Dervala Hanley, Strategist & Writer
How do we shift our healthcare model from standardized to personalized? Innovative business strategist and writer Dervala Hanley imagines a healthcare system that fulfills the needs of everyone. She draws on real-world examples to show the power of universal design.
Dervala Hanley is a strategist and writer based in Oakland, California. She worked at the design consultancy SYPartners in San Francisco until Starbucks CEO Howard Schultz invited her to join his leadership team. At Starbucks, Dervala designed a groundbreaking partnership with Arizona State University, which covered full tuition for any employee working more than 20 hours a week to take any bachelor’s degree program at ASU with no obligation to stay at the company after graduation. Since launch, more than 10,000 baristas have gone through the program. Similar college programs have become standard throughout the service industry.
Today, Dervala works as an independent consultant, helping organizations and institutions understand each other’s worlds so they can combine their superpowers to open up new opportunities.
Show Notes
Dervala Hanley shares her experience and the success of the Starbucks ASU program that offered 10,000 baristas access to higher education. [03:39]
What does health care look like in 2049? [06:44]
Shifting from a standardized healthcare model to a personalized approach that fits each individual. [08:36]
Universal design not only helps those who need it most, it benefits everyone. [09:08]
What is universal design? [11:08]
What will it take to use universal design to create personalized medicine? [11:54]
What are the obstacles to implementing universal design in health care? [13:58]
Two fascinating examples of universal design and how it benefits all. [16:38]
What could be the impediment to creating this personalized model in health care? [21:58]
How can we educate people to understand the urgent need to change the healthcare model? [26:01]
Transcript
Bisi Williams: I’m Bisi Williams, you're listening to health 2049.
Dervala Hanley: We have so many resources that are locked up and are only available to people, kind of going through a very standardized age and set of abilities. And I'm looking for a world that really understands that the very particular body you get to live in and the kind of care it needs for you to play your fullest part in the community, where our society can actually give, extend that consideration to you. And you can extend that empathy to others in return. Where what you learned about your health is something that gives you power and is not something that can be used against you as it often is today.
Bisi Williams: [01:47] My guest today is Dervala Hanley. She's a strategist and writer. She worked at the design consultancy at SY partners in San Francisco until Starbucks CEO, Howard Schultz invited her to join his leadership team. At Starbucks, Dervala designed a groundbreaking partnership with Arizona State University, which covered full tuition for any employee working more than 20 hours a week to take a bachelor's degree program at ASU online with no obligation to stay at the company after graduation.
Today Dervala works as an independent consultant, helping organizations and institutions understand each other's worlds so they can combine their superpowers to open up new opportunities. Dervala’s work on the Starbucks ASU program helped break down barriers to future success by opening access to higher education for more than 10,000 baristas who went through the program. This idea of offering universal access also informs her vision of healthcare in the future as we will soon learn. Welcome to the show Dervala.
Dervala Hanley: [02:52] Hi, Bisi. It's so nice to talk to you.
Bisi Williams [02:54] Can't wait to get started. I invited you to talk about healthcare in the future with me because of your success at Starbucks, creating a program to benefit a large community that no one had done before. So congratulations on that.
Dervala Hanley:[03:08] Thank you.
Bisi Williams [03:09] You know, many people make comparisons between higher education and healthcare and what I'm amazed by is the speed of impact that your work with ASU and Starbucks had. Like that's mobilizing tens of thousands of people in a short amount of time in a very complex system to get access to education. Tell me, what did you break down to quickly get critical scale mass adoption and success?
Dervala Hanley: [03:39] That program to me was very interesting because higher education has been something that has been really set up around exclusivity. And it has been set up where the value of the credential that you earn is based on how many other people are excluded from earning it.
ASU, about 20 years ago, kind of flipped that on its head. We're going to be measured by how many people we include and how well they succeed, their excellence. And there was such a meeting of the minds in a strange way between President Crow of Arizona State and Howard Schultz of Starbucks, who in a consumer world in the eighties had done something similar where you kind of insisted that lots of people would want fancy coffee if they had the opportunity when this was something that was really not considered cool.
