designthinking — Blog — The Better Lab

Imagine what it’s like to experience dementia or a visual impairment – what life really looks and feels like from inside that world.

Or imagine simulating a live surgery as a medical student, holding the scalpel in your hand, hearing the voices of your medical team around you, surveying the choices without risk of harm or mistake.

With advances in virtual reality, you can. The applications for the technology are leading change in the industry by offering enhanced training experiences and experiments in empathy by actually transporting viewers “into another’s shoes.”

It’s a safe bet to say that virtual reality has the potential to alter healthcare in profound and lasting ways.

At The Better Lab, we’re working to advance a project that uses virtual reality to train emergency medicine, surgery and anesthesia providers on collaborative teamwork, professionalism and empathy to improve the care experience during 900 trauma activations. The hope is to develop a training experience using 360 video and immersive storytelling to help these unique teams work together with greater insight. The project is a partnership with David Sarno, of Lighthaus Inc., an award-winning virtual reality studio that has pioneered immersive experiences in healthcare and education, and media technologist Sam Stewart, who has extensive 360 video production experience and trains journalists on the use of digital tools for storytelling at Google News Lab.

Learning from David, Sam and others about the landscape around this technology has been an exciting journey.

One thing we quickly discovered: It’s hard to enter the world of VR without finding yourself at Stanford’s Virtual Human Interaction Lab, founded in 2003 by Jeremy Bailenson. Bailenson studies the psychology of VR – in particular how virtual experiences lead to changes in perceptions of self and others. His lab builds and studies systems that allow people to meet in virtual space, and explores the changes in the nature of social interaction, with recent research focusing on how VR can transform education, environmental conservation, empathy, and health.

Bailenson’s work also led him to a rich partnership with Derek Belch, a former Stanford Cardinal football kicker and assistant coach. Belch did graduate work at Stanford, and his Master’s thesis explored virtual reality applied to sports training. The results of this work led to the development of STRIVR, which created the market for virtual reality sports training.

Who does STRIVR train? Not just the Cardinals (and Cal), but the Giants, New York Jets, Dallas Cowboys, and more.

STRIVR takes a 360 camera to practice and films as close as possible to the decision maker – usually the quarterback or a linebacker. Later, when the athletes come for film study they can transport themselves back to the field to do additional reps. The video is used to get extra practice in a world where mistakes are free so that they can make the best possible decisions in real time. Or, as the STRIVR website describes it: “Unlimited practice repetitions anytime, anywhere. From the exact vantage point of where you actually play the game.”

It’s easy to see why this would lead to healthcare, where physicians and medical teams often work in high-stakes environments where seconds can mean the difference between life and death.

The work of STRIVR has been so successful that they’ve expanded to corporate, enterprise and medical training.

Although the medical space for virtual reality is much younger, the core product for training is similar – “creating virtual reality experiences that allow people to get extra reps so they can be as prepared as possible for their day jobs.”

The applications for empathy training are newer, but no less fascinating or promising. Stanford’s Bailenson did a study that put people in VR to experience color blindness, with a control group going through the same experience in 2D. Both were then given the opportunity to help the colorblind. Results indicated that the VR group spent twice as much effort to help persons with colorblindness compared to participants who had only imagined being colorblind. Those are powerful results.

The technology is also being used to understand “implicit bias” in ways people behave – not to cure them of bias, but to make people aware of bias so they can align their behavior with their values.

Other ways that virtual reality is changing healthcare?

• Relaxing chronic patients by transporting them outside of the hospital to visit a landscape in Iceland or swim with whales in the ocean

• Making children in the hospital feel like they’re at home by taking 360 cameras into their actual homes and allowing them to experience the familiar

• Helping students and physicians experience life as an elderly or impaired person to improve understanding and communication

• Speeding up recovery for stroke victims by starting rehabilitation earlier, with patients “practicing” how to lift their arms and move their fingers with the help of virtual reality

• Improving hospice and end-of-life care by helping those with limited mobility to experience life outside treatment and give them a chance to go back to places in their past that hold fond memories

It’s a tech horizon that’s reaping some big bets. In 2014, Facebook CEO Mark Zuckerberg bought Oculus VR, one of the most prominent virtual reality startups in the industry, for $2 billion. The plan? Zuckerberg expects to spend over $3 billion in the next decade to improve virtual reality and make it accessible to the masses. Today virtual reality may still linger on the margins, but future activity and growth seems inevitable – and the opportunity for innovations in health are vast.

Eric Williams, Co-Creator of OU’s Immersive Media Initiative, said it best in a recent interview: " This technology is so new that the next steps are only limited by our imagination."

We look forward to sharing our own experiences in VR in the future.

Dr. Jonathan Adler OF Olin College of Engineering studies the science of people’s stories. research supports that humans need a coherent story of who they are to support their wellbeing.

One of the most powerful aspects of the fellowship program at Stanford’s d.school is the strong sense of trust and family that develops among the cohorts. Whenever I’m asked what the best thing about the program was, I don’t hesitate. It’s the people – and the relationships formed. I developed a love and trust of my fellow fellows within weeks rather than the months and years it often takes to build a trusting bond. I’ve been thinking about that bond lately as I come to learn more about the nature of narrative identity, and the importance of story in each of our lives.

Why? One of the cornerstones of the Fellows program is the Backstory Dinner – a weekly dinner in a private setting held over the course of the first couple of months of the program in which each week one fellow shares his or her personal story. That story can be told in whatever form the fellow chooses. There are no fixed guidelines.

