Deborah Adler has had a story book career in design. In 2004, she was a grad student at SVA in New York, looking around for a thesis project when she saw her grandmother accidentally take her grandfather’s medication. Thankfully it wasn’t a catastrophe, but it made Adler consider the confusing mess that is the modern prescription bottle. So that patients might never mistake what medication is for them, she designed a system that could be colored coded for the patient. That bottle was almost immediately picked up by Target, and for the MoMA permanent collection; It was later declared a Design of the Decade by the Industrial Designers Society of America. Since then, Adler’s studio has been focused on improving medical outcomes. Which brought her once again to pill bottles.
She found herself talking to Michael Wolf, a noted expert on patient safety, who pointed out that when to take medications was a huge problem. Individually, a direction like “take every 12 hours,” makes enough sense. But if you, like many patients with chronic disease, you were taking a dozen different medications, those directions quickly became a Rubik’s Cube of competing schedules. “When I heard that, I thought, ‘You should be able to look across a bunch of bottles and see a prescription regiment at a glance,” says Adler. She created a prototype of a module labeling system that went on every pill bottle, so that when lined up together, the bottles produced a chart of an overall pill regiment. She took it to CVS. “I felt they had the commitment and the will to see about such a large change,” says Adler. Five years later, the first piece of that system is being rolled out: A single sheet that patients get, showing exactly how all their medicines should be taken. By next year, the redesigned pill labels will hit the market.
The reason it took five years is that a simpler label implies massive business changes for CVS.
“The first, most important part is a system that understands what medicines should be taken together,” explains Kevin Hourican, CVS’s EVP of retail pharmacy. This is a massive data challenge that involves being able to scan thousands of different variations of prescription—”1x every day,” “once a day,” 1x every 24 hrs”—and then slot them into four basic day parts: Morning, Midday, Evening, and Bedtime. It requires verifying that those day parts are in fact right. And then it requires making sure that there are no dangerous drug interactions and that every drug is taken at its optimal time. (For example, blood pressure medications are best taken in the morning; cholesterol medications are best taken at night.) CVS’s system for doing all those calculations, Script Path, is the first of its kind.
The reason it made sense for CVS to tackle the challenge was that retail pharmacies are facing the same pressures as other brick-and-mortar retailers. With the profusion of online pharmacies, CVS realized that to give people a reason to come in, it had to design a better service. The new pill bottle system is just one piece of a larger service-design challenge, inspired by players such as Disney World, Carnival, Delta, and Marriott that have embarked on hardcore overhauls of how they reach their users. (And, as it happens, hired design firms such as Fjord, Frog, and IDEO to execute massive organizational changes.) All those examples hinged upon understanding the user end-to-end, rather than one transaction at a time. For example, Carnival uses a bespoke wearable that replaces money on board a cruise, and also keycards. More than that, it sits atop a platform that records a person’s interests and activities, so that more tailored offerings can be served from among the ship’s thousands of activities. The project isn’t just about erasing friction, but seeing the user holistically, over time. Without that view, it’s impossible to build a better user experience.
CVS realized that one lever it had for creating more customer loyalty was the prescription itself—and how often those prescriptions go wrong. About a third of recurring prescriptions never get filled; of those that do, about one third are forgotten after the first couple refills. CVS’s bet is that a better service can improve those figures, and, in doing so, make patients not only more healthy but better customers as well. “Adherence improves, health improves, and they keep filling at CVS. It’s a full circle,” says Hourican.
The new prescription labels are just a start for a number of things CVS has on its roadmap, including ways to bundle together medications meant to be taken at the same time and an in-home delivery service. But perhaps their most user-friendly aspiration is to redesign the role of pharmacists. Today, they typically spend most of their time counting pills. As Hourican points out, you don’t need a PhD in pharmacology to do that; you do need one to council patients. CVS is working to have better service procedures, in which the pharmacists become a front-line in talking to patients—for example, by giving every patient taking five drugs or more an automatic consultation, which includes talking them through the new prescription schedule.
This actually bears a strong resemblance to Disney World and its MagicBand project, a $1 billion effort to turn the parks into friction-free consumption engines. The MagicBand replaced every transaction in the park with the wave of a wristband. The broader service design goal was to put their cast members in “heads up” mode where they could talk to visitors face to face, and offer a level of service that would make them more likely to return. That’s perhaps the ground truth in service design: You can make a better system, but but face-to-face interactions are always the magic ingredient.