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At Fuse, Cardinal Health’s innovation engine, Alex Annarino is the lone ethnographer, bringing a highly-specialized research approach to inform early-stage innovation and existing product experiences. She collaborates with the Fuse user experience and product teams who are redefining health care with technology.

“I’m not a designer,” she said. “I don’t make things. But I am a design thinker, and my role is to help teams gain a deeper, more empathetic understanding of the people they’re creating products for.”

Ethnography is qualitative research that involves observing and/or interviewing people doing whatever it is we need to learn more about, as close as possible to when and where it’s happening. “This research allows us to learn what is important to care providers, support staff and patients, and to see first-hand exactly what drives how they interact with technology,” Annarino explained. Ethnography empowers innovators to focus on human-centered design, which starts with people and ends with customized digital solutions.

“The research helps us understand what is; it works to mitigate bias – that is, the opinions or insider knowledge about a particular experience,” she said. “As an ethnographer, I focus on getting to the heart of the matter by understanding the people and the contexts where their experiences unfold. My goal is to learn about them and their world, and bring definition to their goals, their priorities and what’s getting in their way. ”

Discovering ethnography: A means to address health disparities
Early in her career, Annarino served as a Peace Corps volunteer, working with HIV/AIDS patients in sub-Saharan Africa. She also worked with social service organizations in Central Ohio and did research in Los Angeles Unified Schools. Whether she was helping low-income patients enroll in Medicaid and access community resources or administering literacy testing in a middle school in East LA, she came to know the inequities in health care. That, in turn, inspired a desire to help close the gaps.

“When I pursued my advanced degree in sociology I wasn’t quite sure exactly what I could do to address disparities, but further study seemed like a good place to start,” she said. “Once I was enrolled at California State University, I took an introductory class in ethnography and just loved it. It seemed like a perfect fit. I thought it would be a useful tool in making an impact.”

After she earned her degree, she cultivated her research skills through years of ethnographic research, first with a small team of ethnographers working with Fortune 500 companies and later with a series of innovation projects at the Mayo Clinic Center for Innovation in Rochester, Minnesota, and at the University of Florida in Gainesville.

Joining the Fuse team
In 2016, Annarino returned to her native Ohio. She found a job description for a position at Fuse that intrigued her. “It was the first time I read a job description that fit exactly what I did.” she said. “I called my mentor in ethnographic research; she said, ‘Alex, show them the possibilities of ethnography.’” After several interviews, Annarino was offered the position, and has been lending her specialized research expertise to the team ever since.

“I knew nothing about technology when I began the job, but I did know how to do research, and quickly came to understand how my research could help influence health care innovations.”

Putting ethnography to work
“At Fuse, our job is to help make our customers more successful and help them provide better care for their patients,” Annarino said. “As an ethnographer, I need to learn who health care workers really are: What do they need? What is their daily life like? How can they provide the very best care for their patients? And what gets in their way?”

Her research provides insights into many audiences, such as providers – often the frontline workers – who use the innovations that Fuse brings to market. “The decision makers, the people who sign the contracts, are very important, of course. But they’re often not the people who use our products and solutions day in and day out. The doctor treats the patients, but it’s the nurses who provide education for patients, who log into websites to start prior authorization, who access co-pay programs for the patients. We want to be designing products for the nurses and others who use them every day. Knowing as much about the end users as possible, understanding what their pain points are, allows us to develop better products.”

Annarino’s research helps influence design decisions on products in various stages of development; she also gets involved on the very front end, brainstorming brand new ideas. For example, last fall, she and a group of her design colleagues spent several days in hospitals, observing pharmacists and pharmacy technicians at work and facilitating conversations with them. “With projects like this one, we’re looking for clues for new products: How can technology make more space for health care providers? How might it make their jobs easier and give them more time with their patients? How might it help them focus on patient safety?” she said. “I mapped everything as it was happening in real time, paying close attention to what the pharmacists and techs were doing, minute by minute, hour by hour.”

Typically, Annarino is part of a shared service at Fuse, meaning she moves from team to team, lending her research expertise wherever it’s needed most. She often works on several projects simultaneously. “We have to be always on,” she explained, “And we have to work together.”

“A good designer, product manager or engineer can ask a lot of the important questions. My role is to help stitch human-centered research across products, to help teams understand what we know and don’t know about the user, and what we need to know. Because when we ask the right questions, we can deliver products and services that really do make a difference.”

Ultimately, what drives Annarino is the desire to improve health care. “We just really don’t have an option,” she said. “I think the world used to hear the word ‘innovation’ and think of some new and sexy kind of work. But now, it’s simply about good health care. We have to reduce the burden on health care providers, make their systems easier to manage, help patients get what they need from health care. We just have to keep innovating to make all of this happen – to make sure that the health care of tomorrow serves all of us better so that fewer people fall through the cracks.”