.

Next, law is not unique with respect to developing jargon and concepts that are familiar to those of us trained in the discipline, but unintelligible to those who actually need our help. Part of a human-centered approach in any field, whether it’s medicine, financial services or law, is recognizing how the embrace of this vocabulary can create a culture that feels exclusive, and actually distances experts from those they serve.

And finally, today’s students, across disciplines, offer hope for the future of equitable design. As Mike noted, students no longer need to be convinced that new approaches to solving problems are necessary. In fact, in many cases, they’re pursuing a degree to be part of that change. So now the impetus is on those of us who educate to respond to this desire by equipping students with the tools, frameworks, and experiences they need to redesign the future of everything.

Thanks to all of you for joining us today. Make sure to subscribe to this podcast wherever you listen. Be sure to leave us a comment and rate the show too. We’ll see you next time on another edition of Law 2030.

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