User-centered design has one quiet flaw: it assumes a single user.

Healthcare has spent 15 years learning to center the patient. Journey maps, empathy research, consumer insight — the infrastructure for understanding the person receiving care is real and growing. What healthcare hasn't built is any equivalent accountability for the people expected to deliver that experience. The scheduler fielding calls a campaign generated. The service line director whose workflow just changed. The clinical staff asked to execute a new pathway on top of everything else they're already carrying. They aren't in the brief. They aren't in the journey map. And when the initiative falls apart at rollout, nobody calls it a design failure.

They call it a change management problem. They say staff were resistant. They say operations didn't prioritize it. What they don't say: those people were never treated as users.

Chris Boyer and Reed Smith examine why the internal user experience of a healthcare initiative is structurally unmeasured, organizationally unowned, and almost always addressed too late:

Why patient experience has infrastructure behind it (scores, research budgets, dedicated roles) and the internal user has almost none
How speed-to-launch pressure and diffuse rework costs produce a decision that looks rational and produces predictable failure
The measurement gap: what gets measured gets designed for, and nobody is measuring whether the service line director's needs were addressed
Why the seam between marketing and operations is unmeasured and why unmeasured seams don't get fixed
How accumulated distrust compounds over initiatives and why "we've always done it this way" is often less about habit than about what the process has taught people to expect

Steve Koch, co-founder of Cast and Hue, brings the frameworks: Jobs to Be Done and the four forces applied not to patients, but to the people who execute the work. His argument is the practical extension of the structural case - empathy interviews before the brief is built, not alignment meetings after the design is done.

If your organization has patient experience leadership and no one whose job includes the internal user experience of your initiatives, you already know where things break. The question is whether you're willing to call it a design problem.

Mentions from the Show:

Prosci Best Practices in Change Management, 12th Edition https://www.prosci.com/blog/the-correlation-between-change-management-and-project-success
Prosci / Stakeholder Inclusion Survey. https://www.prosci.com/blog/how-to-use-a-stakeholder-engagement-plan-sep
StatPearls / NCBI Bookshelf — Change Management in Health Care https://www.ncbi.nlm.nih.gov/books/NBK459380/
Cast and Hue — https://www.castandhue.com
Steve Koch on LinkedIn https://www.linkedin.com/in/stevepkoch/
Reed Smith on LinkedIn https://www.linkedin.com/in/reedtsmith/
Chris Boyer on LinkedIn https://www.linkedin.com/in/chrisboyer/
Chris Boyer on BlueSky https://bsky.app/profile/chrisboyer.bsky.social

Reed Smith on BlueSky https://bsky.app/profile/reedsmith.bsky.social

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