And so, they had a similar vision of like, you'd be surprised at how many people are capable of wanting and liking and appreciating this. And you'd be surprised at being able to create an entire industry that follows that if you choose to believe. So, when I think about how President Crow talks about how, in the sixties, the University of California system took anyone in the state who had a B average, and they created one of the greatest higher education systems in the world at that time. Which is very, very different from measuring success, by how many people, how many applicants we turned down. So kind of once you had that meeting of the minds at a certain level of like, let's just talk about who we can include. And let's just look at this ridiculous system of hoops and financial aid, the dancing that people have to do.
We looked at it from a very simple perspective. How much does it cost us to replace the person who leaves? And how much does it cost you to take in a new student? And what if we just directed all of that money toward them and toward their education and could we make up some of the difference?
And so it was looking at, this is the system we're operating in and it's extremely complicated. Like healthcare, the person who pays is not necessarily the end consumer directly. The money is very, very murky between financial aid and the colleges and employer positions and loans and what feels like real money and what doesn’t. It has some of those qualities in common with healthcare. And it has that feeling of the people who probably need it least have access to the best of it. So we just flipped that and said, obviously talent is not evenly distributed, but the best predictor of earning the degree is your parents' zip code. So we're just going to say, what if anyone who wanted to do this could go?
Bisi Williams [06:28] Dervala, you crack the nut in terms of collaboration and shared interests between ASU and Starbucks, clearing that pathway. And now what I'd love you to do is to share your vision for health and wellness in the year 2049.
Dervala Hanley: [06:44] Sure. I'd be happy to, you know, that whole world where institutions really think about who they can include rather than who they can exclude is something that I learned a lot from working with Arizona State University in particular, and also from the work of Todd Rose and his book, “The End of Average.”
Todd talks a lot about this notion that fit creates opportunity and fit nurtures health. And by fit, he's not talking and I'm not talking about dumbbells or Peloton. I'm talking about a world that rebuilds our systems, rebuilds our institutions to make the simple adaptations that can fit each person's individual abilities and needs at each stage of their life. Because we have so many resources that are locked up and are only available to people kind of going through a very standardized age and stage and set of abilities. But if with some simple tweaks or sometimes some harder adaptations, many more people can be included and for far longer in their lives. And they can rise to make their fullest contribution, whether that's in work in their communities and their families or whatever.
And I'm looking for a world that really understands that the very particular body you get to live in and the kind of care it needs for you to play your fullest part in the community, where our society can actually give, extend that consideration to you. And you can extend that empathy to others in return. And where, what you've learned about your health is something that gives you power and is not something that can be used against you as it often is today. That's a baseline for what I would like to see.
Bisi Williams [08:25] Wow. Okay. That's great to have a lot. You're describing a very personalized approach that would put more responsibility for change on both the individual as well as the larger community, right?
Dervala Hanley: [08:36] Yes, I think so. And I think it's like you know we tend, in the United States in particular, to put so much on individuals to do all of the adapting. And I think this is really about saying actually, no, we need to change the systems in the organizations to demand the changes that can actually adapt to fit the individual rather than what we have today, where you're personalizing by contorting yourself.
Bisi Williams [09:04] That's amazing. Now, why is your vision possible?
Dervala Hanley: [09:08] I think it's possible because I think a lot of it is possible today. I think it's as much a culture change as it is a scientific change. And I will also kind of say that there's a baseline of healthcare first. And I want to see the 2049 where every person arriving and leaving has access to high quality healthcare, good beginnings, dignified endings, full lives in between. And that's already possible because we know that Coca-Cola could use 20th century tools, the distribution and mass branding to put soda within an arm's reach of desire for billions of people, then we can do the same thing with clean water and healthcare. It's a matter of will and money and commitment.
So I think the baseline stuff that I'm talking about both as this standard that every person deserves as they arrive and leave this planet and in between. And then this is the stuff where we actually have the tools and technology to adapt to both first, to understand health on a very individualized basis versus on a kind of a one size fits all and to treat anything or to prevent or to work on prevention on a very individualized basis. So much of that is already possible. We're just not yet able to articulate it and demand it and access it and fund it.
