The first thing you notice when you walk into Tia’s New York City clinic is that it doesn’t look like a doctor’s office.
Its floor-to-ceiling windows allow light to spill in and touch every corner of the space where designer furniture, leafy plants, and even doctor-approved sex toys await those in the waiting room. There are no beige walls, no TVs blasting CNN. And you would be forgiven for thinking you’re on the wrong floor.
This innovative clinic, which opened in March 2019, is the latest product from Tia, a women’s healthcare startup founded by Carolyn Witte and Felicity Yost, both 29. Like most big ideas, Tia’s first and only clinic (so far) was years in the making.
Tia began not as a clinic, but as a simple, private InVision prototype in September 2017 before evolving into a publically-available iOS chat-based Q&A app. The goal? Help women answer common healthcare questions like “I missed my birth control pill what do I do?” and “What does an abnormal Pap smear mean?”
[Move from idea to prototype faster than ever. Create your free InVision account.]
In the early days, the “Tia” that would answer was Carolyn and Felicity. The founders would gather common questions, work with a team of medical advisors, and then “translate” the answers into a more casual, approachable form. The app was like having a private medical consultant or, as the company calls it, a “wing-woman.”
The founders were eventually able to hire a team of healthcare educators to answer users’ questions, and began to notice that women everywhere were unhappy with their medical care. Many wished that the “Tia” they were speaking to could be their doctor, with “her” casual, empathetic tone and fast answers striking a chord with patients used to navigating an often antagonistic healthcare system.
I realized my experience with the healthcare system wasn’t the exception, but the norm. Every woman has had a shitty [women’s health care] experience.
And what started as a chat app evolved into an app and a physical space, complete with doctors, exam rooms, and care options like acupuncture, labs, gynecology, and more. The goal? Build a company from scratch to make women’s healthcare more human. And if that sounds ambitious, it is.
Healthcare is a three-sided marketplace, a precarious balancing act between patients, providers, and insurance companies. And as anyone that’s attempted to receive medical care can tell you, the patient’s needs are increasingly overlooked.
For designers, Tia is a stress test of product design principles. Can user testing, research, user experience design, and all of the tools in our digital product design toolbox work when applied to something as complicated as healthcare? And how can Tia assure its community of users that the company has earned the right to be trusted with something as sensitive and valuable as women’s health?
We spoke with founder Carolyn Witte about what the rest of us can learn about Tia’s ambitious plan to evolve a digital product into something much more.
Prototype first. Then build.
After building countless mockups and prototypes, the Tia team eventually stripped their product down to the most basic level: a texting app with no interface. Just pure text messaging.
“When I’m mentoring others who are starting companies, I tell them ‘Don’t build too early’ because all of your hypotheses are so half-baked, and you can get so far with a prototype,” says Carolyn. “We were able to reach a much, much broader cohort of women and test our product at a bigger scale. We then ultimately connected the dots backward to build more functionality and properly launch the product.”
It became clear that users wanted “Tia” to be their doctor, not just their guide. Tia wasn’t an office or even an app. It was a compassionate, well-educated, trustworthy voice and a budding brand. But until they honed in on what that brand represented, nothing else mattered. So they started with the bare bones, with the knowledge that most women text their friends or use private group chats when making medical decisions.
“We realized that women want continuity of care and they want care that is continuous before, during, and after the doctor’s office. And right now it’s so, so, so fragmented,” Carolyn explains. “And you’re lucky if you have any connected relationship with your provider outside of that dark office.”
What seems like a medical issue, is really a design one: How can a company keep the health experience consistent across all of its touchpoints? And how can it incorporate what it learns from its community while still operating inside the tangled web of the healthcare industry? Especially when not fully in control of things like insurance and pricing.
“If we don’t control what happens in the physical exam room experience, we can’t connect those dots,” she says. “We can’t just be this tool that lives on the side. We have to be integrated and to do that we need to own our own care model end-to-end.”
We can’t just be this tool that lives on the side. We have to be integrated and to do that we need to own our own care model end-to-end.
Your product is your voice and tone
With the coldness of most medical experiences, Tia was hoping to bring back some… humanity. Everything Tia does is designed to enable more human-to-human contact, something the team will emphasize whenever speaking about the product.
In the early days, Tia’s app was helmed by actual humans and humans can respond to context and know that reacting to “I think I might be pregnant” requires a different tone than, say, “Where is my closest pharmacy?”
As Tia began to automate some of its replies, the tone of the design and copy varies. Get it wrong and the experience isn’t just bad, it’s offensive.
