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Jul 31

How To Avoid Death by Inferior Design in Healthcare

Badly designed solutions can kill, certainly in healthcare. Technology is often regarded as one of the key contributors to improve healthcare delivery. This is especially true when technology frees up time for more personal and humane care. The promise of the impact of technology on healthcare remains unfulfilled however for many technological solutions out there due to inherently inferior design. More often than not, and this is not healthcare specific, companies build products instead of experiences.

In healthcare, lots of Electronic Health Record (EHR) systems, for example, suffer from what can be called the “Death by Inferior Design” practice. Due to bad design the solution becomes unusable and costs healthcare providers additional time, instead of freeing up time. Unfortunately in healthcare this Death by Inferior Design can even be taken literally as described in the story of how bad UX killed Jenny.

Many of these systems can learn from how companies like Apple and Google are approaching design and User Experience (UX). Despite the fact that most healthcare processes can’t be simplified to just one click on the button like Google search, there is definitely much room to do better than a User Interface (UI) that looks as it was build in the 90s and filling the screen with as many data entry boxes and buttons as possible. Add to that workflows which are non-intuitive and you end up with a textbook example of how to create a bad user experience. By neglecting user experience, vendors of such EHR systems make it hard for healthcare professionals to fully believe in the added value of Digital Health solutions.

Death by Inferior Design, visualized by Eric Burke.

Although the first generation of EHR systems date back to the 1960s many of them still suffer today from how these first systems were created. They were mainly created by engineers who were tasked to computerize all the data needed to support healthcare processes. A shift from paper to digital, not much more than that. They were not questioning the process itself or spending much time on how the usability would be for the actual end user. Products were engineered, whereas to have real usability, experiences should be crafted instead.

If you have a bad healthcare process and digitize it without questioning how to first improve the process, you end up with a bad digital healthcare process.

EHRs are just one example of how a healthcare technology is not optimized for user experience. This lack of providing an experience is mainly due to an insufficient understanding of the end users of the technology. In other words: a lack of empathy.

Luckily there are strategies helping to avoid the “Death by Inferior Design” with the most well known being Design Thinking.

Is There a Designer in The House?

What Design Thinking is not. Sitting alone behind your desk thinking about the best design of your healthcare solution.

Design Thinking by itself is a fairly old approach popularized at the beginning of the 21st century by design consultancy company IDEO.

The name itself can be a bit misleading as Design Thinking is not about getting hipster designers gather around the coffee table to brainstorm about cool solutions. Design Thinking is about injecting Creative Confidence into corporations well known for their analytical thinking processes for problem solving.

Analytical thinking is excellent for optimizing exploitation of the current business based on data from the past. It falls short however in search for new opportunities, when relying on data from the past is simply not enough. Design Thinking provides a logical process offering room for creativity, uncertainty and divergent thinking leading to more interesting and effective solutions.

The real value of Design Thinking lies in the fact that its process can be learned by anyone in an organization. Even the “least creative” people can use the process to achieve more creative outcomes. Such a Design Thinking approach, based on empathy at its root, is already used in healthcare to come up with a better user experience, regardless of whether there’s a fancy technology behind it or not. Keep in mind technology is only an optional part of the solution and not a means to an end by itself.

The Design Thinking process.

Empathy in Action

great selection of tools for applying Design Thinking in healthcare is made available by the Institute of Healthcare Design Thinking. These tools guide you in how you can use techniques such as storytellingco-creation, the use of personas and vision boards in your Design Thinking process.

Let’s have a look at some examples of how Design Thinking already led to solutions improving user experience in healthcare. The examples show Design Thinking can be used for any type of human-centered problem solving.

  • Building a clinic — Venice Family Clinic. Design Thinking was used for building out the Venice Family Clinic and ensuring a great patient experience. A heterogenous team of clinic administrators, medical staff and others carried out site visits, observations and interviews as a first step to gain empathy and insights. They questioned typical workflows and clinic room layouts to improve patient experience and used full-scale mock-ups of key functional areas of the clinic as a prototype to further test and improve its design. A similar exercise was done at the Stanford emergency department with as goal to improve the patient experience.
  • Specialized center for children with eye problems at the Rotterdam Eye Hospital.

    Reducing Patient’s Fear — Rotterdam Eye Hospital. By using patient-first thinking the design team (including all types of roles in the hospital) uncovered the biggest fear of patients was to go blind. This led them to come up with solutions reducing that fear. By learning from how other industries deal with fear reduction and informally experimenting with ideas they were able to learn what worked and what didn’t work. A small but powerful change involved the children’s hospital. The hospital sends beautiful T-shirts with a specific animal print to children in advance of their stay. The consulting ophthalmologists wear a button with the same animal during the appointment, which gives them a way to immediately connect with the children and to create a feeling of community.

  • Patient-Physician Interaction — Mayo Clinic. In order to make the patient-physician interaction more collaborative the design team used different model rooms and iteratively adapted design of those rooms to experiment. This resulted in so called “Jack and Jill rooms” where the conversation part of the consultation was in a different room than the examination leading to both a better patient and physician experience.
  • Improving Diagnostic Imaging Procedures — GE HealthcareA classic example of Design Thinking is the MRI scanner transformed in to a pirate ship experience. This experience solved the problem of children’s anxiety for scans. Taking away this anxiety resulted in less need for anesthesiologists and hence more patients could get treated each day.

An MRI scanner disguised as a pirate ship.

  • Nurse Knowledge Exchange — Kaiser PermanenteTogether with IDEO, Kaiser Permanente improved how nurses exchange information between shifts by being a fly on the wall and observing nurses day in, day out. Based on this observation they moved the information exchange to the bedside of the patient instead of at the nurses’ station and encouraged patients to participate. To support the information exchange new software was created helping the nurses to compile the information in a standard format throughout their shifts.

If you want to get more inspired on applying Design Thinking in healthcare there’s a great TEDx talk from IDEO CEO Tim Brown on “What happens with a design thinking approach to healthcare?”.

Empathic Health Records

So now that we’ve seen examples of Design Thinking in healthcare let’s get back to the example of EHRs. Fortunately EHR vendors are aware of the lack of usability and involved Design Thinking pioneers IDEO back in 2011 to come up with better designed EHRs focusing on both the patient and provider experience.

They firstly observed and talked to patients and providers to uncover their unmet and latent needs.

 

Patient and Physician Needs (by IDEO)

This led to a different visualizations than the typical EHR screens which show an overload of information. One of the new visualizations was the Collage Concept: a dashboard providing a high level overview of the relevant data with an option to zoom in to get more details.

The IDEO Collage Concept Mockup

Next to the new visualizations they also came up with new scenarios for the next generation EHR. One of the scenarios was having dynamic care plans serving as an action plan for patients and as a way to generate mutually aligned appointment agendas for subsequent physician visits.

This approach shows applying Design Thinking for a future EHR is not about simply redesigning the screens or shuffling the UI. It firstly starts with understanding the needs of the users and getting insights into the workflows to come up with new approaches to optimize the user experience. Once there is a set of interesting ideas they are prototyped and tested. After a survival of the fittest (best user experience), the most outstanding ones are finally built.

Design Thinking makes sure solutions first and foremost provide a good user experience. Only when the user experience is in place the solutions are built, not sooner. This is in contrast to the many solutions out there that were build in the hope or assumption that they would be useable in the field.

Let’s make sure we build solutions that put the user experience first. Not doing that in healthcare is no option as the consequences are potentially lethal.

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