But I think it's possible in 2049, because I think so much of it is possible now. So when we're talking about things that make it possible for more people to make their fullest contribution. For more people, to be comfortable, to be healthy in their bodies, for more people to feel well for longer, because we're making the accommodations that they need, that is something that goes on to benefit everybody. That's what we learned from the world of universal design in the first place. That what makes it easier for the people who need it most makes it easier for everybody.
Bisi Williams: [11:00] So tell me, give me an example of a universal design to help our listeners get attuned to what we mean by universal design.
Dervala Hanley: [11:08] So universal design is design that can adapt to meet and fulfill multiple needs. And one example of that one famous example of that started quite close to where I live, coming out of Berkeley, California was curb cuts and there was a concerted campaign and movement to put cuts in the inside walks so that people who use wheelchairs can get up and down. And of course over time we discovered, well, that's also great if you've got a shopping cart, a stroller, if you've got so many other use cases. And I think that's where we kind of learned that when you're making it easier, you're making it easier for everybody.
Bisi Williams: [11:46] Okay. I'm going to push back a little bit or ask you this. What will it take to build a world where universal design meets personalized medicine?
Dervala Hanley: [11:54] I think it's very hard. I think it's an absolute shift in how we see health beyond the health care systems and so forth, but how we see our food system, our education system, our transportation system, our workplaces. This is a very big set of shifts and those have never really taken place without the people who have the most to lose and who are the most vulnerable really putting up a fight.
In the United States, we saw the fight for the Americans with Disabilities Act. We saw just the years and years of campaigning. We saw policy changes to protect people's status in the workplace and so forth. It's a very tough thing that will take a lot of will and commitment from the people who have a lot who have most to lose. And for whom it will be toughest to fight for this, for what I'm talking about.
I also think the other side of where those changes have come from before, it’s like, if you want to see, I think it was Paul Grim, who said, if you want to see what the future looks like, look at what rich people are doing now. So when you get deeper into the thesis of what personalized medicine and the science of individuality can do, you start to see people with means already making use of that today and you start to ask, well, how would you expand that and how would you scale that? And how would you make use of the fact that it's actually the promise of it is that it should in fact be far cheaper than the way we are dealing with illnesses today, which is after they've already been kicked to catastrophic versus heading anything off.
Bisi Williams: [13:32] I love that. And so you mentioned some of the obstacles today. Mostly the most powerful and the most vulnerable, who have a stake, usually the most conservative, whenever there's change coming. But could you describe some other obstacles that you could imagine that are getting in our way of your ideas and perhaps what you might do to help ease the bridge, to just convince them or seduce them to the other side of your idea?
Dervala Hanley: [13:58] I think there are huge systemic changes that need to happen, you know, on a vast scale. Not just in the healthcare system, but also in education, transportation, the workplace, the food system, you name it. All of the things that really determine our health and how healthy we feel.
The one that's probably most directly within our control is our own mindset around trying to shape ourselves to fit what is asked of us because it's absolutely the standard thing to do. Versus saying, gosh, I would be so much more healthy and thriving if I could just do it this way or do it from here or have this kind of care versus that kind of care.
Often those are not even huge changes to make, but I think that the challenge for us, first of all, is even learning how to know what we're working with. And know what we need and know what would really unlock more within us. And then being able to put that into words, to ask for it. And if that is stuff that is not on the menu today, being able to band together and say, this should be here. We should have these protections. We should have these curb cuts. We should have all of the pieces, all of the first steps toward this, whether it was, you know, on a very massive scale, the Americans with disabilities act. Or those kinds of protections, it came from people saying this cannot work for me. I absolutely can't partake at all, but I really could, if you would give me this.