The stories are often powerful and emotional. It’s implicit in the exercise that each is a deliberately edited product of each fellow’s “backstory” as he or she wants to be seen by the group, but that makes it no less authentic. I remember from my fellows’ narratives a marriage video, artifacts from a challenging childhood, family photos and news covers; a wall of sports trophies displayed by proud parents; stories of creativity born of isolation. One fellow spoke with no notes or artifacts at all, like sharing around a campfire. Others presented Power Points standing, more comfortable and familiar perhaps from years of leadership. I shared excerpts of audio interviews with my aging parents and a sibling, hoping to better understand myself who I was from the perspectives of others.

Was this narrative inventory part of the powerful culture of trust and wellbeing that developed within our cohort? Without a doubt. I left the dinners feeling closer to each fellow who shared their story, a fierce advocate for the story teller – grateful and privileged by the confidence shared.

At The Better Lab at UCSF, we interview both medical professionals and patients for our projects, and the process has encouraged us to consider more deeply the importance of story in a healthcare setting. Is story more than the way we string together words to engage, instruct and entertain? Could story be fundamental to health? There’s a solid body of research that says yes.

Dr. Jonathan Adler of Olin College of Engineering

One person who understands this well is Dr. Jonathan Adler, a professor of psychology at the prestigious Olin College of Engineering in Needham, Massachusetts. Olin is unique among engineering programs not just because of its size – it has just 335 students enrolled, representing 37 states and 13 countries – but because of the way the school positions itself. Heavily influenced by the work of the Stanford d.school and IDEO, the mission of Olin is to do engineering in a different way – starting and ending with people and their desire for a better world. Human-centered design is a governing approach.

Adler’s work centers on narrative identity – the science of people’s stories. He’s particularly interested in the ways personal story relates to mental health and psychological wellbeing.

“Humans tell stories,” Adler says. “This is how we distinguish ourselves from others and navigate the complexities of our lives.”

Adler says the biggest question we each face in our lives is “Who are you?” The answer to that question is the foundation of our mental health.

Research shows just how important the stories answering that question can be – and the structure of that narrative can have profound implications for health. For example, people who have incoherent stories about their lives have poor mental health. Humans, it seems, need a coherent story of who they are to support their mental wellbeing – linked to our relationships and everything we do in the world.

But our stories are fluid, changing over time as we travel the course of our lives. Traumatic events pose a narrative challenge, making it an increasingly hard task to weave a coherent story.

“Certain kinds of populations such as those with violent lives have highly fragmented stories,” Adler says. “A hard story to put together to make sense of it.”

Working in a trauma hospital such as Zuckerberg San Francisco General we encounter patients like that daily – victims of gun shot wounds, stabbings, car accidents and other tragedies that can cleave one’s sense of order in the world. Healthcare by its very nature is isolating and fragmenting, Adler says, and violence can intensify that.

Can story help? Adler believes so.

““When something happens to your body it’s there all the time and you need to grapple with the plot.””

“You can help these patients by helping them frame a story that makes sense,” he says. Illness is a “biographical disruption” that calls people’s identities into question.

“When you develop a chronic illness your body is different than the story you’ve been telling yourself your whole life. It’s a moment when people recreate themselves. When something happens to your body it’s there all the time and you need to grapple with the plot,” Adler says.

Studies have shown that finding positive meaning in such negative events is linked to a more complex sense of self and greater life satisfaction. Sickness or violence in our lives can be framed in a way that can strengthen our narrative identity. Life stories that emphasize redemption in the face of challenge are associated with higher wellbeing.

While those with mood problems can have many good memories, these scenes are usually marred by a negative detail. On the other hand, “generative adults”— those who score highly on tests measuring civic-mindedness, and who are likely to be “energetic and involved” — see the events of their lives as linked by themes of redemption.

In his research, Adler has noticed two themes in people’s stories that tend to correlate with better wellbeing: agency, or feeling like you are in control of your life, and communion, or feeling like you have good relationships.

Helping people frame their stories in a way that promotes a sense of control and coherence can aid the journey to better health.

All of this brought to mind my own experience with my d.school Fellows cohort. This was a group of highly accomplished, deeply empathetic people – “generative adults” by every measure. In retrospect, I can see that the stories they had framed for themselves included the themes of redemption and the qualities of agency and communion central to Adler’s research on positive narrative identity: the dismissive and destructive comment of an early teacher became a story of overcoming; a parent’s painful mistakes provided the opportunity for deeper meaning and wisdom in life; death and isolation led to the creation of something new that had the ability to inspire others. And, sharing these stories deepened and engendered a sense of communion that – imagined or not – seemed to enhance the wellbeing of the group.

“Our experience as a species takes place in a highly rich, complex dynamic social ecosystem,” Adler says. “Our brain needs a medium for working this out – and that medium is story telling.”

Adler says there’s a vital need in the healthcare system for the kind of integrating that story telling provides. Is there a way to bring this learning into the healthcare environment and the patients we meet? We’ll be exploring this at The Better Lab in the months ahead.

Learn more about narrative identity and the role of story telling in healthcare:

Health Story Collaborative

Living into the story: agency and coherence in a longitudinal study of narrative identity development and mental health over the course of psychotherapy, Jonathan M. Adler

Variation in Narrative Identity is Associated with Trajectories of Mental Health over Several Years, Jonathan M. Adler, et al.

The Is Your Life (and How You Tell It), The New York Times

Life’s Stories, The Atlantic