I’ve recently been experiencing the acquisition of a new set of hearing aids, two Widex Inteos. I had my previous hearing aid (Oticon Adapto) for about 5-6 years, and it was conking out on me, sputtering from repair to repair. I finally made the decision to go for hearing aids in both ears (binaural), which has been long recommended to me by audiologists. I understood the argument behind it very well, in that your ears and brain are designed to hear in stereo, and so trying to get amplification through just one ear was providing a lot less improvement than I could be getting. The benefit of two aids over one is supposed to be an exponential improvement.

But as a longtime user of hearing aids, I want to make a few observations about what I see as the significant obstacles to getting, using, and enjoying the benefit of hearing aids. These are the barriers that made me wait a lot longer than I should have to get a hearing aid in the first place, and have prevented me from trying two aids until now.

First, there’s the cost/investment side. Hearing aids, particularly the new digital technologies, are extremely expensive. The type that my hearing loss requires usually run in the neighborhood of $2,500-3,000. Each. Multiply that times two, and you’re talking about wearing an enormous sum in delicate electronic devices on your head (which are subject to damage or breakage from dropping or getting caught on something, getting wet, or being exposed to radiation or chemicals.) In short, the value of a mid-range Rolex, with none of the durability. And the standard hearing aid is not expected to have a shelf life beyond 5 years. That’s an investment of $100 a month, if you’re lucky enough not to break or lose one during that time. And no, health insurance does not cover hearing aids and the warranties typically cover only the first 1-2 years. Therefore, there is a strong financial consideration to be made between making do with just one hearing aid, or splurging on two.

Second, there is the appearance/design factor. I’ve been wearing hearing aids since I started college. I have been hard of hearing my whole life, but I had learned enough coping strategies as a child, like lipreading and defaulting to writing and pictures whenever possible, that I was able to compensate fairly well through my school years with the help of teachers and friends. That changed when I went out into the larger world, away from home and familiar surroundings. The primary thing that kept me from taking advantage of a hearing aid before that is the stigma associated to how ugly and strange these devices look. As a hard of hearing person, you already feel like an outsider. As a kid, I was terrified by the idea of drawing more attention to my disability (as I’m sure most hard-of-hearing children and adults are).

The stigma of wearing a medical device (even one as small as a hearing aid) is significant. Wearing one is bad enough. Two always seemed over the top for me. For a long time, hearing aids have been ugly, ugly, ugly. You know this is true because all of the marketing features pictures of happy people and beautiful landscapes—it never features images of the actual product on a human wearer. It seems that no matter how high-tech these devices become, the engineers see fit to make them look as clinical and awkward as possible for the wearer. Sure, they are getting gradually smaller (I remember the pocket-sized unit my great-uncle wore wired up to an earpiece). But one thing I don’t understand why the industry clings to the paradigm of the prosthesis. A hearing aid isn’t replacing an ear or any other body part, and yet it’s made of awkward, icky-looking skin-toned plastic. Ten years ago I remember looking in the window at a Bang & Olufsen store in Boston at the beautiful and tiny stainless steel headsets and wondering why my hearing aid couldn’t look like that.

When bluetooth and the iPod arrived, and suddenly everyone seemed to have a hip gadget hanging from their ears, there were really no more excuses for the hearing aid manufacturers and their complete disdain for the styling of their products. And so things have progressed in recent years with the introduction of the Oticon Delta [see left], a cute little triangular BTE (Behind The Ear) aid that came on the market in 2006 and comes in a wide choice of colors and patterns, primarily aimed towards the growing market of hard-of-hearing boomers. (Alas, this great-looking aid does not suit my type of hearing loss.) The success of the Delta, along with the iPod, seems to have emboldened manufacturers to pay a little more attention to the appearance of their products, but they are still far too conservative in considering the importance of good design. Who says a hearing aid can’t look cool?

Third, the distribution side of the industry sucks. It’s not that they aren’t developing good technology, but the way that hearing aids are delivered to the market leaves a great deal to be desired. The manufacturers would defend themselves by saying that they are hampered by the excessive regulation that exists around the sale of medical devices. This is not untrue, but it seems obvious, from the lack of information available from the manufacturers about their products, that they also benefit a great deal by the restricted channels available to consumers. It’s near impossible to be an educated consumer when it comes to hearing aids. Choice is practically nonexistent. I challenge you to try to price different models against one another, feature-for-feature, based on what you can find online. It’s all very mysterious.

It’s the law that you have to have a hearing aid prescribed (or “dispensed”) by a trained audiologist. This is to prevent people getting the wrong type of hearing aid, or failing to have it fitted correctly. This is fine. It works the same way that getting glasses requires at least an optometrist’s, if not an ophthalmologist’s, prescription. The problem is that most audiologists tend to be affiliated with just one or two manufacturers. It’s as though you went shopping for eyeglass frames and had to choose between two styles. I’ve never understood why this is, because you’d think that a successful audiologist would want to have a full range of technology and brands to recommend to patients. I’m told that this is because many manufacturers offer such similar products, that there is redundancy in offering multiple brands, and also that each manufacturer requires the audiologist to acquire and learn its own proprietary programming software, and this becomes a burden.

Usually it is impossible to know ahead of time which manufacturer an audiologist represents. You pay an audiologist to produce an audiogram, which then helps to determine the type of hearing aid best suited to your hearing loss. But if you try to take one audiologist’s audiogram to another audiologist, they typically won’t accept it, and will insist on doing their own test. So forget about shopping around.

So it’s left a bit up to chance whether you end up with an audiologist who can or will recommend the hearing aid you would choose, if you had all the information yourself. Yes, they are trained professionals who’s interest is in getting you the right aid, but sometimes you wonder if they aren’t just meeting some kind of quota for a particular model or manufacturer. It doesn’t help that hearing aids are a bit like car models, and each year, manufacturers introduce tiny tweaks to the features of existing models, so you never feel like you can compare apples to apples.