It starts with an individual saying what it is that they need, but when it needs to be bigger than out loud grouping together and saying like, this has to happen, we have to get this done. So I think the first step is like that mindset shift within ourselves of going like, why are we trying to fit into a very unencumbered, able-bodied standard work where your entire value is measured by your productivity and your output versus your humanity, and then saying, well, what do I need to be able to take part as fully as I can to make my fullest contribution? And is there a reason why with all the technology we have today that that cannot be accommodated? And if not, then that's a human change that needs to happen.
Bisi Williams: [16:17] So beautiful. I'm struck by the notion that we are all healthy in the same way, but unhealthy in unique ways. That idea, that standardization that you referred to earlier is the notion of average is kind of wrong for the 21st century. Could you talk about that a bit?
Dervala Hanley: [16:38] Yeah, I’ll mention Todd Rose, when I was starting out, he wrote a book, I think 2016 or 17 called “The End of Average.” And when I first read it, I was like, well, yes, of course nobody's average, we’re all special. And it turned out that’s not what he was saying, It was kind of eye opening for me that he made the point that It feels like a law of nature, but somebody had to figure out the math and the idea of average in the first place.
I think it was a French monk, who had worked out the math to figure out like, well, this is the average harvest, and this is the average lifespan and this is the average yield from your flock of hens or whatever. And it was transformative because suddenly we had a tool to say, well, how are we doing this year versus last year? And what happened over the next 200 years was that was the base from which we were able to standardize. That led to factory management, that led to industrialization. But if we'd had not had the idea of average that none of that would have been possible, which is kind of fascinating.
But what Todd points out is where we went wrong was average can tell you a lot about groups, but it can't tell you anything about an individual. And it's the idea that there literally is not any individual who is average. And that was really just striking to hear. I think in the twenties, they tried to find the average American woman and they discovered that she literally didn't exist. They took all the measurements and they took the average wrist and arm length and leg length and eye spacing and they couldn't find one person who actually was, and it turned out to be absolutely impossible.
So he said, we have designed our health systems and our school systems and our work systems for this average person and it turns out to be a person who doesn't exist. He gave wonderful examples around the Air Force. They had a standardized cockpit in the fighter jets. First of all, there was an accident rate because nothing ever really quite fit anybody. And when they started to make it adjustable, it turned out that one of their best pilots was a woman who would never have qualified before because she wasn't, she was outside the standard, she was too small. And because they finally made seatbelts that could fit her and seats that could move and so forth. The accident rate went way down because things that adjusted to fit were far safer. And they were able to extend it to find talent that they had never been able to have before.
If you think about that in education. If you think about that in, in healthcare, in particular, I think it gets really exciting to kind of say, not only is this like, okay, we'll grudgingly include you, but like, wow, we were just unlocking and including all these people who could not have been included before. It comes from the viewpoint that people are assets, not liabilities. And a world that can adjust in big ways or in small ways, in a lasting way to actually best fit what it is that you can do and that can actually let you make your contribution to your community and to your world. It's kind of extraordinary what people can do and what can happen and what that actually starts to open up for everybody else. So I think about that fighter pilot, and I think the same is true in health.
Even coming at it from a very different angle, Nike’s new shoe where a young teenager with cerebral palsy wrote and said, I love your shoes and I'm really upset that I can't ever wear them. And they hired him to come on as a design consultant and eight years later, they just dropped a shoe that you can step into and it clicks closed.
Not only is he delighted that he can wear this and people with CP are delighted, but it is now something that all kinds of people want not just because I'm pregnant and I can't bend down or I have bad knees and I can’t bend down, but because it's just super cool. Now they're just worried that the sneaker heads are going to drive the price up because this thing actually happens to be just really cool.
So both on the level of what people themselves can contribute as individuals, when they're invited in versus warehoused. And on the level of like what you create to accommodate people itself creates opportunity and help for many more people who didn't even realize that this was possible and for whom it's just an opportunity that they might not have asked for because it wasn't pressing, but it is real nonetheless.
Bisi Williams: [21:27] So that concept of fit makes opportunity as you're describing the world in 2049, where you can live where you want, how you want, work where you will and where you want, get healthcare to meet you, I'm envisioning this incredibly compassionate world. To your mind, with the data and information and technology that we have, what could be an impediment to having that? Wonderful moment where we can actually live self-actualized lives.
