Kaiser Permanente: Designing healthcare that meets people where they are

The Challenge

Kaiser Permanente serves 12.4 million members across an integrated health system that spans hundreds of medical offices, dozens of hospitals, and tens of thousands of physicians. In Southern California alone, that's 4.7 million people across 700+ offices. When the COVID-19 pandemic forced healthcare into a near-overnight digital transformation, the Health Innovation team had to rethink how it understood members in their everyday context.

Traditional research methods couldn't keep up. A focus group or a phone interview might surface what someone said about their care, but it missed the home environment, the multi-generational household, the dynamics happening in the background that shaped what people actually needed.

Without that kind of context, say we'd done a focus group or a phone interview, what's missing is the dynamics. What's happening in the backdrop? Who else is in that household?

The team needed a way to design care delivery, particularly the rapid shift to virtual care, around real lives. That meant getting into homes without being in homes, observing members' contexts without imposing on them, and building in privacy from the start in a category where the bar is exceptionally high.

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The Approach

The Health Innovation team integrated virtual ethnography into its existing human-centred design toolkit alongside workshops, surveys and interviews. Indeemo became the platform for in-context, in-the-moment observation in members' homes.

Virtual ethnography in the HCD toolkit. Virtual ethnography sits alongside workshops, surveys and interviews as the lens for in-context home observation, used wherever the team needs to see what's actually happening in a member's environment.

Privacy-first study design. Over-communicated consent, transparent data use, and clear boundaries on how participant content gets stored and shared, recognising the heightened sensitivity of patient health information in healthcare research.

In-context, mobile-led capture. Members captured what was happening at home using the device they always have on them, sharing video, photos and reflections in their own time.

Truth over comfort. Design briefs were calibrated to surface unfiltered insight, not the answers stakeholders hoped to hear.

Our role, in a way, is to be truth tellers.

The team treated members' homes as their turf, not the researcher's. The shift in framing, from patient comes to us to we come to them, extended into how research was designed and run.

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The Results

After roughly three years of practice, virtual ethnography moved from experimental tool to indispensable part of the Health Innovation team's toolkit.

An indispensable methodology, not a fad. What started as an experiment has become standard practice. The team uses it for insight into multi-generational households, sensitive home dynamics, and the disparities in care access that became more visible during the pandemic.

Smarter design decisions for digital care. Real in-home context, who else is in the household, what privacy looks like in a small flat, how members actually use their devices, feeds directly into how Kaiser designs and communicates virtual care options.

A way to hear quieter voices. Where focus groups can let one confident person dominate the conversation, virtual ethnography gives everyone in a study their own space to share. The introverted, the cautious, the ones with the most to lose from being seen, they get heard.

A strong evidence base for stakeholders. In a data-driven organisation, the human stories and home contexts virtual ethnography surfaces sit alongside quantitative data as proof points, giving leaders the why behind the trend lines and enabling decisions on members' behalf with real context attached.

Insight without action isn't really helpful to anyone, not to our members, not to us.

The combination, quantitative trend data plus virtual ethnography for context, has reshaped how the team frames and presents recommendations. The data tells leaders what. Virtual ethnography tells them why, in members' own words and in their own homes.