Oticon Adapto and Widex Inteo, the old and new hearing aids

In my recent hearing aid purchase, I sought out an audiologist here in Chicago who had the largest available representation of different manufacturers. I ended up choosing AHS, primarily because they provided a lot information on their website and a good variety of manufacturers. I could have had my hearing test covered by my insurance if I had gone to their one approved audiologist, but that audiologist did not carry the brands I was interested in looking at. Since the hearing aids themselves aren’t covered at all, and I knew I’d be plonking down significant cash, it was more important for me to get the right audiologist than a free test.

This ended up being a good choice, because I think I got the most thorough hearing test I’ve ever had, and Theresa Jabaley, the audiologist, was willing to treat me like an intelligent adult. She laid all the options out for me, with her recommendations, and helped me understand the various costs/benefits. I felt good about the choice we made together. It is a bit experimental, since the Inteo has a new feature called the “audibility extender”, which transposes high frequencies to low. I’ll report back on that experience another time.

So, back to the exponential improvement that two hearing aids may bring for my interactions with other people. Definite improvement so far, though it is taking some real adjustments to get used to all the extra amplification and the weirdness of using the phone with a hearing aid (before, I always had my left ear free). At times it is pretty overwhelming to get so much sound that I’m not used to, especially all the background noise that my hearing loss normally allows me to tune out completely. But if it means that I will be able to participate more fully in conversations and not miss out so frequently on what’s happening around me, it will be worth it. My thirty day trial period just ended, so at this point I’ve committed to my purchase. (Personally, 30 days isn’t really enough to be sure, but that’s another aspect of the distribution problems above.) I’m hoping that I will be gradually learning to hear better .

Oticon Delta image copyright Tony Cenicola /The New York Times

Whether you’ve realized it or not, milk is expensive to ship, and a lot of that expense has been dictated by the type of plastic container that’s typically been used for a gallon of milk. Because of the shape, it is not possible to stack for shipment, thus requiring crates. These crates carry a lot of unused space and that increases the inefficiency of transporting milk cheaply. With fuel cost rising and food cost increasing as well, making successful cost savings to packaging can have a big impact. In fact, the new jugs lower the cost of a gallon of milk from $2.58 a gallon to $2.18 (a savings of just over 15%). Not only that, the new design has cut labor in half and water use (for cleaning the crates which birds love to roost in) by 60 to 70 percent. So, lower fuel use, lower water use, cheaper to purchase, and more convenient to stack and store. What’s not to like?

Well, for one thing, it doesn’t work for the customer.

It seems that the jug is extremely difficult to pour from and almost impossible for children to use. Costco even has a representatives demonstating the use of the jug in store who informs shoppers that the correct pouring technique is a “rock-and-pour instead of a lift-and-tip.” Shoppers are not convinced.

Of course with any big change to a common product there will be initial resistance to adoption. But the issue that I find interesting and all too common is that it was obvious that a large amount of effort was put into redesigning an artifact that affects a great deal of people. But, as is all too often the case, the goal of the design was short-sighted. Milk producers pretty much nailed the design requirements for stacking, transport, and resource savings. But did anyone consider those that need to actually use the product that is being shipped? It seems impossible that the designers, or even those who sponsored the change, didn’t try to use the jug themselves. So it appears that it was decided that if anyone needed to compromise on usability, it would be the people who had to use the jug day to day.

There is a hubris to design that often disregards those that we are ultimately designing for. Of course any design problem comes with acceptable compromise – you just can’t please everyone all the time. But this is a case where the key aspect of a milk jug (pouring the milk where you want to as easily as possible) wasn’t actually one of the key design goals. The customer was cut out of the equation. But this type of one-sided design isn’t reserved for just cutting out the consumer. In customer service organizations processes and systems are often designed with the end user in mind (fantastic!), but completely disregard the internal user (whoops!). Call centers are plagued by issues where customer service representatives need to go through complex work-arounds to actually help their clients. Or the informal networks that develop in bureaucracies to get around limited access to needed resources (Call Ted in processing, he knows what to do…). We’ve all experienced these issues, likely on both sides of the coin. What keeps us building half-sucessful designs?

A major factor is that most design challenges are part of a larger goal and that goal is often determined by people outside of managing a user’s experience. In the case of the Costco milk jug, it was likely designed under the direction of an operations manager who had a very specific need – cut costs. And cut cost they did. It remains to be seen if they also will end up cutting their own profits if consumers refuse to adopt the ill-designed jug. So how could this be avoided?

As designers, we need to be much more concerned with the complete picture of the work that we do. Personally, I am a strong advocate that design as a method needs to play a much stronger role in the actual day-to-day management and decision making of all organizations, both private and governmental. The role of design will be expanded to include all aspects of business and public policy. To do this, those that are playing lead roles for these organizations will need to rely on design strategy, development, and integration on a whole new level than what they are used to. This also invites the traditional designer to step up to roles not typically adopted, or even desired, to influence decision making where it matters. The end result should be a much more “user” focused world. Products would be designed not just for the consumer, but also for the environment, for processing, for cost, for support staff, for shareholders. You see where this is going.

Should design evolve into the role of making and influencing key decisions, it will require designers who ensure all aspects of a design problem and all those who would be affected by it are considered. The milk manufacturing and distribution business has a vested interest in solving a major problem in cost savings and their new jug has adressed that narrow aspect almost completely. However, they seem to have created another problem that even the most perfunctory testing would have revealed. The opportunity for designing to the “whole problem” was not entertained. The shame is that a “whole problem” approach is not de rigueur for most industries.