Dervala Hanley: [21:58] One thing I do think about is, as I said I think it starts with having the opportunity to understand yourself first as a learner, as a person with a body, to understand your own strengths and challenges in all of those dimensions. And from the health perspective on that, you get your test at the start of your life and it can kind of tell you a lot about this body that you are going to be embodying as long as you're around. And what's some of the possibilities for it are.
I think one impediment is, I would love to see that being like, this is wonderful, now I know what I'm working with and how to keep myself healthy. And these are particular things that I can ideally head off or I can deal with in a particular way because I know that that particular way will work for me.
I think a dystopian version of that is right now that can be used against you. If you know that kind of information, sometimes I think today you are better off trying not to find out that you have something because frankly life is a preexisting condition but people will and can legally discriminate against you because you have a pre-existing condition. There's a law of unintended consequences, which is the more we put in protections, the more people with power over you can try to preempt the protections by not taking you in the first place. Whether that's in your job or in your healthcare. I'm talking about the US specifically in that. But I can imagine that applying in many other cases where it’s like, if I find out that I am predisposed to this, that should be a wonderful opportunity for me to get whatever prophylactic treatment will help me.
But right now it would be very bad for me if somebody found out and said, I don't want you on my payroll when your insurance is paying, for example, preemptive double mastectomy. I think it would be just an enormous transformation if we could get to that point where it's something that really empowers you and that everybody is invested in helping you live with and work with. I think that part of that comes from that business side. I’m talking in the US in our very odd and peculiar system, but it is a real hot potato about who pays for anything that goes wrong. So people are always trying to shunt off anyone with risks. In that world, anyone who discovers they have risks. Why would you want to discover you have risks?
But of course, what ends up happening is it is just catastrophic financially, physically and emotionally, diseases that play out because they aren't caught fast or because you're covered an amputation, but not for the checkup.
Bisi Williams: [25:22] Right. I think that the articulation you talk about is really important. Being able to say what we need and what we want. Most importantly, you're not really talking about enormous technological changes. You're really talking about a mindset, compassion, looking around to see what are the little things that we can do to make life better that really doesn't cost a ton. And so is there a question that I haven't asked you that you wished I would ask you to shade in the little areas of your vision?
Dervala Hanley: [26:01] I wouldn't put that pressure on you but one thing that I have a question about, but not yet, necessarily an answer for, is right now the kinds of changes that I'm talking about, where it really is In the interests of power to keep pretty rigid systems that people have to fit themselves into. And there's a lot of kind of arbitrary responses to laws and requirements that kind of backfire on the people who are most vulnerable.
I often think about, like, we might say that you have to give healthcare for part-time workers and then what ends up happening is you can only find jobs where they won't let you work more than 20 hours a week, so you end up with three jobs. Making those kinds of changes, it takes a lot, there’s a lot at stake. And the question I think that I'm most interested in on that is how can the people who have less at stake and more energy to make those changes, feel the urgency to actually work toward them as well. Rather than it being the parents of the vulnerable child or the people in the capital fighting for the affordable care act because they are the ones who absolutely will die without it.
How can people who need it less, fight for those changes, too? And I think about 30 years from now, 2049, we are going to have a very different kind of working life anyway. The jobs that are breaking people's bodies today, hopefully will not exist and we will have all kinds of capacities to do other things. I think that piece of saying, so what will we do with that? What will we do with that time? What will we do with that energy? What will we do with that, with the stuff that only humans can do is just so worthwhile in its own right. And it also is part of that notion of when we have a world that adapts to include people that fit to abilities, creates opportunity and it creates health.
Bisi Williams: [28:23] Dervala I'm so inspired. Thank you so much for joining us today on health 2049.
Dervala Hanley: [28:29] Thanks Bisi.
Bisi Williams: [28:31] And that wraps up our show with Dervala Hanley, writer, author, and strategist. Thanks for listening. If you enjoy our show, please subscribe or share with a friend until next time. I'm Bisi Williams.
