Modo Moves Medicine

Modo knows that there's more to medical technology carts than four wheels and a platform. Well-designed medical carts can build confidence in the technology they hold, reassure nervous patients and provide ergonomic comfort to caregivers.

Modo CEO Bob Marchant relates a story he heard years ago about the time a medical technology company surveyed customers on the graphical interface of its product. The questionnaire left a space for "other comments," in which 50% of the respondents wrote "we don't like your cart!" That surprised the product manager since the cart wasn't even mentioned or considered part of the technology.

But the response didn't surprise Marchant, who describes medical carts as a form of three-dimensional branding. "If you put a $30,000 medical device on a cart that squeaks, is difficult to maneuver or is too large, the OEM's [original equipment manufacturer] customer is going to associate that deficiency with the technology of its brand," he says. "On the other hand, if the cart is simple, reliable and easy-to-use, those attributes will be ascribed to the brand too."

The latter has been Modo's goal for more than a decade. Noting how technology was becoming pervasive in medicine, in the mid-1990s Modo turned from creating carts for the general technology market to focusing exclusively on the health care industry. Since then, it has been designing and manufacturing award-winning technology carts for the world's leading medical device makers including Allergan, Philips, GE Medical Systems, Medtronic, Shimadzu and others.

When Modo first entered the field, Marchant recalls, OEMs had to design their own cart to hold the medical device because "no one else was doing it." The OEM would form a design/engineering team to come up with a cart for the device. As soon as the product was introduced, the team would be disbanded. The result was an absence of cumulative expertise and deep knowledge about hospital protocol and manufacturing sourcing related to carts.

By specializing in medical technology carts, Modo has proven itself invaluable to medical device makers and their in-house or outside product design teams. Modo is often consulted early-on before the design of the medical device gets underway. "We inform the design process with clinical information," says Marchant. "We explain the human factors in carts and the cost implications. We explain such things as the difference between maneuvering and transporting. When in the patient room, you are micropositioning or maneuvering. When moving from room to room, you are transporting."

Glenn Polinsky, Modo design director, adds, "One of the first questions we ask is 'Is the cart going into an operating room (OR) or a clinic setting?' If the cart is going into an OR, it has to be robust. You don't want it to be too cute. In an OR, we are trying to reduce visual clutter. Companies are inventing new technologies that require it to be within arm's reach of the surgeon. It has to be compact so it won't get in the way and still easy to access. Footprint is a very big deal. But now medical companies are also doing a lot of cosmetic and elective procedures in an almost spa-type setting, so those carts have to have a spa look."

The Modo design team spends a lot of time inside hospitals studying the setting in which their products will be used. Visits point out needs and sometimes inspire solutions. Marchant mentions the time the team was conducting research for an electrosurgery product and noticed that a nurse had taped a coat hanger to a cart to manage cables and keep them from interfering with the surgical procedure. "We took a photograph of it, spoke to her about it, and designed it into the next generation of carts." On another visit to a neonatal monitoring facility, the team noticed how charts were hung on the incubators, causing a clatter that disturbed the preemies' rest each time records were checked. This prompted them to make sure their new cart design kept the chart hook separate from the incubator.

Modo also helps its OEM customers understand who the user is. "So often people think that the user is the doctor, nurse or technician, but the user is also the patient and patient's family," Marchant says. "They may not physically interact with the device but they are passive visual users. So, if the product has a lot of visible cords, cables or exposed probes, patients may get a sense of impending doom. If an alarm sounds, it is going to disturb them. If a hospital has a $15,000 monitoring device sitting on a broken office chair, it impacts the hospital's image and credibility."

The right cart design sometimes goes a long way in alleviating a patient's apprehension. Polinsky cites as an example a breast biopsy device that uses a six-inch long needle. "The caregiver may want the needle prominently displayed for easy access, but the patient may not want to see it," he explains. "We have to meld those two needs-make it easily accessible but nonvisible so it doesn't freak the patient out."

For similar reasons, Modo has moved away from "sky hooks," a vertical element designed to keep cables off the floor and out of the way. Patients found them imposing and ominous. "We are still managing the cable, but keeping it at a lower level within the overall mass of the cart," says Polinsky.

Moving the cable in second-generation products has made an incredible difference, says Marchant. "The physical perception of the product went from being an intimidating 6'8" man in a dark suit to being a child holding flowers. The whole personality of the product was transformed."

Marchant emphasizes that there is more to good design than meets the eye. "People tend to think of the product in purely visual terms, but nonvisual attributes are critical," he says. "For instance, noise-any rattle or vibration gives the sense it is unstable or not well-made. Temperature-if it's cold to the touch, it seems less friendly and approachable. If you jacket a handle in a warmer material [medical-grade Santoprene], customers will give the product a higher rating in focus groups."

Modo is sensitive to cultural superstitions as well. The color black is avoided because it symbolizes death to people in the West. "Probably the safest colors are white, off-white or light gray," says Polinsky. "White implies cleanliness, but an all-white product could be seen as too sterile. So if it is going into a clinical setting, we may introduce an accent color to warm it up."

Modo accommodates cultural biases too. For instance, operating rooms in Europe require the use of conductive casters, a tradition that harkens back to the days when volatile ether could send a charge through the floor. Even though ether hasn't been used in decades, Marchant says, "if your cart doesn't have conductive casters, it won't be accepted. There's a sense you are selling an inferior product."

Perception also drives the use of certain materials in Japan. "Aluminum has an almost semi-precious character in energy-dependent Japan because it is a very energy-intensive material to produce," Marchant explains. "Even if you can make the same part in steel, aluminum is perceived to be so much more valuable. It has a jewel-like quality. We look for opportunities where we can expose an aluminum detail." To address such preferences without creating separate models for each culture, Modo "designs for the constraining region and imports it to other markets. The goal is to streamline the logistics so our OEM customer only has to have one part number for worldwide distribution, but the part anticipates cultural requirements."

While the health care industry worldwide places a premium on quality, it frowns on ostentation. "Products need to look well-designed but not opulent," says Marchant. "Caregivers are driven by altruistic motivation and are sensitive to what health care costs. Our goal is to be credible and sophisticated, but understated and appropriate. The visual purpose of design is to generate trust. That's a huge design value, and we do that through simplicity and integrating the cart with the device."

The need to integrate cart and device is becoming more important to OEMs whose cutting-edge innovation is increasingly in their proprietary software. "Without that cart, all it is is a PC, keyboard and monitor," says Polinsky. To give the OEM product brand distinction, "we try to pick up on the device's design language to give a sense that these two things were meant to go together. For instance, if a product has a lot of ellipses going on, we'll pick that up in the cart too."

One misnomer is that the equipment in the operating room does not have to be aesthetically pleasing since the patient is usually unconscious, but Modo has found that surgeons appreciate a cart for its beauty as well as its functionality. "Surgeons are human too," Polinsky says. "They get excited about and emotionally attached to things that are well-designed."

Still, Marchant understands that the cart should support the OEM product, not outshine it. "Our role from a design standpoint is to create a stage on which the technology is the hero," he says. "We are creating a product that is visible but unobtrusive. You walk up to it and use it in an almost unconscious manner. Our value-add is to make sure that the cart is not a barrier between the caregiver and the patient."