“We talk about the voice as a spectrum from clinical to colloquial, from sweet and sassy, to serious. It’s a grid. Depending on who’s speaking whether it’s Tia or a doctor, the voice is different,” Carolyn says. “What is the right context to insert a heart Emoji or prayer hands? Probably not when you’re delivering test results.”
Don’t assume you know the answers
When designing the physical space, Tia leaned on its users asking questions via special websites and even Instagram stories.
“Every woman described the exact same thing,” Carolyn says. “They want it super cool and sex-positive and [doctors] wouldn’t judge you and it would be this space you actually want to go to and you wouldn’t have heart palpitations in the waiting room.”
As a result, the Tia clinic has a handful of touches inspired by user and patient feedback.
They want it super cool and sex-positive and [doctors] wouldn’t judge you and it would be this space you actually want to go to and you wouldn’t have heart palpitations in the waiting room.
An easy-to-read health record
“We heard that women hate going to the doctor and it feeling like they are just sitting on the bench and being grilled. Also: is that a good use of an MDs time to be doing data collection?” Carolyn asks.
That’s why Tia created “TiaMD.” In its consumer app, Tia collects all the needed information before patients walk into the exam room (saving providers precious time) and then displays the health record on the exam room television for both the patient and provider to discuss. No more hidden charts.
“You then also have the ability to see [your medical information] and say, ‘I know you’re recommending I take out gluten in my diet, but I don’t want to do that.’ And so she can take that off the screen and you see her changing your care plan in real-time,” says Carolyn.
A redesigned gown
“We heard an enormous amount of stories about women and being cold,” says Carolyn. “And it’s really hard to advocate for yourself and your healthcare when you feel naked and don’t even know how to walk down the hallway.”
Rather than being handed a disposable (and breezy) paper gown patients are given a warm robe.
Clinic photos: Kezi Ban at Blonde Artists, courtesy of Rockwell Group.
A place for your clothes
A common refrain you’ll hear from Tia is that the providers and patients each have different concerns, and those are reflected in the design of most doctor’s offices. One example: where do you put your clothes after you’re asked to change into a medical gown?
As a result, each clinic is outfitted with a simple closet and hangers for patients to hang their clothes safely (and wrinkle-free) out of the way.
“We told our chief medical officer that she was like, ‘Well, why does that matter? I don’t care about their underwear. I see underwear all day long. It doesn’t matter to me,” Carolyn continues. “So much of it is just miscommunication, misaligned expectations. I think that’s the role of design in this system.”
A reminder to breathe
When conducting research, Tia heard a refrain. “Women would say ‘This is probably weird but I bring socks to the gynecologist’s office,’” says Carolyn.
Doctors’ offices are notoriously cold and often overwhelming. So in the exam room, there are two design touches to combat both. Resting on each exam chair are a pair of socks with a reminder to breathe and relax.
Meanwhile, a “meditative animation” will play on the television, designed specifically to mimic a natural breathing rhythm. Both serve as a low-stress reminder to relax.
“It’s the magic moment of Tia where we have real clinical research and science paired with really cool design paired with experiential elements. So you’re like, ‘Oh, I’m a person and this isn’t so bad.’”
“I keep this gif on my desktop to calm me down,” says Tia’s Head of Design Allison Ball.
“We even considered playing Beyonce videos,” says Carolyn.
Know when to say “not right now”
While Tia may have greater ambitions, it has to move deliberately. There’s no “move fast and break things” when people’s well-being is at stake. And that’s not even taking into account how the healthcare landscape can be thrown into chaos with the passing of one law.
Take the way insurance payments work: It’s a complicated process where prices are set by insurance companies in pre-arranged agreements that can take years to negotiate. And it’s often unclear what something costs until after the treatment is administered. It’s not exactly how you would start a patient-first payment system in 2019.
“It’s not the thing I would make, right? But we can’t make a better [model] right now. We’re going to really think about what are we changing. We are not saying ‘never’, just ‘not right now.’”
There’s no ‘move fast and break things’ when people’s well-being is at stake.
Gain trust through delivery
Healthcare depends on trust, and that’s not won overnight. Especially in a fraught political climate where tech companies are facing (often deserved) backlash on privacy and over-promising and healthcare is a constant, hot-button issue.
“[We know that if] we deliver great human-centered care then women will go write about it, talk about it, and share it,” she says. “If you can’t deliver on the care, then, like, who cares about the socks?”
On Inside Design, we write often about the industries and companies that are undergoing a design transformation. But, according to InVision research, healthcare is next to the last in digitization.
Tia is making the bet that now is the time to improve that ranking. It’s betting that design thinking, which has revolutionized so much of our day-to-day life, is finally, and mercifully, ready for women’s healthcare.